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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. how does eos release MBP to kill protozoa etc?
(urine PAH x urine flow rate)/plasma PAH
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
Anterior circumflex (and axillary nerve)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

2. biotin is used By what in tissues responsible for gluconeogenesis
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
TCAs and prazosin
Tissue redistribution (out of plasma) rather than metabolism
As a CO2 carrier with the carboxylase enzyme

3. at three years of age What are social - fine motor - gross motor and language developments?
Vagus nerve stimulation
II; I (I more abundant)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Strength of cell mediated immune response

4. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
High potassium conductance and some sodium conductance

5. What test would be best to determine if a gene is being transcribed? translated?
Inhibits it
Terminal bronchioles; small bronchi
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Southern - western

6. other than parvo B19 - what else is associated with red cell aplasia?
SSRI
Initiation - pointing; pincer grasp; walking; mama/dada
Thymic tumor
Increases

7. How do you treat gonococcal infection? chlymadia?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Inhibits it
Ceftriaxone; azithromycin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

8. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
4 - 4 - 9
11 aa polypeptide; pain NT in CNS and PNS

9. why does neutrophila occur with corticosteroids?
Coagulation factors are made in the liver
Rabies encephalitis from cave bats; rabies killed vaccines
Classical conditioning
Demargination of neutrophils from the vessel walls

10. What are the three causes of acute MI in context of normal coronary arteries ?
Inhaled animal dander allergens
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
G to T in p53; HCC
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

11. what clinical findings help distinguish small cell carcinoma?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Intussusception
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
ZDV or AZT

12. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
SVC and IVC; right below the aortic knob
Drink plenty of fluids
Hexokinase

13. What are the long term consequences of hydrocephalus?
APP on chrom 21 (this is why downs more susceptible)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Underestimation of gestational age

14. What is an abortive viral infection?
Retinitis; mononucleosis
APP on chrom 21 (this is why downs more susceptible)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Little effect on cell and no change

15. what chromosome is c - myc found on?
Ceftriaxone; azithromycin
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Chrom 8
Ketone body production by preventing fatty acids into the mitochondria

16. What does nitroprusside do to afterload? preload?
Chrom 8
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Decreases both
Prepatellar

17. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
8; 12
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Turbulence

18. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Serum creatine kinase; reperfusion injury causes necrosis
No; MRI
8; 12

19. How do you calculate atributable risk percent?
Common peroneal; bony fractures and compression; sciatic
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Spongiosis
RR-1/RR

20. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Ig A deficiency
OCPs - multiparity - breast feeding
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

21. what hernia has a similar mechanism to hydrocele?
Minimal change disease
differentiate
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Close but purkinje system to ensure contraction in a bottom up fashion

22. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Not lined by epithelium

23. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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24. after a thrombus extraction - what serum enzyme shoots up and why?
RER; RER
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
only up to bronchi
Serum creatine kinase; reperfusion injury causes necrosis

25. what defines hypoxemia?
Pulmonary hypertension
Tzanck smear
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
SaO2 <92%

26. Which nerve lies in close proximity to the inferior thyroid artery?
Atrial
Recurrent larygneal
HSV ( also in utero: chlymadia - neisseria - group B strep)
Trochlear nerve (IV); abducens nerve (VI)

27. What type of calcium channels dictate the plateau in cardiac myocyte?
Fibronectin - laminin - collagen
Dihydropyridine sensitive Ca channels (L type)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Raphe

28. what has the greatest effect on prognosis when treating c. diptheriae?
Protamine sulfate
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Intussusception

29. What can nitrates lead to that is bad for angina therapy? How do you counter this?
LT (LTD4 - E4 - C4) - and Ach
Congenital hypothyroidism - downs - amyloidosis - acromegaly
As a CO2 carrier with the carboxylase enzyme
Relfex tachycardia; giving beta blockers

30. What is the difference between paranoid personality disorder and delusional disorder?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Gluteus maximus; difficulty getting up from seated position and climbing chair
In the extracellular space

31. What does anti phospholipid syndrome in SLE patients predispose them to?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Thymic tumor
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Multiple miscarriages d/t hypercoaguability

32. What is 5- HETE and What does it do?
G to T in p53; HCC
Leukotriene precursor and does neutrophil chemotaxis
When it invades the bm; carcinoma in situ
Localized dermatologic pain that persists for more than one month after zoster eruption

33. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Inhaled animal dander allergens
RBC mass; epo levels (secondary has high)
Bronchogenic carcinoma
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

34. do Class IC agents prolong the QT interval?
No
Vascular endothelium; protease
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
chronic urticaria and allergic symptoms

35. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Tibial
To pump calcium out in cardiac myocytes so that relaxation occurs
transcription activation/suppression

36. what drugs causes the red man syndrome? how does it occur?
Another type of aldosterone antagonist (like spironolactone)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
RR-1/RR
Vancomycin; histamine mediated

37. What are two indicators of chronic alcohol consumption?
Decreases both
Elevated GGT and macrocytosis
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Turners`

38. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Raphe
Because of vasodiation to skeletal muscles
Think Hb deformation diseases

39. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Integration of viral DNA into genome of host hepatocytes
Acute interstitial nephritis
E. coli; staphylococcus saprophyticus
Varying; erythema nodosum is common

40. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Drink plenty of fluids
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

41. In what form are mitochondrial DNA? What do they transcribe?
Anti cholinergic effects of pupil dilation and lack of accomodation
Gluteus medius and minimus; positive trendelenberg
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Circular - outside nucleus; transport proteins - rRNA - tRNA

42. What is the stabilizing force for the secondary structure of proteins?
INTRApartum Abs (ampicillin/penicillin)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Hydrogen bonds dictate alpha or beta structure
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

43. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Boiling - bleach - formalin - UV irradiation
Radial nerve damage
SSRI; erectile dysfunction

44. What can chronic vit A toxicity cause?
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
Proteasome inhibitor; treatment for MM and waldenstroms
Radial nerve damage
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

45. What are three symptoms in s.typhi?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
200-500
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
INTRApartum Abs (ampicillin/penicillin)

46. What is easiest way to treat nephrolithiasis?
Increases cytokine production
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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Drink plenty of fluids

47. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Susceptible; soluble (unable to be cultured in bile)
Bronchial dilation (bronchiectasis)
II; I (I more abundant)

48. When is an S4 sound normal?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Syringomelia
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Well trained athletes and children

49. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Superior larygeal; cricothyroid; recurrent laryngeal

50. What does Rb protein do? what chrom is it on?
Hypertension - edema - and proteinuria
Prepatellar
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Myasthenia gravis