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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. What antibiotic is best to treat alcoholic pulm infections? why?
SSRI; erectile dysfunction
Vancomycin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

2. Which is faster atrial muscle or ventricular muscle?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Ether and other organic solvents
Atrial
Medial part

3. What is the cause of fixed splitting of S2? why?
TSh (in testicular tumors can cause hyperthyroidism)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

4. what diseases can vit A be used to treat?
INTRApartum Abs (ampicillin/penicillin)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
ATP binding (resets the myosin head to contract again for next binding)
Measles and M3 AML`

5. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Bronchial dilation (bronchiectasis)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Phencyclidine (PCP)

6. What does NF- KB do?
Hereditary angioedema; ACE inhibitors
Inhaled animal dander allergens
Echinococcus granulosus; anaphylaxis
Increases cytokine production

7. When does opening snap begin?
Pulmonary hypertension
Right before diastole (filling begins)
Right heart failure
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

8. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Gluteus medius and minimus; positive trendelenberg
Curlings ulcers
Smoking

9. where are the two classical places that the ulnar nerve can be injured?

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10. do Class IC agents prolong the QT interval?
No
S. aureus
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Vagus nerve stimulation

11. What is the mc malignancy in asbestosis?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Bronchogenic carcinoma
Octreotide
Vagus nerve stimulation

12. which two virus families have hemagluttinin on their surface?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Extrinsic def; instrinsic def; platelet def
Paramyxo and influenza
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

13. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Anterior nares
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

14. What is the neurologic manifestation of ADPKD?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Little effect on cell and no change
T test; chi squared
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

15. What is the stabilizing force for the secondary structure of proteins?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increases cytokine production
Aromatase deficiency in child
Hydrogen bonds dictate alpha or beta structure

16. which are the only glycosylated proteins in HIV virus?
Close but purkinje system to ensure contraction in a bottom up fashion
Env genes (for getting into target cells)
Dihydropyridine sensitive Ca channels (L type)
Biphosphonate

17. What is an abortive viral infection?
gram positive organisms
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
chronic urticaria and allergic symptoms
Little effect on cell and no change

18. What is used to compare means? categorical outcomes?
Gluteus maximus; difficulty getting up from seated position and climbing chair
T test; chi squared
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Inhibits it

19. why is crohns disease associated with oxaloacetate kidney stones?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
V fib; v. failure
Right before diastole (filling begins)
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption

20. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Prevents hepatic VLDL production
Echinococcus granulosus; anaphylaxis
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Squatting - sitting - lying supine - passive leg raising

21. what locations of UC increase the risk of Colon cancer?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Pulmonic and systemic!
Pan colitis and right sided colitis (more than left sided and proctitis)
Increases

22. What does extended consumption of appetite suppressants lead to?
Localized dermatologic pain that persists for more than one month after zoster eruption
Pulmonary hypertension
Serum creatine kinase; reperfusion injury causes necrosis
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

23. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
hyponatremia (aldosterone activation equilibrates body volume)
Phencyclidine (PCP)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Mean greater than median greater than mode

24. if there are keratin swirls does that mean well or poorly differentiated?
P53 mutation; AD
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Well

25. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

26. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Adductor
SSRI
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

27. What are the two coagulase negative staphylococci? How do you distinguish them?
Measles and M3 AML`
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
S. saprophyticus - and s. epidermidis; novobiocin
Appetite suppressants

28. What is damaged in early syringomelia? later?
SVC and IVC; right below the aortic knob
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Ig A deficiency
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

29. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Vancomycin; histamine mediated
frameshift mutations (missense is substitution)

30. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Hexokinase
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Classical conditioning
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

31. what protein is increased in Crohns disease? What does it do?
Increase lymphatic drainage!
NF- KB; responsible for cytokine production
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Reiter syndrome; B27

32. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Decreases both
In the extracellular space
Gluteus maximus; difficulty getting up from seated position and climbing chair

33. What is the most common location of colonization of all s. aureus types?
Chorda tympani branch
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Anterior nares
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

34. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
women
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Raphe

35. which cells produce surfactant? which ones mediate gas exchange?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Echinococcus granulosus; anaphylaxis
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
II; I (I more abundant)

36. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Phencyclidine (PCP)
Dihydropyridine sensitive Ca channels (L type)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

37. other than in pyelonephritis - where else are WBC casts seen?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Tibial
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Acute interstitial nephritis

38. What can long term leg cast wearing cause?
High potassium conductance and some sodium conductance
Duration and extent of disease
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Large stroke volumes with ventricular contraction; aortic regurg

39. why are pregnant predisposed to cholelithiasis?
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
RER; RER
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
CGD; t cell dysfxn (diGeorge)

40. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Varying; erythema nodosum is common
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SSRI; erectile dysfunction
Bronchogenic carcinoma

41. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Increase; decreased
APP on chrom 21 (this is why downs more susceptible)
Pulmonary hypertension

42. What is best to prevent GBS infection in a baby?
Right before diastole (filling begins)
Fat - fertile - forty - female
INTRApartum Abs (ampicillin/penicillin)
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase

43. what nerve and artery course along the posterior aspect of the humerus?
Radial nerve and deep brachial artery
Increases cytokine production
11 aa polypeptide; pain NT in CNS and PNS
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

44. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Elevated GGT and macrocytosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy

45. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Retinitis; mononucleosis
Increase; decreased
Extrinsic def; instrinsic def; platelet def
Dissolved in plasma and attached to Hgb

46. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Transported to liver - glycerol kinase converts it to glycerol 3 phosphate Which is then converted to DHAP which can either join glycolysis for ATP or be used to make glucose
Amiloride - spironolactone - triamterene
Varying; erythema nodosum is common

47. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
women
SVT; increases vagal tone; rectus abdominis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

48. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Apocrine; eccrine
Aromatase deficiency in child
Become beta pleated and then form neurofibrillary tangle!

49. What are some of the permissive effects of cortisol?
P53 mutation; AD
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

50. What does sustained hand grip do to the C/V system?
II; I (I more abundant)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract