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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 a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Bile soluble which means they are bile sensitive
4 - 4 - 9
Hyperkalemia; potassium sparing diuretics - potassium supplements

2. What is an abortive viral infection?
liver specific
low in serum
Little effect on cell and no change
Sarcoid

3. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
E. coli
Downs; regurgitant AV valves - ASDs
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

4. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Chorda tympani branch
Atrial
HSV ( also in utero: chlymadia - neisseria - group B strep)

5. What is congestive hepatomegaly specific for?
No; yes
Primary
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Right heart failure

6. Where is conduction in heart fastest? slowest?
PDA open
Nonsense; mRNA processing
Purkinje system; AV node
CGD; t cell dysfxn (diGeorge)

7. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
GI tract; mood!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Prostate tumor and increased osteoclast activity
MAO inhibitors; wine and cheese

8. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
Aromatase deficiency in child
Hypertension - edema - and proteinuria
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

9. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Prevent phagocytosis
Bile soluble which means they are bile sensitive

10. what enzyme converts procarcinogens into carcinogens?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
P450 mitochondrial monooxygenase
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Syncope - angina - dyspnea (SAD)

11. What is the precursor protein to beta amyloid and On what chromosome is it found?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Myasthenia gravis
APP on chrom 21 (this is why downs more susceptible)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

12. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Hyperkalemia; potassium sparing diuretics - potassium supplements
P450 mitochondrial monooxygenase
Anti centromere; anti DNA topoisomerase
Mean greater than median greater than mode

13. What is gardeners mydriasis? How is it treated?
Pulmonic and systemic!
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Ig A deficiency

14. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Rabies encephalitis from cave bats; rabies killed vaccines
Insulin like growth factor 1 (just another name)
Anti - apoptotic (prevents going into apoptosis)- 18; 14
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

15. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
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
S. saprophyticus - and s. epidermidis; novobiocin

16. Where does 90% of serotonin lie? What is this NT responsible?
Raphe
GI tract; mood!
HSV ( also in utero: chlymadia - neisseria - group B strep)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

17. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Insulin like growth factor 1 (just another name)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Strength of cell mediated immune response

18. What is the presentation of angioedema? Where is most commonly affected?
Inactivates kallikrein which activates kininogen into bradykinin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Inhaled animal dander allergens
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

19. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Ig A deficiency
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Boiling - bleach - formalin - UV irradiation

20. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Inhaled animal dander allergens
P53 mutation; DCC is also required for adenoma to carcinoma
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
E. coli

21. carnitine deficiency impairs production of What and how?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Ketone body production by preventing fatty acids into the mitochondria
Anterior nares

22. after a thrombus extraction - what serum enzyme shoots up and why?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Serum creatine kinase; reperfusion injury causes necrosis
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

23. What is a cord factor and Which bugs have it? How do they appear on culture?
HSV and VZV
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Fat - fertile - forty - female
Relfex tachycardia; giving beta blockers

24. What is difference between Arnold Chiari type I and II?
Bronchial dilation (bronchiectasis)
indomethacin
Folic acid treatment!
I is more benign and can present later in adulthood

25. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Regular insulin (Not fast acting - regular better)
Hydrogen bonds dictate alpha or beta structure

26. What are examples of action that decrease venous return to the heart?
Medullary
Primary
Standing suddenly from supine position; valsalva maneuver
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

27. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
SVC and IVC; right below the aortic knob
I is more benign and can present later in adulthood
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

28. there are mucus secreting cells in the bronchioles...
Vagus (auricular branch); vasovagal syncope!
Susceptible; soluble (unable to be cultured in bile)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
only up to bronchi

29. What does C1 esterase do other than inhibiting complement pathway?
Folic acid treatment!
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Squatting - sitting - lying supine - passive leg raising
Inactivates kallikrein which activates kininogen into bradykinin

30. What type of endocarditis is cytoscopy induced?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Enterococci (e. faecalis)- found on genitalia area

31. What is pickwickian syndrome? What are the lab findings?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Insulin like growth factor 1 (just another name)
Radial nerve and deep brachial artery

32. a patient fearing all white coats is a phenomenon of what?
Rabies encephalitis from cave bats; rabies killed vaccines
High potassium conductance and some sodium conductance
Classical conditioning
Radial nerve damage

33. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
AV node slowest - to allow time for diastole
Vagus (auricular branch); vasovagal syncope!
Increase; decreased
Sarcoid

34. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Susceptible; soluble (unable to be cultured in bile)
MAO inhibitors; wine and cheese
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
E6 and E7 of HPV knock off p53 and Rb suppressor genes

35. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Highly negative resting potential
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Intussusception
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

36. which nucleus releases serotonin?
No; yes
Hypo or hyper pigmentations; after tanning
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Raphe

37. do Class IC agents prolong the QT interval?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ig A deficiency
Hypothyroidism
No

38. what clinical findings help distinguish small cell carcinoma?
Protamine sulfate
Increase by 50% in urine osmolality
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

39. what nerve and artery course along the posterior aspect of the humerus?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Kallmans
Radial nerve and deep brachial artery
Amiloride - spironolactone - triamterene

40. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
INTRApartum Abs (ampicillin/penicillin)
Around 70 (normal measured diastolic pressures); 9--
P53 mutation; DCC is also required for adenoma to carcinoma
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

41. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Retinitis; mononucleosis
Increase in permeability of two ions with equal and opposite equilibrium potentials

42. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
No (unlike adenomyosis); yes
Fat - fertile - forty - female
Turners`

43. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Purkinje system; AV node
hyponatremia (aldosterone activation equilibrates body volume)
Faulty positioning of the genital tubercle
Cluster

44. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Increased reticulocytes
Atrial
Proteasome inhibitor; treatment for MM and waldenstroms

45. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Standing suddenly from supine position; valsalva maneuver
RER; RER
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
RER; copper

46. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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
E. coli; staphylococcus saprophyticus
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

47. at one year of age - What are the social - fine motor - gross motor and language developments?
MAO inhibitors; wine and cheese
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Initiation - pointing; pincer grasp; walking; mama/dada
P53 mutation; AD

48. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

49. what immune deficiency causes recurrent neisseria infections?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Because of the low output from heart failure - they will have increased aldosterone levels
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
MAC complex (C5b - C9 complement deficiency)

50. h1 receptor anatagonists are not effective in treatment of asthma only for...
Increase lymphatic drainage!
chronic urticaria and allergic symptoms
8; 12
Another type of aldosterone antagonist (like spironolactone)