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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 most common cause of pyelonephritis in both adults and childre?
E. coli
Anterior nares
Radial nerve damage
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

2. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
Squatting - sitting - lying supine - passive leg raising
Varying; erythema nodosum is common
P53 mutation; DCC is also required for adenoma to carcinoma

3. what enzyme converts procarcinogens into carcinogens?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
P450 mitochondrial monooxygenase
Covalent (between two cysteines)- allows protein to withstand denaturation

4. why is crohns disease associated with oxaloacetate kidney stones?
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Ceftriaxone; azithromycin

5. prostaglandin synthesis keeps...
Coagulation factors are made in the liver
Ether and other organic solvents
PDA open
Integration of viral DNA into genome of host hepatocytes

6. What test would be best to determine if a gene is being transcribed? translated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Southern - western
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

7. What is the mc location of brain germinomas?What are the classic symptoms?
E. coli; staphylococcus saprophyticus
Terminal bronchioles; small bronchi
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Little effect on cell and no change

8. What are some side effects seen in TCAs?
Turners`
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Trochlear nerve (IV); abducens nerve (VI)
Extrinsic def; instrinsic def; platelet def

9. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Smoking
chronic urticaria and allergic symptoms
Common peroneal; bony fractures and compression; sciatic
MAO inhibitors; wine and cheese

10. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
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)
Smoking
Localized dermatologic pain that persists for more than one month after zoster eruption
P53 mutation; DCC is also required for adenoma to carcinoma

11. what makes bruits?
T test; chi squared
RR-1/RR
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Turbulence

12. how long is substance P? What does it do?
11 aa polypeptide; pain NT in CNS and PNS
Amiloride - spironolactone - triamterene
Around 70 (normal measured diastolic pressures); 9--
By vascular permeability and vasodilation

13. What is the mcc of extrinsic allergic asthma?
Trochlear nerve (IV); abducens nerve (VI)
Thymic tumor
Inhaled animal dander allergens
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

14. What is used to compare means? categorical outcomes?
T test; chi squared
E. coli
Rabies encephalitis from cave bats; rabies killed vaccines
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

15. where are Beta 1 receptors found?
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
On cardiac tissue and renal juxtaglomerular cells
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
SS +rNA

16. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Sarcoid
TCAs and prazosin
Around 70 (normal measured diastolic pressures); 9--
Normal; low

17. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hypothyroidism
Strength of cell mediated immune response
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

18. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
MAO inhibitors; wine and cheese
Clindamycin; covers anaerobic oral flora and aerobic bacteria
When it invades the bm; carcinoma in situ
I is more benign and can present later in adulthood

19. What is 5- HETE and What does it do?
II; I (I more abundant)
Radial nerve and deep brachial artery
Leukotriene precursor and does neutrophil chemotaxis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

20. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
8 (myc protein) with 2 - 14 - 22 (iG chains)
AV node slowest - to allow time for diastole
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
To pump calcium out in cardiac myocytes so that relaxation occurs

21. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
(urine PAH x urine flow rate)/plasma PAH
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Minimal change disease

22. how can HAV be inactivated?
<1% - 55% - concentration dependent
Boiling - bleach - formalin - UV irradiation
Measles and M3 AML`
Increase lymphatic drainage!

23. What does TGF beta do? What produces it?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Fibrosis; macrophages

24. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Adeno
No and yes

25. What effects does cortisol have on catecholamines?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
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
(urine PAH x urine flow rate)/plasma PAH
Dihydropyridine sensitive Ca channels (L type)

26. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Regular insulin (Not fast acting - regular better)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Pulmonary hypertension

27. how does achalasia present? What does barium swallow show on dilated esophagus?
Anterior circumflex (and axillary nerve)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Ketone body production by preventing fatty acids into the mitochondria

28. why does hypothyroidism cause increased CPK levels?
Lateral; RV; RA; LV
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Abnormal closing of the urethral folds

29. What translocations can cause c - myc overexpression?
Amiloride - spironolactone - triamterene
Adductor
8 (myc protein) with 2 - 14 - 22 (iG chains)
Joints d/t increased purine production and thus uric acid production

30. In what population does cholelithiasis occur?
Fat - fertile - forty - female
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Highly negative resting potential
Because gamma chains replace beta chains and then gamma chain formation wanes

31. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Serum FFA and serum triglyceride levels

32. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Smoking
only up to bronchi
Susceptible; soluble (unable to be cultured in bile)
No

33. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Anterior nares
Bile salt accumulation in urine
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

34. what phase do adenosine and acetylcholine act on? doing what?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Octreotide
Localized dermatologic pain that persists for more than one month after zoster eruption

35. Which is slower AV node or ventricular muscle?
P53 mutation; AD
Squatting - sitting - lying supine - passive leg raising
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
AV node slowest - to allow time for diastole

36. What is the triad seen in pre eclampsia?
G to T in p53; HCC
Hypertension - edema - and proteinuria
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Pain reliever - reduces pain by locking substance P in the PNS

37. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Decreases both
Elevated GGT and macrocytosis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Insulin like growth factor 1 (just another name)

38. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Regular insulin (Not fast acting - regular better)
Recurrent larygneal
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

39. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
E. coli; staphylococcus saprophyticus
Echinococcus granulosus; anaphylaxis

40. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Headaches and facial flushing; vasodilation in meninges and skin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Localized dermatologic pain that persists for more than one month after zoster eruption

41. which two virus families have hemagluttinin on their surface?
hyponatremia (aldosterone activation equilibrates body volume)
Sydenham chorea
Paramyxo and influenza
Increase; decreased

42. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Cluster
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Adductor
Excessive collagen formation during tissue repair in susceptible individuals

43. Would alpha 1 agonists cause flushing? muscarinic antagonist?
low in serum
Think Hb deformation diseases
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
No; yes

44. what murmur is enhanced by decreased blood flow to the heart?
Bronchogenic carcinoma
Radial nerve damage
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
SVT; increases vagal tone; rectus abdominis

45. What does 'oxygen' content in blood refer to?
Boiling - bleach - formalin - UV irradiation
Superior larygeal; cricothyroid; recurrent laryngeal
Hypothyroidism
Dissolved in plasma and attached to Hgb

46. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Tissue redistribution (out of plasma) rather than metabolism
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
RBC mass; epo levels (secondary has high)
Smoking

47. What is Tzanck smear used to detect?
HSV and VZV
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
II; I (I more abundant)
Multiple miscarriages d/t hypercoaguability

48. What are the long term consequences of hydrocephalus?
MAC complex (C5b - C9 complement deficiency)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
FGF and VEGF
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

49. What does hypocapnia cause in teh brain? What is hypocapnia?
Fat - fertile - forty - female
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Insulin like growth factor 1 (just another name)
Standing suddenly from supine position; valsalva maneuver

50. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Reticulocytes
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
4 - 4 - 9