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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. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
ATP binding (resets the myosin head to contract again for next binding)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

2. other than parvo B19 - what else is associated with red cell aplasia?
Closer to head; closer to diaphragm
Radial nerve and deep brachial artery
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Thymic tumor

3. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Susceptible; soluble (unable to be cultured in bile)
Measles and M3 AML`
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

4. What are the primary determinants of colon cancer risk in UC patients
Measles and M3 AML`
Duration and extent of disease
Elevated GGT and macrocytosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy

5. what would be a sign of absence of cardiogenic pulm edem?
46 - 4N; 23 2N
gram positive organisms
Hypertension - edema - and proteinuria
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

6. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
RBC mass; epo levels (secondary has high)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
SVT; increases vagal tone; rectus abdominis

7. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
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
46 - 4N; 23 2N
Anti centromere; anti DNA topoisomerase
Downs; regurgitant AV valves - ASDs

8. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
P53 mutation; DCC is also required for adenoma to carcinoma
Circular - outside nucleus; transport proteins - rRNA - tRNA
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

9. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Insulin like growth factor 1 (just another name)
P53 mutation; DCC is also required for adenoma to carcinoma
Increase by 50% in urine osmolality
Dihydropyridine sensitive Ca channels (L type)

10. in the LV and aorta - What are the pressures?
Normally close to systolic
Brief psychotic disorder; schizophreniform; schizophrenia
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Medial circumflex artery; avascular necrosis

11. on which chromosome is wilms tumor found?
Prevent phagocytosis
11
Diabetic microangiopathy
Standing suddenly from supine position; valsalva maneuver

12. why does liver dysfunction cause coagulation disorders?
<1% - 55% - concentration dependent
Coagulation factors are made in the liver
women
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

13. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Chrom 8
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
E. coli
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

14. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Skin flushing and warmth; prostaglandins; give with aspirin
Prevents hepatic VLDL production
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

15. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Tissue redistribution (out of plasma) rather than metabolism
frameshift mutations (missense is substitution)
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
Vertical diplopia

16. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
Anterior nares
NF- KB; responsible for cytokine production
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

17. What does prolonged PT indicated? aPTT? bleeding time?
The term used to describe decreased drug responsiveness with repeated administration
Extrinsic def; instrinsic def; platelet def
RBC mass; epo levels (secondary has high)
Congenital hypothyroidism - downs - amyloidosis - acromegaly

18. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Boiling - bleach - formalin - UV irradiation
Vagus (auricular branch); vasovagal syncope!
Strength of cell mediated immune response

19. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
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
8; 12
Phencyclidine (PCP)

20. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
Ketone body production by preventing fatty acids into the mitochondria
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

21. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Standing suddenly from supine position; valsalva maneuver
Demargination of neutrophils from the vessel walls
liver specific
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

22. what drugs causes the red man syndrome? how does it occur?
25; 25
Smoking
Headaches and facial flushing; vasodilation in meninges and skin
Vancomycin; histamine mediated

23. What does L/S stand for in fetal lung maturity? When does maturity occur?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Headaches and facial flushing; vasodilation in meninges and skin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Localized dermatologic pain that persists for more than one month after zoster eruption

24. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Varying; erythema nodosum is common
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

25. what bursa is affected when on knees like a maid/gardner?
Curlings ulcers
Prepatellar
Amiloride - spironolactone - triamterene
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis

26. What does NF- KB do?
Adductor
Folic acid treatment!
Another type of aldosterone antagonist (like spironolactone)
Increases cytokine production

27. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Close but purkinje system to ensure contraction in a bottom up fashion
Neisseria induced small cell vasculitis (including hands and soles)
Turners`
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

28. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
PDA open
RER; RER
Curlings ulcers
(urine PAH x urine flow rate)/plasma PAH

29. Which nerve lies in close proximity to the inferior thyroid artery?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
HSV and VZV
Recurrent larygneal
Regular insulin (Not fast acting - regular better)

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

31. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
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
Turbulence
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

32. 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?)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Circular - outside nucleus; transport proteins - rRNA - tRNA
Vagus nerve stimulation

33. What is damaged in early syringomelia? later?
Measure of depth invasion (vertical!)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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)

34. do Class IC agents prolong the QT interval?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
No
Drug induced interstitial nephritis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

35. which antiarrythmic is associated with blue gray discoloration ?
Sydenham chorea
No and yes
Amiadarone
Acute interstitial nephritis

36. What is intussusception? how does ischemia and necrosis occur?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
Terminal bronchioles; small bronchi
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)

37. What is the mc location of brain germinomas?What are the classic symptoms?
Chorda tympani branch
Leukotriene precursor and does neutrophil chemotaxis
Class I
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

38. What is the most common cause of pyelonephritis in both adults and childre?
APP on chrom 21 (this is why downs more susceptible)
Myasthenia gravis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
E. coli

39. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Trauma to stereociliated hair cells of the organ of corti
Bronchogenic carcinoma
RBF= PAH clearance/(1- hematocrit)
Large stroke volumes with ventricular contraction; aortic regurg

40. How do you calculate atributable risk percent?
Relfex tachycardia; giving beta blockers
LT (LTD4 - E4 - C4) - and Ach
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
RR-1/RR

41. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
frameshift mutations (missense is substitution)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Anterior nares
NF- KB; responsible for cytokine production

42. What does Rb protein do? what chrom is it on?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Appetite suppressants
Elevated GGT and macrocytosis

43. What causes release of myosin head from the actin filament?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Hexokinase
ATP binding (resets the myosin head to contract again for next binding)

44. What does extended consumption of appetite suppressants lead to?
transcription activation/suppression
Pulmonary hypertension
SaO2 <92%
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

45. why is crohns disease associated with oxaloacetate kidney stones?
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
Nocardia
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
The term used to describe decreased drug responsiveness with repeated administration

46. what protects the resting heart from arrhythmias?
gram positive organisms
Extrinsic def; instrinsic def; platelet def
Medullary
Highly negative resting potential

47. What type of calcium channels dictate the plateau in cardiac myocyte?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Vagus (auricular branch); vasovagal syncope!
Dihydropyridine sensitive Ca channels (L type)
APP on chrom 21 (this is why downs more susceptible)

48. other than proteinuria - What can cause foamy froathy urine?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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
Bile salt accumulation in urine
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

49. Which is faster atrial muscle or ventricular muscle?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Atrial
Selective alpha 1 (increases SVR)
Localized dermatologic pain that persists for more than one month after zoster eruption

50. Is there edema in primary Conns? secondary hyperaldosteronism? why?
E. coli
Inhibits it
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
46 - 4N; 23 2N