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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Anti centromere; anti DNA topoisomerase
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
Measles and M3 AML`
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

2. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
High potassium conductance and some sodium conductance
CGD; t cell dysfxn (diGeorge)
Normally close to systolic
Become beta pleated and then form neurofibrillary tangle!

3. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Phencyclidine (PCP)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
S. saprophyticus - and s. epidermidis; novobiocin
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

4. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
women
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Underestimation of gestational age

5. What is used to treat heparin toxicity?
Protamine sulfate
Southern - western
Recurrent larygneal
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

6. within the right ventricle - What are maximum pressures? the pulm arter?
SS +rNA
25; 25
E. coli; staphylococcus saprophyticus
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

7. What is the mc manifestation of CMV in HIV patient? immunocompetent?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
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
Spongiosis
Retinitis; mononucleosis

8. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
low in serum
Hydrogen bonds dictate alpha or beta structure

9. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
INTRApartum Abs (ampicillin/penicillin)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Rabies encephalitis from cave bats; rabies killed vaccines

10. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Vertical diplopia
Radial nerve and deep brachial artery

11. sporadic colon cancer tend to arise From what type of polyps?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Bile salt accumulation in urine
Single adenomatous ones
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

12. What pulmonary structural change can kartageners syndrome cause?
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Myasthenia gravis
Bronchial dilation (bronchiectasis)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

13. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Amiloride - spironolactone - triamterene
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Varying; erythema nodosum is common

14. a patient fearing all white coats is a phenomenon of what?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
II; I (I more abundant)
Classical conditioning
Pulmonic and systemic!

15. What are three symptoms in s.typhi?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Proteasome inhibitor; treatment for MM and waldenstroms
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

16. What does the tuberoinfundibular pathway connect? What is it responsible for?
RBC mass; epo levels (secondary has high)
Appetite suppressants
RR-1/RR
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

17. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Hyperkalemia; potassium sparing diuretics - potassium supplements
Right heart failure

18. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
No (unlike adenomyosis); yes
Insulin like growth factor 1 (just another name)
Turners`

19. What does p53 do? what chrom is it on?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Little effect on cell and no change

20. in overweight individuals What is thought to contribute to insulin resistance?
Drug induced interstitial nephritis
Diabetic microangiopathy
Serum FFA and serum triglyceride levels
Prevents hepatic VLDL production

21. name three pathological states that present with large tongues.
Sickle cell; G6PD
Congenital hypothyroidism - downs - amyloidosis - acromegaly
E. coli; staphylococcus saprophyticus
Myasthenia gravis

22. what hormone is structurally similar to hCG?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
TSh (in testicular tumors can cause hyperthyroidism)
RBC mass; epo levels (secondary has high)
frameshift mutations (missense is substitution)

23. when do ghon complexes form - primary or secondary TB?
Primary
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Serum FFA and serum triglyceride levels
Atrial

24. PDAs are often asymptomatic. How do you treat?
Common peroneal; bony fractures and compression; sciatic
indomethacin
P450 mitochondrial monooxygenase
Prostate tumor and increased osteoclast activity

25. What causes release of myosin head from the actin filament?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
ATP binding (resets the myosin head to contract again for next binding)
Adeno

26. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Large stroke volumes with ventricular contraction; aortic regurg
Skin flushing and warmth; prostaglandins; give with aspirin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

27. which trisomy is associated with endocardial cushion defects? What does thsi mean>
RBF= PAH clearance/(1- hematocrit)
Downs; regurgitant AV valves - ASDs
SS +rNA
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

28. What is diagnostic (and possible therapeutic for intussusception)?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Barium enema
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Rabies encephalitis from cave bats; rabies killed vaccines

29. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
4 - 4 - 9
E. coli; staphylococcus saprophyticus
Sickle cell; G6PD
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

30. what bursa is affected when on knees like a maid/gardner?
Hereditary angioedema; ACE inhibitors
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Prepatellar
Spongiosis

31. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Sarcoid
11
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

32. why is crohns disease associated with oxaloacetate kidney stones?
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Selective alpha 1 (increases SVR)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

33. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
When it invades the bm; carcinoma in situ
Hypo or hyper pigmentations; after tanning
CGD; t cell dysfxn (diGeorge)

34. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
ANCA because of lack of Ig and C3 deposits on IF
T test; chi squared
Acute interstitial nephritis

35. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Inhaled animal dander allergens
Hereditary angioedema; ACE inhibitors
Hydrogen bonds dictate alpha or beta structure

36. on which chromosome is wilms tumor found?
11
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
SVC and IVC; right below the aortic knob
S3 gallop; S2 to opening snap interval

37. what defines hypoxemia?
Because gamma chains replace beta chains and then gamma chain formation wanes
SaO2 <92%
No; yes
APP on chrom 21 (this is why downs more susceptible)

38. What type of endocarditis is cytoscopy induced?
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)
Headaches and facial flushing; vasodilation in meninges and skin
Enterococci (e. faecalis)- found on genitalia area
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

39. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Class I
Valproate
SVT; increases vagal tone; rectus abdominis

40. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Elastance
Pulmonic and systemic!
Minimal change disease

41. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Gluteus maximus; difficulty getting up from seated position and climbing chair
MAO inhibitors; wine and cheese

42. How do bradykinin - C3a and C5a cause edema?
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
Bronchogenic carcinoma
By vascular permeability and vasodilation

43. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Regular insulin (Not fast acting - regular better)
Selective alpha 1 (increases SVR)
Decreases both
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

44. What are the two coagulase negative staphylococci? How do you distinguish them?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Protamine sulfate
S. saprophyticus - and s. epidermidis; novobiocin
Hereditary angioedema; ACE inhibitors

45. what marker should be followed in a patient with cirrhosis?
GI malignancies and Insulin resistance (acromegal for ex)
Raphe
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

46. What is the difference between additive and synergistic?
Abnormal closing of the urethral folds
ATP binding (resets the myosin head to contract again for next binding)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
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

47. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

48. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Purkinje system; AV node
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Protamine sulfate

49. What does hypocapnia cause in teh brain? What is hypocapnia?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Thymic tumor

50. at one year of age - What are the social - fine motor - gross motor and language developments?
chronic urticaria and allergic symptoms
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
Decreases both
Initiation - pointing; pincer grasp; walking; mama/dada

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USMLE Prep 2

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