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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. carnitine deficiency impairs production of What and how?
chronic urticaria and allergic symptoms
Hereditary angioedema; ACE inhibitors
Ketone body production by preventing fatty acids into the mitochondria
SSRI; erectile dysfunction

2. What is the mainstay treatment for acute mania?
Highly negative resting potential
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
No; yes
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

3. nucleotide deletions do not cause missense mutations - they cause...
Reticulocytes
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
frameshift mutations (missense is substitution)
Biphosphonate

4. what vessel would a fracture to the neck of the of the humerus damage?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Tissue redistribution (out of plasma) rather than metabolism
Anterior circumflex (and axillary nerve)
Nocardia

5. What is an abortive viral infection?
Inhibits it
TCAs and prazosin
Little effect on cell and no change
Adeno

6. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
S3 gallop; S2 to opening snap interval
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
Bile soluble which means they are bile sensitive

7. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Retinitis; mononucleosis
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Right before diastole (filling begins)

8. What is best to prevent GBS infection in a baby?
MAC complex (C5b - C9 complement deficiency)
Adductor
Chlorpheniramine and diphenhydramine
INTRApartum Abs (ampicillin/penicillin)

9. What is pickwickian syndrome? What are the lab findings?
ZDV or AZT
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Insulin like growth factor 1 (just another name)

10. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
TCAs and prazosin
SVC and IVC; right below the aortic knob
Excessive collagen formation during tissue repair in susceptible individuals

11. How do you calculate atributable risk percent?
RR-1/RR
RBC mass; epo levels (secondary has high)
Varying; erythema nodosum is common
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

12. What is difference between Arnold Chiari type I and II?
MAO inhibitors; wine and cheese
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Insulin like growth factor 1 (just another name)
I is more benign and can present later in adulthood

13. which has better side effect profile - SSRI or TCA?
Curlings ulcers
SSRI
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Octreotide

14. What is the mutation type in thalassemias? what process is defective because of this?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
gram positive organisms
Nonsense; mRNA processing

15. when do ghon complexes form - primary or secondary TB?
Initiation - pointing; pincer grasp; walking; mama/dada
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Primary

16. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Spongiosis
RR-1/RR

17. What can too much IgA in serum produces?
ANCA because of lack of Ig and C3 deposits on IF
Underestimation of gestational age
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

18. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Single adenomatous ones
As a CO2 carrier with the carboxylase enzyme
Syringomelia

19. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Ig A deficiency
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
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

20. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
46 - 4N; 23 2N
Phencyclidine (PCP)
Measure of depth invasion (vertical!)

21. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Kallmans
Pulmonic and systemic!
Neisseria induced small cell vasculitis (including hands and soles)

22. what hormone is structurally similar to hCG?
Barium enema
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
TSh (in testicular tumors can cause hyperthyroidism)
Trochlear nerve (IV); abducens nerve (VI)

23. What type of bond is a disulfide bond?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Covalent (between two cysteines)- allows protein to withstand denaturation
Vagus nerve stimulation

24. after a thrombus extraction - what serum enzyme shoots up and why?
Serum creatine kinase; reperfusion injury causes necrosis
Leukotriene precursor and does neutrophil chemotaxis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
APP on chrom 21 (this is why downs more susceptible)

25. Which is faster purkinje system or atrial muscle?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Reiter syndrome; B27
Close but purkinje system to ensure contraction in a bottom up fashion
Vancomycin; histamine mediated

26. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Rabies encephalitis from cave bats; rabies killed vaccines
Drug induced interstitial nephritis

27. PDAs are often asymptomatic. How do you treat?
Another type of aldosterone antagonist (like spironolactone)
Closer to head; closer to diaphragm
Pan colitis and right sided colitis (more than left sided and proctitis)
indomethacin

28. What type of endocarditis is cytoscopy induced?
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
Insulin like growth factor 1 (just another name)
Amiadarone
Enterococci (e. faecalis)- found on genitalia area

29. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
LT (LTD4 - E4 - C4) - and Ach
Insulin like growth factor 1 (just another name)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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

30. What is Bortezomib and What is it used for?
Terminal bronchioles; small bronchi
Proteasome inhibitor; treatment for MM and waldenstroms
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

31. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
Medial part
MAC complex (C5b - C9 complement deficiency)
Nocardia

32. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Brief psychotic disorder; schizophreniform; schizophrenia
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Another type of aldosterone antagonist (like spironolactone)
Think Hb deformation diseases

33. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Increase; decreased
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
Inhibits it

34. What is the difference between additive and synergistic?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
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
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
TSh (in testicular tumors can cause hyperthyroidism)

35. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Sickle cell; G6PD
Diabetic microangiopathy
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

36. what protein is increased in Crohns disease? What does it do?
Measure of depth invasion (vertical!)
NF- KB; responsible for cytokine production
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
11

37. What causes release of myosin head from the actin filament?
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)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
ATP binding (resets the myosin head to contract again for next binding)
Retinitis; mononucleosis

38. What is achalasia and how would this correlate on the esophageal mannometry?
RBC mass; epo levels (secondary has high)
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
Hydrogen bonds dictate alpha or beta structure
Chlorpheniramine and diphenhydramine

39. What is the mcc of elevated AFP leves in pregnancy>
Not lined by epithelium
Increases
Underestimation of gestational age
Increases bronchial and vascular smooth muscle reactivity to catecholamines

40. What type of disease has selective proteinuria? What is found in urine? What is not?
Fat - fertile - forty - female
hyponatremia (aldosterone activation equilibrates body volume)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Trochlear nerve (IV); abducens nerve (VI)

41. what drug is useful for secretory diarrhea?
Ketone body production by preventing fatty acids into the mitochondria
Medial circumflex artery; avascular necrosis
Octreotide
ZDV or AZT

42. what chromosome is c - myc found on?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Chrom 8
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
AV node slowest - to allow time for diastole

43. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Because gamma chains replace beta chains and then gamma chain formation wanes
Sarcoid
Apocrine; eccrine

44. How do you treat gonococcal infection? chlymadia?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
S. aureus
Ceftriaxone; azithromycin
Bile soluble which means they are bile sensitive

45. Metronidizaole does not cover...
Well trained athletes and children
gram positive organisms
Radial nerve and deep brachial artery
Intussusception

46. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
liver specific
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Inactivates kallikrein which activates kininogen into bradykinin

47. What is the immune deficinecy seen in ataxia telangactasia?
Barium enema
Right before diastole (filling begins)
Ig A deficiency
Folic acid treatment!

48. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Both sides
Bile soluble which means they are bile sensitive
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

49. within the right ventricle - What are maximum pressures? the pulm arter?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Squatting - sitting - lying supine - passive leg raising
25; 25
SaO2 <92%

50. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Anti cholinergic effects of pupil dilation and lack of accomodation
Highly negative resting potential