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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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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 is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
P53 mutation; AD
Enterococci (e. faecalis)- found on genitalia area
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Integration of viral DNA into genome of host hepatocytes

2. What is a primary HSV 1 infection like?
P53 mutation; AD
Radial nerve and deep brachial artery
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

3. within the right ventricle - What are maximum pressures? the pulm arter?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
gram positive organisms
Nonsense; mRNA processing
25; 25

4. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Duration and extent of disease
Become beta pleated and then form neurofibrillary tangle!
Gluteus maximus; difficulty getting up from seated position and climbing chair

5. carnitine deficiency impairs production of What and how?
4 - 4 - 9
Ketone body production by preventing fatty acids into the mitochondria
low in serum
E6 and E7 of HPV knock off p53 and Rb suppressor genes

6. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Regular insulin (Not fast acting - regular better)
No; yes
Appetite suppressants

7. What triggers the neoplastic changes that are associated with HBV infecton?
Regular insulin (Not fast acting - regular better)
TCAs and prazosin
Integration of viral DNA into genome of host hepatocytes
Prevents hepatic VLDL production

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
T test; chi squared
Standing suddenly from supine position; valsalva maneuver
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

9. What is the primary histologic finding in patients with eczematous dermatitis?
Apocrine; eccrine
Spongiosis
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Anterior circumflex (and axillary nerve)

10. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
Covalent (between two cysteines)- allows protein to withstand denaturation
Increase in permeability of two ions with equal and opposite equilibrium potentials
Fat - fertile - forty - female

11. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Ceftriaxone; azithromycin
Anterior nares
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

12. what chromosome is c - myc found on?
Sydenham chorea
Chrom 8
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

13. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Because of the low output from heart failure - they will have increased aldosterone levels
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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
Nocardia

14. What do you treat s. epidermidis with?
Vancomycin
IgE
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

15. How is dobutamine better than dopamine?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
PDA open
In the extracellular space

16. What is epispadias caused by?
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
I is more benign and can present later in adulthood
Cluster
Faulty positioning of the genital tubercle

17. how can HAV be inactivated?
liver specific
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Boiling - bleach - formalin - UV irradiation
Reiter syndrome; B27

18. What actions increase venous return?
Turbulence
Squatting - sitting - lying supine - passive leg raising
Terminal bronchioles; small bronchi
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

19. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
No and yes
Dissolved in plasma and attached to Hgb
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

20. Which is faster atrial muscle or ventricular muscle?
Env genes (for getting into target cells)
Atrial
Cluster
Medial circumflex artery; avascular necrosis

21. What is a clara cell?
Medial circumflex artery; avascular necrosis
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
low in serum
G to T in p53; HCC

22. if there are keratin swirls does that mean well or poorly differentiated?
Well
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
E. coli; staphylococcus saprophyticus
Chorda tympani branch

23. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Chlorpheniramine and diphenhydramine
Medullary
TCAs and prazosin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

24. How do left sided colon adenocarcinomas present? right sided?
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
ZDV or AZT
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

25. which opponens muscle does ulnar innervate?
chronic urticaria and allergic symptoms
Adductor
S3 gallop; S2 to opening snap interval
Sickle cell; G6PD

26. What type of drug is alendronate?
Regular insulin (Not fast acting - regular better)
Reiter syndrome; B27
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
Biphosphonate

27. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
P53 mutation; AD
Extrinsic def; instrinsic def; platelet def
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

28. What are pancreatic pseudocysts called pseudo rather than true cysts?
HSV and VZV
Amiloride - spironolactone - triamterene
Not lined by epithelium
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

29. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Hypothyroidism
Neisseria induced small cell vasculitis (including hands and soles)
Common peroneal; bony fractures and compression; sciatic

30. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
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
Classical conditioning
Both sides

31. What does VIP do to gastric acid secretion?
RR-1/RR
Close but purkinje system to ensure contraction in a bottom up fashion
Inhibits it
Adductor

32. Where does terminal peptide cleavage of collagen fibrils take place?
Classical conditioning
Initiation - pointing; pincer grasp; walking; mama/dada
In the extracellular space
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

33. is Rifampin ever used as monotherapY? why either way?
In the extracellular space for collagen cross linking; zinc
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
S3 gallop; S2 to opening snap interval
Amiloride - spironolactone - triamterene

34. What are the common causes of metabolic alkalosis? How do you differentiate between them?
II; I (I more abundant)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Strength of cell mediated immune response
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

35. Metronidizaole does not cover...
Mean greater than median greater than mode
Prevent phagocytosis
gram positive organisms
S. aureus

36. What is the cause of fixed splitting of S2? why?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
11
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

37. What is used to prevent vertical transmission of HIV?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Susceptible; soluble (unable to be cultured in bile)
ZDV or AZT
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

38. what protects the resting heart from arrhythmias?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Highly negative resting potential
In ER of bile canaliculi
Primary

39. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Strength of cell mediated immune response
Inhaled animal dander allergens

40. how long is substance P? What does it do?
Turners`
11 aa polypeptide; pain NT in CNS and PNS
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Trauma to stereociliated hair cells of the organ of corti

41. why is crohns disease associated with oxaloacetate kidney stones?
Well
Covalent (between two cysteines)- allows protein to withstand denaturation
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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

42. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Excessive collagen formation during tissue repair in susceptible individuals
transcription activation/suppression
46 - 4N; 23 2N
Turbulence

43. non ceruloplasmin deposition - ceruloplasmin is...
Because gamma chains replace beta chains and then gamma chain formation wanes
Brief psychotic disorder; schizophreniform; schizophrenia
low in serum
DIC; TTP- HUS dont bleed that much

44. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

45. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
OCPs - multiparity - breast feeding
By vascular permeability and vasodilation
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

46. What is the presentation of angioedema? Where is most commonly affected?
Insulin like growth factor 1 (just another name)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Another type of aldosterone antagonist (like spironolactone)
Acute interstitial nephritis

47. What is Tzanck smear used to detect?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Hereditary angioedema; ACE inhibitors
HSV and VZV
Cluster

48. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Strength of cell mediated immune response
46 - 4N; 23 2N
Gluteus medius and minimus; positive trendelenberg
Hypertension - edema - and proteinuria

49. What are three symptoms in s.typhi?
Pan colitis and right sided colitis (more than left sided and proctitis)
Protamine sulfate
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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)

50. What is used to compare means? categorical outcomes?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
T test; chi squared
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

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USMLE Prep 2

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