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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. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Chorda tympani branch
Acute interstitial nephritis
G to T in p53; HCC

2. What translocations can cause c - myc overexpression?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Bronchogenic carcinoma
chronic urticaria and allergic symptoms
8 (myc protein) with 2 - 14 - 22 (iG chains)

3. at three years of age What are social - fine motor - gross motor and language developments?
Terminal bronchioles; small bronchi
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Syncope - angina - dyspnea (SAD)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

4. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Integration of viral DNA into genome of host hepatocytes
low in serum

5. in the LV and aorta - What are the pressures?
GI tract; mood!
Normally close to systolic
Inhibits it
Varying; erythema nodosum is common

6. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Elastance
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
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
Single adenomatous ones

7. What is difference between Arnold Chiari type I and II?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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
I is more benign and can present later in adulthood

8. why are pregnant predisposed to cholelithiasis?
Amiadarone
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Inactivates kallikrein which activates kininogen into bradykinin
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

9. is Rifampin ever used as monotherapY? why either way?
No (unlike adenomyosis); yes
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
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
ANCA because of lack of Ig and C3 deposits on IF

10. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Vagus (auricular branch); vasovagal syncope!
SaO2 <92%
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

11. on which chromosome is wilms tumor found?
Initiation - pointing; pincer grasp; walking; mama/dada
ANCA because of lack of Ig and C3 deposits on IF
11
ATP binding (resets the myosin head to contract again for next binding)

12. What does anti phospholipid syndrome in SLE patients predispose them to?
IgE
Multiple miscarriages d/t hypercoaguability
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Raphe

13. What is somatomedin C?
Insulin like growth factor 1 (just another name)
SVC and IVC; right below the aortic knob
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

14. what phase do adenosine and acetylcholine act on? doing what?
The term used to describe decreased drug responsiveness with repeated administration
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

15. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
8; 12
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Because of the low output from heart failure - they will have increased aldosterone levels

16. what induces bronchial squamous metaplasia?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Smoking
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
RBC mass; epo levels (secondary has high)

17. What is the mc location for avascular necrosis? What is it associated with?
Both sides
Intussusception
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

18. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
RER; copper
Decreases both
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

19. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Bile salt accumulation in urine
Trauma to stereociliated hair cells of the organ of corti
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

20. how does increased ICP result in curlings ulcers?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Vagus nerve stimulation
Env genes (for getting into target cells)

21. What are the lab findings in poststreptococcal GN?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Bronchial dilation (bronchiectasis)
Ether and other organic solvents
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

22. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Classical conditioning
Another type of aldosterone antagonist (like spironolactone)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

23. What is achalasia and how would this correlate on the esophageal mannometry?
Varying; erythema nodosum is common
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
DIC; TTP- HUS dont bleed that much
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

24. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Dissolved in plasma and attached to Hgb
RER; copper
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
P450 mitochondrial monooxygenase

25. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Barium enema
Gluteus medius and minimus; positive trendelenberg
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

26. What is hypospadias caused by?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
RBC mass; epo levels (secondary has high)
Abnormal closing of the urethral folds
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

27. What three pathogens cause infectious esophagitis in HIV positive patients?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
CMV - HSV 1 - Candida
Boiling - bleach - formalin - UV irradiation
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

28. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Tzanck smear
8; 12
transcription activation/suppression

29. What agonists reduce the gradient across the LV outflow tract?
Hypo or hyper pigmentations; after tanning
Selective alpha 1 (increases SVR)
Inactivates kallikrein which activates kininogen into bradykinin
Little effect on cell and no change

30. why does hypothyroidism cause increased CPK levels?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
APP on chrom 21 (this is why downs more susceptible)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

31. what diseases can vit A be used to treat?
Become beta pleated and then form neurofibrillary tangle!
S. saprophyticus - and s. epidermidis; novobiocin
Amiloride - spironolactone - triamterene
Measles and M3 AML`

32. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Boiling - bleach - formalin - UV irradiation
Faulty positioning of the genital tubercle
Hydrogen bonds dictate alpha or beta structure

33. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
DIC; TTP- HUS dont bleed that much
No and yes
11 aa polypeptide; pain NT in CNS and PNS

34. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Cluster
Superior larygeal; cricothyroid; recurrent laryngeal
indomethacin
Anterior nares

35. Where is the base of the heart? apex?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Pain reliever - reduces pain by locking substance P in the PNS
Closer to head; closer to diaphragm
Adductor

36. what receptors do first generation anti histamines block?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
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
Selective alpha 1 (increases SVR)

37. What is damaged in early syringomelia? later?
Increased reticulocytes
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Class I
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

38. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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
Underestimation of gestational age
High potassium conductance and some sodium conductance
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)

39. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Well trained athletes and children
Hypothyroidism
SSRI; erectile dysfunction
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

40. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Amiadarone
Relfex tachycardia; giving beta blockers
Dissolved in plasma and attached to Hgb
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

41. which cells produce surfactant? which ones mediate gas exchange?
MAO inhibitors; wine and cheese
V fib; v. failure
II; I (I more abundant)
Lateral; RV; RA; LV

42. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
APP on chrom 21 (this is why downs more susceptible)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Increase by 50% in urine osmolality

43. What is the Na/Ca exchange used for?
Because of vasodiation to skeletal muscles
Leukotriene precursor and does neutrophil chemotaxis
To pump calcium out in cardiac myocytes so that relaxation occurs
SSRI

44. What are the three dopaminergic systems and What are they responsible for? disease?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Amiadarone
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

45. what drugs causes the red man syndrome? how does it occur?
Boiling - bleach - formalin - UV irradiation
Vancomycin; histamine mediated
Chorda tympani branch
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

46. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Large stroke volumes with ventricular contraction; aortic regurg
Reiter syndrome; B27
Serum creatine kinase; reperfusion injury causes necrosis

47. biotin is used By what in tissues responsible for gluconeogenesis
Because of vasodiation to skeletal muscles
As a CO2 carrier with the carboxylase enzyme
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Bile soluble which means they are bile sensitive

48. what has the greatest effect on prognosis when treating c. diptheriae?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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

49. what clinical findings help distinguish small cell carcinoma?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Little effect on cell and no change
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

50. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Radial nerve damage
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
CMV - HSV 1 - Candida
Chorda tympani branch