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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 is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
No
S. saprophyticus - and s. epidermidis; novobiocin
Vertical diplopia
Thymic tumor

2. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Echinococcus granulosus; anaphylaxis

3. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Abnormal closing of the urethral folds
Squatting - sitting - lying supine - passive leg raising

4. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Curlings ulcers
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
E. coli; staphylococcus saprophyticus

5. What does extended consumption of appetite suppressants lead to?
Multiple miscarriages d/t hypercoaguability
Southern - western
G to T in p53; HCC
Pulmonary hypertension

6. How is dobutamine better than dopamine?
Insulin like growth factor 1 (just another name)
Recurrent larygneal
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
SSRI

7. What are the three dopaminergic systems and What are they responsible for? disease?
Phencyclidine (PCP)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
In the extracellular space
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

8. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

9. what kind of drug is sertraline? What is a common side effect?
Measles and M3 AML`
Hydrogen bonds dictate alpha or beta structure
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
SSRI; erectile dysfunction

10. at three years of age What are social - fine motor - gross motor and language developments?
Sarcoid
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

11. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Measles and M3 AML`
Kallmans
Right heart failure

12. What translocations can cause c - myc overexpression?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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
Hexokinase
8 (myc protein) with 2 - 14 - 22 (iG chains)

13. how can HAV be inactivated?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Boiling - bleach - formalin - UV irradiation
FGF and VEGF

14. Where does terminal peptide cleavage of collagen fibrils take place?
Serum FFA and serum triglyceride levels
V fib; v. failure
Faulty positioning of the genital tubercle
In the extracellular space

15. Which is faster atrial muscle or ventricular muscle?
Normal; low
Atrial
Bronchial dilation (bronchiectasis)
Increases

16. what commonly happens in GI in response to acute physiologic stress?
Acute gastric mucosal defects (superficial or full thickness)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Barium enema
Biphosphonate

17. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Coagulation factors are made in the liver
To pump calcium out in cardiac myocytes so that relaxation occurs
Raphe

18. which opponens muscle does ulnar innervate?
Around 70 (normal measured diastolic pressures); 9--
Adductor
Multiple miscarriages d/t hypercoaguability
Pain reliever - reduces pain by locking substance P in the PNS

19. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Primary
Headaches and facial flushing; vasodilation in meninges and skin
Because of vasodiation to skeletal muscles
Closer to head; closer to diaphragm

20. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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
Fibronectin - laminin - collagen
Standing suddenly from supine position; valsalva maneuver

21. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

22. What is capacitance inversely proportional to?
MAC complex (C5b - C9 complement deficiency)
Sarcoid
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Elastance

23. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
P53 mutation; AD
Fibrosis; macrophages

24. What is the fibrinogen level in patient with TTP- HUS? DIC?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
SaO2 <92%
...
Normal; low

25. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
LT (LTD4 - E4 - C4) - and Ach
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Spongiosis

26. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Trochlear nerve (IV); abducens nerve (VI)
Insulin like growth factor 1 (just another name)
Prepatellar
When it invades the bm; carcinoma in situ

27. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

28. What is diagnostic (and possible therapeutic for intussusception)?
Elevated GGT and macrocytosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Barium enema
Measles and M3 AML`

29. who bleed more DIC or TTP- HUS patients?
Increases cytokine production
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
200-500
DIC; TTP- HUS dont bleed that much

30. what dissolves the lipid bilayer of a viral envelope?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Insulin like growth factor 1 (just another name)
No (unlike adenomyosis); yes
Ether and other organic solvents

31. in overweight individuals What is thought to contribute to insulin resistance?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Serum FFA and serum triglyceride levels
liver specific

32. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
RER; copper
(urine PAH x urine flow rate)/plasma PAH

33. if there are keratin swirls does that mean well or poorly differentiated?
Vancomycin
As a CO2 carrier with the carboxylase enzyme
ATP binding (resets the myosin head to contract again for next binding)
Well

34. What type of bond is a disulfide bond?
RER; copper
Covalent (between two cysteines)- allows protein to withstand denaturation
gram positive organisms
frameshift mutations (missense is substitution)

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

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36. Which is slower AV node or ventricular muscle?
Cluster
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
GI tract; mood!
AV node slowest - to allow time for diastole

37. What is used to prevent vertical transmission of HIV?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
differentiate
Inhibits it
ZDV or AZT

38. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
The term used to describe decreased drug responsiveness with repeated administration
Leukotriene precursor and does neutrophil chemotaxis
4 - 4 - 9

39. What causes wrist drop?
Measles and M3 AML`
Elevated GGT and macrocytosis
Because of the low output from heart failure - they will have increased aldosterone levels
Radial nerve damage

40. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Adductor
Not lined by epithelium
4 - 4 - 9

41. there are mucus secreting cells in the bronchioles...
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
46 - 4N; 23 2N
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
only up to bronchi

42. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
S. saprophyticus - and s. epidermidis; novobiocin
In the extracellular space for collagen cross linking; zinc
glycerol kinase

43. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
CGD; t cell dysfxn (diGeorge)
Valproate
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

44. What are two indicators of chronic alcohol consumption?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
differentiate
Elevated GGT and macrocytosis

45. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Sarcoid
Proteasome inhibitor; treatment for MM and waldenstroms
Raphe

46. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Ig A deficiency
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Squatting - sitting - lying supine - passive leg raising

47. What does nitroprusside do to afterload? preload?
Decreases both
FGF and VEGF
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Highly negative resting potential

48. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Smoking
Leukotriene precursor and does neutrophil chemotaxis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Bronchial dilation (bronchiectasis)

49. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Vagus nerve stimulation
RER; RER
AV node slowest - to allow time for diastole
Coagulation factors are made in the liver

50. What are the potassium sparing diuretics?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Amiloride - spironolactone - triamterene
No; yes
Standing suddenly from supine position; valsalva maneuver

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USMLE Prep 2

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