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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can study here.
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 is the precursor protein to beta amyloid and On what chromosome is it found?
Well
Turners`
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
APP on chrom 21 (this is why downs more susceptible)

2. What are the skin presentation in sarcoid?
Adeno
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)
Varying; erythema nodosum is common
Well

3. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Myasthenia gravis
FGF and VEGF

4. What is a cell surface marker seen in liver angiosarcoma?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Because of vasodiation to skeletal muscles
Large stroke volumes with ventricular contraction; aortic regurg

5. What pulmonary structural change can kartageners syndrome cause?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Bronchial dilation (bronchiectasis)
No and yes
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

6. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
PDA open
T test; chi squared
Dissolved in plasma and attached to Hgb

7. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Radial nerve and deep brachial artery
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

8. What is the most common neurologic complication of VZV reactivation?
Localized dermatologic pain that persists for more than one month after zoster eruption
glycerol kinase
Increases cytokine production
Classical conditioning

9. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
T test; chi squared
Boiling - bleach - formalin - UV irradiation
OCPs - multiparity - breast feeding
Env genes (for getting into target cells)

10. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Retinitis; mononucleosis
differentiate

11. what should you think of in 'smear of an oral ulcer base'?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Tzanck smear
46 - 4N; 23 2N
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

12. What is mcc of death pre hospital phase of MI? in hospital phase?
Coagulation factors are made in the liver
V fib; v. failure
Downs; regurgitant AV valves - ASDs
Dissolved in plasma and attached to Hgb

13. What do you treat s. epidermidis with?
Vancomycin
Headaches and facial flushing; vasodilation in meninges and skin
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Large stroke volumes with ventricular contraction; aortic regurg

14. What antibodies are present in CREST? What is the most specific?
HSV and VZV
ATP binding (resets the myosin head to contract again for next binding)
Anti centromere; anti DNA topoisomerase
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

15. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Increases
MAO inhibitors; wine and cheese
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
RR-1/RR

16. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

17. ___________ is liver specific
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Bronchogenic carcinoma
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
glycerol kinase

18. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
TSh (in testicular tumors can cause hyperthyroidism)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Well

19. what vessel would a fracture to the neck of the of the humerus damage?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Anterior circumflex (and axillary nerve)
Proteasome inhibitor; treatment for MM and waldenstroms

20. what hernia has a similar mechanism to hydrocele?
No and yes
hyponatremia (aldosterone activation equilibrates body volume)
ZDV or AZT
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

21. What is normal fibrinogen levels?
200-500
Fibrosis; macrophages
G to T in p53; HCC
Standing suddenly from supine position; valsalva maneuver

22. what protects the resting heart from arrhythmias?
Highly negative resting potential
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Bile soluble which means they are bile sensitive
Covalent (between two cysteines)- allows protein to withstand denaturation

23. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Ether and other organic solvents
C3 decreased after 5-10 days; sulfonamides
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

24. biotin is used By what in tissues responsible for gluconeogenesis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
As a CO2 carrier with the carboxylase enzyme
In ER of bile canaliculi
II; I (I more abundant)

25. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Curlings ulcers
Class I
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

26. other than mycobacterim wha other bacteria is acid fast?
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)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Env genes (for getting into target cells)
Nocardia

27. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
ZDV or AZT
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
4 - 4 - 9
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

28. What is used to compare means? categorical outcomes?
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
T test; chi squared
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
ZDV or AZT

29. What does Rb protein do? what chrom is it on?
SS +rNA
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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
Medial part

30. What is congestive hepatomegaly specific for?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Right heart failure
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

31. What type of endocarditis is cytoscopy induced?
Because of the low output from heart failure - they will have increased aldosterone levels
46 - 4N; 23 2N
Bronchial dilation (bronchiectasis)
Enterococci (e. faecalis)- found on genitalia area

32. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
liver specific
Echinococcus granulosus; anaphylaxis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Neisseria induced small cell vasculitis (including hands and soles)

33. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
women
46 - 4N; 23 2N
IgE
HSV ( also in utero: chlymadia - neisseria - group B strep)

34. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Tibial
Primary
Little effect on cell and no change
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

35. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Ether and other organic solvents

36. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Proteasome inhibitor; treatment for MM and waldenstroms
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

37. What is used to prevent vertical transmission of HIV?
ZDV or AZT
...
Normally close to systolic
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

38. why are beta thal major patients asymptomatic at birth?
Dissolved in plasma and attached to Hgb
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Because gamma chains replace beta chains and then gamma chain formation wanes

39. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Prostate tumor and increased osteoclast activity
INTRApartum Abs (ampicillin/penicillin)
RER; RER
Amiadarone

40. what bursa is affected when on knees like a maid/gardner?
facultative intracellular
RBF= PAH clearance/(1- hematocrit)
Prepatellar
4 - 4 - 9

41. do patients with cor pulmonale have increased or decreased levels of aldosterone?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Because of the low output from heart failure - they will have increased aldosterone levels
S3 gallop; S2 to opening snap interval

42. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Normally close to systolic
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
As a CO2 carrier with the carboxylase enzyme

43. how does increased ICP result in curlings ulcers?
Bronchogenic carcinoma
Elevated GGT and macrocytosis
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vagus nerve stimulation

44. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Apocrine; eccrine
SVC and IVC; right below the aortic knob
Not lined by epithelium
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

45. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Chorda tympani branch

46. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
differentiate
Vagus (auricular branch); vasovagal syncope!
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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

47. What is gardeners mydriasis? How is it treated?
25; 25
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
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

48. after a thrombus extraction - what serum enzyme shoots up and why?
Leukotriene precursor and does neutrophil chemotaxis
Serum creatine kinase; reperfusion injury causes necrosis
Diabetic microangiopathy
Underestimation of gestational age

49. How do you treat gonococcal infection? chlymadia?
Increased reticulocytes
Vancomycin
Ceftriaxone; azithromycin
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

50. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
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
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
P53 mutation; DCC is also required for adenoma to carcinoma