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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 cell surface marker seen in liver angiosarcoma?
Demargination of neutrophils from the vessel walls
Large stroke volumes with ventricular contraction; aortic regurg
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

2. where are the two classical places that the ulnar nerve can be injured?

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3. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
E. coli; staphylococcus saprophyticus
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

4. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
To pump calcium out in cardiac myocytes so that relaxation occurs
Because gamma chains replace beta chains and then gamma chain formation wanes

5. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Amiloride - spironolactone - triamterene
Vagus (auricular branch); vasovagal syncope!
Skin flushing and warmth; prostaglandins; give with aspirin

6. What is the best indicator for the severity of mitral stenosis?
APP on chrom 21 (this is why downs more susceptible)
HSV and VZV
Pain reliever - reduces pain by locking substance P in the PNS
The time interval between S2 and OS- the shorter the interval - the more intense

7. which RPGN is also called pauci immune GN? why?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
The time interval between S2 and OS- the shorter the interval - the more intense
As a CO2 carrier with the carboxylase enzyme
ANCA because of lack of Ig and C3 deposits on IF

8. What does anti phospholipid syndrome in SLE patients predispose them to?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Covalent (between two cysteines)- allows protein to withstand denaturation
indomethacin
Multiple miscarriages d/t hypercoaguability

9. What is the triad seen in pre eclampsia?
Acute interstitial nephritis
Hypertension - edema - and proteinuria
Reiter syndrome; B27
ATP binding (resets the myosin head to contract again for next binding)

10. other than in pyelonephritis - where else are WBC casts seen?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Acute interstitial nephritis
Single adenomatous ones
Terminal bronchioles; small bronchi

11. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
RER; RER
Hexokinase
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
HSV ( also in utero: chlymadia - neisseria - group B strep)

12. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
E. coli
liver specific

13. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
<1% - 55% - concentration dependent
The time interval between S2 and OS- the shorter the interval - the more intense
RBF= PAH clearance/(1- hematocrit)
Reiter syndrome; B27

14. What causes release of myosin head from the actin filament?
HSV ( also in utero: chlymadia - neisseria - group B strep)
ATP binding (resets the myosin head to contract again for next binding)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

15. what marker should be followed in a patient with cirrhosis?
To pump calcium out in cardiac myocytes so that relaxation occurs
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Thymic tumor
11 aa polypeptide; pain NT in CNS and PNS

16. What is pickwickian syndrome? What are the lab findings?
In the extracellular space for collagen cross linking; zinc
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

17. what protects the resting heart from arrhythmias?
Highly negative resting potential
Tissue redistribution (out of plasma) rather than metabolism
indomethacin
8 (myc protein) with 2 - 14 - 22 (iG chains)

18. What type of mutation does aflatoxin cause? what cancer does this increase for?
SVC and IVC; right below the aortic knob
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
G to T in p53; HCC
Syncope - angina - dyspnea (SAD)

19. What does prolonged PT indicated? aPTT? bleeding time?
frameshift mutations (missense is substitution)
Ig A deficiency
Covalent (between two cysteines)- allows protein to withstand denaturation
Extrinsic def; instrinsic def; platelet def

20. What is gardeners mydriasis? How is it treated?
Adductor
Skin flushing and warmth; prostaglandins; give with aspirin
Tissue redistribution (out of plasma) rather than metabolism
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

21. What type of vision is myopia? In What type of patients does it improve?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
8; 12
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
PDA open

22. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
No and yes
Fat - fertile - forty - female
11

23. What is the mutation type in thalassemias? what process is defective because of this?
Dissolved in plasma and attached to Hgb
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Nonsense; mRNA processing

24. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
RBC mass; epo levels (secondary has high)
In the extracellular space
transcription activation/suppression

25. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Radial nerve and deep brachial artery
Abnormal closing of the urethral folds
Syncope - angina - dyspnea (SAD)

26. What is the difference between additive and synergistic?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
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
No

27. Where is the base of the heart? apex?
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)
Closer to head; closer to diaphragm
Increase in permeability of two ions with equal and opposite equilibrium potentials
Inactivates kallikrein which activates kininogen into bradykinin

28. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
gram positive organisms
Lateral; RV; RA; LV
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

29. What is used to compare means? categorical outcomes?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
T test; chi squared
Superior larygeal; cricothyroid; recurrent laryngeal

30. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Pulmonic and systemic!
Inactivates kallikrein which activates kininogen into bradykinin
Purkinje system; AV node
RBC mass; epo levels (secondary has high)

31. what hormone is structurally similar to hCG?
Lateral; RV; RA; LV
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
TSh (in testicular tumors can cause hyperthyroidism)
Brief psychotic disorder; schizophreniform; schizophrenia

32. What is a keloid?
Pain reliever - reduces pain by locking substance P in the PNS
Excessive collagen formation during tissue repair in susceptible individuals
When it invades the bm; carcinoma in situ
Around 70 (normal measured diastolic pressures); 9--

33. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Pulmonic and systemic!
Medial circumflex artery; avascular necrosis
E. coli
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

34. at one year of age - What are the social - fine motor - gross motor and language developments?
Serum creatine kinase; reperfusion injury causes necrosis
Hyperkalemia; potassium sparing diuretics - potassium supplements
Sydenham chorea
Initiation - pointing; pincer grasp; walking; mama/dada

35. what makes bruits?
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
Turbulence
Varying; erythema nodosum is common
Normal; low

36. which cells produce surfactant? which ones mediate gas exchange?
Think Hb deformation diseases
II; I (I more abundant)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

37. what has the greatest effect on prognosis when treating c. diptheriae?
In ER of bile canaliculi
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
ZDV or AZT
(urine PAH x urine flow rate)/plasma PAH

38. What is the sole neurologic manifestation of acute rheumatic fever?
4 - 4 - 9
Reiter syndrome; B27
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Sydenham chorea

39. Acyl coA synthetase is not...
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
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
liver specific
Common peroneal; bony fractures and compression; sciatic

40. ___________ is liver specific
MAC complex (C5b - C9 complement deficiency)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
glycerol kinase

41. How can renal blood flow be calculated from RPF?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Increases
Dissolved in plasma and attached to Hgb
RBF= PAH clearance/(1- hematocrit)

42. How do you explain the selective proteinuria of loss to albumin only in MCD?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Class I
Syringomelia

43. how does increased ICP result in curlings ulcers?
Hereditary angioedema; ACE inhibitors
Vagus (auricular branch); vasovagal syncope!
Vagus nerve stimulation
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

44. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Phencyclidine (PCP)
P53 mutation; AD
Another type of aldosterone antagonist (like spironolactone)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

45. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Hydrogen bonds dictate alpha or beta structure
Inactivates kallikrein which activates kininogen into bradykinin
Pain reliever - reduces pain by locking substance P in the PNS

46. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Gluteus medius and minimus; positive trendelenberg
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

47. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Bile soluble which means they are bile sensitive
Sarcoid
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

48. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Squatting - sitting - lying supine - passive leg raising
Large stroke volumes with ventricular contraction; aortic regurg
IgE
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

49. What is Tzanck smear used to detect?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Elastance
Increased reticulocytes
HSV and VZV

50. 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?
Normally close to systolic
Medullary
Apocrine; eccrine
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)