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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 aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
The term used to describe decreased drug responsiveness with repeated administration
Neisseria induced small cell vasculitis (including hands and soles)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

2. In what population does cholelithiasis occur?
Excessive collagen formation during tissue repair in susceptible individuals
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Fat - fertile - forty - female

3. What are two common side effects of both acute and long acting nitrates? What causes them?
PDA open
E. coli; staphylococcus saprophyticus
Smoking
Headaches and facial flushing; vasodilation in meninges and skin

4. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Standing suddenly from supine position; valsalva maneuver
Pulmonic and systemic!
frameshift mutations (missense is substitution)
Rabies encephalitis from cave bats; rabies killed vaccines

5. What is a common complication of acute pancreatitis? What is it?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Syncope - angina - dyspnea (SAD)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

6. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Become beta pleated and then form neurofibrillary tangle!
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

7. How do bradykinin - C3a and C5a cause edema?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
By vascular permeability and vasodilation
Class I

8. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Paramyxo and influenza
Covalent (between two cysteines)- allows protein to withstand denaturation
Vertical diplopia
Common peroneal; bony fractures and compression; sciatic

9. Which is slower AV node or ventricular muscle?
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
AV node slowest - to allow time for diastole
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Covalent (between two cysteines)- allows protein to withstand denaturation

10. What is used to compare means? categorical outcomes?
T test; chi squared
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Drug induced interstitial nephritis

11. What are pancreatic pseudocysts called pseudo rather than true cysts?
Tibial
Acute gastric mucosal defects (superficial or full thickness)
Not lined by epithelium
Covalent (between two cysteines)- allows protein to withstand denaturation

12. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Faulty positioning of the genital tubercle
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Nonsense; mRNA processing
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

13. What are three symptoms in s.typhi?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
TSh (in testicular tumors can cause hyperthyroidism)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

14. ___________ is liver specific
Pain reliever - reduces pain by locking substance P in the PNS
I is more benign and can present later in adulthood
glycerol kinase
Drink plenty of fluids

15. at one year of age - What are the social - fine motor - gross motor and language developments?
Vascular endothelium; protease
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Initiation - pointing; pincer grasp; walking; mama/dada
E. coli

16. What are the primary determinants of colon cancer risk in UC patients
Reticulocytes
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Duration and extent of disease

17. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Faulty positioning of the genital tubercle

18. What is a keloid?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Curlings ulcers
Drink plenty of fluids
Excessive collagen formation during tissue repair in susceptible individuals

19. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
46 - 4N; 23 2N
MAO inhibitors; wine and cheese
Sickle cell; G6PD
Kallmans

20. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
P450 mitochondrial monooxygenase
facultative intracellular
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

21. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
DIC; TTP- HUS dont bleed that much
SVC and IVC; right below the aortic knob
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
On cardiac tissue and renal juxtaglomerular cells

22. What does VIP do to gastric acid secretion?
Southern - western
Joints d/t increased purine production and thus uric acid production
Inhibits it
V fib; v. failure

23. What agonists reduce the gradient across the LV outflow tract?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Selective alpha 1 (increases SVR)
Prostate tumor and increased osteoclast activity

24. what would be a sign of absence of cardiogenic pulm edem?
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
Highly negative resting potential
Pain reliever - reduces pain by locking substance P in the PNS
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

25. What does nitroprusside do to afterload? preload?
Increases cytokine production
Decreases both
Normally close to systolic
Drug induced interstitial nephritis

26. What is the mainstay treatment for acute mania?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Bronchial dilation (bronchiectasis)
Faulty positioning of the genital tubercle

27. What are the three predominant symptoms of VHL? What is its mode of inheritance?
4 - 4 - 9
Intussusception
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

28. What are the two growth factors associated with angiogenesis?
Atrial
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Minimal change disease
FGF and VEGF

29. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
Enterococci (e. faecalis)- found on genitalia area
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
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

30. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
Purkinje system; AV node
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
Nonsense; mRNA processing

31. What does TGF beta do? What produces it?
FGF and VEGF
Around 70 (normal measured diastolic pressures); 9--
NF- KB; responsible for cytokine production
Fibrosis; macrophages

32. how long is substance P? What does it do?
Bronchogenic carcinoma
Gluteus maximus; difficulty getting up from seated position and climbing chair
11 aa polypeptide; pain NT in CNS and PNS
Vascular endothelium; protease

33. What are the long term consequences of hydrocephalus?
S3 gallop; S2 to opening snap interval
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
SVC and IVC; right below the aortic knob
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

34. What is the mc location for avascular necrosis? What is it associated with?
On cardiac tissue and renal juxtaglomerular cells
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Adductor
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

35. which virus inactivates both Rb and p53?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Amiadarone
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

36. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Hexokinase
Relfex tachycardia; giving beta blockers
Become beta pleated and then form neurofibrillary tangle!
Lateral; RV; RA; LV

37. other than parvo B19 - what else is associated with red cell aplasia?
DIC; TTP- HUS dont bleed that much
Inactivates kallikrein which activates kininogen into bradykinin
Thymic tumor
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

38. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Vancomycin
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
(urine PAH x urine flow rate)/plasma PAH

39. What type of mutation does aflatoxin cause? what cancer does this increase for?
Estrogen induced cholesterol hypersecretion (increase HMG CoA reductase activity) and progesterone induced gallbladder hypomotility (decreases bile acid secretion)-- both these conditions predispose cholesterole to insolubilize out
G to T in p53; HCC
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Around 70 (normal measured diastolic pressures); 9--

40. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Abnormal closing of the urethral folds
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
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)

41. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
LT (LTD4 - E4 - C4) - and Ach
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
GI tract; mood!

42. What can cause aortic regurg? What is the heart sound you hear?
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
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

43. which nucleus releases serotonin?
Because gamma chains replace beta chains and then gamma chain formation wanes
RER; copper
Raphe
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

44. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Acute interstitial nephritis
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Hydrogen bonds dictate alpha or beta structure
P53 mutation; AD

45. What does prolonged PT indicated? aPTT? bleeding time?
Varying; erythema nodosum is common
Boiling - bleach - formalin - UV irradiation
Kallmans
Extrinsic def; instrinsic def; platelet def

46. What is the mcc of elevated AFP leves in pregnancy>
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Underestimation of gestational age
RBF= PAH clearance/(1- hematocrit)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac

47. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
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
Large stroke volumes with ventricular contraction; aortic regurg
Strength of cell mediated immune response

48. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Large stroke volumes with ventricular contraction; aortic regurg
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Abnormal closing of the urethral folds

49. What is the precursor protein to beta amyloid and On what chromosome is it found?
200-500
Rabies encephalitis from cave bats; rabies killed vaccines
APP on chrom 21 (this is why downs more susceptible)
Vertical diplopia

50. What is the most important prognostic indicator in patients with malignant melanoma?
Smoking
Measure of depth invasion (vertical!)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
High potassium conductance and some sodium conductance

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