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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 is epleronone?
Joints d/t increased purine production and thus uric acid production
Another type of aldosterone antagonist (like spironolactone)
Abnormal closing of the urethral folds
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

2. at three years of age What are social - fine motor - gross motor and language developments?
II; I (I more abundant)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Another type of aldosterone antagonist (like spironolactone)

3. why is glucagon used in beta blocker toxicitiy?
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
TSh (in testicular tumors can cause hyperthyroidism)

4. What is 5- HETE and What does it do?
Medial part
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
Leukotriene precursor and does neutrophil chemotaxis
Amiadarone

5. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Phencyclidine (PCP)
Turbulence
Measles and M3 AML`

6. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Strength of cell mediated immune response
Sickle cell; G6PD
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
In the extracellular space for collagen cross linking; zinc

7. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
DIC; TTP- HUS dont bleed that much
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
LT (LTD4 - E4 - C4) - and Ach
Faulty positioning of the genital tubercle

8. What does NF- KB do?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Because of vasodiation to skeletal muscles
Increases cytokine production

9. What does p53 do? what chrom is it on?
P53 mutation; AD
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Measure of depth invasion (vertical!)

10. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Turbulence
gram positive organisms
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

11. What are pancreatic pseudocysts called pseudo rather than true cysts?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
T test; chi squared
LT (LTD4 - E4 - C4) - and Ach
Not lined by epithelium

12. What actions increase venous return?
Squatting - sitting - lying supine - passive leg raising
Reticulocytes
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Smoking

13. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Inhaled animal dander allergens
Chorda tympani branch
Enterococci (e. faecalis)- found on genitalia area
P450 mitochondrial monooxygenase

14. how does neisseria cause a petechial rash?
Extrinsic def; instrinsic def; platelet def
11
Think Hb deformation diseases
Neisseria induced small cell vasculitis (including hands and soles)

15. What can long term leg cast wearing cause?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
Increases cytokine production
Anti cholinergic effects of pupil dilation and lack of accomodation

16. at four years of age - What are the social - fine motor - gross motor - and language developments?
ATP binding (resets the myosin head to contract again for next binding)
Southern - western
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Anterior nares

17. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
TCAs and prazosin
The term used to describe decreased drug responsiveness with repeated administration

18. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
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
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
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

19. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Southern - western
Adeno
Hereditary angioedema; ACE inhibitors

20. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Acute gastric mucosal defects (superficial or full thickness)

21. What is the immune deficinecy seen in ataxia telangactasia?
Headaches and facial flushing; vasodilation in meninges and skin
APP on chrom 21 (this is why downs more susceptible)
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
Ig A deficiency

22. if there are keratin swirls does that mean well or poorly differentiated?
Well
HSV ( also in utero: chlymadia - neisseria - group B strep)
Inactivates kallikrein which activates kininogen into bradykinin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

23. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Vagus nerve stimulation

24. What is normal fibrinogen levels?
Excessive collagen formation during tissue repair in susceptible individuals
200-500
Medullary
The time interval between S2 and OS- the shorter the interval - the more intense

25. What is the diagnosis in delayed puberty plus anosmia?
Relfex tachycardia; giving beta blockers
Demargination of neutrophils from the vessel walls
RER; copper
Kallmans

26. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Sarcoid
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
only up to bronchi

27. How is dobutamine better than dopamine?
SS +rNA
Sydenham chorea
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

28. What are three symptoms in s.typhi?
Thymic tumor
Retinitis; mononucleosis
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Proteasome inhibitor; treatment for MM and waldenstroms

29. Acyl coA synthetase is not...
Turners`
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
liver specific
E. coli

30. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Squatting - sitting - lying supine - passive leg raising
By vascular permeability and vasodilation
Increased reticulocytes
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

31. What is used to prevent vertical transmission of HIV?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
ZDV or AZT
Large stroke volumes with ventricular contraction; aortic regurg
Prevents hepatic VLDL production

32. How do bradykinin - C3a and C5a cause edema?
Both sides
Pulmonic and systemic!
Chrom 8
By vascular permeability and vasodilation

33. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Turners`
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
T test; chi squared

34. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
High potassium conductance and some sodium conductance
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Inhibits it

35. what induces bronchial squamous metaplasia?
Anti centromere; anti DNA topoisomerase
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Covalent (between two cysteines)- allows protein to withstand denaturation
Smoking

36. What can chronic vit A toxicity cause?
RER; copper
RBC mass; epo levels (secondary has high)
liver specific
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

37. 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
Pulmonary hypertension
Prostate tumor and increased osteoclast activity
Another type of aldosterone antagonist (like spironolactone)

38. What is the most common cause of pyelonephritis in both adults and childre?
P53 mutation; AD
E. coli
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

39. What is a cord factor and Which bugs have it? How do they appear on culture?
Amiadarone
High potassium conductance and some sodium conductance
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
GI malignancies and Insulin resistance (acromegal for ex)

40. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Normally close to systolic
Curlings ulcers
<1% - 55% - concentration dependent
Hexokinase

41. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Selective alpha 1 (increases SVR)
Fibrosis; macrophages
Vancomycin; histamine mediated

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?
liver specific
INTRApartum Abs (ampicillin/penicillin)
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Common peroneal; bony fractures and compression; sciatic

43. Where does complement bind on the Fc region of Ig chains?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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)
Vancomycin; histamine mediated

44. what dictates the resting membrane potential of most cells?
Valproate
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Southern - western
High potassium conductance and some sodium conductance

45. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Aromatase deficiency in child

46. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
LT (LTD4 - E4 - C4) - and Ach
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Rabies encephalitis from cave bats; rabies killed vaccines

47. how long is substance P? What does it do?
SSRI; erectile dysfunction
Single adenomatous ones
11 aa polypeptide; pain NT in CNS and PNS
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

48. prostaglandin synthesis keeps...
No and yes
PDA open
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Multiple miscarriages d/t hypercoaguability

49. What is a primary HSV 1 infection like?
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)
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

50. What is the mc location for avascular necrosis? What is it associated with?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Underestimation of gestational age
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
P53 mutation; AD

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USMLE Prep 2

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