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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. What causes the blurry vision side effects in first generation anti histamines?
RR-1/RR
Anti cholinergic effects of pupil dilation and lack of accomodation
Bronchial dilation (bronchiectasis)
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

2. where are the vegetations on the valves of a libman sacks endocarditis?
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Both sides
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

3. what enzyme converts procarcinogens into carcinogens?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Standing suddenly from supine position; valsalva maneuver
P450 mitochondrial monooxygenase
Because gamma chains replace beta chains and then gamma chain formation wanes

4. What is easiest way to treat nephrolithiasis?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Curlings ulcers
Drink plenty of fluids
Common peroneal; bony fractures and compression; sciatic

5. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Echinococcus granulosus; anaphylaxis
Because of the low output from heart failure - they will have increased aldosterone levels
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

6. on What part of the clavicle does the SCM attach?
Vascular endothelium; protease
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
CGD; t cell dysfxn (diGeorge)
Medial part

7. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
Medial part
Echinococcus granulosus; anaphylaxis
Enterococci (e. faecalis)- found on genitalia area

8. What is difference between Arnold Chiari type I and II?
CGD; t cell dysfxn (diGeorge)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
I is more benign and can present later in adulthood
T test; chi squared

9. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
DIC; TTP- HUS dont bleed that much
Single adenomatous ones
Terminal bronchioles; small bronchi
By vascular permeability and vasodilation

10. What is cataplexy and When is it seen?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Anti centromere; anti DNA topoisomerase
Normal; low
Sudden loss of muscle tone without loss of consciousness; narcolepsy

11. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Prepatellar
Biphosphonate
S. aureus

12. where exactly is ACE expressed in the lungs? What type of enzyme is it?
On cardiac tissue and renal juxtaglomerular cells
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Vascular endothelium; protease

13. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
FGF and VEGF
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

14. What is Bortezomib and What is it used for?
Increases
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Proteasome inhibitor; treatment for MM and waldenstroms
IgE

15. there are mucus secreting cells in the bronchioles...
only up to bronchi
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Kallmans
P53 mutation; AD

16. Where does terminal peptide cleavage of collagen fibrils take place?
Measles and M3 AML`
Elevated GGT and macrocytosis
In the extracellular space
Hyperkalemia; potassium sparing diuretics - potassium supplements

17. if there are keratin swirls does that mean well or poorly differentiated?
Measles and M3 AML`
Well
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

18. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
SSRI; erectile dysfunction
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Covalent (between two cysteines)- allows protein to withstand denaturation
No and yes

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

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20. What is pickwickian syndrome? What are the lab findings?
Anti centromere; anti DNA topoisomerase
Southern - western
Measles and M3 AML`
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

21. are there signs of inflammation in avascular necrosis? then How do you diagnose?
differentiate
No; MRI
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

22. 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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Vagus (auricular branch); vasovagal syncope!
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

23. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Neisseria induced small cell vasculitis (including hands and soles)
Demargination of neutrophils from the vessel walls
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
I is more benign and can present later in adulthood

24. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SSRI; erectile dysfunction
Purkinje system; AV node
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

25. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
On cardiac tissue and renal juxtaglomerular cells
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Vertical diplopia

26. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Increases
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

27. What does L/S stand for in fetal lung maturity? When does maturity occur?
frameshift mutations (missense is substitution)
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
11

28. What translocations can cause c - myc overexpression?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Headaches and facial flushing; vasodilation in meninges and skin
8 (myc protein) with 2 - 14 - 22 (iG chains)

29. which are the only glycosylated proteins in HIV virus?
By vascular permeability and vasodilation
Env genes (for getting into target cells)
Anti centromere; anti DNA topoisomerase
Boiling - bleach - formalin - UV irradiation

30. which virus inactivates both Rb and p53?
Recurrent larygneal
8 (myc protein) with 2 - 14 - 22 (iG chains)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
SVT; increases vagal tone; rectus abdominis

31. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
8 (myc protein) with 2 - 14 - 22 (iG chains)
Because of vasodiation to skeletal muscles
transcription activation/suppression

32. 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?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Highly negative resting potential

33. What type of drug is alendronate?
Hypertension - edema - and proteinuria
Smoking
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Biphosphonate

34. what marker should be followed in a patient with cirrhosis?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Think Hb deformation diseases
chronic urticaria and allergic symptoms

35. what defines hypoxemia?
Hydrogen bonds dictate alpha or beta structure
Elevated GGT and macrocytosis
SaO2 <92%
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

36. in the LV and aorta - What are the pressures?
MAC complex (C5b - C9 complement deficiency)
Retinitis; mononucleosis
Drug induced interstitial nephritis
Normally close to systolic

37. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Pulmonary hypertension
Amiloride - spironolactone - triamterene

38. nucleotide deletions do not cause missense mutations - they cause...
Intussusception
frameshift mutations (missense is substitution)
Hexokinase
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

39. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
OCPs - multiparity - breast feeding
SSRI
Intussusception

40. other than in pyelonephritis - where else are WBC casts seen?
S. aureus
46 - 4N; 23 2N
Acute interstitial nephritis
Curlings ulcers

41. what clinical findings help distinguish small cell carcinoma?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
SVC and IVC; right below the aortic knob
Hypothyroidism

42. What does Rb protein do? what chrom is it on?
Localized dermatologic pain that persists for more than one month after zoster eruption
hyponatremia (aldosterone activation equilibrates body volume)
facultative intracellular
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

43. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Chorda tympani branch
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)
Chlorpheniramine and diphenhydramine

44. What type of mutation does aflatoxin cause? what cancer does this increase for?
<1% - 55% - concentration dependent
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
G to T in p53; HCC
Dissolved in plasma and attached to Hgb

45. Metronidizaole does not cover...
gram positive organisms
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
P450 mitochondrial monooxygenase
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

46. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
AV node slowest - to allow time for diastole
Syncope - angina - dyspnea (SAD)
Intussusception
Fibronectin - laminin - collagen

47. What causes wrist drop?
Increases
Lateral; RV; RA; LV
Radial nerve damage
Atrial

48. what indicates the severity of a mitral regurg ? mitral stenosis?
No and yes
S3 gallop; S2 to opening snap interval
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
T test; chi squared

49. What are fenfluramine - phentermine?
Appetite suppressants
Underestimation of gestational age
P53 mutation; DCC is also required for adenoma to carcinoma
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

50. what hernia has a similar mechanism to hydrocele?
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
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
In ER of bile canaliculi