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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 causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Ceftriaxone; azithromycin
Inhibits it
Increases
Become beta pleated and then form neurofibrillary tangle!

2. What is cataplexy and When is it seen?
RR-1/RR
Skin flushing and warmth; prostaglandins; give with aspirin
Acute interstitial nephritis
Sudden loss of muscle tone without loss of consciousness; narcolepsy

3. What type of bond is a disulfide bond?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Downs; regurgitant AV valves - ASDs
Covalent (between two cysteines)- allows protein to withstand denaturation
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

4. nucleotide deletions do not cause missense mutations - they 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
Echinococcus granulosus; anaphylaxis
frameshift mutations (missense is substitution)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

5. What is epleronone?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Another type of aldosterone antagonist (like spironolactone)
Syncope - angina - dyspnea (SAD)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

6. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Nonsense; mRNA processing
No; MRI
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Underestimation of gestational age

7. What is capsaicin? Where does it work?
Downs; regurgitant AV valves - ASDs
Reiter syndrome; B27
Pain reliever - reduces pain by locking substance P in the PNS
Localized dermatologic pain that persists for more than one month after zoster eruption

8. at four years of age - What are the social - fine motor - gross motor - and language developments?
Ceftriaxone; azithromycin
liver specific
Right heart failure
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

9. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
8; 12
SSRI; erectile dysfunction
differentiate
Increases cytokine production

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

11. What is the mcc of elevated AFP leves in pregnancy>
Become beta pleated and then form neurofibrillary tangle!
Gluteus medius and minimus; positive trendelenberg
Underestimation of gestational age
Faulty positioning of the genital tubercle

12. why does liver dysfunction cause coagulation disorders?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Coagulation factors are made in the liver
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
Reiter syndrome; B27

13. What is used to treat heparin toxicity?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Single adenomatous ones
Relfex tachycardia; giving beta blockers
Protamine sulfate

14. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
SVT; increases vagal tone; rectus abdominis
Fibrosis; macrophages
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

15. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Ether and other organic solvents
Prevents hepatic VLDL production

16. a patient fearing all white coats is a phenomenon of what?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Classical conditioning
I is more benign and can present later in adulthood

17. which are the only glycosylated proteins in HIV virus?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
GI tract; mood!
Env genes (for getting into target cells)
Serum FFA and serum triglyceride levels

18. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Inhaled animal dander allergens
Standing suddenly from supine position; valsalva maneuver
C3 decreased after 5-10 days; sulfonamides
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)

19. What are some side effects seen in TCAs?
200-500
Increase in permeability of two ions with equal and opposite equilibrium potentials
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

20. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
G to T in p53; HCC
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fat - fertile - forty - female
Because of the low output from heart failure - they will have increased aldosterone levels

21. What is achalasia and how would this correlate on the esophageal mannometry?
Bile salt accumulation in urine
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
As a CO2 carrier with the carboxylase enzyme
SaO2 <92%

22. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
Chorda tympani branch
Anterior nares
Multiple miscarriages d/t hypercoaguability

23. What is subacute sclerosisng encephalitis caused by?
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Increase by 50% in urine osmolality
Barium enema
Tzanck smear

24. What does prolonged PT indicated? aPTT? bleeding time?
RR-1/RR
T test; chi squared
Extrinsic def; instrinsic def; platelet def
Elevated GGT and macrocytosis

25. What is an abortive viral infection?
Little effect on cell and no change
Ether and other organic solvents
Trauma to stereociliated hair cells of the organ of corti
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

26. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Not lined by epithelium
No and yes

27. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Sarcoid
Sickle cell; G6PD
E. coli; staphylococcus saprophyticus

28. What is suggestive of complete central DI?
Increase; decreased
Increase by 50% in urine osmolality
Neisseria induced small cell vasculitis (including hands and soles)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

29. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Pan colitis and right sided colitis (more than left sided and proctitis)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Insulin like growth factor 1 (just another name)
Vagus (auricular branch); vasovagal syncope!

30. what dictates the resting membrane potential of most cells?
MAC complex (C5b - C9 complement deficiency)
High potassium conductance and some sodium conductance
S3 gallop; S2 to opening snap interval
Pan colitis and right sided colitis (more than left sided and proctitis)

31. What is difference between Arnold Chiari type I and II?
E. coli
I is more benign and can present later in adulthood
Insulin like growth factor 1 (just another name)
APP on chrom 21 (this is why downs more susceptible)

32. What is capacitance inversely proportional to?
Leukotriene precursor and does neutrophil chemotaxis
In the extracellular space
Abnormal closing of the urethral folds
Elastance

33. which nucleus releases serotonin?
No (unlike adenomyosis); yes
Raphe
Chrom 8
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

34. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
P53 mutation; AD
Decreases both

35. What does sustained hand grip do to the C/V system?
Selective alpha 1 (increases SVR)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Boiling - bleach - formalin - UV irradiation

36. is Rifampin ever used as monotherapY? why either way?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Turbulence
MAC complex (C5b - C9 complement deficiency)
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

37. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
Inactivates kallikrein which activates kininogen into bradykinin
Pan colitis and right sided colitis (more than left sided and proctitis)
Smoking

38. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Hypertension - edema - and proteinuria

39. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Downs; regurgitant AV valves - ASDs
MAO inhibitors; wine and cheese
Insulin like growth factor 1 (just another name)

40. What is the most common neurologic complication of VZV reactivation?
ANCA because of lack of Ig and C3 deposits on IF
Become beta pleated and then form neurofibrillary tangle!
Localized dermatologic pain that persists for more than one month after zoster eruption
Barium enema

41. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
200-500
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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

42. What is omalizumab and What is it used for?
Prevent phagocytosis
11 aa polypeptide; pain NT in CNS and PNS
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
AV node slowest - to allow time for diastole

43. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
MAO inhibitors; wine and cheese
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Increases cytokine production

44. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
gram positive organisms
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Anti cholinergic effects of pupil dilation and lack of accomodation
Think Hb deformation diseases

45. which cells produce surfactant? which ones mediate gas exchange?
Hypo or hyper pigmentations; after tanning
Decreases both
DIC; TTP- HUS dont bleed that much
II; I (I more abundant)

46. What is a clara cell?
Inhibits it
Prevents hepatic VLDL production
Vagus (auricular branch); vasovagal syncope!
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

47. What can cause virilization of a mother during pregnancy?
Regular insulin (Not fast acting - regular better)
Inhibits it
Aromatase deficiency in child
chronic urticaria and allergic symptoms

48. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Paramyxo and influenza
Hydrogen bonds dictate alpha or beta structure
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

49. What is acanthosis nigricans associated with?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Amiloride - spironolactone - triamterene
LT (LTD4 - E4 - C4) - and Ach
GI malignancies and Insulin resistance (acromegal for ex)

50. how much percent of sodium is excreted? urea? glucose?
<1% - 55% - concentration dependent
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
TCAs and prazosin
SaO2 <92%