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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 are the three predominant symptoms of VHL? What is its mode of inheritance?
...
By vascular permeability and vasodilation
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Acute interstitial nephritis

2. 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
Bronchial dilation (bronchiectasis)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

3. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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
Octreotide

4. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Common peroneal; bony fractures and compression; sciatic
CGD; t cell dysfxn (diGeorge)
Nocardia

5. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Diabetic microangiopathy
Because of vasodiation to skeletal muscles
Single adenomatous ones

6. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Fibronectin - laminin - collagen
...
4 - 4 - 9

7. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
TSh (in testicular tumors can cause hyperthyroidism)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Increase by 50% in urine osmolality

8. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Vertical diplopia
Hyperkalemia; potassium sparing diuretics - potassium supplements

9. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
IgE
Standing suddenly from supine position; valsalva maneuver
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

10. which staphylococci can do mannitol fermaentation?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
S. aureus
No (unlike adenomyosis); yes
Nocardia

11. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
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)
Elastance
Regular insulin (Not fast acting - regular better)
P53 mutation; DCC is also required for adenoma to carcinoma

12. what happens with LDL receptor density in statin therapy?
Ether and other organic solvents
Sydenham chorea
Increases
DIC; TTP- HUS dont bleed that much

13. What is hypospadias caused by?
Abnormal closing of the urethral folds
No and yes
Turners`
Apocrine; eccrine

14. in essential fructosuria - what enzyme do patients use to metabolize fructose?
INTRApartum Abs (ampicillin/penicillin)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
facultative intracellular
Hexokinase

15. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
HSV ( also in utero: chlymadia - neisseria - group B strep)
Strength of cell mediated immune response
Anterior circumflex (and axillary nerve)

16. What are pancreatic pseudocysts called pseudo rather than true cysts?
Turbulence
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Not lined by epithelium
Neisseria induced small cell vasculitis (including hands and soles)

17. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Pain reliever - reduces pain by locking substance P in the PNS
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

18. What antibiotic is best to treat alcoholic pulm infections? why?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Hereditary angioedema; ACE inhibitors
Single adenomatous ones
Clindamycin; covers anaerobic oral flora and aerobic bacteria

19. at three years of age What are social - fine motor - gross motor and language developments?
Nocardia
RBF= PAH clearance/(1- hematocrit)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
RER; copper

20. 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
Demargination of neutrophils from the vessel walls
Intussusception
Pulmonary hypertension

21. What is capacitance inversely proportional to?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Elastance
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Acute interstitial nephritis

22. What is Bortezomib and What is it used for?
11 aa polypeptide; pain NT in CNS and PNS
Bile salt accumulation in urine
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Proteasome inhibitor; treatment for MM and waldenstroms

23. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Regular insulin (Not fast acting - regular better)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Increases bronchial and vascular smooth muscle reactivity to catecholamines

24. a patient fearing all white coats is a phenomenon of what?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Classical conditioning
Raphe
INTRApartum Abs (ampicillin/penicillin)

25. What is a keloid?
Increase lymphatic drainage!
Myasthenia gravis
Intussusception
Excessive collagen formation during tissue repair in susceptible individuals

26. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Nocardia
facultative intracellular

27. What are the potassium sparing diuretics?
SVC and IVC; right below the aortic knob
Strength of cell mediated immune response
Amiloride - spironolactone - triamterene
RBC mass; epo levels (secondary has high)

28. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Fibronectin - laminin - collagen
Vertical diplopia
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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

29. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Elastance
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Hypo or hyper pigmentations; after tanning
II; I (I more abundant)

30. after a thrombus extraction - what serum enzyme shoots up and why?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Serum creatine kinase; reperfusion injury causes necrosis
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
Hexokinase

31. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Ceftriaxone; azithromycin
Insulin like growth factor 1 (just another name)

32. what indicates the severity of a mitral regurg ? mitral stenosis?
Bile soluble which means they are bile sensitive
RBC mass; epo levels (secondary has high)
S3 gallop; S2 to opening snap interval
Integration of viral DNA into genome of host hepatocytes

33. at four years of age - What are the social - fine motor - gross motor - and language developments?
Env genes (for getting into target cells)
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
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
V fib; v. failure

34. What does C1 esterase do other than inhibiting complement pathway?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Inactivates kallikrein which activates kininogen into bradykinin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Adeno

35. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

36. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
SSRI; erectile dysfunction
only up to bronchi
Bronchogenic carcinoma

37. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Prostate tumor and increased osteoclast activity
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
25; 25

38. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
The term used to describe decreased drug responsiveness with repeated administration
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
MAO inhibitors; wine and cheese

39. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
V fib; v. failure
The term used to describe decreased drug responsiveness with repeated administration
Medial part

40. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
8; 12
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

41. What is suggestive of complete central DI?
AV node slowest - to allow time for diastole
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
frameshift mutations (missense is substitution)
Increase by 50% in urine osmolality

42. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Bile soluble which means they are bile sensitive
Diabetic microangiopathy
indomethacin

43. what makes bruits?
Squatting - sitting - lying supine - passive leg raising
Amiloride - spironolactone - triamterene
Syncope - angina - dyspnea (SAD)
Turbulence

44. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Covalent (between two cysteines)- allows protein to withstand denaturation
Adeno
Kallmans

45. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Fibronectin - laminin - collagen
Dihydropyridine sensitive Ca channels (L type)
hyponatremia (aldosterone activation equilibrates body volume)
Class I

46. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Skin flushing and warmth; prostaglandins; give with aspirin
SVC and IVC; right below the aortic knob
TCAs and prazosin
I is more benign and can present later in adulthood

47. metabolism of 1 gram of protein produces How many calories? carb? fat?
Squatting - sitting - lying supine - passive leg raising
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
4 - 4 - 9
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

48. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Chorda tympani branch
8; 12

49. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
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)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Anti centromere; anti DNA topoisomerase

50. what virus causes pharyngoconjuctival fever?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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
INTRApartum Abs (ampicillin/penicillin)
Adeno