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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 does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Selective alpha 1 (increases SVR)
Relfex tachycardia; giving beta blockers
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

2. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Primary
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
GI malignancies and Insulin resistance (acromegal for ex)
Right heart failure

3. What does protein M do in Group A strep<
Prevent phagocytosis
Amiloride - spironolactone - triamterene
Increases cytokine production
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

4. What are two indicators of chronic alcohol consumption?
In the extracellular space for collagen cross linking; zinc
women
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Elevated GGT and macrocytosis

5. What is easiest way to treat nephrolithiasis?
Intussusception
Minimal change disease
LT (LTD4 - E4 - C4) - and Ach
Drink plenty of fluids

6. What are the three dopaminergic systems and What are they responsible for? disease?
only up to bronchi
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
TCAs and prazosin
Barium enema

7. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
SS +rNA
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
S3 gallop; S2 to opening snap interval

8. What is the cause of rapid plasma decay of thiopental?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Anterior nares
Leukotriene precursor and does neutrophil chemotaxis
Tissue redistribution (out of plasma) rather than metabolism

9. What are diastolic (lowest) pressures in aorta? LV?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Elevated GGT and macrocytosis
No
Around 70 (normal measured diastolic pressures); 9--

10. What are pancreatic pseudocysts called pseudo rather than true cysts?
Sarcoid
Vagus nerve stimulation
Not lined by epithelium
Anterior nares

11. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
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
CGD; t cell dysfxn (diGeorge)
Right before diastole (filling begins)

12. What are the two coagulase negative staphylococci? How do you distinguish them?
Large stroke volumes with ventricular contraction; aortic regurg
S. saprophyticus - and s. epidermidis; novobiocin
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

13. What is best to prevent GBS infection in a baby?
Integration of viral DNA into genome of host hepatocytes
INTRApartum Abs (ampicillin/penicillin)
Apocrine; eccrine
Abnormal closing of the urethral folds

14. which staphylococci can do mannitol fermaentation?
RBF= PAH clearance/(1- hematocrit)
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
S. aureus
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

15. what indicates the severity of a mitral regurg ? mitral stenosis?
Single adenomatous ones
S3 gallop; S2 to opening snap interval
Standing suddenly from supine position; valsalva maneuver
Octreotide

16. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Highly negative resting potential
Mean greater than median greater than mode
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Acute interstitial nephritis

17. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Squatting - sitting - lying supine - passive leg raising
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Single adenomatous ones
Anti centromere; anti DNA topoisomerase

18. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Little effect on cell and no change
Vagus (auricular branch); vasovagal syncope!
Superior larygeal; cricothyroid; recurrent laryngeal

19. What is acanthosis nigricans associated with?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
GI malignancies and Insulin resistance (acromegal for ex)
glycerol kinase
Gluteus medius and minimus; positive trendelenberg

20. what bursa is affected when on knees like a maid/gardner?
When it invades the bm; carcinoma in situ
Prepatellar
Closer to head; closer to diaphragm
Increase by 50% in urine osmolality

21. What is Tzanck smear used to detect?
Acute gastric mucosal defects (superficial or full thickness)
HSV and VZV
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Southern - western

22. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Sickle cell; G6PD
Curlings ulcers

23. Where does complement bind on the Fc region of Ig chains?
Tibial
Prevent phagocytosis
Vagus nerve stimulation
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

24. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Varying; erythema nodosum is common
facultative intracellular

25. other than mycobacterim wha other bacteria is acid fast?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Enterococci (e. faecalis)- found on genitalia area
Nocardia
Diabetic microangiopathy

26. What is the neurologic manifestation of ADPKD?
(urine PAH x urine flow rate)/plasma PAH
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Raphe
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

27. What is Bortezomib and What is it used for?
Thymic tumor
Covalent (between two cysteines)- allows protein to withstand denaturation
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
Proteasome inhibitor; treatment for MM and waldenstroms

28. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
In the extracellular space
Ceftriaxone; azithromycin
chronic urticaria and allergic symptoms

29. where exactly is ACE expressed in the lungs? What type of enzyme is it?
46 - 4N; 23 2N
Around 70 (normal measured diastolic pressures); 9--
Vascular endothelium; protease
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

30. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Dissolved in plasma and attached to Hgb
No; MRI
When it invades the bm; carcinoma in situ
C3 decreased after 5-10 days; sulfonamides

31. which has better side effect profile - SSRI or TCA?
Regular insulin (Not fast acting - regular better)
SSRI
Integration of viral DNA into genome of host hepatocytes
Anti cholinergic effects of pupil dilation and lack of accomodation

32. what defines hypoxemia?
SaO2 <92%
Drug induced interstitial nephritis
Well trained athletes and children
Decreases both

33. What antibiotic is best to treat alcoholic pulm infections? why?
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
(urine PAH x urine flow rate)/plasma PAH
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Clindamycin; covers anaerobic oral flora and aerobic bacteria

34. what would be a sign of absence of cardiogenic pulm edem?
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Increases

35. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Well
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Radial nerve damage
Kallmans

36. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
RBF= PAH clearance/(1- hematocrit)
Pulmonary hypertension
No and yes
Terminal bronchioles; small bronchi

37. What is normal fibrinogen levels?
Bronchial dilation (bronchiectasis)
200-500
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Fibronectin - laminin - collagen

38. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Recurrent larygneal
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
SVT; increases vagal tone; rectus abdominis
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

39. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
11
No; MRI

40. 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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Ceftriaxone; azithromycin

41. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Right before diastole (filling begins)
In the extracellular space
Anterior circumflex (and axillary nerve)

42. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
G to T in p53; HCC
low in serum
Closer to head; closer to diaphragm

43. What can cause aortic regurg? What is the heart sound you hear?
Echinococcus granulosus; anaphylaxis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chrom 8
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

44. what dictates the resting membrane potential of most cells?
Hydrogen bonds dictate alpha or beta structure
High potassium conductance and some sodium conductance
Leukotriene precursor and does neutrophil chemotaxis
Rabies encephalitis from cave bats; rabies killed vaccines

45. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Primary
Fibronectin - laminin - collagen
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

46. What causes vertical diplopia? horizontal?
Spongiosis
P53 mutation; DCC is also required for adenoma to carcinoma
Trochlear nerve (IV); abducens nerve (VI)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

47. What does TGF beta do? What produces it?
Thymic tumor
Reticulocytes
Fibrosis; macrophages
ANCA because of lack of Ig and C3 deposits on IF

48. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
E. coli; staphylococcus saprophyticus
Medial circumflex artery; avascular necrosis
200-500
No (unlike adenomyosis); yes

49. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Phencyclidine (PCP)
8 (myc protein) with 2 - 14 - 22 (iG chains)
OCPs - multiparity - breast feeding
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

50. what kind of drug is sertraline? What is a common side effect?
SSRI; erectile dysfunction
Become beta pleated and then form neurofibrillary tangle!
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

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USMLE Prep 2

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