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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. IL4 is used for isotypye switching to what?
SVC and IVC; right below the aortic knob
IgE
Trochlear nerve (IV); abducens nerve (VI)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

2. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Classical conditioning
SaO2 <92%
Curlings ulcers

3. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Tissue redistribution (out of plasma) rather than metabolism
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Pan colitis and right sided colitis (more than left sided and proctitis)
Hereditary angioedema; ACE inhibitors

4. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
In ER of bile canaliculi
HSV ( also in utero: chlymadia - neisseria - group B strep)
Vagus (auricular branch); vasovagal syncope!

5. What is a clara cell?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Normally close to systolic

6. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Highly negative resting potential
Syringomelia
No and yes
DIC; TTP- HUS dont bleed that much

7. what would be a sign of absence of cardiogenic pulm edem?
To pump calcium out in cardiac myocytes so that relaxation occurs
Sydenham chorea
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
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

8. What would a deflection of the membrane potential to near zero indicate?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
46 - 4N; 23 2N
Increase in permeability of two ions with equal and opposite equilibrium potentials

9. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
indomethacin
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Cluster

10. what protein is increased in Crohns disease? What does it do?
Chrom 8
Abnormal closing of the urethral folds
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
NF- KB; responsible for cytokine production

11. What are the two mcc of focal brain lesions in HIV positive patients?
Initiation - pointing; pincer grasp; walking; mama/dada
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Vancomycin

12. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Excessive collagen formation during tissue repair in susceptible individuals
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Both sides
Vagus (auricular branch); vasovagal syncope!

13. What is the cause of fixed splitting of S2? why?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
No
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Anti - apoptotic (prevents going into apoptosis)- 18; 14

14. which viruses require a protease?
Radial nerve damage
MAO inhibitors; wine and cheese
SS +rNA
Amiloride - spironolactone - triamterene

15. other than increasing HDL levels - what else does niacin do?
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
Ketone body production by preventing fatty acids into the mitochondria
Prevents hepatic VLDL production
Appetite suppressants

16. What is gardeners mydriasis? How is it treated?
Inactivates kallikrein which activates kininogen into bradykinin
S. aureus
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

17. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Relfex tachycardia; giving beta blockers
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Phencyclidine (PCP)
Single adenomatous ones

18. What are the lab findings in poststreptococcal GN?
Demargination of neutrophils from the vessel walls
Measles and M3 AML`
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Right heart failure

19. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
APP on chrom 21 (this is why downs more susceptible)
Env genes (for getting into target cells)
Apocrine; eccrine
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

20. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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)
Around 70 (normal measured diastolic pressures); 9--

21. What does sustained hand grip do to the C/V system?
Pain reliever - reduces pain by locking substance P in the PNS
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

22. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Both sides
Medial circumflex artery; avascular necrosis
Elastance
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

23. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
T test; chi squared
Coagulation factors are made in the liver

24. What is capacitance inversely proportional to?
Elastance
Decreases both
Vagus nerve stimulation
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

25. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
8; 12
Regular insulin (Not fast acting - regular better)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

26. why does hypothyroidism cause increased CPK levels?
Normally close to systolic
Superior larygeal; cricothyroid; recurrent laryngeal
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)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

27. why does variocele occur more in left side?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
High potassium conductance and some sodium conductance
Closer to head; closer to diaphragm

28. on What part of the clavicle does the SCM attach?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Medial part
Serum FFA and serum triglyceride levels
gram positive organisms

29. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Joints d/t increased purine production and thus uric acid production
Hypertension - edema - and proteinuria

30. what virus causes pharyngoconjuctival fever?
Standing suddenly from supine position; valsalva maneuver
Adeno
MAO inhibitors; wine and cheese
Trauma to stereociliated hair cells of the organ of corti

31. 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)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
transcription activation/suppression

32. other than parvo B19 - what else is associated with red cell aplasia?
Coagulation factors are made in the liver
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Thymic tumor
Squatting - sitting - lying supine - passive leg raising

33. sporadic colon cancer tend to arise From what type of polyps?
differentiate
Inhibits it
Increases
Single adenomatous ones

34. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Class I
11
In ER of bile canaliculi

35. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Underestimation of gestational age
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
No and yes
Bronchial dilation (bronchiectasis)

36. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
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
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)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

37. which virus inactivates both Rb and p53?
Turbulence
women
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Downs; regurgitant AV valves - ASDs

38. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Hypo or hyper pigmentations; after tanning

39. What does anti phospholipid syndrome in SLE patients predispose them to?
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)
Multiple miscarriages d/t hypercoaguability
hyponatremia (aldosterone activation equilibrates body volume)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

40. What are fenfluramine - phentermine?
Around 70 (normal measured diastolic pressures); 9--
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Hexokinase
Appetite suppressants

41. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
hyponatremia (aldosterone activation equilibrates body volume)
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
Increase by 50% in urine osmolality

42. What is the primary histologic finding in patients with eczematous dermatitis?
Excessive collagen formation during tissue repair in susceptible individuals
Ether and other organic solvents
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)
Spongiosis

43. what bursa is affected when on knees like a maid/gardner?
Prepatellar
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

44. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
GI malignancies and Insulin resistance (acromegal for ex)
Env genes (for getting into target cells)
SVT; increases vagal tone; rectus abdominis

45. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Terminal bronchioles; small bronchi
Gluteus maximus; difficulty getting up from seated position and climbing chair
Sickle cell; G6PD

46. what hormone is structurally similar to hCG?
25; 25
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
TSh (in testicular tumors can cause hyperthyroidism)

47. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
<1% - 55% - concentration dependent
When it invades the bm; carcinoma in situ
differentiate
Class I

48. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
S3 gallop; S2 to opening snap interval

49. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Env genes (for getting into target cells)
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
Relfex tachycardia; giving beta blockers
Highly negative resting potential

50. what hernia has a similar mechanism to hydrocele?
Initiation - pointing; pincer grasp; walking; mama/dada
Demargination of neutrophils from the vessel walls
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

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USMLE Prep 2

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