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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. What is the immune deficinecy seen in ataxia telangactasia?
Syncope - angina - dyspnea (SAD)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Ig A deficiency
manifestations - congenital (stretching of periventricular pyrimadal fibers)

2. what dictates the resting membrane potential of most cells?
RER; RER
High potassium conductance and some sodium conductance
Chlorpheniramine and diphenhydramine
Selective alpha 1 (increases SVR)

3. What is easiest way to treat nephrolithiasis?
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
Drink plenty of fluids
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Think Hb deformation diseases

4. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Increase; decreased
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Class I

5. What is a keloid?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Because gamma chains replace beta chains and then gamma chain formation wanes
Excessive collagen formation during tissue repair in susceptible individuals
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

6. what dissolves the lipid bilayer of a viral envelope?
46 - 4N; 23 2N
Ether and other organic solvents
SVT; increases vagal tone; rectus abdominis
Smoking

7. which are the only glycosylated proteins in HIV virus?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Env genes (for getting into target cells)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

8. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
Bile soluble which means they are bile sensitive
INTRApartum Abs (ampicillin/penicillin)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

9. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Well trained athletes and children
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Sarcoid

10. How do you treat gonococcal infection? chlymadia?
Another type of aldosterone antagonist (like spironolactone)
Ceftriaxone; azithromycin
C3 decreased after 5-10 days; sulfonamides
Regular insulin (Not fast acting - regular better)

11. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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
Intussusception
Abnormal closing of the urethral folds

12. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Well trained athletes and children
Susceptible; soluble (unable to be cultured in bile)

13. which staphylococci can do mannitol fermaentation?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hyperkalemia; potassium sparing diuretics - potassium supplements
S. aureus
S3 gallop; S2 to opening snap interval

14. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

15. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Increase; decreased
Well trained athletes and children
When it invades the bm; carcinoma in situ
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

16. What are some side effects seen in TCAs?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Cluster
Coagulation factors are made in the liver

17. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Increase; decreased
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
(urine PAH x urine flow rate)/plasma PAH

18. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Recurrent larygneal
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

19. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Phencyclidine (PCP)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

20. 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?
46 - 4N; 23 2N
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
RBC mass; epo levels (secondary has high)
Ketone body production by preventing fatty acids into the mitochondria

21. Where does lysyl oxidase act? What is the cofactor for that?
Cluster
Downs; regurgitant AV valves - ASDs
Headaches and facial flushing; vasodilation in meninges and skin
In the extracellular space for collagen cross linking; zinc

22. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
P53 mutation; DCC is also required for adenoma to carcinoma
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
CGD; t cell dysfxn (diGeorge)

23. in B12 deficiency - what levels in blood rise very quickly and then drop?
Reticulocytes
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Initiation - pointing; pincer grasp; walking; mama/dada
Gluteus medius and minimus; positive trendelenberg

24. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Faulty positioning of the genital tubercle
Joints d/t increased purine production and thus uric acid production
MAO inhibitors; wine and cheese

25. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Valproate
Appetite suppressants

26. How do you calculate atributable risk percent?
Leukotriene precursor and does neutrophil chemotaxis
Medial circumflex artery; avascular necrosis
Neisseria induced small cell vasculitis (including hands and soles)
RR-1/RR

27. What is a cell surface marker seen in liver angiosarcoma?
Anti cholinergic effects of pupil dilation and lack of accomodation
G to T in p53; HCC
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Clindamycin; covers anaerobic oral flora and aerobic bacteria

28. What is diagnostic (and possible therapeutic for intussusception)?
Fat - fertile - forty - female
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
Barium enema
By vascular permeability and vasodilation

29. What is the presentation of sever aortic stenosis?
Fibronectin - laminin - collagen
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
RER; copper
Syncope - angina - dyspnea (SAD)

30. What type of mutation does aflatoxin cause? what cancer does this increase for?
Both sides
hyponatremia (aldosterone activation equilibrates body volume)
G to T in p53; HCC
LT (LTD4 - E4 - C4) - and Ach

31. What is congestive hepatomegaly specific for?
Underestimation of gestational age
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Think Hb deformation diseases
Right heart failure

32. What is somatomedin C?
Nocardia
Insulin like growth factor 1 (just another name)
CMV - HSV 1 - Candida
differentiate

33. What is the mc location for avascular necrosis? What is it associated with?
NF- KB; responsible for cytokine production
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
TCAs and prazosin
Close but purkinje system to ensure contraction in a bottom up fashion

34. What are two indicators of chronic alcohol consumption?
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
Elevated GGT and macrocytosis
Around 70 (normal measured diastolic pressures); 9--
Increases cytokine production

35. What causes the blurry vision side effects in first generation anti histamines?
Anti cholinergic effects of pupil dilation and lack of accomodation
GI malignancies and Insulin resistance (acromegal for ex)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Minimal change disease

36. what induces bronchial squamous metaplasia?
Spongiosis
Valproate
Smoking
8; 12

37. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Terminal bronchioles; small bronchi
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
Retinitis; mononucleosis
Susceptible; soluble (unable to be cultured in bile)

38. which nerve provides innervation for plantar flexion and inversion?
Tibial
Hypo or hyper pigmentations; after tanning
Bronchial dilation (bronchiectasis)
Become beta pleated and then form neurofibrillary tangle!

39. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Trauma to stereociliated hair cells of the organ of corti
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)
Bile salt accumulation in urine

40. What is the fibrinogen level in patient with TTP- HUS? DIC?
Well trained athletes and children
Normal; low
Initiation - pointing; pincer grasp; walking; mama/dada
Sydenham chorea

41. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Boiling - bleach - formalin - UV irradiation
Tissue redistribution (out of plasma) rather than metabolism
Pain reliever - reduces pain by locking substance P in the PNS

42. carnitine deficiency impairs production of What and how?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Serum creatine kinase; reperfusion injury causes necrosis
Ketone body production by preventing fatty acids into the mitochondria
Initiation - pointing; pincer grasp; walking; mama/dada

43. which virus inactivates both Rb and p53?
P450 mitochondrial monooxygenase
Covalent (between two cysteines)- allows protein to withstand denaturation
No
E6 and E7 of HPV knock off p53 and Rb suppressor genes

44. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
No; MRI
Increase in permeability of two ions with equal and opposite equilibrium potentials
No and yes

45. What is best to prevent GBS infection in a baby?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
MAC complex (C5b - C9 complement deficiency)
Measles and M3 AML`
INTRApartum Abs (ampicillin/penicillin)

46. nucleotide deletions do not cause missense mutations - they cause...
frameshift mutations (missense is substitution)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Intussusception
Ceftriaxone; azithromycin

47. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
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
25; 25
Prepatellar

48. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
hyponatremia (aldosterone activation equilibrates body volume)
Joints d/t increased purine production and thus uric acid production
LT (LTD4 - E4 - C4) - and Ach
V fib; v. failure

49. What is the difference between paranoid personality disorder and delusional disorder?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Duration and extent of disease

50. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
liver specific
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
SS +rNA