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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 is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
glycerol kinase
II; I (I more abundant)

2. 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?)?
Terminal bronchioles; small bronchi
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

3. what induces bronchial squamous metaplasia?
Smoking
Echinococcus granulosus; anaphylaxis
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Tibial

4. within the right ventricle - What are maximum pressures? the pulm arter?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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
25; 25

5. What are the two growth factors associated with angiogenesis?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Nocardia
FGF and VEGF
Curlings ulcers

6. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Appetite suppressants
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Because gamma chains replace beta chains and then gamma chain formation wanes

7. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Purkinje system; AV node
Amiloride - spironolactone - triamterene
Little effect on cell and no change

8. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Normal; low
TSh (in testicular tumors can cause hyperthyroidism)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

9. What is a common complication of acute pancreatitis? What is it?
Increase by 50% in urine osmolality
LT (LTD4 - E4 - C4) - and Ach
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Apocrine; eccrine

10. What type of bond is a disulfide bond?
Increases
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Covalent (between two cysteines)- allows protein to withstand denaturation
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

11. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Hexokinase
gram positive organisms
Increases bronchial and vascular smooth muscle reactivity to catecholamines

12. how long is substance P? What does it do?
Aromatase deficiency in child
11 aa polypeptide; pain NT in CNS and PNS
Intussusception
E6 and E7 of HPV knock off p53 and Rb suppressor genes

13. what hernia has a similar mechanism to hydrocele?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Southern - western
Multiple miscarriages d/t hypercoaguability
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

14. what has the greatest effect on prognosis when treating c. diptheriae?
Vertical diplopia
8 (myc protein) with 2 - 14 - 22 (iG chains)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

15. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
MAO inhibitors; wine and cheese
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
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)

16. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
hyponatremia (aldosterone activation equilibrates body volume)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Minimal change disease
Closer to head; closer to diaphragm

17. where are Beta 1 receptors found?
On cardiac tissue and renal juxtaglomerular cells
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Hypothyroidism
No (unlike adenomyosis); yes

18. What does TGF beta do? What produces it?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Fibrosis; macrophages
Another type of aldosterone antagonist (like spironolactone)
Vertical diplopia

19. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Standing suddenly from supine position; valsalva maneuver
Thymic tumor
Syncope - angina - dyspnea (SAD)

20. What is medullary sponge kidney disease and how does it present? What does it lead to?
women
Vertical diplopia
Phencyclidine (PCP)
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)

21. What is achalasia and how would this correlate on the esophageal mannometry?
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
Syringomelia
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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

22. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

23. how does neisseria cause a petechial rash?
V fib; v. failure
As a CO2 carrier with the carboxylase enzyme
Neisseria induced small cell vasculitis (including hands and soles)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

24. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
DIC; TTP- HUS dont bleed that much
Congenital hypothyroidism - downs - amyloidosis - acromegaly
GI malignancies and Insulin resistance (acromegal for ex)
Medial circumflex artery; avascular necrosis

25. what phase do adenosine and acetylcholine act on? doing what?
Think Hb deformation diseases
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Radial nerve and deep brachial artery
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

26. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
200-500
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
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
<1% - 55% - concentration dependent

27. name three pathological states that present with large tongues.
Duration and extent of disease
Congenital hypothyroidism - downs - amyloidosis - acromegaly
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

28. What are the three dopaminergic systems and What are they responsible for? disease?
Fibronectin - laminin - collagen
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
25; 25
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

29. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
No
Increased reticulocytes

30. Where does 90% of serotonin lie? What is this NT responsible?
Kallmans
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
GI tract; mood!

31. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
P53 mutation; DCC is also required for adenoma to carcinoma
SSRI; erectile dysfunction
LT (LTD4 - E4 - C4) - and Ach
Enterococci (e. faecalis)- found on genitalia area

32. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

33. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Folic acid treatment!
Southern - western
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

34. what makes bruits?
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
Turbulence
Atrial
frameshift mutations (missense is substitution)

35. which viruses require a protease?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Chrom 8
SS +rNA

36. What does C1 esterase do other than inhibiting complement pathway?
Cluster
Squatting - sitting - lying supine - passive leg raising
Acute gastric mucosal defects (superficial or full thickness)
Inactivates kallikrein which activates kininogen into bradykinin

37. What can too much IgA in serum produces?
Amiloride - spironolactone - triamterene
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Phencyclidine (PCP)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

38. what drug is useful for secretory diarrhea?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Adductor
Octreotide
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

39. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
glycerol kinase
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Vagus (auricular branch); vasovagal syncope!
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

40. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Anti cholinergic effects of pupil dilation and lack of accomodation
Nonsense; mRNA processing
Downs; regurgitant AV valves - ASDs
Normally close to systolic

41. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Prostate tumor and increased osteoclast activity
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
CMV - HSV 1 - Candida
Valproate

42. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Hereditary angioedema; ACE inhibitors
SVT; increases vagal tone; rectus abdominis
Insulin like growth factor 1 (just another name)
Hypertension - edema - and proteinuria

43. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Elevated GGT and macrocytosis
LT (LTD4 - E4 - C4) - and Ach
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
No (unlike adenomyosis); yes

44. why does neutrophila occur with corticosteroids?
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
Demargination of neutrophils from the vessel walls
Fibronectin - laminin - collagen
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

45. What is the mcc of extrinsic allergic asthma?
11
Right before diastole (filling begins)
Well trained athletes and children
Inhaled animal dander allergens

46. What is the fibrinogen level in patient with TTP- HUS? DIC?
Initiation - pointing; pincer grasp; walking; mama/dada
Normal; low
Turbulence
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

47. if there are keratin swirls does that mean well or poorly differentiated?
Because gamma chains replace beta chains and then gamma chain formation wanes
Well
T test; chi squared
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

48. within the right atrium - What is the maximum pressure? left atrium?
S. saprophyticus - and s. epidermidis; novobiocin
Increase by 50% in urine osmolality
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
8; 12

49. what would be a sign of absence of cardiogenic pulm edem?
Increase lymphatic drainage!
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Tibial

50. what diseases can vit A be used to treat?
Adeno
Sydenham chorea
Measles and M3 AML`
Lateral; RV; RA; LV