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USMLE Prep 2

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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. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
SSRI
Syncope - angina - dyspnea (SAD)

2. What is an abortive viral infection?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
E. coli; staphylococcus saprophyticus
Little effect on cell and no change
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

3. what kind of drug is sertraline? What is a common side effect?
Acute interstitial nephritis
Integration of viral DNA into genome of host hepatocytes
FGF and VEGF
SSRI; erectile dysfunction

4. What is a keloid?
...
Excessive collagen formation during tissue repair in susceptible individuals
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

5. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Anti centromere; anti DNA topoisomerase
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hereditary angioedema; ACE inhibitors
Extrinsic def; instrinsic def; platelet def

6. Where does terminal peptide cleavage of collagen fibrils take place?
Radial nerve and deep brachial artery
In the extracellular space
Vagus (auricular branch); vasovagal syncope!
Close but purkinje system to ensure contraction in a bottom up fashion

7. Metronidizaole does not cover...
Increased reticulocytes
Serum creatine kinase; reperfusion injury causes necrosis
Initiation - pointing; pincer grasp; walking; mama/dada
gram positive organisms

8. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Headaches and facial flushing; vasodilation in meninges and skin
Syringomelia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

9. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Smoking
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
No (unlike adenomyosis); yes
Tibial

10. When is an S4 sound normal?
Highly negative resting potential
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Serum FFA and serum triglyceride levels
Well trained athletes and children

11. SIADH patients have normal blood volume but...
transcription activation/suppression
Because of vasodiation to skeletal muscles
Increase by 50% in urine osmolality
hyponatremia (aldosterone activation equilibrates body volume)

12. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Terminal bronchioles; small bronchi
S. aureus
46 - 4N; 23 2N
Sickle cell; G6PD

13. What is the most important prognostic indicator in patients with malignant melanoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Decreases both
Increase by 50% in urine osmolality
Measure of depth invasion (vertical!)

14. at three years of age What are social - fine motor - gross motor and language developments?
ANCA because of lack of Ig and C3 deposits on IF
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
The time interval between S2 and OS- the shorter the interval - the more intense
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

15. What does protein M do in Group A strep<
Prevent phagocytosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

16. what happens to capacitance with age?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Localized dermatologic pain that persists for more than one month after zoster eruption
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
...

17. What is congestive hepatomegaly specific for?
Protamine sulfate
Right heart failure
Increases
NF- KB; responsible for cytokine production

18. the rate of blood flow of which two circulations must equal each other at all times?
V fib; v. failure
Pulmonic and systemic!
Closer to head; closer to diaphragm
In ER of bile canaliculi

19. What is a common complication of acute pancreatitis? What is it?
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
hyponatremia (aldosterone activation equilibrates body volume)
Normally close to systolic
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

20. What does C1 esterase do other than inhibiting complement pathway?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Inactivates kallikrein which activates kininogen into bradykinin

21. which viruses require a protease?
SS +rNA
only up to bronchi
Think Hb deformation diseases
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

22. What does NF- KB do?
No and yes
SaO2 <92%
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Increases cytokine production

23. what defines hypoxemia?
Ether and other organic solvents
Faulty positioning of the genital tubercle
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
SaO2 <92%

24. What is capsaicin? Where does it work?
Pan colitis and right sided colitis (more than left sided and proctitis)
Pain reliever - reduces pain by locking substance P in the PNS
11
Well

25. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Octreotide

26. at one year of age - What are the social - fine motor - gross motor and language developments?
Pain reliever - reduces pain by locking substance P in the PNS
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Initiation - pointing; pincer grasp; walking; mama/dada
The time interval between S2 and OS- the shorter the interval - the more intense

27. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Tzanck smear
Close but purkinje system to ensure contraction in a bottom up fashion
frameshift mutations (missense is substitution)

28. What is the mc malignancy in asbestosis?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
46 - 4N; 23 2N
C3 decreased after 5-10 days; sulfonamides
Bronchogenic carcinoma

29. What does Rb protein do? what chrom is it on?
Myasthenia gravis
Biphosphonate
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

30. what vessel would a fracture to the neck of the of the humerus damage?
Prepatellar
ATP binding (resets the myosin head to contract again for next binding)
Anterior circumflex (and axillary nerve)
Myasthenia gravis

31. What is used to compare means? categorical outcomes?
Hereditary angioedema; ACE inhibitors
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
T test; chi squared
Selective alpha 1 (increases SVR)

32. ___________ is liver specific
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
S3 gallop; S2 to opening snap interval
glycerol kinase
liver specific

33. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Minimal change disease
Thymic tumor
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

34. 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?
Appetite suppressants
SSRI; erectile dysfunction
Closer to head; closer to diaphragm
Cluster

35. when do ghon complexes form - primary or secondary TB?
Drink plenty of fluids
To pump calcium out in cardiac myocytes so that relaxation occurs
Primary
Anti - apoptotic (prevents going into apoptosis)- 18; 14

36. What is the most common neurologic complication of VZV reactivation?
Adductor
11
Localized dermatologic pain that persists for more than one month after zoster eruption
Headaches and facial flushing; vasodilation in meninges and skin

37. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Terminal bronchioles; small bronchi
Intussusception
OCPs - multiparity - breast feeding

38. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
OCPs - multiparity - breast feeding
Abnormal closing of the urethral folds

39. What are fenfluramine - phentermine?
Closer to head; closer to diaphragm
Appetite suppressants
Hypothyroidism
As a CO2 carrier with the carboxylase enzyme

40. how does increased ICP result in curlings ulcers?
SSRI
Terminal bronchioles; small bronchi
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vagus nerve stimulation

41. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Headaches and facial flushing; vasodilation in meninges and skin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Varying; erythema nodosum is common
Because of the low output from heart failure - they will have increased aldosterone levels

42. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Cluster
gram positive organisms
Radial nerve and deep brachial artery

43. 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?
ANCA because of lack of Ig and C3 deposits on IF
Superior larygeal; cricothyroid; recurrent laryngeal
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

44. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Ether and other organic solvents
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
INTRApartum Abs (ampicillin/penicillin)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

45. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
E. coli
Chrom 8
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

46. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Purkinje system; AV node
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Increases cytokine production

47. What type of endocarditis is cytoscopy induced?
Fibrosis; macrophages
Enterococci (e. faecalis)- found on genitalia area
Increase in permeability of two ions with equal and opposite equilibrium potentials
Elastance

48. What is best to prevent GBS infection in a baby?
Serum creatine kinase; reperfusion injury causes necrosis
INTRApartum Abs (ampicillin/penicillin)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

49. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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50. What can too much IgA in serum produces?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
indomethacin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

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USMLE Prep 2

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