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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 does C1 esterase do other than inhibiting complement pathway?
Hydrogen bonds dictate alpha or beta structure
Raphe
Southern - western
Inactivates kallikrein which activates kininogen into bradykinin

2. 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
Regular insulin (Not fast acting - regular better)
Tibial
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

3. What type of calcium channels dictate the plateau in cardiac myocyte?
Kallmans
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
E. coli; staphylococcus saprophyticus
Dihydropyridine sensitive Ca channels (L type)

4. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Tissue redistribution (out of plasma) rather than metabolism
Increased reticulocytes
Turners`

5. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

6. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Fibrosis; macrophages
Raphe
Inhaled animal dander allergens

7. which nucleus releases serotonin?
Raphe
Right heart failure
Adductor
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

8. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Smoking
Anti - apoptotic (prevents going into apoptosis)- 18; 14
manifestations - congenital (stretching of periventricular pyrimadal fibers)

9. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RBF= PAH clearance/(1- hematocrit)
Biphosphonate

10. What are the two coagulase negative staphylococci? How do you distinguish them?
Inhibits it
S. saprophyticus - and s. epidermidis; novobiocin
Decreases both
T test; chi squared

11. what diseases can vit A be used to treat?
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
The term used to describe decreased drug responsiveness with repeated administration
Increase; decreased
Measles and M3 AML`

12. In what population does cholelithiasis occur?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
IgE
Fat - fertile - forty - female

13. In what form are mitochondrial DNA? What do they transcribe?
Nonsense; mRNA processing
Circular - outside nucleus; transport proteins - rRNA - tRNA
Bile salt accumulation in urine
SaO2 <92%

14. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
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
Duration and extent of disease
SVT; increases vagal tone; rectus abdominis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

15. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Hypothyroidism
LT (LTD4 - E4 - C4) - and Ach
Curlings ulcers
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

16. What is the most common neurologic complication of VZV reactivation?
Acute interstitial nephritis
IgE
Localized dermatologic pain that persists for more than one month after zoster eruption
11

17. What does anti phospholipid syndrome in SLE patients predispose them to?
Terminal bronchioles; small bronchi
Multiple miscarriages d/t hypercoaguability
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Sudden loss of muscle tone without loss of consciousness; narcolepsy

18. What does prolonged PT indicated? aPTT? bleeding time?
MAO inhibitors; wine and cheese
Sydenham chorea
Extrinsic def; instrinsic def; platelet def
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

19. What is pickwickian syndrome? What are the lab findings?
Varying; erythema nodosum is common
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
NF- KB; responsible for cytokine production
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

20. What are the common causes of metabolic alkalosis? How do you differentiate between them?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Serum FFA and serum triglyceride levels
Increase lymphatic drainage!

21. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Increase by 50% in urine osmolality
Turbulence

22. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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23. What are some side effects seen in TCAs?
G to T in p53; HCC
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increases bronchial and vascular smooth muscle reactivity to catecholamines

24. is Rifampin ever used as monotherapY? why either way?
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
Prepatellar
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
C3 decreased after 5-10 days; sulfonamides

25. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
APP on chrom 21 (this is why downs more susceptible)
Enterococci (e. faecalis)- found on genitalia area
Become beta pleated and then form neurofibrillary tangle!

26. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
INTRApartum Abs (ampicillin/penicillin)
Kallmans
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

27. sporadic colon cancer tend to arise From what type of polyps?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
...
Smoking
Single adenomatous ones

28. What is a cord factor and Which bugs have it? How do they appear on culture?
Serum creatine kinase; reperfusion injury causes necrosis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
TCAs and prazosin

29. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Adductor
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
P53 mutation; AD

30. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
Drink plenty of fluids
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Cluster

31. what vessel would a fracture to the neck of the of the humerus damage?
Pulmonary hypertension
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anterior circumflex (and axillary nerve)
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)

32. what defines hypoxemia?
SaO2 <92%
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Normally close to systolic
Because of the low output from heart failure - they will have increased aldosterone levels

33. What type of mutation does aflatoxin cause? what cancer does this increase for?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Anti cholinergic effects of pupil dilation and lack of accomodation
G to T in p53; HCC
S. saprophyticus - and s. epidermidis; novobiocin

34. What is best to prevent GBS infection in a baby?
Echinococcus granulosus; anaphylaxis
INTRApartum Abs (ampicillin/penicillin)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
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

35. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
Coagulation factors are made in the liver
Smoking
Amiloride - spironolactone - triamterene

36. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
P450 mitochondrial monooxygenase
Terminal bronchioles; small bronchi
P53 mutation; AD
Primary

37. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Normally close to systolic
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Folic acid treatment!

38. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Coagulation factors are made in the liver
Because of the low output from heart failure - they will have increased aldosterone levels
Drink plenty of fluids
RBF= PAH clearance/(1- hematocrit)

39. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
No (unlike adenomyosis); yes

40. What are the long term consequences of hydrocephalus?
Both sides
CGD; t cell dysfxn (diGeorge)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Barium enema

41. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Drug induced interstitial nephritis
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

42. PDAs are often asymptomatic. How do you treat?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Varying; erythema nodosum is common
Well
indomethacin

43. ___________ is liver specific
Fat - fertile - forty - female
Fibronectin - laminin - collagen
HSV ( also in utero: chlymadia - neisseria - group B strep)
glycerol kinase

44. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Inactivates kallikrein which activates kininogen into bradykinin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
DIC; TTP- HUS dont bleed that much
Medial circumflex artery; avascular necrosis

45. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Terminal bronchioles; small bronchi
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

46. what commonly happens in GI in response to acute physiologic stress?
Neisseria induced small cell vasculitis (including hands and soles)
SSRI; erectile dysfunction
Acute gastric mucosal defects (superficial or full thickness)
CGD; t cell dysfxn (diGeorge)

47. what chromosome is c - myc found on?
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)
When it invades the bm; carcinoma in situ
Chrom 8
P53 mutation; AD

48. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

49. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Initiation - pointing; pincer grasp; walking; mama/dada
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

50. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
(urine PAH x urine flow rate)/plasma PAH
In the extracellular space
Superior larygeal; cricothyroid; recurrent laryngeal