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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 presentation of sever aortic stenosis?
MAO inhibitors; wine and cheese
Serum creatine kinase; reperfusion injury causes necrosis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Syncope - angina - dyspnea (SAD)

2. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Another type of aldosterone antagonist (like spironolactone)
Retinitis; mononucleosis
P53 mutation; AD

3. what chromosome is c - myc found on?
Chrom 8
Vertical diplopia
only up to bronchi
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

4. What causes release of myosin head from the actin filament?
Hypertension - edema - and proteinuria
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
ATP binding (resets the myosin head to contract again for next binding)
Rabies encephalitis from cave bats; rabies killed vaccines

5. What type of bond is a disulfide bond?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Not lined by epithelium
Spongiosis
Covalent (between two cysteines)- allows protein to withstand denaturation

6. What pulmonary structural change can kartageners syndrome cause?
Vagus nerve stimulation
The term used to describe decreased drug responsiveness with repeated administration
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Bronchial dilation (bronchiectasis)

7. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Right before diastole (filling begins)
Not lined by epithelium

8. How do you treat gonococcal infection? chlymadia?
Chrom 8
LT (LTD4 - E4 - C4) - and Ach
Hydrogen bonds dictate alpha or beta structure
Ceftriaxone; azithromycin

9. PDAs are often asymptomatic. How do you treat?
Vascular endothelium; protease
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
indomethacin
RBF= PAH clearance/(1- hematocrit)

10. What is congestive hepatomegaly specific for?
Right heart failure
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Reiter syndrome; B27
Adductor

11. which two virus families have hemagluttinin on their surface?
By vascular permeability and vasodilation
Paramyxo and influenza
Trochlear nerve (IV); abducens nerve (VI)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

12. what virus causes pharyngoconjuctival fever?
Adeno
Diabetic microangiopathy
Dissolved in plasma and attached to Hgb
Medullary

13. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Vagus nerve stimulation
Sudden loss of muscle tone without loss of consciousness; narcolepsy
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
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

14. why is glucagon used in beta blocker toxicitiy?
Proteasome inhibitor; treatment for MM and waldenstroms
T test; chi squared
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Because of the low output from heart failure - they will have increased aldosterone levels

15. after a thrombus extraction - what serum enzyme shoots up and why?
Dissolved in plasma and attached to Hgb
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
In ER of bile canaliculi
Serum creatine kinase; reperfusion injury causes necrosis

16. What can cause aortic regurg? What is the heart sound you hear?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
facultative intracellular
Anterior circumflex (and axillary nerve)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

17. What does extended consumption of appetite suppressants lead to?
Reiter syndrome; B27
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Pulmonary hypertension
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

18. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Vagus nerve stimulation
Nonsense; mRNA processing
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

19. Which is slower AV node or ventricular muscle?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
AV node slowest - to allow time for diastole
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Underestimation of gestational age

20. where are the vegetations on the valves of a libman sacks endocarditis?
Normally close to systolic
Both sides
Single adenomatous ones
Drink plenty of fluids

21. in overweight individuals What is thought to contribute to insulin resistance?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
11 aa polypeptide; pain NT in CNS and PNS
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Serum FFA and serum triglyceride levels

22. What does 'oxygen' content in blood refer to?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Dissolved in plasma and attached to Hgb
Demargination of neutrophils from the vessel walls
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

23. nucleotide deletions do not cause missense mutations - they cause...
...
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Acute gastric mucosal defects (superficial or full thickness)
frameshift mutations (missense is substitution)

24. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Adductor
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
CGD; t cell dysfxn (diGeorge)

25. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
MAC complex (C5b - C9 complement deficiency)
Trochlear nerve (IV); abducens nerve (VI)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Because of the low output from heart failure - they will have increased aldosterone levels

26. carnitine deficiency impairs production of What and how?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Hypothyroidism
Lateral; RV; RA; LV
Ketone body production by preventing fatty acids into the mitochondria

27. What is the mc location of brain germinomas?What are the classic symptoms?
Inhaled animal dander allergens
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Ketone body production by preventing fatty acids into the mitochondria
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

28. prostaglandin synthesis keeps...
PDA open
In the extracellular space for collagen cross linking; zinc
SSRI; erectile dysfunction
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

29. metabolism of 1 gram of protein produces How many calories? carb? fat?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Acute interstitial nephritis
4 - 4 - 9
low in serum

30. When is an S4 sound normal?
Hypertension - edema - and proteinuria
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
RER; copper
Well trained athletes and children

31. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Increase by 50% in urine osmolality
glycerol kinase
Common peroneal; bony fractures and compression; sciatic

32. What is subacute sclerosisng encephalitis caused by?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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
Strength of cell mediated immune response

33. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Lateral; RV; RA; LV
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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)

34. How do you calculate atributable risk percent?
RR-1/RR
Terminal bronchioles; small bronchi
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Relfex tachycardia; giving beta blockers

35. what protects the resting heart from arrhythmias?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Echinococcus granulosus; anaphylaxis
Highly negative resting potential
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

36. what vessel would a fracture to the neck of the of the humerus damage?
Raphe
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Anterior circumflex (and axillary nerve)
SSRI; erectile dysfunction

37. which staphylococci can do mannitol fermaentation?
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
Minimal change disease
S. aureus
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

38. which virus inactivates both Rb and p53?
RBC mass; epo levels (secondary has high)
Localized dermatologic pain that persists for more than one month after zoster eruption
Adductor
E6 and E7 of HPV knock off p53 and Rb suppressor genes

39. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
DIC; TTP- HUS dont bleed that much
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
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

40. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Closer to head; closer to diaphragm
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Downs; regurgitant AV valves - ASDs
Turners`

41. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
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
only up to bronchi
Right heart failure

42. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Syringomelia
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

43. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Pulmonic and systemic!
Mean greater than median greater than mode
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

44. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Atrial
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

45. What is used to treat heparin toxicity?
Increases cytokine production
Protamine sulfate
Increases bronchial and vascular smooth muscle reactivity to catecholamines
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

46. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Southern - western

47. what bursa is affected when on knees like a maid/gardner?
DIC; TTP- HUS dont bleed that much
Anti centromere; anti DNA topoisomerase
Prepatellar
Around 70 (normal measured diastolic pressures); 9--

48. What would a deflection of the membrane potential to near zero indicate?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Enterococci (e. faecalis)- found on genitalia area
Increase in permeability of two ions with equal and opposite equilibrium potentials
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

49. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Fibronectin - laminin - collagen
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Paramyxo and influenza
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

50. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Myasthenia gravis
TCAs and prazosin
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

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