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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 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)
Because of the low output from heart failure - they will have increased aldosterone levels
Medullary
P53 mutation; DCC is also required for adenoma to carcinoma

2. what immune deficiency causes recurrent neisseria infections?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Octreotide
Apocrine; eccrine
MAC complex (C5b - C9 complement deficiency)

3. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Sydenham chorea
Hereditary angioedema; ACE inhibitors
Closer to head; closer to diaphragm
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

4. which cells produce surfactant? which ones mediate gas exchange?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Single adenomatous ones
II; I (I more abundant)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

5. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Raphe
S3 gallop; S2 to opening snap interval
Drink plenty of fluids
Syringomelia

6. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

7. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Serum FFA and serum triglyceride levels
LT (LTD4 - E4 - C4) - and Ach
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Amiloride - spironolactone - triamterene

8. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Raphe
Phencyclidine (PCP)
Syringomelia

9. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Radial nerve and deep brachial artery
Measure of depth invasion (vertical!)
200-500

10. What is epleronone?
HSV and VZV
Primary
Another type of aldosterone antagonist (like spironolactone)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

11. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Susceptible; soluble (unable to be cultured in bile)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
11 aa polypeptide; pain NT in CNS and PNS

12. what chromosome is c - myc found on?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Chrom 8
(urine PAH x urine flow rate)/plasma PAH
4 - 4 - 9

13. What is the preferred treatment for DKA?
Strength of cell mediated immune response
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Regular insulin (Not fast acting - regular better)

14. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
differentiate
Minimal change disease
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

15. at four years of age - What are the social - fine motor - gross motor - and language developments?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Vancomycin; histamine mediated
Medullary
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

16. Which is slower AV node or ventricular muscle?
AV node slowest - to allow time for diastole
High potassium conductance and some sodium conductance
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Rabies encephalitis from cave bats; rabies killed vaccines

17. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Leukotriene precursor and does neutrophil chemotaxis

18. What does extended consumption of appetite suppressants lead to?
Trochlear nerve (IV); abducens nerve (VI)
Pulmonary hypertension
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
Elastance

19. which two virus families have hemagluttinin on their surface?
The time interval between S2 and OS- the shorter the interval - the more intense
FGF and VEGF
NF- KB; responsible for cytokine production
Paramyxo and influenza

20. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
<1% - 55% - concentration dependent
Bronchogenic carcinoma

21. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
frameshift mutations (missense is substitution)
Sarcoid
RBC mass; epo levels (secondary has high)
Increases cytokine production

22. What type of bond is a disulfide bond?
frameshift mutations (missense is substitution)
Measles and M3 AML`
Covalent (between two cysteines)- allows protein to withstand denaturation
Another type of aldosterone antagonist (like spironolactone)

23. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Because of the low output from heart failure - they will have increased aldosterone levels
Atrial
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

24. What are the potassium sparing diuretics?
S. saprophyticus - and s. epidermidis; novobiocin
Both sides
Coagulation factors are made in the liver
Amiloride - spironolactone - triamterene

25. What is the triad seen in pre eclampsia?
DIC; TTP- HUS dont bleed that much
Hypertension - edema - and proteinuria
Mean greater than median greater than mode
SVC and IVC; right below the aortic knob

26. What is hypospadias caused by?
Covalent (between two cysteines)- allows protein to withstand denaturation
Abnormal closing of the urethral folds
Serum creatine kinase; reperfusion injury causes necrosis
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)

27. how much percent of sodium is excreted? urea? glucose?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Bronchogenic carcinoma
<1% - 55% - concentration dependent

28. What is an abortive viral infection?
Coagulation factors are made in the liver
Paramyxo and influenza
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
Little effect on cell and no change

29. why is crohns disease associated with oxaloacetate kidney stones?
I is more benign and can present later in adulthood
No; yes
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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

30. ___________ is liver specific
As a CO2 carrier with the carboxylase enzyme
Serum creatine kinase; reperfusion injury causes necrosis
Echinococcus granulosus; anaphylaxis
glycerol kinase

31. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
frameshift mutations (missense is substitution)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Medullary

32. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
CMV - HSV 1 - Candida
Curlings ulcers
Syringomelia

33. What is a cord factor and Which bugs have it? How do they appear on culture?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Trauma to stereociliated hair cells of the organ of corti
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

34. What is the mcc of extrinsic allergic asthma?
NF- KB; responsible for cytokine production
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Protamine sulfate
Inhaled animal dander allergens

35. What are the first generation anti histamines?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Chlorpheniramine and diphenhydramine
Folic acid treatment!
Prevent phagocytosis

36. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Sydenham chorea
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Drink plenty of fluids
E. coli

37. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Chlorpheniramine and diphenhydramine
Downs; regurgitant AV valves - ASDs
Sudden loss of muscle tone without loss of consciousness; narcolepsy

38. What is the presentation of sever aortic stenosis?
Retinitis; mononucleosis
...
Syncope - angina - dyspnea (SAD)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

39. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Inhibits it
P53 mutation; AD
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
Both sides

40. How do left sided colon adenocarcinomas present? right sided?
As a CO2 carrier with the carboxylase enzyme
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
Right before diastole (filling begins)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

41. what hormone is structurally similar to hCG?
Drink plenty of fluids
SaO2 <92%
Decreases both
TSh (in testicular tumors can cause hyperthyroidism)

42. sporadic colon cancer tend to arise From what type of polyps?
Serum creatine kinase; reperfusion injury causes necrosis
Neisseria induced small cell vasculitis (including hands and soles)
Single adenomatous ones
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

43. Which is faster purkinje system or atrial muscle?
Selective alpha 1 (increases SVR)
Susceptible; soluble (unable to be cultured in bile)
Close but purkinje system to ensure contraction in a bottom up fashion
hyponatremia (aldosterone activation equilibrates body volume)

44. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Kallmans
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Become beta pleated and then form neurofibrillary tangle!

45. why does neutrophila occur with corticosteroids?
Ether and other organic solvents
Demargination of neutrophils from the vessel walls
FGF and VEGF
Ketone body production by preventing fatty acids into the mitochondria

46. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Pulmonary hypertension
Raphe

47. what happens with LDL receptor density in statin therapy?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Classical conditioning
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Increases

48. what phase do adenosine and acetylcholine act on? doing what?
SS +rNA
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
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
Hypothyroidism

49. what protects the resting heart from arrhythmias?
Elastance
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Highly negative resting potential
Vertical diplopia

50. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Gluteus maximus; difficulty getting up from seated position and climbing chair
SVC and IVC; right below the aortic knob
Folic acid treatment!