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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 type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
II; I (I more abundant)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

2. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
transcription activation/suppression
Increase lymphatic drainage!
Another type of aldosterone antagonist (like spironolactone)

3. What is the presentation of angioedema? Where is most commonly affected?
Drink plenty of fluids
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Minimal change disease
Fat - fertile - forty - female

4. Where does lysyl oxidase act? What is the cofactor for that?
RER; RER
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
In the extracellular space for collagen cross linking; zinc
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

5. what has the greatest effect on prognosis when treating c. diptheriae?
Pain reliever - reduces pain by locking substance P in the PNS
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

6. which antiarrythmic is associated with blue gray discoloration ?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Amiadarone
GI malignancies and Insulin resistance (acromegal for ex)
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

7. what receptors do first generation anti histamines block?
Pulmonic and systemic!
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
CGD; t cell dysfxn (diGeorge)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

8. What is epispadias caused by?
Fat - fertile - forty - female
To pump calcium out in cardiac myocytes so that relaxation occurs
Faulty positioning of the genital tubercle
Phencyclidine (PCP)

9. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Hypothyroidism
Inactivates kallikrein which activates kininogen into bradykinin
Hexokinase

10. there are mucus secreting cells in the bronchioles...
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
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
only up to bronchi
Increases

11. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Enterococci (e. faecalis)- found on genitalia area
Ig A deficiency
Susceptible; soluble (unable to be cultured in bile)

12. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Standing suddenly from supine position; valsalva maneuver
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Ig A deficiency

13. what marker should be followed in a patient with cirrhosis?
Myasthenia gravis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Minimal change disease

14. What are the primary determinants of colon cancer risk in UC patients
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Duration and extent of disease

15. 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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16. What can long term leg cast wearing cause?
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
Serum creatine kinase; reperfusion injury causes necrosis
LT (LTD4 - E4 - C4) - and Ach
Pan colitis and right sided colitis (more than left sided and proctitis)

17. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Classical conditioning
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
200-500
Sarcoid

18. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Nonsense; mRNA processing
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Retinitis; mononucleosis

19. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
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
Highly negative resting potential
Regular insulin (Not fast acting - regular better)

20. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Serum creatine kinase; reperfusion injury causes necrosis

21. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Gluteus medius and minimus; positive trendelenberg
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Terminal bronchioles; small bronchi

22. 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?
Cluster
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
PDA open
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

23. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Thymic tumor
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Congenital hypothyroidism - downs - amyloidosis - acromegaly

24. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
By vascular permeability and vasodilation
Echinococcus granulosus; anaphylaxis
SS +rNA

25. What is somatomedin C?
Insulin like growth factor 1 (just another name)
OCPs - multiparity - breast feeding
Syncope - angina - dyspnea (SAD)
Hereditary angioedema; ACE inhibitors

26. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Little effect on cell and no change
APP on chrom 21 (this is why downs more susceptible)
Classical conditioning

27. What causes vertical diplopia? horizontal?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
SSRI; erectile dysfunction
Trochlear nerve (IV); abducens nerve (VI)
P450 mitochondrial monooxygenase

28. What type of calcium channels dictate the plateau in cardiac myocyte?
Both sides
SVC and IVC; right below the aortic knob
Dihydropyridine sensitive Ca channels (L type)
11

29. What does nitroprusside do to afterload? preload?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Elastance
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
Decreases both

30. What is the mc location of brain germinomas?What are the classic symptoms?
Chorda tympani branch
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Trauma to stereociliated hair cells of the organ of corti
low in serum

31. what phase do adenosine and acetylcholine act on? doing what?
Classical conditioning
200-500
Phencyclidine (PCP)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

32. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Nocardia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
No
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

33. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Both sides
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Classical conditioning

34. at three years of age What are social - fine motor - gross motor and language developments?
Fibrosis; macrophages
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Amiloride - spironolactone - triamterene
Strength of cell mediated immune response

35. What are two indicators of chronic alcohol consumption?
Fibrosis; macrophages
Elevated GGT and macrocytosis
Vancomycin
Syncope - angina - dyspnea (SAD)

36. What is the diagnosis in delayed puberty plus anosmia?
Nonsense; mRNA processing
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Anterior nares
Kallmans

37. What type of endocarditis is cytoscopy induced?
Anterior nares
Enterococci (e. faecalis)- found on genitalia area
G to T in p53; HCC
Not lined by epithelium

38. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Coagulation factors are made in the liver
Vascular endothelium; protease
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Think Hb deformation diseases

39. What is a cord factor and Which bugs have it? How do they appear on culture?
Think Hb deformation diseases
Tibial
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Env genes (for getting into target cells)

40. what makes bruits?
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
Medial circumflex artery; avascular necrosis
Turbulence
E6 and E7 of HPV knock off p53 and Rb suppressor genes

41. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Normally close to systolic
46 - 4N; 23 2N
Inactivates kallikrein which activates kininogen into bradykinin
Fibronectin - laminin - collagen

42. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
Prostate tumor and increased osteoclast activity
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

43. What is the fibrinogen level in patient with TTP- HUS? DIC?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Normal; low
Common peroneal; bony fractures and compression; sciatic
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

44. neisseria are...
Trauma to stereociliated hair cells of the organ of corti
Fibrosis; macrophages
facultative intracellular
No; MRI

45. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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)
The time interval between S2 and OS- the shorter the interval - the more intense

46. What is the most common cause of pyelonephritis in both adults and childre?
Elevated GGT and macrocytosis
When it invades the bm; carcinoma in situ
E. coli
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

47. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
PDA open
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RBC mass; epo levels (secondary has high)

48. What are the first generation anti histamines?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Chlorpheniramine and diphenhydramine
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)

49. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
differentiate
Brief psychotic disorder; schizophreniform; schizophrenia
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

50. What do you treat s. epidermidis with?
Vancomycin
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Intussusception
Vertical diplopia

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