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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. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Medial circumflex artery; avascular necrosis
Hexokinase
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Increase; decreased

2. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Because gamma chains replace beta chains and then gamma chain formation wanes
11 aa polypeptide; pain NT in CNS and PNS
Inhibits it

3. What does extended consumption of appetite suppressants lead to?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Pulmonary hypertension
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Trochlear nerve (IV); abducens nerve (VI)

4. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Coagulation factors are made in the liver
To pump calcium out in cardiac myocytes so that relaxation occurs
S. saprophyticus - and s. epidermidis; novobiocin

5. what virus causes pharyngoconjuctival fever?
Adeno
liver specific
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
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

6. What is Bortezomib and What is it used for?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Proteasome inhibitor; treatment for MM and waldenstroms
S. aureus
RBC mass; epo levels (secondary has high)

7. What is the most common initital symptom of ADPKD? what else?
Pulmonic and systemic!
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Highly negative resting potential
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

8. What is the preferred treatment for DKA?
...
Regular insulin (Not fast acting - regular better)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
T test; chi squared

9. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
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)
S. saprophyticus - and s. epidermidis; novobiocin
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

10. within the right ventricle - What are maximum pressures? the pulm arter?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
25; 25
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
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)

11. What does the severity of leprosy depend on?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Strength of cell mediated immune response
Vagus (auricular branch); vasovagal syncope!
ATP binding (resets the myosin head to contract again for next binding)

12. what drugs causes the red man syndrome? how does it occur?
AV node slowest - to allow time for diastole
Inactivates kallikrein which activates kininogen into bradykinin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Vancomycin; histamine mediated

13. What are the three predominant symptoms of VHL? What is its mode of inheritance?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Excessive collagen formation during tissue repair in susceptible individuals
Proteasome inhibitor; treatment for MM and waldenstroms

14. ___________ is liver specific
glycerol kinase
Common peroneal; bony fractures and compression; sciatic
Insulin like growth factor 1 (just another name)
Headaches and facial flushing; vasodilation in meninges and skin

15. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
Circular - outside nucleus; transport proteins - rRNA - tRNA
Become beta pleated and then form neurofibrillary tangle!
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

16. If a patient has higher levels of HbF - What does this mean?
Vascular endothelium; protease
Apocrine; eccrine
liver specific
Think Hb deformation diseases

17. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Downs; regurgitant AV valves - ASDs
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Vancomycin

18. What three factors effect total oxygen content of blood?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Skin flushing and warmth; prostaglandins; give with aspirin
Chorda tympani branch
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

19. What is acanthosis nigricans associated with?
Leukotriene precursor and does neutrophil chemotaxis
Dissolved in plasma and attached to Hgb
Hydrogen bonds dictate alpha or beta structure
GI malignancies and Insulin resistance (acromegal for ex)

20. within the right atrium - What is the maximum pressure? left atrium?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
transcription activation/suppression
liver specific
8; 12

21. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Chrom 8
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
LT (LTD4 - E4 - C4) - and Ach

22. What is normal fibrinogen levels?
200-500
SS +rNA
Pan colitis and right sided colitis (more than left sided and proctitis)
Nonsense; mRNA processing

23. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Fat - fertile - forty - female
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
CMV - HSV 1 - Candida
Chorda tympani branch

24. What does p53 do? what chrom is it on?
Boiling - bleach - formalin - UV irradiation
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Acute gastric mucosal defects (superficial or full thickness)

25. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

26. What type of mutation does aflatoxin cause? what cancer does this increase for?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
G to T in p53; HCC

27. When does opening snap begin?
Fat - fertile - forty - female
ZDV or AZT
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Right before diastole (filling begins)

28. What type of calcium channels dictate the plateau in cardiac myocyte?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Dihydropyridine sensitive Ca channels (L type)
Brief psychotic disorder; schizophreniform; schizophrenia
By vascular permeability and vasodilation

29. what defines hypoxemia?
Smoking
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
SaO2 <92%
Sydenham chorea

30. Where does lysyl oxidase act? What is the cofactor for that?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Joints d/t increased purine production and thus uric acid production
In the extracellular space for collagen cross linking; zinc
Ceftriaxone; azithromycin

31. What is the cause of fixed splitting of S2? why?
<1% - 55% - concentration dependent
chronic urticaria and allergic symptoms
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
G to T in p53; HCC

32. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Large stroke volumes with ventricular contraction; aortic regurg
By vascular permeability and vasodilation
Curlings ulcers
11 aa polypeptide; pain NT in CNS and PNS

33. What is a keloid?
Another type of aldosterone antagonist (like spironolactone)
Excessive collagen formation during tissue repair in susceptible individuals
<1% - 55% - concentration dependent
Increase; decreased

34. where are the two classical places that the ulnar nerve can be injured?

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35. SIADH patients have normal blood volume but...
Selective alpha 1 (increases SVR)
hyponatremia (aldosterone activation equilibrates body volume)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
No (unlike adenomyosis); yes

36. 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
Susceptible; soluble (unable to be cultured in bile)
Amiloride - spironolactone - triamterene
GI malignancies and Insulin resistance (acromegal for ex)

37. What does nitroprusside do to afterload? preload?
Reticulocytes
Decreases both
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

38. which staphylococci can do mannitol fermaentation?
indomethacin
S. aureus
Terminal bronchioles; small bronchi
Syncope - angina - dyspnea (SAD)

39. 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?
No
As a CO2 carrier with the carboxylase enzyme
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)
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

40. on What part of the clavicle does the SCM attach?
Medial part
Regular insulin (Not fast acting - regular better)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

41. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Well trained athletes and children
only up to bronchi
S. saprophyticus - and s. epidermidis; novobiocin

42. how does neisseria cause a petechial rash?
Bile salt accumulation in urine
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)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

43. in the LV and aorta - What are the pressures?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Normally close to systolic
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)

44. What is Tzanck smear used to detect?
HSV and VZV
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Anti centromere; anti DNA topoisomerase

45. nucleotide deletions do not cause missense mutations - they cause...
Increase; decreased
frameshift mutations (missense is substitution)
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
Initiation - pointing; pincer grasp; walking; mama/dada

46. who bleed more DIC or TTP- HUS patients?
Duration and extent of disease
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
DIC; TTP- HUS dont bleed that much
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

47. What is the mcc of extrinsic allergic asthma?
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
Inhaled animal dander allergens
ZDV or AZT
Leukotriene precursor and does neutrophil chemotaxis

48. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Covalent (between two cysteines)- allows protein to withstand denaturation
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Neisseria induced small cell vasculitis (including hands and soles)
(urine PAH x urine flow rate)/plasma PAH

49. What is extraocular muscle weakness a common symptom of?
Susceptible; soluble (unable to be cultured in bile)
Southern - western
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Myasthenia gravis

50. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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