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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. where are the two classical places that the ulnar nerve can be injured?

2. neisseria are...
Vascular endothelium; protease
When it invades the bm; carcinoma in situ
Ketone body production by preventing fatty acids into the mitochondria
facultative intracellular

3. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
HSV and VZV
ATP binding (resets the myosin head to contract again for next binding)
Boiling - bleach - formalin - UV irradiation

4. name three pathological states that present with large tongues.
11 aa polypeptide; pain NT in CNS and PNS
By vascular permeability and vasodilation
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly

5. What is the difference between additive and synergistic?
Intussusception
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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

6. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Hypo or hyper pigmentations; after tanning
Susceptible; soluble (unable to be cultured in bile)
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
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

7. Where does complement bind on the Fc region of Ig chains?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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
Relfex tachycardia; giving beta blockers

8. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
LT (LTD4 - E4 - C4) - and Ach
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

9. What is a common complication of acute pancreatitis? What is it?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
FGF and VEGF
Kallmans
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

10. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
In the extracellular space for collagen cross linking; zinc
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Increased reticulocytes
Syncope - angina - dyspnea (SAD)

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
only up to bronchi
Phencyclidine (PCP)

12. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Hereditary angioedema; ACE inhibitors
Anterior nares
P53 mutation; AD

13. How do left sided colon adenocarcinomas present? right sided?
Because of the low output from heart failure - they will have increased aldosterone levels
Increases bronchial and vascular smooth muscle reactivity to catecholamines
liver specific
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste

14. What are the three dopaminergic systems and What are they responsible for? disease?
Spongiosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Closer to head; closer to diaphragm

15. are there signs of inflammation in avascular necrosis? then How do you diagnose?
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
No; MRI
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

16. What are the two mcc of focal brain lesions in HIV positive patients?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Chlorpheniramine and diphenhydramine
Downs; regurgitant AV valves - ASDs

17. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
On cardiac tissue and renal juxtaglomerular cells
Anterior circumflex (and axillary nerve)

18. What three factors effect total oxygen content of blood?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
No

19. What are examples of action that decrease venous return to the heart?
No (unlike adenomyosis); yes
Selective alpha 1 (increases SVR)
Vagus nerve stimulation
Standing suddenly from supine position; valsalva maneuver

20. What is the most common location of colonization of all s. aureus types?
Downs; regurgitant AV valves - ASDs
Anterior nares
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

21. What are the acute effects of corticosteroids on the CBC?
Underestimation of gestational age
Close but purkinje system to ensure contraction in a bottom up fashion
Protamine sulfate
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

22. do Class IC agents prolong the QT interval?
G to T in p53; HCC
indomethacin
I is more benign and can present later in adulthood
No

23. What causes vertical diplopia? horizontal?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Amiloride - spironolactone - triamterene
Trochlear nerve (IV); abducens nerve (VI)
Insulin like growth factor 1 (just another name)

24. is Rifampin ever used as monotherapY? why either way?
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
hyponatremia (aldosterone activation equilibrates body volume)
Nonsense; mRNA processing
In the extracellular space for collagen cross linking; zinc

25. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Hexokinase
Increase lymphatic drainage!
Brief psychotic disorder; schizophreniform; schizophrenia

26. What can too much IgA in serum produces?
Neisseria induced small cell vasculitis (including hands and soles)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Anterior nares
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

27. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Increase lymphatic drainage!
Vertical diplopia

28. What are the two coagulase negative staphylococci? How do you distinguish them?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Inactivates kallikrein which activates kininogen into bradykinin
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
S. saprophyticus - and s. epidermidis; novobiocin

29. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Pan colitis and right sided colitis (more than left sided and proctitis)
Neisseria induced small cell vasculitis (including hands and soles)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

30. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Prepatellar

31. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Anti centromere; anti DNA topoisomerase
Regular insulin (Not fast acting - regular better)
Highly negative resting potential

32. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Terminal bronchioles; small bronchi
Because of vasodiation to skeletal muscles
Vagus nerve stimulation

33. What is the best indicator for the severity of mitral stenosis?
NF- KB; responsible for cytokine production
The time interval between S2 and OS- the shorter the interval - the more intense
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

34. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Increase lymphatic drainage!
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
No (unlike adenomyosis); yes

35. in the LV and aorta - What are the pressures?
Normally close to systolic
Prevent phagocytosis
Congenital hypothyroidism - downs - amyloidosis - acromegaly
S. saprophyticus - and s. epidermidis; novobiocin

36. What causes curlings ulcers?
Raphe
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Enterococci (e. faecalis)- found on genitalia area

37. What are diastolic (lowest) pressures in aorta? LV?
Pulmonary hypertension
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
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
Around 70 (normal measured diastolic pressures); 9--

38. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Tzanck smear
Well trained athletes and children
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)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

39. What is congestive hepatomegaly specific for?
Right heart failure
Radial nerve damage
Southern - western
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

40. What antibiotic is best to treat alcoholic pulm infections? why?
Regular insulin (Not fast acting - regular better)
I is more benign and can present later in adulthood
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Initiation - pointing; pincer grasp; walking; mama/dada

41. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Recurrent larygneal
Turbulence
No and yes
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

42. ___________ is liver specific
ANCA because of lack of Ig and C3 deposits on IF
Because of the low output from heart failure - they will have increased aldosterone levels
glycerol kinase
Brief psychotic disorder; schizophreniform; schizophrenia

43. What does 'oxygen' content in blood refer to?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Dissolved in plasma and attached to Hgb
Ketone body production by preventing fatty acids into the mitochondria

44. What does the severity of leprosy depend on?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
When it invades the bm; carcinoma in situ
Strength of cell mediated immune response
APP on chrom 21 (this is why downs more susceptible)

45. how does eos release MBP to kill protozoa etc?
I is more benign and can present later in adulthood
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
indomethacin
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis

46. What is suggestive of complete central DI?
By vascular permeability and vasodilation
Increase by 50% in urine osmolality
SS +rNA
SaO2 <92%

47. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Reticulocytes
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Nocardia

48. what enzyme converts procarcinogens into carcinogens?
Chorda tympani branch
Little effect on cell and no change
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
P450 mitochondrial monooxygenase

49. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Medial circumflex artery; avascular necrosis
Skin flushing and warmth; prostaglandins; give with aspirin
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

50. carnitine deficiency impairs production of What and how?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Ketone body production by preventing fatty acids into the mitochondria
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)