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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. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hereditary angioedema; ACE inhibitors
No; yes

2. Acyl coA synthetase is not...
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
NF- KB; responsible for cytokine production
liver specific

3. What causes release of myosin head from the actin filament?
Acute gastric mucosal defects (superficial or full thickness)
Diabetic microangiopathy
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
ATP binding (resets the myosin head to contract again for next binding)

4. what commonly happens in GI in response to acute physiologic stress?
Biphosphonate
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Acute gastric mucosal defects (superficial or full thickness)
SVC and IVC; right below the aortic knob

5. how does increased ICP result in curlings ulcers?
RER; RER
Vagus nerve stimulation
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Superior larygeal; cricothyroid; recurrent laryngeal

6. other than in pyelonephritis - where else are WBC casts seen?
ATP binding (resets the myosin head to contract again for next binding)
Brief psychotic disorder; schizophreniform; schizophrenia
ANCA because of lack of Ig and C3 deposits on IF
Acute interstitial nephritis

7. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
200-500
Varying; erythema nodosum is common
Duration and extent of disease

8. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Sarcoid
Folic acid treatment!
Increased reticulocytes

9. what kind of drug is sertraline? What is a common side effect?
MAO inhibitors; wine and cheese
SSRI; erectile dysfunction
Intussusception
No; yes

10. do Class IC agents prolong the QT interval?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Thymic tumor
Adductor
No

11. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Trauma to stereociliated hair cells of the organ of corti
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SS +rNA
Hypo or hyper pigmentations; after tanning

12. What causes curlings ulcers?
Folic acid treatment!
Standing suddenly from supine position; valsalva maneuver
women
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

13. which nerve provides innervation for plantar flexion and inversion?
FGF and VEGF
Vascular endothelium; protease
TCAs and prazosin
Tibial

14. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Vertical diplopia
Fibrosis; macrophages
Nonsense; mRNA processing

15. What antibiotic is best to treat alcoholic pulm infections? why?
Mean greater than median greater than mode
Regular insulin (Not fast acting - regular better)
Myasthenia gravis
Clindamycin; covers anaerobic oral flora and aerobic bacteria

16. how can HAV be inactivated?
FGF and VEGF
Boiling - bleach - formalin - UV irradiation
No
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

17. What does protein M do in Group A strep<
Env genes (for getting into target cells)
Prevent phagocytosis
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

18. on which chromosome is wilms tumor found?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Think Hb deformation diseases
11
Medullary

19. What is the Na/Ca exchange used for?
Aromatase deficiency in child
To pump calcium out in cardiac myocytes so that relaxation occurs
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
The term used to describe decreased drug responsiveness with repeated administration

20. Where does complement bind on the Fc region of Ig chains?
facultative intracellular
ANCA because of lack of Ig and C3 deposits on IF
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Integration of viral DNA into genome of host hepatocytes

21. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
In ER of bile canaliculi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RER; RER
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

22. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
No; MRI
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)
Initiation - pointing; pincer grasp; walking; mama/dada

23. why is glucagon used in beta blocker toxicitiy?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Demargination of neutrophils from the vessel walls
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

24. which two virus families have hemagluttinin on their surface?
Closer to head; closer to diaphragm
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Drink plenty of fluids
Paramyxo and influenza

25. why are beta thal major patients asymptomatic at birth?
Nonsense; mRNA processing
E. coli; staphylococcus saprophyticus
Pulmonic and systemic!
Because gamma chains replace beta chains and then gamma chain formation wanes

26. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Fibrosis; macrophages
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
200-500

27. What are examples of action that decrease venous return to the heart?
Anti cholinergic effects of pupil dilation and lack of accomodation
INTRApartum Abs (ampicillin/penicillin)
Standing suddenly from supine position; valsalva maneuver
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

28. is Rifampin ever used as monotherapY? why either way?
Retinitis; mononucleosis
Southern - western
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
Relfex tachycardia; giving beta blockers

29. biotin is used By what in tissues responsible for gluconeogenesis
Strength of cell mediated immune response
Right heart failure
As a CO2 carrier with the carboxylase enzyme
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

30. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Increases
Primary

31. what dissolves the lipid bilayer of a viral envelope?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Initiation - pointing; pincer grasp; walking; mama/dada
Ether and other organic solvents

32. what happens to capacitance with age?
Pulmonic and systemic!
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
S3 gallop; S2 to opening snap interval
...

33. What actions increase venous return?
CGD; t cell dysfxn (diGeorge)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Squatting - sitting - lying supine - passive leg raising
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

34. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Increase; decreased
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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

35. the rate of blood flow of which two circulations must equal each other at all times?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rabies encephalitis from cave bats; rabies killed vaccines
Pulmonic and systemic!
Increases

36. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
GI malignancies and Insulin resistance (acromegal for ex)
Rabies encephalitis from cave bats; rabies killed vaccines
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
facultative intracellular

37. what clinical findings help distinguish small cell carcinoma?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Drug induced interstitial nephritis
Normally close to systolic

38. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Because gamma chains replace beta chains and then gamma chain formation wanes
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Increased reticulocytes

39. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Hypothyroidism
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Elastance

40. which RPGN is also called pauci immune GN? why?
Varying; erythema nodosum is common
ANCA because of lack of Ig and C3 deposits on IF
Chlorpheniramine and diphenhydramine
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

41. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

42. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Increase; decreased
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

43. What is used to compare means? categorical outcomes?
RER; copper
Vascular endothelium; protease
8 (myc protein) with 2 - 14 - 22 (iG chains)
T test; chi squared

44. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Nocardia
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Anterior nares

45. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

46. what drugs causes the red man syndrome? how does it occur?
TSh (in testicular tumors can cause hyperthyroidism)
Abnormal closing of the urethral folds
Vancomycin; histamine mediated
Drink plenty of fluids

47. What is the difference between paranoid personality disorder and delusional disorder?
S. saprophyticus - and s. epidermidis; novobiocin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Well trained athletes and children
Multiple miscarriages d/t hypercoaguability

48. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
P450 mitochondrial monooxygenase
RBC mass; epo levels (secondary has high)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

49. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Pulmonary hypertension
Adductor
Become beta pleated and then form neurofibrillary tangle!

50. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Reticulocytes
Retinitis; mononucleosis
Paramyxo and influenza
Increases cytokine production

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USMLE Prep 2

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