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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 does Rb protein do? what chrom is it on?
Ketone body production by preventing fatty acids into the mitochondria
Drink plenty of fluids
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

2. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Extrinsic def; instrinsic def; platelet def
Serum FFA and serum triglyceride levels
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Intussusception

3. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Ig A deficiency
Integration of viral DNA into genome of host hepatocytes
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
AV node slowest - to allow time for diastole

4. which trisomy is associated with endocardial cushion defects? What does thsi mean>
High potassium conductance and some sodium conductance
Abnormal closing of the urethral folds
Downs; regurgitant AV valves - ASDs
Mean greater than median greater than mode

5. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Both sides
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Brief psychotic disorder; schizophreniform; schizophrenia

6. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
APP on chrom 21 (this is why downs more susceptible)
Strength of cell mediated immune response
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Increase lymphatic drainage!

7. What can worse neurologic dysfunction in cobalamic def?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Folic acid treatment!
GI tract; mood!

8. which two virus families have hemagluttinin on their surface?
Around 70 (normal measured diastolic pressures); 9--
Paramyxo and influenza
S. aureus
Classical conditioning

9. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Because of vasodiation to skeletal muscles
Spongiosis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Decreases both

10. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

11. who bleed more DIC or TTP- HUS patients?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Primary
46 - 4N; 23 2N
DIC; TTP- HUS dont bleed that much

12. Where does 90% of serotonin lie? What is this NT responsible?
Adeno
Close but purkinje system to ensure contraction in a bottom up fashion
GI tract; mood!
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

13. What are two indicators of chronic alcohol consumption?
gram positive organisms
Elevated GGT and macrocytosis
chronic urticaria and allergic symptoms
Purkinje system; AV node

14. What is the cause of fixed splitting of S2? why?
glycerol kinase
...
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Brief psychotic disorder; schizophreniform; schizophrenia

15. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
gram positive organisms
RER; RER
Common peroneal; bony fractures and compression; sciatic
SSRI; erectile dysfunction

16. what dictates the resting membrane potential of most cells?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
High potassium conductance and some sodium conductance
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Hyperkalemia; potassium sparing diuretics - potassium supplements

17. what drug is useful for secretory diarrhea?
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
Octreotide
11 aa polypeptide; pain NT in CNS and PNS
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

18. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Thymic tumor
APP on chrom 21 (this is why downs more susceptible)
Bile salt accumulation in urine
Hyperkalemia; potassium sparing diuretics - potassium supplements

19. What does VIP do to gastric acid secretion?
Inhibits it
S. saprophyticus - and s. epidermidis; novobiocin
Excessive collagen formation during tissue repair in susceptible individuals
only up to bronchi

20. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
S3 gallop; S2 to opening snap interval
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Drug induced interstitial nephritis

21. how does noise induced hearing loss occur?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Sickle cell; G6PD
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Trauma to stereociliated hair cells of the organ of corti

22. What is the mutation type in thalassemias? what process is defective because of this?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
P53 mutation; DCC is also required for adenoma to carcinoma
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Nonsense; mRNA processing

23. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
OCPs - multiparity - breast feeding
P53 mutation; AD
INTRApartum Abs (ampicillin/penicillin)

24. What are the two mcc of focal brain lesions in HIV positive patients?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Trochlear nerve (IV); abducens nerve (VI)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

25. what chromosome is c - myc found on?
Purkinje system; AV node
In the extracellular space
Chrom 8
Reiter syndrome; B27

26. What is an abortive viral infection?
Little effect on cell and no change
Decreases both
Increases cytokine production
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

27. What is extraocular muscle weakness a common symptom of?
Rabies encephalitis from cave bats; rabies killed vaccines
Myasthenia gravis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Vagus (auricular branch); vasovagal syncope!

28. what nerve and artery course along the posterior aspect of the humerus?
INTRApartum Abs (ampicillin/penicillin)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Radial nerve and deep brachial artery
Measles and M3 AML`

29. What is diagnostic (and possible therapeutic for intussusception)?
Barium enema
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Hexokinase
Prevent phagocytosis

30. What type of bond is a disulfide bond?
Neisseria induced small cell vasculitis (including hands and soles)
hyponatremia (aldosterone activation equilibrates body volume)
Covalent (between two cysteines)- allows protein to withstand denaturation
Barium enema

31. What pulmonary structural change can kartageners syndrome cause?
Tzanck smear
Large stroke volumes with ventricular contraction; aortic regurg
Bronchial dilation (bronchiectasis)
Multiple miscarriages d/t hypercoaguability

32. What does p53 do? what chrom is it on?
Sickle cell; G6PD
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Recurrent larygneal
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

33. which has better side effect profile - SSRI or TCA?
indomethacin
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
SSRI
GI tract; mood!

34. What is a primary HSV 1 infection like?
ZDV or AZT
Atrial
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

35. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
GI tract; mood!
Hypothyroidism
INTRApartum Abs (ampicillin/penicillin)
Elevated GGT and macrocytosis

36. What is the difference between paranoid personality disorder and delusional disorder?
Relfex tachycardia; giving beta blockers
Inactivates kallikrein which activates kininogen into bradykinin
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Sudden loss of muscle tone without loss of consciousness; narcolepsy

37. What are diastolic (lowest) pressures in aorta? LV?
Appetite suppressants
Trauma to stereociliated hair cells of the organ of corti
Around 70 (normal measured diastolic pressures); 9--
RBF= PAH clearance/(1- hematocrit)

38. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SS +rNA
Diabetic microangiopathy
Retinitis; mononucleosis

39. IL4 is used for isotypye switching to what?
Radial nerve damage
IgE
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
INTRApartum Abs (ampicillin/penicillin)

40. When does opening snap begin?
S. saprophyticus - and s. epidermidis; novobiocin
No; MRI
Right before diastole (filling begins)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

41. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Both sides
Hexokinase
Serum creatine kinase; reperfusion injury causes necrosis
Prostate tumor and increased osteoclast activity

42. 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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43. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Because of vasodiation to skeletal muscles
Circular - outside nucleus; transport proteins - rRNA - tRNA
Pan colitis and right sided colitis (more than left sided and proctitis)

44. Which is faster purkinje system or atrial muscle?
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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
When it invades the bm; carcinoma in situ
Close but purkinje system to ensure contraction in a bottom up fashion

45. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Relfex tachycardia; giving beta blockers
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Large stroke volumes with ventricular contraction; aortic regurg

46. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Appetite suppressants
transcription activation/suppression
Reticulocytes
Vagus (auricular branch); vasovagal syncope!

47. which viruses require a protease?
SS +rNA
Increases
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
MAO inhibitors; wine and cheese

48. what locations of UC increase the risk of Colon cancer?
Intussusception
8; 12
S. aureus
Pan colitis and right sided colitis (more than left sided and proctitis)

49. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Sickle cell; G6PD
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Multiple miscarriages d/t hypercoaguability

50. What is hypospadias caused by?
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
In ER of bile canaliculi
INTRApartum Abs (ampicillin/penicillin)
Abnormal closing of the urethral folds