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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 does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vagus nerve stimulation
Increases cytokine production
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

2. What can chronic vit A toxicity cause?
Because gamma chains replace beta chains and then gamma chain formation wanes
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
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
The term used to describe decreased drug responsiveness with repeated administration

3. how can HAV be inactivated?
S3 gallop; S2 to opening snap interval
Boiling - bleach - formalin - UV irradiation
Class I
Around 70 (normal measured diastolic pressures); 9--

4. Where does conjugation of bilirubin take place?
Folic acid treatment!
In ER of bile canaliculi
Hexokinase
Measure of depth invasion (vertical!)

5. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Fat - fertile - forty - female
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Spongiosis

6. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Folic acid treatment!
Turners`

7. What triggers the neoplastic changes that are associated with HBV infecton?
The time interval between S2 and OS- the shorter the interval - the more intense
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)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Integration of viral DNA into genome of host hepatocytes

8. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
Around 70 (normal measured diastolic pressures); 9--
E. coli; staphylococcus saprophyticus
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)

9. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Nonsense; mRNA processing

10. What is diagnostic (and possible therapeutic for intussusception)?
Bile soluble which means they are bile sensitive
Barium enema
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Varying; erythema nodosum is common

11. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
APP on chrom 21 (this is why downs more susceptible)
P53 mutation; DCC is also required for adenoma to carcinoma
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

12. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Adeno
Tzanck smear
Biphosphonate

13. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
TCAs and prazosin
II; I (I more abundant)

14. What is pickwickian syndrome? What are the lab findings?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Measure of depth invasion (vertical!)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

15. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Nonsense; mRNA processing
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Bile salt accumulation in urine
Become beta pleated and then form neurofibrillary tangle!

16. What type of endocarditis is cytoscopy induced?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Enterococci (e. faecalis)- found on genitalia area
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
Squatting - sitting - lying supine - passive leg raising

17. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
OCPs - multiparity - breast feeding
Mean greater than median greater than mode
Drink plenty of fluids

18. What are three symptoms in s.typhi?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
RER; copper
hyponatremia (aldosterone activation equilibrates body volume)

19. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Bile soluble which means they are bile sensitive
Selective alpha 1 (increases SVR)
Gluteus medius and minimus; positive trendelenberg
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

20. which has better side effect profile - SSRI or TCA?
RR-1/RR
low in serum
P53 mutation; AD
SSRI

21. What can worse neurologic dysfunction in cobalamic def?
RER; RER
Because of the low output from heart failure - they will have increased aldosterone levels
Folic acid treatment!
The time interval between S2 and OS- the shorter the interval - the more intense

22. What are diastolic (lowest) pressures in aorta? LV?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Around 70 (normal measured diastolic pressures); 9--
Gluteus maximus; difficulty getting up from seated position and climbing chair
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

23. What is extraocular muscle weakness a common symptom of?
Localized dermatologic pain that persists for more than one month after zoster eruption
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
Myasthenia gravis
Hyperkalemia; potassium sparing diuretics - potassium supplements

24. who bleed more DIC or TTP- HUS patients?
On cardiac tissue and renal juxtaglomerular cells
Echinococcus granulosus; anaphylaxis
DIC; TTP- HUS dont bleed that much
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

25. Metronidizaole does not cover...
gram positive organisms
Octreotide
Syncope - angina - dyspnea (SAD)
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

26. what would be a sign of absence of cardiogenic pulm edem?
4 - 4 - 9
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
High potassium conductance and some sodium conductance

27. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Skin flushing and warmth; prostaglandins; give with aspirin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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

28. What is medullary sponge kidney disease and how does it present? What does it lead to?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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)
Bronchial dilation (bronchiectasis)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

29. how does achalasia present? What does barium swallow show on dilated esophagus?
DIC; TTP- HUS dont bleed that much
CGD; t cell dysfxn (diGeorge)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

30. What is best to prevent GBS infection in a baby?
INTRApartum Abs (ampicillin/penicillin)
ATP binding (resets the myosin head to contract again for next binding)
Aromatase deficiency in child
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

31. what induces bronchial squamous metaplasia?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Smoking
Biphosphonate

32. What is the mc location for avascular necrosis? What is it associated with?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Relfex tachycardia; giving beta blockers

33. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Valproate
Serum creatine kinase; reperfusion injury causes necrosis

34. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Abnormal closing of the urethral folds
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Pulmonary hypertension
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

35. what drug is useful for secretory diarrhea?
ATP binding (resets the myosin head to contract again for next binding)
Medial part
Octreotide
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

36. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
TCAs and prazosin
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Insulin like growth factor 1 (just another name)

37. on which chromosome is wilms tumor found?
Enterococci (e. faecalis)- found on genitalia area
11
Well
Covalent (between two cysteines)- allows protein to withstand denaturation

38. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
differentiate
Terminal bronchioles; small bronchi
Duration and extent of disease

39. What does anti phospholipid syndrome in SLE patients predispose them to?
Chlorpheniramine and diphenhydramine
Multiple miscarriages d/t hypercoaguability
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

40. 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
Lateral; RV; RA; LV
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Multiple miscarriages d/t hypercoaguability

41. which opponens muscle does ulnar innervate?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Adductor
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Circular - outside nucleus; transport proteins - rRNA - tRNA

42. metabolism of 1 gram of protein produces How many calories? carb? fat?
Bile soluble which means they are bile sensitive
Because gamma chains replace beta chains and then gamma chain formation wanes
4 - 4 - 9
Right before diastole (filling begins)

43. What does Rb protein do? what chrom is it on?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
In ER of bile canaliculi
Increase in permeability of two ions with equal and opposite equilibrium potentials
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

44. What three pathogens cause infectious esophagitis in HIV positive patients?
The term used to describe decreased drug responsiveness with repeated administration
CMV - HSV 1 - Candida
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SS +rNA

45. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Dissolved in plasma and attached to Hgb
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Because of vasodiation to skeletal muscles

46. What are two indicators of chronic alcohol consumption?
Hypertension - edema - and proteinuria
Elevated GGT and macrocytosis
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
S. saprophyticus - and s. epidermidis; novobiocin

47. What is damaged in early syringomelia? later?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
S3 gallop; S2 to opening snap interval
Little effect on cell and no change

48. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
4 - 4 - 9
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Terminal bronchioles; small bronchi

49. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Rabies encephalitis from cave bats; rabies killed vaccines

50. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
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)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Reiter syndrome; B27
Echinococcus granulosus; anaphylaxis