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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. why are pregnant predisposed to cholelithiasis?
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
Relfex tachycardia; giving beta blockers
Vagus (auricular branch); vasovagal syncope!
Anti centromere; anti DNA topoisomerase

2. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
The time interval between S2 and OS- the shorter the interval - the more intense
HSV ( also in utero: chlymadia - neisseria - group B strep)
LT (LTD4 - E4 - C4) - and Ach
Increases bronchial and vascular smooth muscle reactivity to catecholamines

3. What are three symptoms in s.typhi?
Drink plenty of fluids
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
The time interval between S2 and OS- the shorter the interval - the more intense
Pain reliever - reduces pain by locking substance P in the PNS

4. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Covalent (between two cysteines)- allows protein to withstand denaturation
Fibrosis; macrophages

5. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Fat - fertile - forty - female
Vascular endothelium; protease
SaO2 <92%
Ketone body production by preventing fatty acids into the mitochondria

6. 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
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
No; yes
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

7. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
S3 gallop; S2 to opening snap interval
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Multiple miscarriages d/t hypercoaguability

8. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Neisseria induced small cell vasculitis (including hands and soles)
women
Standing suddenly from supine position; valsalva maneuver

9. Which is faster atrial muscle or ventricular muscle?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Atrial
Integration of viral DNA into genome of host hepatocytes
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

10. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Reiter syndrome; B27
Dihydropyridine sensitive Ca channels (L type)
Well

11. at three years of age What are social - fine motor - gross motor and language developments?
Proteasome inhibitor; treatment for MM and waldenstroms
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Reticulocytes

12. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Aromatase deficiency in child

13. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Adeno
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
CGD; t cell dysfxn (diGeorge)

14. What does VIP do to gastric acid secretion?
Kallmans
Inhibits it
Large stroke volumes with ventricular contraction; aortic regurg
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

15. What is best to prevent GBS infection in a baby?
25; 25
INTRApartum Abs (ampicillin/penicillin)
Cluster
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

16. In what form are mitochondrial DNA? What do they transcribe?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Circular - outside nucleus; transport proteins - rRNA - tRNA
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

17. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Brief psychotic disorder; schizophreniform; schizophrenia
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

18. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Cluster
Gluteus maximus; difficulty getting up from seated position and climbing chair
liver specific

19. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Class I
RER; RER
MAO inhibitors; wine and cheese
T test; chi squared

20. What are examples of action that decrease venous return to the heart?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
In ER of bile canaliculi
Standing suddenly from supine position; valsalva maneuver
Insulin like growth factor 1 (just another name)

21. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Folic acid treatment!
Rabies encephalitis from cave bats; rabies killed vaccines
Increases cytokine production
Myasthenia gravis

22. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Medial circumflex artery; avascular necrosis
Classical conditioning
Purkinje system; AV node

23. What are the two mcc of focal brain lesions in HIV positive patients?
ANCA because of lack of Ig and C3 deposits on IF
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Anti centromere; anti DNA topoisomerase
Vascular endothelium; protease

24. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
On cardiac tissue and renal juxtaglomerular cells
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

25. What is hypospadias caused by?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Abnormal closing of the urethral folds
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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

26. What does hypocapnia cause in teh brain? What is hypocapnia?
Fibrosis; macrophages
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
In the extracellular space for collagen cross linking; zinc
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

27. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Hypo or hyper pigmentations; after tanning
Increase by 50% in urine osmolality

28. what makes bruits?
liver specific
46 - 4N; 23 2N
Turbulence
Amiloride - spironolactone - triamterene

29. what happens with LDL receptor density in statin therapy?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Not lined by epithelium
Increases
Kallmans

30. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Leukotriene precursor and does neutrophil chemotaxis
C3 decreased after 5-10 days; sulfonamides
Trauma to stereociliated hair cells of the organ of corti
11 aa polypeptide; pain NT in CNS and PNS

31. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Hereditary angioedema; ACE inhibitors
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

32. What are the skin presentation in sarcoid?
Syringomelia
RER; copper
Diabetic microangiopathy
Varying; erythema nodosum is common

33. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Increased reticulocytes
46 - 4N; 23 2N
HSV ( also in utero: chlymadia - neisseria - group B strep)

34. What can worse neurologic dysfunction in cobalamic def?
Drink plenty of fluids
Regular insulin (Not fast acting - regular better)
Folic acid treatment!
Adductor

35. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
No and yes
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Acute gastric mucosal defects (superficial or full thickness)

36. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
4 - 4 - 9
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
No; MRI
Increase; decreased

37. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Turners`
Rabies encephalitis from cave bats; rabies killed vaccines
Medullary
Congenital hypothyroidism - downs - amyloidosis - acromegaly

38. Is there edema in primary Conns? secondary hyperaldosteronism? why?
TCAs and prazosin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
No and yes
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

39. What is subacute sclerosisng encephalitis caused by?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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
HSV and VZV
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

40. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
NF- KB; responsible for cytokine production
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

41. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Prevent phagocytosis
...

42. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
TCAs and prazosin
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
Pain reliever - reduces pain by locking substance P in the PNS

43. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Underestimation of gestational age
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
Superior larygeal; cricothyroid; recurrent laryngeal

44. which opponens muscle does ulnar innervate?
Intussusception
Duration and extent of disease
Adductor
8 (myc protein) with 2 - 14 - 22 (iG chains)

45. What is the most common neurologic complication of VZV reactivation?
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
Localized dermatologic pain that persists for more than one month after zoster eruption
Prostate tumor and increased osteoclast activity
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

46. in B12 deficiency - what levels in blood rise very quickly and then drop?
IgE
HSV and VZV
Reticulocytes
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

47. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Hexokinase
P53 mutation; AD
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Drink plenty of fluids

48. why does hypothyroidism cause increased CPK levels?
Intussusception
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Myasthenia gravis
Large stroke volumes with ventricular contraction; aortic regurg

49. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
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
Prevents hepatic VLDL production
Standing suddenly from supine position; valsalva maneuver

50. how does noise induced hearing loss occur?
OCPs - multiparity - breast feeding
When it invades the bm; carcinoma in situ
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Trauma to stereociliated hair cells of the organ of corti