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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. Acyl coA synthetase is not...
Well
liver specific
Inactivates kallikrein which activates kininogen into bradykinin
low in serum

2. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Common peroneal; bony fractures and compression; sciatic
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

3. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Tzanck smear
Varying; erythema nodosum is common
Boiling - bleach - formalin - UV irradiation

4. how does increased ICP result in curlings ulcers?
Become beta pleated and then form neurofibrillary tangle!
Vagus nerve stimulation
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
...

5. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Medial circumflex artery; avascular necrosis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

6. What does sustained hand grip do to the C/V system?
200-500
In ER of bile canaliculi
Spongiosis
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

7. PDAs are often asymptomatic. How do you treat?
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
Right heart failure
indomethacin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

8. How do you calculate RPF from urine PAH?
Single adenomatous ones
Smoking
Around 70 (normal measured diastolic pressures); 9--
(urine PAH x urine flow rate)/plasma PAH

9. what dictates the resting membrane potential of most cells?
frameshift mutations (missense is substitution)
High potassium conductance and some sodium conductance
8; 12
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

10. What are the two growth factors associated with angiogenesis?
46 - 4N; 23 2N
Medullary
Superior larygeal; cricothyroid; recurrent laryngeal
FGF and VEGF

11. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Paramyxo and influenza
Susceptible; soluble (unable to be cultured in bile)
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

12. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

13. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Hypo or hyper pigmentations; after tanning
Echinococcus granulosus; anaphylaxis
SaO2 <92%

14. What effects does cortisol have on catecholamines?
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
GI tract; mood!
In the extracellular space for collagen cross linking; zinc

15. What is the immune deficinecy seen in ataxia telangactasia?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Ig A deficiency
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

16. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Paramyxo and influenza
In ER of bile canaliculi

17. is Rifampin ever used as monotherapY? why either way?
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
Phencyclidine (PCP)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Appetite suppressants

18. when do ghon complexes form - primary or secondary TB?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Primary
frameshift mutations (missense is substitution)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

19. If a patient has higher levels of HbF - What does this mean?
Brief psychotic disorder; schizophreniform; schizophrenia
Think Hb deformation diseases
Serum creatine kinase; reperfusion injury causes necrosis
Close but purkinje system to ensure contraction in a bottom up fashion

20. what induces bronchial squamous metaplasia?
Initiation - pointing; pincer grasp; walking; mama/dada
FGF and VEGF
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Smoking

21. What is mcc of death pre hospital phase of MI? in hospital phase?
Both sides
Hypertension - edema - and proteinuria
Single adenomatous ones
V fib; v. failure

22. What is achalasia and how would this correlate on the esophageal mannometry?
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
P53 mutation; AD
Purkinje system; AV node
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

23. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Dihydropyridine sensitive Ca channels (L type)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
SaO2 <92%
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

24. biotin is used By what in tissues responsible for gluconeogenesis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
As a CO2 carrier with the carboxylase enzyme
Become beta pleated and then form neurofibrillary tangle!
gram positive organisms

25. why does hypothyroidism cause increased CPK levels?
Tzanck smear
liver specific
Increase in permeability of two ions with equal and opposite equilibrium potentials
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

26. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Biphosphonate
No and yes
No
Thymic tumor

27. In What type of nephritis would you see high serum eos count?
Retinitis; mononucleosis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
On cardiac tissue and renal juxtaglomerular cells
Drug induced interstitial nephritis

28. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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)
Relfex tachycardia; giving beta blockers

29. in overweight individuals What is thought to contribute to insulin resistance?
On cardiac tissue and renal juxtaglomerular cells
Well
Serum FFA and serum triglyceride levels
Insulin like growth factor 1 (just another name)

30. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
In the extracellular space
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Increase in permeability of two ions with equal and opposite equilibrium potentials

31. Which nerve lies in close proximity to the inferior thyroid artery?
DIC; TTP- HUS dont bleed that much
Recurrent larygneal
Demargination of neutrophils from the vessel walls
Additive is equal to the sum of the two actions (lets say agonists at a receptor) and synergistic is when the sum is greater than just their two effects together

32. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Excessive collagen formation during tissue repair in susceptible individuals
Minimal change disease
differentiate

33. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Vascular endothelium; protease
Another type of aldosterone antagonist (like spironolactone)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
MAO inhibitors; wine and cheese

34. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Because of vasodiation to skeletal muscles
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

35. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
T test; chi squared
Chlorpheniramine and diphenhydramine
When it invades the bm; carcinoma in situ

36. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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
Fat - fertile - forty - female
46 - 4N; 23 2N

37. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
TSh (in testicular tumors can cause hyperthyroidism)
Drink plenty of fluids
Because of vasodiation to skeletal muscles
4 - 4 - 9

38. which nerve provides innervation for plantar flexion and inversion?
High potassium conductance and some sodium conductance
Tibial
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Fibronectin - laminin - collagen

39. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Env genes (for getting into target cells)
PDA open

40. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Closer to head; closer to diaphragm
SVT; increases vagal tone; rectus abdominis
Pain reliever - reduces pain by locking substance P in the PNS

41. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Kallmans
Curlings ulcers
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Lateral; RV; RA; LV

42. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Elastance
hyponatremia (aldosterone activation equilibrates body volume)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

43. What is medullary sponge kidney disease and how does it present? What does it lead to?
Extrinsic def; instrinsic def; platelet def
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)
Prevent phagocytosis
SVC and IVC; right below the aortic knob

44. What is the cause of fixed splitting of S2? why?
Dihydropyridine sensitive Ca channels (L type)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Anti cholinergic effects of pupil dilation and lack of accomodation
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

45. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Joints d/t increased purine production and thus uric acid production
Hereditary angioedema; ACE inhibitors
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

46. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Because gamma chains replace beta chains and then gamma chain formation wanes

47. Where does 90% of serotonin lie? What is this NT responsible?
Around 70 (normal measured diastolic pressures); 9--
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
GI tract; mood!
Purkinje system; AV node

48. on What part of the clavicle does the SCM attach?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
In the extracellular space
Radial nerve damage
Medial part

49. What causes wrist drop?
Radial nerve damage
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Strength of cell mediated immune response
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

50. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Become beta pleated and then form neurofibrillary tangle!
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe