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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 are two common side effects of both acute and long acting nitrates? What causes them?
P53 mutation; DCC is also required for adenoma to carcinoma
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Headaches and facial flushing; vasodilation in meninges and skin

2. What does TGF beta do? What produces it?
Fibrosis; macrophages
SSRI; erectile dysfunction
Radial nerve and deep brachial artery
Regular insulin (Not fast acting - regular better)

3. biotin is used By what in tissues responsible for gluconeogenesis
...
As a CO2 carrier with the carboxylase enzyme
Increases bronchial and vascular smooth muscle reactivity to catecholamines
ZDV or AZT

4. what makes bruits?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vagus (auricular branch); vasovagal syncope!
Increases cytokine production
Turbulence

5. why does variocele occur more in left side?
Purkinje system; AV node
Increase in permeability of two ions with equal and opposite equilibrium potentials
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Strength of cell mediated immune response

6. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Decreases both
Highly negative resting potential
Apocrine; eccrine

7. what protein is increased in Crohns disease? What does it do?
Enterococci (e. faecalis)- found on genitalia area
DIC; TTP- HUS dont bleed that much
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
NF- KB; responsible for cytokine production

8. What is the cause of rapid plasma decay of thiopental?
Think Hb deformation diseases
Tissue redistribution (out of plasma) rather than metabolism
Sarcoid
To pump calcium out in cardiac myocytes so that relaxation occurs

9. on which chromosome is wilms tumor found?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
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
11

10. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Headaches and facial flushing; vasodilation in meninges and skin
Because of vasodiation to skeletal muscles
Medial circumflex artery; avascular necrosis

11. 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?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
46 - 4N; 23 2N
Vancomycin; histamine mediated

12. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Turners`
HSV ( also in utero: chlymadia - neisseria - group B strep)
differentiate

13. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Radial nerve and deep brachial artery
Leukotriene precursor and does neutrophil chemotaxis
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Inhibits it

14. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
APP on chrom 21 (this is why downs more susceptible)
Diabetic microangiopathy
Folic acid treatment!
Increase; decreased

15. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
25; 25
Fibronectin - laminin - collagen
Measure of depth invasion (vertical!)
Echinococcus granulosus; anaphylaxis

16. What is the difference between additive and synergistic?
Abnormal closing of the urethral folds
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
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
Insulin like growth factor 1 (just another name)

17. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

18. What antibodies are present in CREST? What is the most specific?
Around 70 (normal measured diastolic pressures); 9--
Anti centromere; anti DNA topoisomerase
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Purkinje system; AV node

19. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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20. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
SaO2 <92%
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Increased reticulocytes
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

21. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

22. what hernia has a similar mechanism to hydrocele?
Increase lymphatic drainage!
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
11
Syringomelia

23. what bursa is affected when on knees like a maid/gardner?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Fibrosis; macrophages
Trochlear nerve (IV); abducens nerve (VI)
Prepatellar

24. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Intussusception
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
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
TCAs and prazosin

25. What causes wrist drop?
Radial nerve damage
Drink plenty of fluids
Close but purkinje system to ensure contraction in a bottom up fashion
Duration and extent of disease

26. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
Increase by 50% in urine osmolality
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

27. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Vagus (auricular branch); vasovagal syncope!
Vertical diplopia
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

28. What test would be best to determine if a gene is being transcribed? translated?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
G to T in p53; HCC
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Southern - western

29. what protects the resting heart from arrhythmias?
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
Fibronectin - laminin - collagen
Minimal change disease
Highly negative resting potential

30. How do left sided colon adenocarcinomas present? right sided?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
No
Susceptible; soluble (unable to be cultured in bile)
Tibial

31. where are Beta 1 receptors found?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Duration and extent of disease
On cardiac tissue and renal juxtaglomerular cells

32. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Demargination of neutrophils from the vessel walls
Hyperkalemia; potassium sparing diuretics - potassium supplements
Lateral; RV; RA; LV
Radial nerve damage

33. What is extraocular muscle weakness a common symptom of?
Large stroke volumes with ventricular contraction; aortic regurg
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Myasthenia gravis
No

34. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
Both sides
SaO2 <92%
Class I

35. what clinical findings help distinguish small cell carcinoma?
Selective alpha 1 (increases SVR)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Standing suddenly from supine position; valsalva maneuver
(urine PAH x urine flow rate)/plasma PAH

36. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Increase by 50% in urine osmolality
HSV and VZV
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Bile soluble which means they are bile sensitive

37. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
When it invades the bm; carcinoma in situ
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
OCPs - multiparity - breast feeding
Nocardia

38. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Regular insulin (Not fast acting - regular better)
8 (myc protein) with 2 - 14 - 22 (iG chains)
Ig A deficiency

39. What are the two coagulase negative staphylococci? How do you distinguish them?
HSV ( also in utero: chlymadia - neisseria - group B strep)
S. saprophyticus - and s. epidermidis; novobiocin
Close but purkinje system to ensure contraction in a bottom up fashion
Covalent (between two cysteines)- allows protein to withstand denaturation

40. Acyl coA synthetase is not...
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
liver specific

41. how does neisseria cause a petechial rash?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
No; MRI
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Neisseria induced small cell vasculitis (including hands and soles)

42. why are pregnant predisposed to cholelithiasis?
Insulin like growth factor 1 (just another name)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
RER; copper
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

43. What does p53 do? what chrom is it on?
T test; chi squared
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Ether and other organic solvents
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

44. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
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
Medial part
Hypothyroidism

45. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Joints d/t increased purine production and thus uric acid production
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
ATP binding (resets the myosin head to contract again for next binding)
Paramyxo and influenza

46. What is capacitance inversely proportional to?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Relfex tachycardia; giving beta blockers
Elastance
Neisseria induced small cell vasculitis (including hands and soles)

47. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Curlings ulcers
Fibrosis; macrophages
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

48. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
differentiate
E. coli; staphylococcus saprophyticus
Increased reticulocytes
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

49. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Demargination of neutrophils from the vessel walls
Highly negative resting potential
liver specific
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

50. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Rabies encephalitis from cave bats; rabies killed vaccines
P53 mutation; AD
transcription activation/suppression
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

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