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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. How can renal blood flow be calculated from RPF?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
11 aa polypeptide; pain NT in CNS and PNS
Trochlear nerve (IV); abducens nerve (VI)
RBF= PAH clearance/(1- hematocrit)

2. What does hypocapnia cause in teh brain? What is hypocapnia?
Raphe
Anti cholinergic effects of pupil dilation and lack of accomodation
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Another type of aldosterone antagonist (like spironolactone)

3. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Because of vasodiation to skeletal muscles
CGD; t cell dysfxn (diGeorge)
Increased reticulocytes
Apocrine; eccrine

4. which nerve provides innervation for plantar flexion and inversion?
differentiate
Right heart failure
Tibial
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

5. Where is the base of the heart? apex?
High potassium conductance and some sodium conductance
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Closer to head; closer to diaphragm

6. 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?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
46 - 4N; 23 2N
RER; copper
G to T in p53; HCC

7. What does nitroprusside do to afterload? preload?
The term used to describe decreased drug responsiveness with repeated administration
Little effect on cell and no change
Decreases both
Elevated GGT and macrocytosis

8. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Serum FFA and serum triglyceride levels
Nonsense; mRNA processing
Headaches and facial flushing; vasodilation in meninges and skin

9. What are the first generation anti histamines?
Opiate anti diarrheal that binds to mu opiate receptors in GI tract and slows motility; meperidine; low doses - but therapeutic doses combined with atropine (under marked brand name lomotil)
Chlorpheniramine and diphenhydramine
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

10. within the right atrium - What is the maximum pressure? left atrium?
Multiple miscarriages d/t hypercoaguability
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
8; 12
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

11. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Hexokinase
frameshift mutations (missense is substitution)
Vagus (auricular branch); vasovagal syncope!
Hypertension - edema - and proteinuria

12. what protein is increased in Crohns disease? What does it do?
Fibronectin - laminin - collagen
liver specific
NF- KB; responsible for cytokine production
Little effect on cell and no change

13. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Pain reliever - reduces pain by locking substance P in the PNS
liver specific
Sudden loss of muscle tone without loss of consciousness; narcolepsy

14. If a patient has higher levels of HbF - What does this mean?
Reiter syndrome; B27
Well
Think Hb deformation diseases
11

15. What is a keloid?
Both sides
Brief psychotic disorder; schizophreniform; schizophrenia
LT (LTD4 - E4 - C4) - and Ach
Excessive collagen formation during tissue repair in susceptible individuals

16. What are the three dopaminergic systems and What are they responsible for? disease?
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)
Octreotide
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

17. What is normal fibrinogen levels?
200-500
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Strength of cell mediated immune response
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

18. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
manifestations - congenital (stretching of periventricular pyrimadal fibers)
I is more benign and can present later in adulthood
Superior larygeal; cricothyroid; recurrent laryngeal

19. on What part of the clavicle does the SCM attach?
In the extracellular space for collagen cross linking; zinc
Medial part
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Env genes (for getting into target cells)

20. What is hyaline arteriosclerosis usually a sign of ?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Vagus nerve stimulation
Diabetic microangiopathy
As a CO2 carrier with the carboxylase enzyme

21. what locations of UC increase the risk of Colon cancer?
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
CGD; t cell dysfxn (diGeorge)
Pan colitis and right sided colitis (more than left sided and proctitis)
Hereditary angioedema; ACE inhibitors

22. What is the mainstay treatment for acute mania?
only up to bronchi
SVT; increases vagal tone; rectus abdominis
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

23. What can too much IgA in serum produces?
Anti centromere; anti DNA topoisomerase
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Boiling - bleach - formalin - UV irradiation

24. h1 receptor anatagonists are not effective in treatment of asthma only for...
OCPs - multiparity - breast feeding
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
chronic urticaria and allergic symptoms
Acute interstitial nephritis

25. What is cataplexy and When is it seen?
CGD; t cell dysfxn (diGeorge)
Because of vasodiation to skeletal muscles
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Lateral; RV; RA; LV

26. What is capsaicin? Where does it work?
Syringomelia
Kallmans
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Pain reliever - reduces pain by locking substance P in the PNS

27. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Turners`
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Enterococci (e. faecalis)- found on genitalia area

28. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
ANCA because of lack of Ig and C3 deposits on IF
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
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
Minimal change disease

29. What type of vision is myopia? In What type of patients does it improve?
Increases
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

30. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Decreases both
RBF= PAH clearance/(1- hematocrit)
Enterococci (e. faecalis)- found on genitalia area

31. what vessel would a fracture to the neck of the of the humerus damage?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Ketone body production by preventing fatty acids into the mitochondria
Anterior circumflex (and axillary nerve)

32. What is Bortezomib and What is it used for?
Little effect on cell and no change
Proteasome inhibitor; treatment for MM and waldenstroms
Sarcoid
Sudden loss of muscle tone without loss of consciousness; narcolepsy

33. What does L/S stand for in fetal lung maturity? When does maturity occur?
Regular insulin (Not fast acting - regular better)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Vagus (auricular branch); vasovagal syncope!

34. What is the preferred treatment for DKA?
Hypothyroidism
Vagus nerve stimulation
...
Regular insulin (Not fast acting - regular better)

35. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Multiple miscarriages d/t hypercoaguability
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Hypothyroidism
Intussusception

36. How do you calculate RPF from urine PAH?
Classical conditioning
(urine PAH x urine flow rate)/plasma PAH
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
...

37. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Purkinje system; AV node
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
DIC; TTP- HUS dont bleed that much

38. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Mean greater than median greater than mode
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Acute interstitial nephritis
FGF and VEGF

39. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
High potassium conductance and some sodium conductance
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
PDA open

40. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Recurrent larygneal
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Elevated GGT and macrocytosis
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

41. what murmur is enhanced by decreased blood flow to the heart?
Radial nerve damage
Spongiosis
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

42. What are the skin presentation in sarcoid?
<1% - 55% - concentration dependent
Phencyclidine (PCP)
Increased reticulocytes
Varying; erythema nodosum is common

43. what happens to capacitance with age?
Medullary
Demargination of neutrophils from the vessel walls
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
...

44. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Measles and M3 AML`
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

45. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hydrogen bonds dictate alpha or beta structure
Hyperkalemia; potassium sparing diuretics - potassium supplements
Chlorpheniramine and diphenhydramine
liver specific

46. in B12 deficiency - what levels in blood rise very quickly and then drop?
P450 mitochondrial monooxygenase
Medial circumflex artery; avascular necrosis
Reticulocytes
Increase in permeability of two ions with equal and opposite equilibrium potentials

47. which two drug types can cause orthostatic hypotension (think depression and BPH)?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
TCAs and prazosin
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
Superior larygeal; cricothyroid; recurrent laryngeal

48. What is congestive hepatomegaly specific for?
Right heart failure
PDA open
Sarcoid
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

49. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
P53 mutation; AD
Initiation - pointing; pincer grasp; walking; mama/dada
No; yes

50. In what form are mitochondrial DNA? What do they transcribe?
Multiple miscarriages d/t hypercoaguability
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Circular - outside nucleus; transport proteins - rRNA - tRNA
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

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USMLE Prep 2

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