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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. carnitine deficiency impairs production of What and how?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Biphosphonate
Increase by 50% in urine osmolality
Ketone body production by preventing fatty acids into the mitochondria

2. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Atrial
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Prevents hepatic VLDL production
G to T in p53; HCC
Minimal change disease
TCAs and prazosin

4. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Terminal bronchioles; small bronchi
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Hypo or hyper pigmentations; after tanning
II; I (I more abundant)

5. What is congestive hepatomegaly specific for?
Right heart failure
Ketone body production by preventing fatty acids into the mitochondria
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

6. how does neisseria cause a petechial rash?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Neisseria induced small cell vasculitis (including hands and soles)
Diabetic microangiopathy

7. other than mycobacterim wha other bacteria is acid fast?
Extrinsic def; instrinsic def; platelet def
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Nocardia

8. What is medullary sponge kidney disease and how does it present? What does it lead to?
In ER of bile canaliculi
Skin flushing and warmth; prostaglandins; give with aspirin
Myasthenia gravis
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)

9. What are the two mcc of focal brain lesions in HIV positive patients?
Anti cholinergic effects of pupil dilation and lack of accomodation
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

10. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Hydrogen bonds dictate alpha or beta structure
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
HSV ( also in utero: chlymadia - neisseria - group B strep)

11. what vessel would a fracture to the neck of the of the humerus damage?
II; I (I more abundant)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Anterior circumflex (and axillary nerve)
only up to bronchi

12. What are the two coagulase negative staphylococci? How do you distinguish them?
The term used to describe decreased drug responsiveness with repeated administration
S. saprophyticus - and s. epidermidis; novobiocin
Fat - fertile - forty - female
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

13. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
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
Decreases both
No and yes

14. What are the two growth factors associated with angiogenesis?
Smoking
FGF and VEGF
PDA open
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

15. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Thymic tumor
Medullary
Hexokinase
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

16. Which nerve lies in close proximity to the inferior thyroid artery?
Normal; low
Elastance
Recurrent larygneal
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

17. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
No; MRI
Cluster
Because of vasodiation to skeletal muscles

18. What does p53 do? what chrom is it on?
P450 mitochondrial monooxygenase
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Acute interstitial nephritis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

19. what murmur is enhanced by decreased blood flow to the heart?
Medullary
<1% - 55% - concentration dependent
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

20. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
11 aa polypeptide; pain NT in CNS and PNS
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)
Protamine sulfate
Initiation - pointing; pincer grasp; walking; mama/dada

21. What is the mc location for avascular necrosis? What is it associated with?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Neisseria induced small cell vasculitis (including hands and soles)
Ether and other organic solvents
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

22. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
G to T in p53; HCC
No; MRI
SVC and IVC; right below the aortic knob
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

23. What does Rb protein do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Drug induced interstitial nephritis
Sydenham chorea

24. what virus causes pharyngoconjuctival fever?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Adeno
Joints d/t increased purine production and thus uric acid production
Little effect on cell and no change

25. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Bronchogenic carcinoma
ATP binding (resets the myosin head to contract again for next binding)
Single adenomatous ones
differentiate

26. where exactly is ACE expressed in the lungs? What type of enzyme is it?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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
P53 mutation; DCC is also required for adenoma to carcinoma
Vascular endothelium; protease

27. what happens to capacitance with age?
Chrom 8
HSV ( also in utero: chlymadia - neisseria - group B strep)
NF- KB; responsible for cytokine production
...

28. what dissolves the lipid bilayer of a viral envelope?
Increase by 50% in urine osmolality
Ether and other organic solvents
Intussusception
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

29. how does eos release MBP to kill protozoa etc?
facultative intracellular
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Radial nerve damage

30. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
In the extracellular space
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
<1% - 55% - concentration dependent
Sarcoid

31. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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)

32. What is Bortezomib and What is it used for?
200-500
Measles and M3 AML`
Regular insulin (Not fast acting - regular better)
Proteasome inhibitor; treatment for MM and waldenstroms

33. in overweight individuals What is thought to contribute to insulin resistance?
T test; chi squared
11
E. coli; staphylococcus saprophyticus
Serum FFA and serum triglyceride levels

34. When is acid phosphatase elevated (Name two times)?
Inhibits it
Prostate tumor and increased osteoclast activity
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
Tzanck smear

35. What is the most common initital symptom of ADPKD? what else?
SVT; increases vagal tone; rectus abdominis
Tzanck smear
P53 mutation; AD
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

36. which staphylococci can do mannitol fermaentation?
On cardiac tissue and renal juxtaglomerular cells
S. aureus
Prevents hepatic VLDL production
MAC complex (C5b - C9 complement deficiency)

37. a patient fearing all white coats is a phenomenon of what?
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
Localized dermatologic pain that persists for more than one month after zoster eruption
Classical conditioning
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

38. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
APP on chrom 21 (this is why downs more susceptible)

39. which virus inactivates both Rb and p53?
Because gamma chains replace beta chains and then gamma chain formation wanes
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Pulmonary hypertension
Think Hb deformation diseases

40. Where does complement bind on the Fc region of Ig chains?
Superior larygeal; cricothyroid; recurrent laryngeal
Varying; erythema nodosum is common
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Regular insulin (Not fast acting - regular better)

41. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Think Hb deformation diseases
RER; RER
Large stroke volumes with ventricular contraction; aortic regurg

42. non ceruloplasmin deposition - ceruloplasmin is...
Radial nerve damage
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
low in serum
Ig A deficiency

43. What is the Na/Ca exchange used for?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
To pump calcium out in cardiac myocytes so that relaxation occurs
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

44. What type of drug is alendronate?
Biphosphonate
Selective alpha 1 (increases SVR)
Increase by 50% in urine osmolality
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

45. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
On cardiac tissue and renal juxtaglomerular cells
MAO inhibitors; wine and cheese
SS +rNA
Radial nerve and deep brachial artery

46. neisseria are...
HSV and VZV
facultative intracellular
Selective alpha 1 (increases SVR)
Myasthenia gravis

47. other than increasing HDL levels - what else does niacin do?
Ig A deficiency
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Downs; regurgitant AV valves - ASDs
Prevents hepatic VLDL production

48. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
gram positive organisms
Selective alpha 1 (increases SVR)
MAC complex (C5b - C9 complement deficiency)

49. What is hyaline arteriosclerosis usually a sign of ?
...
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)
women
Diabetic microangiopathy

50. why does neutrophila occur with corticosteroids?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
facultative intracellular
Standing suddenly from supine position; valsalva maneuver
Demargination of neutrophils from the vessel walls