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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. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Diabetic microangiopathy
Lateral; RV; RA; LV
V fib; v. failure
Bile soluble which means they are bile sensitive

2. What does prolonged PT indicated? aPTT? bleeding time?
Drug induced interstitial nephritis
Spongiosis
Extrinsic def; instrinsic def; platelet def
LT (LTD4 - E4 - C4) - and Ach

3. what happens to capacitance with age?
liver specific
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
...
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

4. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
In ER of bile canaliculi
Radial nerve and deep brachial artery
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
No; yes

5. at three years of age What are social - fine motor - gross motor and language developments?
Reiter syndrome; B27
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on

6. which nucleus releases serotonin?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Hypertension - edema - and proteinuria
Brief psychotic disorder; schizophreniform; schizophrenia
Raphe

7. other than increasing HDL levels - what else does niacin do?
SVC and IVC; right below the aortic knob
Echinococcus granulosus; anaphylaxis
SS +rNA
Prevents hepatic VLDL production

8. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
chronic urticaria and allergic symptoms
Sickle cell; G6PD
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

9. What does VIP do to gastric acid secretion?
P450 mitochondrial monooxygenase
Atrial
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Inhibits it

10. What does the severity of leprosy depend on?
CGD; t cell dysfxn (diGeorge)
Strength of cell mediated immune response
Ketone body production by preventing fatty acids into the mitochondria
Bronchogenic carcinoma

11. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
ANCA because of lack of Ig and C3 deposits on IF
Boiling - bleach - formalin - UV irradiation
SVT; increases vagal tone; rectus abdominis

12. What is difference between Arnold Chiari type I and II?
Rabies encephalitis from cave bats; rabies killed vaccines
AV node slowest - to allow time for diastole
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
I is more benign and can present later in adulthood

13. What is the mc location of brain germinomas?What are the classic symptoms?
...
Localized dermatologic pain that persists for more than one month after zoster eruption
GI malignancies and Insulin resistance (acromegal for ex)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

14. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Coagulation factors are made in the liver
Because of the low output from heart failure - they will have increased aldosterone levels
Ether and other organic solvents

15. what defines hypoxemia?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Kallmans
SaO2 <92%
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

16. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Kallmans
Initiation - pointing; pincer grasp; walking; mama/dada
women

17. a patient fearing all white coats is a phenomenon of what?
Acute gastric mucosal defects (superficial or full thickness)
Classical conditioning
Vagus nerve stimulation
High potassium conductance and some sodium conductance

18. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
indomethacin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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
Pulmonic and systemic!

19. What is somatomedin C?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Insulin like growth factor 1 (just another name)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

20. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
SSRI; erectile dysfunction
8 (myc protein) with 2 - 14 - 22 (iG chains)
FGF and VEGF

21. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Excessive collagen formation during tissue repair in susceptible individuals
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

22. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Hexokinase
Syringomelia
only up to bronchi

23. why are pregnant predisposed to cholelithiasis?
Around 70 (normal measured diastolic pressures); 9--
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
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
Inactivates kallikrein which activates kininogen into bradykinin

24. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Lateral; RV; RA; LV
Anterior circumflex (and axillary nerve)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Gluteus medius and minimus; positive trendelenberg

25. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
transcription activation/suppression
Selective alpha 1 (increases SVR)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

26. What is intussusception? how does ischemia and necrosis occur?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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
Little effect on cell and no change
Medial circumflex artery; avascular necrosis

27. What antibodies are present in CREST? What is the most specific?
Acute interstitial nephritis
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Anti centromere; anti DNA topoisomerase
Ig A deficiency

28. what murmur is enhanced by decreased blood flow to the heart?
Demargination of neutrophils from the vessel walls
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Appetite suppressants
Congenital hypothyroidism - downs - amyloidosis - acromegaly

29. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Strength of cell mediated immune response
To pump calcium out in cardiac myocytes so that relaxation occurs
RER; copper

30. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
GI tract; mood!
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
8 (myc protein) with 2 - 14 - 22 (iG chains)

31. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Valproate
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
RBC mass; epo levels (secondary has high)
hyponatremia (aldosterone activation equilibrates body volume)

32. which two virus families have hemagluttinin on their surface?
Enterococci (e. faecalis)- found on genitalia area
Paramyxo and influenza
8; 12
Proteasome inhibitor; treatment for MM and waldenstroms

33. h1 receptor anatagonists are not effective in treatment of asthma only for...
PDA open
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
chronic urticaria and allergic symptoms
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

34. What is used to treat heparin toxicity?
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
Protamine sulfate
MAC complex (C5b - C9 complement deficiency)
SSRI; erectile dysfunction

35. why does variocele occur more in left side?
Prevent phagocytosis
Measure of depth invasion (vertical!)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Terminal bronchioles; small bronchi

36. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Closer to head; closer to diaphragm
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Syncope - angina - dyspnea (SAD)

37. What is hypospadias caused by?
Because of vasodiation to skeletal muscles
Well trained athletes and children
Anterior circumflex (and axillary nerve)
Abnormal closing of the urethral folds

38. 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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Smoking
Dissolved in plasma and attached to Hgb

39. What causes vertical diplopia? horizontal?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Trochlear nerve (IV); abducens nerve (VI)
When it invades the bm; carcinoma in situ

40. What is the diagnosis in delayed puberty plus anosmia?
Highly negative resting potential
Radial nerve damage
LT (LTD4 - E4 - C4) - and Ach
Kallmans

41. How do bradykinin - C3a and C5a cause edema?
Right heart failure
By vascular permeability and vasodilation
Protamine sulfate
Because of the low output from heart failure - they will have increased aldosterone levels

42. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Hydrogen bonds dictate alpha or beta structure
HSV ( also in utero: chlymadia - neisseria - group B strep)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

43. What effects does cortisol have on catecholamines?
As a CO2 carrier with the carboxylase enzyme
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Tzanck smear

44. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Standing suddenly from supine position; valsalva maneuver
Lateral; RV; RA; LV
Protamine sulfate

45. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Ig A deficiency
Medullary
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

46. What type of bond is a disulfide bond?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Covalent (between two cysteines)- allows protein to withstand denaturation
...
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

47. What is an abortive viral infection?
No; MRI
TSh (in testicular tumors can cause hyperthyroidism)
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
Little effect on cell and no change

48. what drugs causes the red man syndrome? how does it occur?
Single adenomatous ones
Hydrogen bonds dictate alpha or beta structure
Vancomycin; histamine mediated
RBC mass; epo levels (secondary has high)

49. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Sudden loss of muscle tone without loss of consciousness; narcolepsy
APP on chrom 21 (this is why downs more susceptible)
Cluster

50. What is cataplexy and When is it seen?
CMV - HSV 1 - Candida
Increase; decreased
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Anti cholinergic effects of pupil dilation and lack of accomodation

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USMLE Prep 2

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