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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.
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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. which cells produce surfactant? which ones mediate gas exchange?
Decreases both
Because of vasodiation to skeletal muscles
II; I (I more abundant)
Neisseria induced small cell vasculitis (including hands and soles)

2. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Brief psychotic disorder; schizophreniform; schizophrenia
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
LT (LTD4 - E4 - C4) - and Ach

3. What are the two mcc of focal brain lesions in HIV positive patients?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

4. What is the neurologic manifestation of ADPKD?
E. coli; staphylococcus saprophyticus
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Regular insulin (Not fast acting - regular better)
Smoking

5. what hernia has a similar mechanism to hydrocele?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

6. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

7. What is contraindicated in toxic mega colon?
Superior larygeal; cricothyroid; recurrent laryngeal
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
ANCA because of lack of Ig and C3 deposits on IF
...

8. at four years of age - What are the social - fine motor - gross motor - and language developments?
glycerol kinase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Neisseria induced small cell vasculitis (including hands and soles)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

9. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Regular insulin (Not fast acting - regular better)
Bronchogenic carcinoma
Clindamycin; covers anaerobic oral flora and aerobic bacteria

10. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
MAC complex (C5b - C9 complement deficiency)
Integration of viral DNA into genome of host hepatocytes
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

11. What is gardeners mydriasis? How is it treated?
Inactivates kallikrein which activates kininogen into bradykinin
Downs; regurgitant AV valves - ASDs
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

12. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
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)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Turbulence
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

13. SIADH patients have normal blood volume but...
Leukotriene precursor and does neutrophil chemotaxis
hyponatremia (aldosterone activation equilibrates body volume)
Folic acid treatment!
Class I

14. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Prevent phagocytosis
Increased reticulocytes
Rabies encephalitis from cave bats; rabies killed vaccines
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

15. 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
Skin flushing and warmth; prostaglandins; give with aspirin
The time interval between S2 and OS- the shorter the interval - the more intense
Fat - fertile - forty - female

16. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Neisseria induced small cell vasculitis (including hands and soles)
Relfex tachycardia; giving beta blockers
Hypo or hyper pigmentations; after tanning
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

17. What antibiotic is best to treat alcoholic pulm infections? why?
Underestimation of gestational age
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

18. What can long term leg cast wearing cause?
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly
I is more benign and can present later in adulthood
Fat - fertile - forty - female

19. what drugs causes the red man syndrome? how does it occur?
Reiter syndrome; B27
Vancomycin; histamine mediated
Atrial
gram positive organisms

20. neisseria are...
facultative intracellular
By vascular permeability and vasodilation
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
No (unlike adenomyosis); yes

21. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Close but purkinje system to ensure contraction in a bottom up fashion
transcription activation/suppression
Chrom 8

22. What test would be best to determine if a gene is being transcribed? translated?
only up to bronchi
Pain reliever - reduces pain by locking substance P in the PNS
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Southern - western

23. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
AV node slowest - to allow time for diastole
Not lined by epithelium
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

24. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Dihydropyridine sensitive Ca channels (L type)
Sickle cell; G6PD
APP on chrom 21 (this is why downs more susceptible)
Dissolved in plasma and attached to Hgb

25. What is mcc of death pre hospital phase of MI? in hospital phase?
Vascular endothelium; protease
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
V fib; v. failure
Drug induced interstitial nephritis

26. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Duration and extent of disease
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
RER; RER

27. What does protein M do in Group A strep<
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Increase in permeability of two ions with equal and opposite equilibrium potentials
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Prevent phagocytosis

28. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
E. coli
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Hereditary angioedema; ACE inhibitors
Acute interstitial nephritis

29. What is the presentation of angioedema? Where is most commonly affected?
Ceftriaxone; azithromycin
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
When it invades the bm; carcinoma in situ
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

30. prostaglandin synthesis keeps...
Sickle cell; G6PD
PDA open
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anti cholinergic effects of pupil dilation and lack of accomodation

31. within the right ventricle - What are maximum pressures? the pulm arter?
Leukotriene precursor and does neutrophil chemotaxis
25; 25
11 aa polypeptide; pain NT in CNS and PNS
P53 mutation; DCC is also required for adenoma to carcinoma

32. What is a common complication of acute pancreatitis? What is it?
S3 gallop; S2 to opening snap interval
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
S. saprophyticus - and s. epidermidis; novobiocin

33. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Increases bronchial and vascular smooth muscle reactivity to catecholamines
RBF= PAH clearance/(1- hematocrit)
No (unlike adenomyosis); yes

34. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
PDA open
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Skin flushing and warmth; prostaglandins; give with aspirin

35. What does extended consumption of appetite suppressants lead to?
Reiter syndrome; B27
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Env genes (for getting into target cells)
Pulmonary hypertension

36. if there are keratin swirls does that mean well or poorly differentiated?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
S3 gallop; S2 to opening snap interval
Well
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

37. What causes curlings ulcers?
Enterococci (e. faecalis)- found on genitalia area
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
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Closer to head; closer to diaphragm

38. What is a cell surface marker seen in liver angiosarcoma?
MAO inhibitors; wine and cheese
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Acute interstitial nephritis

39. What is normal fibrinogen levels?
Terminal bronchioles; small bronchi
RR-1/RR
200-500
The time interval between S2 and OS- the shorter the interval - the more intense

40. What is the mc location for avascular necrosis? What is it associated with?
Vascular endothelium; protease
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Recurrent larygneal
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

41. What are pancreatic pseudocysts called pseudo rather than true cysts?
S. saprophyticus - and s. epidermidis; novobiocin
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Duration and extent of disease
Not lined by epithelium

42. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Intussusception
Relfex tachycardia; giving beta blockers
Abnormal closing of the urethral folds

43. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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44. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Amiadarone
INTRApartum Abs (ampicillin/penicillin)
Hypertension - edema - and proteinuria

45. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Anti centromere; anti DNA topoisomerase
women

46. What is the best indicator for the severity of mitral stenosis?
S3 gallop; S2 to opening snap interval
The time interval between S2 and OS- the shorter the interval - the more intense
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)
V fib; v. failure

47. How do left sided colon adenocarcinomas present? right sided?
Pulmonary hypertension
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

48. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
The time interval between S2 and OS- the shorter the interval - the more intense
HSV and VZV

49. What is the most common neurologic complication of VZV reactivation?
Increases
Curlings ulcers
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Localized dermatologic pain that persists for more than one month after zoster eruption

50. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Medullary
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
RER; copper
Headaches and facial flushing; vasodilation in meninges and skin