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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What are fenfluramine - phentermine?
No (unlike adenomyosis); yes
Increase; decreased
Demargination of neutrophils from the vessel walls
Appetite suppressants

2. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Fat - fertile - forty - female
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Ether and other organic solvents

3. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Elastance
Serum creatine kinase; reperfusion injury causes necrosis
Valproate
SVC and IVC; right below the aortic knob

4. What agonists reduce the gradient across the LV outflow tract?
Joints d/t increased purine production and thus uric acid production
Selective alpha 1 (increases SVR)
Bile salt accumulation in urine
Varying; erythema nodosum is common

5. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
liver specific
Bronchial dilation (bronchiectasis)
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

6. 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
CMV - HSV 1 - Candida
Reticulocytes
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

7. What type of vision is myopia? In What type of patients does it improve?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
MAC complex (C5b - C9 complement deficiency)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

8. What are some side effects seen in TCAs?
Anti centromere; anti DNA topoisomerase
Coagulation factors are made in the liver
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

9. which staphylococci can do mannitol fermaentation?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
S. aureus
Chorda tympani branch

10. What does sustained hand grip do to the C/V system?
Regular insulin (Not fast acting - regular better)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
G to T in p53; HCC

11. What are the two mcc of focal brain lesions in HIV positive patients?
Nonsense; mRNA processing
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Anterior nares
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

12. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
SSRI; erectile dysfunction
No; MRI
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

13. which two virus families have hemagluttinin on their surface?
Increase lymphatic drainage!
Strength of cell mediated immune response
Paramyxo and influenza
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

14. why does neutrophila occur with corticosteroids?
Excessive collagen formation during tissue repair in susceptible individuals
Demargination of neutrophils from the vessel walls
RBF= PAH clearance/(1- hematocrit)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

15. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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

16. how does eos release MBP to kill protozoa etc?
Biphosphonate
Squatting - sitting - lying supine - passive leg raising
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Extrinsic def; instrinsic def; platelet def

17. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
In the extracellular space
Superior larygeal; cricothyroid; recurrent laryngeal
Brief psychotic disorder; schizophreniform; schizophrenia

18. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Curlings ulcers
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Prevents hepatic VLDL production
Class I

19. what chromosome is c - myc found on?
Chrom 8
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Inhaled animal dander allergens
Folic acid treatment!

20. What causes the blurry vision side effects in first generation anti histamines?
Mean greater than median greater than mode
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Anti cholinergic effects of pupil dilation and lack of accomodation
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

21. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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22. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Joints d/t increased purine production and thus uric acid production
RBC mass; epo levels (secondary has high)
As a CO2 carrier with the carboxylase enzyme

23. what virus causes pharyngoconjuctival fever?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Adeno
Intussusception

24. What are the potassium sparing diuretics?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Extrinsic def; instrinsic def; platelet def
Amiloride - spironolactone - triamterene

25. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Hypothyroidism
Hydrogen bonds dictate alpha or beta structure
Nonsense; mRNA processing
Increase lymphatic drainage!

26. what locations of UC increase the risk of Colon cancer?
Hypothyroidism
Chrom 8
Dissolved in plasma and attached to Hgb
Pan colitis and right sided colitis (more than left sided and proctitis)

27. What is diagnostic (and possible therapeutic for intussusception)?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Barium enema
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

28. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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)
Strength of cell mediated immune response

29. What is omalizumab and What is it used for?
Demargination of neutrophils from the vessel walls
Adductor
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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)

30. What is the mc location of brain germinomas?What are the classic symptoms?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Atrial
Demargination of neutrophils from the vessel walls

31. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
When it invades the bm; carcinoma in situ
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

32. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Octreotide
Hexokinase

33. What type of disease has selective proteinuria? What is found in urine? What is not?
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
Sydenham chorea
Leukotriene precursor and does neutrophil chemotaxis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

34. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Sarcoid
Inhaled animal dander allergens
Southern - western

35. other than parvo B19 - what else is associated with red cell aplasia?
differentiate
Thymic tumor
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

36. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Covalent (between two cysteines)- allows protein to withstand denaturation
No
ATP binding (resets the myosin head to contract again for next binding)
Skin flushing and warmth; prostaglandins; give with aspirin

37. What does p53 do? what chrom is it on?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
S3 gallop; S2 to opening snap interval
Terminal bronchioles; small bronchi

38. in overweight individuals What is thought to contribute to insulin resistance?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Serum FFA and serum triglyceride levels
In the extracellular space
indomethacin

39. What is the Na/Ca exchange used for?
8; 12
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
To pump calcium out in cardiac myocytes so that relaxation occurs

40. What is damaged in early syringomelia? later?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Leukotriene precursor and does neutrophil chemotaxis

41. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Chrom 8
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

42. 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?
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)
Minimal change disease
SSRI

43. What are the common causes of metabolic alkalosis? How do you differentiate between them?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Retinitis; mononucleosis
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

44. Which nerve lies in close proximity to the inferior thyroid artery?
Hypothyroidism
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Recurrent larygneal
SSRI

45. How can renal blood flow be calculated from RPF?
Extrinsic def; instrinsic def; platelet def
Inactivates kallikrein which activates kininogen into bradykinin
Bile salt accumulation in urine
RBF= PAH clearance/(1- hematocrit)

46. What is the most important prognostic indicator in patients with malignant melanoma?
SVT; increases vagal tone; rectus abdominis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Measure of depth invasion (vertical!)
Trauma to stereociliated hair cells of the organ of corti

47. What is the fibrinogen level in patient with TTP- HUS? DIC?
Normal; low
Squatting - sitting - lying supine - passive leg raising
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Brief psychotic disorder; schizophreniform; schizophrenia

48. In what population does cholelithiasis occur?
Smoking
Fat - fertile - forty - female
Class I
RER; copper

49. ___________ is liver specific
glycerol kinase
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Classical conditioning
Smoking

50. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TSh (in testicular tumors can cause hyperthyroidism)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
TCAs and prazosin

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USMLE Prep 2

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