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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Hypertension - edema - and proteinuria
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Appetite suppressants

2. what dictates the resting membrane potential of most cells?
Folic acid treatment!
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Raphe
High potassium conductance and some sodium conductance

3. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
P53 mutation; DCC is also required for adenoma to carcinoma
Turners`
Myasthenia gravis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

4. What is the best indicator for the severity of mitral stenosis?
PDA open
Phencyclidine (PCP)
indomethacin
The time interval between S2 and OS- the shorter the interval - the more intense

5. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Recurrent larygneal
SVT; increases vagal tone; rectus abdominis
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

6. What agonists reduce the gradient across the LV outflow tract?
Ceftriaxone; azithromycin
chronic urticaria and allergic symptoms
Selective alpha 1 (increases SVR)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

7. what induces bronchial squamous metaplasia?
Smoking
On cardiac tissue and renal juxtaglomerular cells
Boiling - bleach - formalin - UV irradiation
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

8. what enzyme converts procarcinogens into carcinogens?
Primary
P450 mitochondrial monooxygenase
Kallmans
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

9. what clinical findings help distinguish small cell carcinoma?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Reiter syndrome; B27
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Syncope - angina - dyspnea (SAD)

10. What is the mc location for avascular necrosis? What is it associated with?
Radial nerve and deep brachial artery
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Pan colitis and right sided colitis (more than left sided and proctitis)
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

11. What does p53 do? what chrom is it on?
Purkinje system; AV node
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Kallmans

12. What three factors effect total oxygen content of blood?
Ketone body production by preventing fatty acids into the mitochondria
Anti centromere; anti DNA topoisomerase
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

13. 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
Nonsense; mRNA processing
ANCA because of lack of Ig and C3 deposits on IF
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

14. What is the presentation of angioedema? Where is most commonly affected?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
NF- KB; responsible for cytokine production
T test; chi squared
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

15. What does L/S stand for in fetal lung maturity? When does maturity occur?
Vancomycin; histamine mediated
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
No; yes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

16. What are the long term consequences of hydrocephalus?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
In ER of bile canaliculi
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
transcription activation/suppression

17. What are the skin presentation in sarcoid?
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
T test; chi squared
Varying; erythema nodosum is common
Close but purkinje system to ensure contraction in a bottom up fashion

18. What does VIP do to gastric acid secretion?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Dihydropyridine sensitive Ca channels (L type)
Inhibits it
In ER of bile canaliculi

19. what happens to capacitance with age?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
...
Localized dermatologic pain that persists for more than one month after zoster eruption
HSV and VZV

20. What does NF- KB do?
MAO inhibitors; wine and cheese
Spongiosis
NF- KB; responsible for cytokine production
Increases cytokine production

21. What is the mainstay treatment for acute mania?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Reiter syndrome; B27
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
CGD; t cell dysfxn (diGeorge)

22. What is the most common initital symptom of ADPKD? what else?
Fat - fertile - forty - female
Relfex tachycardia; giving beta blockers
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

23. What can nitrates lead to that is bad for angina therapy? How do you counter this?
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
GI tract; mood!
Relfex tachycardia; giving beta blockers
Right before diastole (filling begins)

24. What are some of the permissive effects of cortisol?
Because gamma chains replace beta chains and then gamma chain formation wanes
SS +rNA
Increased reticulocytes
Increases bronchial and vascular smooth muscle reactivity to catecholamines

25. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
women
INTRApartum Abs (ampicillin/penicillin)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

26. at four years of age - What are the social - fine motor - gross motor - and language developments?
Hypertension - edema - and proteinuria
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Large stroke volumes with ventricular contraction; aortic regurg

27. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Prevent phagocytosis

28. what organ would an activating mutation in PRPP synthetase effect?
Hypertension - edema - and proteinuria
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Joints d/t increased purine production and thus uric acid production
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

29. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

30. What does nitroprusside do to afterload? preload?
Decreases both
OCPs - multiparity - breast feeding
Valproate
Medial part

31. What are three symptoms in s.typhi?
Demargination of neutrophils from the vessel walls
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Excessive collagen formation during tissue repair in susceptible individuals

32. What triggers the neoplastic changes that are associated with HBV infecton?
Radial nerve and deep brachial artery
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Drink plenty of fluids
Integration of viral DNA into genome of host hepatocytes

33. In what form are mitochondrial DNA? What do they transcribe?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Circular - outside nucleus; transport proteins - rRNA - tRNA
S. aureus

34. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Thymic tumor
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
In the extracellular space for collagen cross linking; zinc

35. What is normal fibrinogen levels?
200-500
CMV - HSV 1 - Candida
ANCA because of lack of Ig and C3 deposits on IF
Nonsense; mRNA processing

36. how can HAV be inactivated?
RBF= PAH clearance/(1- hematocrit)
Boiling - bleach - formalin - UV irradiation
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
indomethacin

37. how does neisseria cause a petechial rash?
Strength of cell mediated immune response
INTRApartum Abs (ampicillin/penicillin)
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
Neisseria induced small cell vasculitis (including hands and soles)

38. what drugs causes the red man syndrome? how does it occur?
Rabies encephalitis from cave bats; rabies killed vaccines
Vancomycin; histamine mediated
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Anti cholinergic effects of pupil dilation and lack of accomodation

39. non ceruloplasmin deposition - ceruloplasmin is...
Anti cholinergic effects of pupil dilation and lack of accomodation
low in serum
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Lateral; RV; RA; LV

40. the rate of blood flow of which two circulations must equal each other at all times?
Well trained athletes and children
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
SaO2 <92%
Pulmonic and systemic!

41. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Trauma to stereociliated hair cells of the organ of corti
Octreotide
Hypo or hyper pigmentations; after tanning
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

42. What type of endocarditis is cytoscopy induced?
Folic acid treatment!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Increases cytokine production
Enterococci (e. faecalis)- found on genitalia area

43. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
Tibial
Aromatase deficiency in child
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

44. What is the mc manifestation of CMV in HIV patient? immunocompetent?
G to T in p53; HCC
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
200-500
Retinitis; mononucleosis

45. How is dobutamine better than dopamine?
NF- KB; responsible for cytokine production
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

46. Where does complement bind on the Fc region of Ig chains?
...
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

47. what defines hypoxemia?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
SaO2 <92%
Leukotriene precursor and does neutrophil chemotaxis
Aromatase deficiency in child

48. Would alpha 1 agonists cause flushing? muscarinic antagonist?
As a CO2 carrier with the carboxylase enzyme
46 - 4N; 23 2N
INTRApartum Abs (ampicillin/penicillin)
No; yes

49. what drug is useful for secretory diarrhea?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Octreotide

50. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Primary
...
In the extracellular space