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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 is the most common cause of pyelonephritis in both adults and childre?
Gluteus medius and minimus; positive trendelenberg
E. coli
Headaches and facial flushing; vasodilation in meninges and skin
DIC; TTP- HUS dont bleed that much

2. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Integration of viral DNA into genome of host hepatocytes
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
No and yes

3. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Radial nerve damage
Integration of viral DNA into genome of host hepatocytes
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Increases cytokine production

4. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
As a CO2 carrier with the carboxylase enzyme
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
LT (LTD4 - E4 - C4) - and Ach

5. What is the primary histologic finding in patients with eczematous dermatitis?
Fibronectin - laminin - collagen
Spongiosis
Superior larygeal; cricothyroid; recurrent laryngeal
Abnormal closing of the urethral folds

6. What is the neurologic manifestation of ADPKD?
(urine PAH x urine flow rate)/plasma PAH
INTRApartum Abs (ampicillin/penicillin)
Relfex tachycardia; giving beta blockers
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

7. What is somatomedin C?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
25; 25
Insulin like growth factor 1 (just another name)
Dissolved in plasma and attached to Hgb

8. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
TCAs and prazosin
Become beta pleated and then form neurofibrillary tangle!
4 - 4 - 9
200-500

9. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
Folic acid treatment!
Trochlear nerve (IV); abducens nerve (VI)
Class I

10. What are examples of action that decrease venous return to the heart?
Standing suddenly from supine position; valsalva maneuver
P53 mutation; AD
hyponatremia (aldosterone activation equilibrates body volume)
LT (LTD4 - E4 - C4) - and Ach

11. What does the severity of leprosy depend on?
Raphe
hyponatremia (aldosterone activation equilibrates body volume)
Strength of cell mediated immune response
Highly negative resting potential

12. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Multiple miscarriages d/t hypercoaguability
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Underestimation of gestational age
Valproate

13. what happens with LDL receptor density in statin therapy?
NF- KB; responsible for cytokine production
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Trauma to stereociliated hair cells of the organ of corti
Increases

14. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
SaO2 <92%
No and yes

15. there are mucus secreting cells in the bronchioles...
Class I
E6 and E7 of HPV knock off p53 and Rb suppressor genes
only up to bronchi
Atrial

16. what clinical findings help distinguish small cell carcinoma?
No
Nocardia
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

17. What are the potassium sparing diuretics?
When it invades the bm; carcinoma in situ
Amiloride - spironolactone - triamterene
Pan colitis and right sided colitis (more than left sided and proctitis)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

18. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Vagus nerve stimulation
Aromatase deficiency in child
Echinococcus granulosus; anaphylaxis

19. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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
Pulmonic and systemic!
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

20. What does 'oxygen' content in blood refer to?
Rabies encephalitis from cave bats; rabies killed vaccines
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
Dissolved in plasma and attached to Hgb
Bile soluble which means they are bile sensitive

21. What agonists reduce the gradient across the LV outflow tract?
...
CGD; t cell dysfxn (diGeorge)
Selective alpha 1 (increases SVR)
glycerol kinase

22. What is the stabilizing force for the secondary structure of proteins?
Radial nerve damage
Hydrogen bonds dictate alpha or beta structure
Acute interstitial nephritis
Little effect on cell and no change

23. If a patient has higher levels of HbF - What does this mean?
PDA open
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
TSh (in testicular tumors can cause hyperthyroidism)
Think Hb deformation diseases

24. What triggers the neoplastic changes that are associated with HBV infecton?
Well trained athletes and children
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Integration of viral DNA into genome of host hepatocytes
Paramyxo and influenza

25. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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)
Leukotriene precursor and does neutrophil chemotaxis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

26. Where does terminal peptide cleavage of collagen fibrils take place?
Retinitis; mononucleosis
In the extracellular space
Terminal bronchioles; small bronchi
Enterococci (e. faecalis)- found on genitalia area

27. what vessel would a fracture to the neck of the of the humerus damage?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Minimal change disease
Anterior circumflex (and axillary nerve)
Because of the low output from heart failure - they will have increased aldosterone levels

28. do patients with cor pulmonale have increased or decreased levels of aldosterone?
E. coli
Anti cholinergic effects of pupil dilation and lack of accomodation
Increase by 50% in urine osmolality
Because of the low output from heart failure - they will have increased aldosterone levels

29. What pulmonary structural change can kartageners syndrome cause?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Bronchial dilation (bronchiectasis)
Proteasome inhibitor; treatment for MM and waldenstroms

30. In what population does cholelithiasis occur?
Fat - fertile - forty - female
low in serum
Measles and M3 AML`
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

31. What does NF- KB do?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Boiling - bleach - formalin - UV irradiation
Brief psychotic disorder; schizophreniform; schizophrenia
Increases cytokine production

32. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
P450 mitochondrial monooxygenase
Phencyclidine (PCP)
Increase in permeability of two ions with equal and opposite equilibrium potentials
RER; copper

33. Which is faster atrial muscle or ventricular muscle?
Relfex tachycardia; giving beta blockers
Protamine sulfate
Hypertension - edema - and proteinuria
Atrial

34. What is achalasia and how would this correlate on the esophageal mannometry?
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
Acute interstitial nephritis
Increase in permeability of two ions with equal and opposite equilibrium potentials
TCAs and prazosin

35. What type of drug is alendronate?
Classical conditioning
Anti centromere; anti DNA topoisomerase
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Biphosphonate

36. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
RER; RER
Valproate
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

37. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
AV node slowest - to allow time for diastole
Aromatase deficiency in child
Single adenomatous ones
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

38. What is a cord factor and Which bugs have it? How do they appear on culture?
Radial nerve and deep brachial artery
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
E. coli; staphylococcus saprophyticus
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

39. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
ANCA because of lack of Ig and C3 deposits on IF
Echinococcus granulosus; anaphylaxis
Sickle cell; G6PD
Measles and M3 AML`

40. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
E. coli; staphylococcus saprophyticus
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Rabies encephalitis from cave bats; rabies killed vaccines
Integration of viral DNA into genome of host hepatocytes

41. in the LV and aorta - What are the pressures?
Normally close to systolic
frameshift mutations (missense is substitution)
S. saprophyticus - and s. epidermidis; novobiocin
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

42. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
Coagulation factors are made in the liver
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Thymic tumor

43. What are two common side effects of both acute and long acting nitrates? What causes them?
Octreotide
Pulmonary hypertension
Headaches and facial flushing; vasodilation in meninges and skin
Joints d/t increased purine production and thus uric acid production

44. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

45. What is best to prevent GBS infection in a baby?
<1% - 55% - concentration dependent
No
INTRApartum Abs (ampicillin/penicillin)
MAC complex (C5b - C9 complement deficiency)

46. In what form are mitochondrial DNA? What do they transcribe?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Circular - outside nucleus; transport proteins - rRNA - tRNA
Inactivates kallikrein which activates kininogen into bradykinin
SS +rNA

47. What is the mcc of extrinsic allergic asthma?
TCAs and prazosin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Inhaled animal dander allergens
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

48. what dictates the resting membrane potential of most cells?
SS +rNA
High potassium conductance and some sodium conductance
Tissue redistribution (out of plasma) rather than metabolism
Leukotriene precursor and does neutrophil chemotaxis

49. ___________ is liver specific
glycerol kinase
Close but purkinje system to ensure contraction in a bottom up fashion
Because of vasodiation to skeletal muscles
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

50. 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?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
46 - 4N; 23 2N

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USMLE Prep 2

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