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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 nerve and artery course along the posterior aspect of the humerus?
facultative intracellular
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)
Radial nerve and deep brachial artery
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

2. what drug is useful for secretory diarrhea?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Measure of depth invasion (vertical!)
Intussusception
Octreotide

3. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
AV node slowest - to allow time for diastole
OCPs - multiparity - breast feeding
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

4. what virus causes pharyngoconjuctival fever?
Measure of depth invasion (vertical!)
Env genes (for getting into target cells)
Adeno
Normal; low

5. what kind of drug is sertraline? What is a common side effect?
Turbulence
Tzanck smear
SSRI; erectile dysfunction
Abnormal closing of the urethral folds

6. which antiarrythmic is associated with blue gray discoloration ?
Chlorpheniramine and diphenhydramine
8 (myc protein) with 2 - 14 - 22 (iG chains)
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
Amiadarone

7. What is the difference between paranoid personality disorder and delusional disorder?
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
gram positive organisms
Insulin like growth factor 1 (just another name)

8. What is the mc malignancy in asbestosis?
Sarcoid
Closer to head; closer to diaphragm
Bronchogenic carcinoma
Drink plenty of fluids

9. What is the fibrinogen level in patient with TTP- HUS? DIC?
Myasthenia gravis
Cluster
ATP binding (resets the myosin head to contract again for next binding)
Normal; low

10. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Pain reliever - reduces pain by locking substance P in the PNS
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
The time interval between S2 and OS- the shorter the interval - the more intense

11. What is tachyphylaxis?
S. aureus
The term used to describe decreased drug responsiveness with repeated administration
Demargination of neutrophils from the vessel walls
Aromatase deficiency in child

12. other than proteinuria - What can cause foamy froathy urine?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Bile salt accumulation in urine
facultative intracellular

13. What causes curlings ulcers?
Inactivates kallikrein which activates kininogen into bradykinin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Measure of depth invasion (vertical!)

14. What can chronic vit A toxicity cause?
I is more benign and can present later in adulthood
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hypo or hyper pigmentations; after tanning
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

15. what clinical findings help distinguish small cell carcinoma?
46 - 4N; 23 2N
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

16. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Relfex tachycardia; giving beta blockers
RER; RER

17. What is the most common neurologic complication of VZV reactivation?
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
Coagulation factors are made in the liver
Localized dermatologic pain that persists for more than one month after zoster eruption
Chrom 8

18. What is subacute sclerosisng encephalitis caused by?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
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
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Classical conditioning

19. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Apocrine; eccrine
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

20. on What part of the clavicle does the SCM attach?
Chorda tympani branch
Integration of viral DNA into genome of host hepatocytes
Ketone body production by preventing fatty acids into the mitochondria
Medial part

21. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Classical conditioning

22. What antibiotic is best to treat alcoholic pulm infections? why?
Anterior circumflex (and axillary nerve)
frameshift mutations (missense is substitution)
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)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

23. What is used to compare means? categorical outcomes?
T test; chi squared
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
Anti centromere; anti DNA topoisomerase
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

24. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
MAC complex (C5b - C9 complement deficiency)
TSh (in testicular tumors can cause hyperthyroidism)
(urine PAH x urine flow rate)/plasma PAH
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

25. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Appetite suppressants

26. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Amiadarone
Common peroneal; bony fractures and compression; sciatic
Ig A deficiency
Skin flushing and warmth; prostaglandins; give with aspirin

27. What are two common side effects of both acute and long acting nitrates? What causes them?
Tissue redistribution (out of plasma) rather than metabolism
Close but purkinje system to ensure contraction in a bottom up fashion
Headaches and facial flushing; vasodilation in meninges and skin
Superior larygeal; cricothyroid; recurrent laryngeal

28. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Drug induced interstitial nephritis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Minimal change disease

29. When is acid phosphatase elevated (Name two times)?
The term used to describe decreased drug responsiveness with repeated administration
NF- KB; responsible for cytokine production
Prostate tumor and increased osteoclast activity
Paramyxo and influenza

30. in overweight individuals What is thought to contribute to insulin resistance?
The term used to describe decreased drug responsiveness with repeated administration
Both sides
Serum FFA and serum triglyceride levels
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

31. 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?
hyponatremia (aldosterone activation equilibrates body volume)
Lateral; RV; RA; LV
Well
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

32. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Hyperkalemia; potassium sparing diuretics - potassium supplements
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

33. 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
Elastance
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
The term used to describe decreased drug responsiveness with repeated administration

34. at four years of age - What are the social - fine motor - gross motor - and language developments?
indomethacin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Bronchogenic carcinoma
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

35. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
CMV - HSV 1 - Candida
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

36. What is epispadias caused by?
C3 decreased after 5-10 days; sulfonamides
Bile salt accumulation in urine
Faulty positioning of the genital tubercle
Dissolved in plasma and attached to Hgb

37. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
8; 12
Anterior nares

38. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
LT (LTD4 - E4 - C4) - and Ach
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

39. What is intussusception? how does ischemia and necrosis occur?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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)
Retinitis; mononucleosis
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis

40. Where does lysyl oxidase act? What is the cofactor for that?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
In the extracellular space for collagen cross linking; zinc
MAO inhibitors; wine and cheese

41. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
Pulmonic and systemic!
Serum creatine kinase; reperfusion injury causes necrosis
ATP binding (resets the myosin head to contract again for next binding)

42. What is the diagnosis in delayed puberty plus anosmia?
In ER of bile canaliculi
Kallmans
...
Hexokinase

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

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44. what hormone is structurally similar to hCG?
<1% - 55% - concentration dependent
TSh (in testicular tumors can cause hyperthyroidism)
Inactivates kallikrein which activates kininogen into bradykinin
Normal; low

45. What is the best indicator for the severity of mitral stenosis?
Single adenomatous ones
The time interval between S2 and OS- the shorter the interval - the more intense
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
SSRI; erectile dysfunction

46. What does nitroprusside do to afterload? preload?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Decreases both
Sickle cell; G6PD
Demargination of neutrophils from the vessel walls

47. ___________ is liver specific
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
glycerol kinase
Become beta pleated and then form neurofibrillary tangle!
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

48. What are pancreatic pseudocysts called pseudo rather than true cysts?
Inhaled animal dander allergens
Not lined by epithelium
V fib; v. failure
No (unlike adenomyosis); yes

49. which opponens muscle does ulnar innervate?
E. coli
Close but purkinje system to ensure contraction in a bottom up fashion
P53 mutation; AD
Adductor

50. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Vertical diplopia
In the extracellular space for collagen cross linking; zinc
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Syringomelia

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