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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?
Radial nerve and deep brachial artery
Faulty positioning of the genital tubercle
S3 gallop; S2 to opening snap interval
Chlorpheniramine and diphenhydramine

2. Which is faster purkinje system or atrial muscle?
Close but purkinje system to ensure contraction in a bottom up fashion
Smoking
Env genes (for getting into target cells)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

3. What is the neurologic manifestation of ADPKD?
Ketone body production by preventing fatty acids into the mitochondria
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Medial circumflex artery; avascular necrosis

4. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
NF- KB; responsible for cytokine production
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

5. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Covalent (between two cysteines)- allows protein to withstand denaturation
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

6. What translocations can cause c - myc overexpression?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
8 (myc protein) with 2 - 14 - 22 (iG chains)
Acute interstitial nephritis

7. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Medial part
transcription activation/suppression
Chlorpheniramine and diphenhydramine
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

8. What are the two coagulase negative staphylococci? How do you distinguish them?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Spongiosis
S. saprophyticus - and s. epidermidis; novobiocin

9. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Classical conditioning
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Hexokinase
differentiate

10. Where is conduction in heart fastest? slowest?
TSh (in testicular tumors can cause hyperthyroidism)
Purkinje system; AV node
Boiling - bleach - formalin - UV irradiation
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

11. 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
Excessive collagen formation during tissue repair in susceptible individuals
Elastance
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

12. When does opening snap begin?
Reticulocytes
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Right before diastole (filling begins)
High potassium conductance and some sodium conductance

13. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Because of the low output from heart failure - they will have increased aldosterone levels
Valproate

14. why does neutrophila occur with corticosteroids?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Fibrosis; macrophages
Demargination of neutrophils from the vessel walls

15. What is the difference between additive and synergistic?
Inhaled animal dander allergens
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

16. What causes release of myosin head from the actin filament?
ATP binding (resets the myosin head to contract again for next binding)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
gram positive organisms
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

17. What is the cause of fixed splitting of S2? why?
Faulty positioning of the genital tubercle
Vascular endothelium; protease
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
CMV - HSV 1 - Candida

18. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
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
Tissue redistribution (out of plasma) rather than metabolism
Strength of cell mediated immune response
Cluster

19. What are the three causes of acute MI in context of normal coronary arteries ?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hyperkalemia; potassium sparing diuretics - potassium supplements
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

20. When is acid phosphatase elevated (Name two times)?
Recurrent larygneal
FGF and VEGF
Prostate tumor and increased osteoclast activity
Bronchial dilation (bronchiectasis)

21. what hormone is structurally similar to hCG?
Dihydropyridine sensitive Ca channels (L type)
Radial nerve damage
TSh (in testicular tumors can cause hyperthyroidism)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

22. What does anti phospholipid syndrome in SLE patients predispose them to?
Hydrogen bonds dictate alpha or beta structure
Turbulence
Appetite suppressants
Multiple miscarriages d/t hypercoaguability

23. what protein is increased in Crohns disease? What does it do?
Elastance
Fibrosis; macrophages
Boiling - bleach - formalin - UV irradiation
NF- KB; responsible for cytokine production

24. What antibodies are present in CREST? What is the most specific?
No; MRI
gram positive organisms
Anti centromere; anti DNA topoisomerase
Large stroke volumes with ventricular contraction; aortic regurg

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Curlings ulcers
Valproate
Right heart failure
Become beta pleated and then form neurofibrillary tangle!

26. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
Env genes (for getting into target cells)
chronic urticaria and allergic symptoms
Excessive collagen formation during tissue repair in susceptible individuals

27. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Pan colitis and right sided colitis (more than left sided and proctitis)
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hyperkalemia; potassium sparing diuretics - potassium supplements

28. What does nitroprusside do to afterload? preload?
Decreases both
Relfex tachycardia; giving beta blockers
Terminal bronchioles; small bronchi
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

29. What is the fibrinogen level in patient with TTP- HUS? DIC?
Anterior circumflex (and axillary nerve)
Normal; low
Measure of depth invasion (vertical!)
Elevated GGT and macrocytosis

30. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Terminal bronchioles; small bronchi
Radial nerve damage
On cardiac tissue and renal juxtaglomerular cells

31. what drug is useful for secretory diarrhea?
Octreotide
Ether and other organic solvents
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
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

32. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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
Gluteus medius and minimus; positive trendelenberg

33. what chromosome is c - myc found on?
Chrom 8
Reticulocytes
GI tract; mood!
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

34. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
SSRI
Vancomycin
Hexokinase
Increase; decreased

35. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Relfex tachycardia; giving beta blockers
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)
Integration of viral DNA into genome of host hepatocytes

36. on What part of the clavicle does the SCM attach?
4 - 4 - 9
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
<1% - 55% - concentration dependent
Medial part

37. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Fibrosis; macrophages
46 - 4N; 23 2N
Susceptible; soluble (unable to be cultured in bile)

38. how does achalasia present? What does barium swallow show on dilated esophagus?
hyponatremia (aldosterone activation equilibrates body volume)
Prevents hepatic VLDL production
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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

39. What is the mcc of elevated AFP leves in pregnancy>
Paramyxo and influenza
Localized dermatologic pain that persists for more than one month after zoster eruption
Underestimation of gestational age
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

40. what marker should be followed in a patient with cirrhosis?
Terminal bronchioles; small bronchi
Prevent phagocytosis
LT (LTD4 - E4 - C4) - and Ach
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

41. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Measles and M3 AML`
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

42. What is the mainstay treatment for acute mania?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Rabies encephalitis from cave bats; rabies killed vaccines
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

43. What does TGF beta do? What produces it?
Retinitis; mononucleosis
Anti cholinergic effects of pupil dilation and lack of accomodation
Fibrosis; macrophages
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

44. what clinical findings help distinguish small cell carcinoma?
chronic urticaria and allergic symptoms
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Turbulence

45. which are the only glycosylated proteins in HIV virus?
Medial part
Valproate
Env genes (for getting into target cells)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

46. why are beta thal major patients asymptomatic at birth?
E. coli; staphylococcus saprophyticus
Because gamma chains replace beta chains and then gamma chain formation wanes
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Kallmans

47. biotin is used By what in tissues responsible for gluconeogenesis
Reticulocytes
Pan colitis and right sided colitis (more than left sided and proctitis)
glycerol kinase
As a CO2 carrier with the carboxylase enzyme

48. where are the vegetations on the valves of a libman sacks endocarditis?
I is more benign and can present later in adulthood
Both sides
Regular insulin (Not fast acting - regular better)
The term used to describe decreased drug responsiveness with repeated administration

49. how much percent of sodium is excreted? urea? glucose?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
<1% - 55% - concentration dependent
SSRI
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

50. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Normally close to systolic
MAC complex (C5b - C9 complement deficiency)
Normal; low

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USMLE Prep 2

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