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USMLE Prep 2

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.

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 mc malignancy in asbestosis?
Reiter syndrome; B27
Bronchogenic carcinoma
As a CO2 carrier with the carboxylase enzyme
Sickle cell; G6PD

2. What is subacute sclerosisng encephalitis caused by?
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
Excessive collagen formation during tissue repair in susceptible individuals
only up to bronchi
Downs; regurgitant AV valves - ASDs

3. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
GI malignancies and Insulin resistance (acromegal for ex)
Raphe

4. do Class IC agents prolong the QT interval?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Measles and M3 AML`
Varying; erythema nodosum is common
No

5. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Nonsense; mRNA processing
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
E6 and E7 of HPV knock off p53 and Rb suppressor genes

6. other than increasing HDL levels - what else does niacin do?
Apocrine; eccrine
Underestimation of gestational age
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Prevents hepatic VLDL production

7. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Echinococcus granulosus; anaphylaxis
IgE
Selective alpha 1 (increases SVR)

8. Where does lysyl oxidase act? What is the cofactor for that?
Pulmonic and systemic!
In the extracellular space for collagen cross linking; zinc
T test; chi squared
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

9. what would be a sign of absence of cardiogenic pulm edem?
Underestimation of gestational age
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Tissue redistribution (out of plasma) rather than metabolism
Normally close to systolic

10. how does increased ICP result in curlings ulcers?
Multiple miscarriages d/t hypercoaguability
Vagus nerve stimulation
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
Hypo or hyper pigmentations; after tanning

11. What is Tzanck smear used to detect?
Turners`
HSV and VZV
Bronchial dilation (bronchiectasis)
Acute gastric mucosal defects (superficial or full thickness)

12. sporadic colon cancer tend to arise From what type of polyps?
ZDV or AZT
Faulty positioning of the genital tubercle
Single adenomatous ones
4 - 4 - 9

13. what makes bruits?
Turbulence
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
RBC mass; epo levels (secondary has high)
differentiate

14. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Boiling - bleach - formalin - UV irradiation
Thymic tumor
differentiate

15. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
GI malignancies and Insulin resistance (acromegal for ex)
No (unlike adenomyosis); yes
E6 and E7 of HPV knock off p53 and Rb suppressor genes

16. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
SSRI; erectile dysfunction
P53 mutation; AD
Close but purkinje system to ensure contraction in a bottom up fashion

17. What would a deflection of the membrane potential to near zero indicate?
Raphe
Increase in permeability of two ions with equal and opposite equilibrium potentials
P53 mutation; AD
Normal; low

18. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Nonsense; mRNA processing
Reiter syndrome; B27
Not lined by epithelium

19. What is the mutation type in thalassemias? what process is defective because of this?
Nonsense; mRNA processing
RR-1/RR
As a CO2 carrier with the carboxylase enzyme
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

20. why are pregnant predisposed to cholelithiasis?
Mean greater than median greater than mode
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
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

21. why is crohns disease associated with oxaloacetate kidney stones?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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
Ketone body production by preventing fatty acids into the mitochondria
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

22. What is acanthosis nigricans associated with?
Spongiosis
GI malignancies and Insulin resistance (acromegal for ex)
The time interval between S2 and OS- the shorter the interval - the more intense
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

23. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Decreases both
SSRI; erectile dysfunction
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

24. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Gluteus maximus; difficulty getting up from seated position and climbing chair
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

25. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Inactivates kallikrein which activates kininogen into bradykinin
Skin flushing and warmth; prostaglandins; give with aspirin

26. What is somatomedin C?
Protamine sulfate
Reticulocytes
Insulin like growth factor 1 (just another name)
S3 gallop; S2 to opening snap interval

27. in essential fructosuria - what enzyme do patients use to metabolize fructose?
liver specific
To pump calcium out in cardiac myocytes so that relaxation occurs
Hexokinase
Common peroneal; bony fractures and compression; sciatic

28. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Increase lymphatic drainage!
SVC and IVC; right below the aortic knob
Pulmonary hypertension

29. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Downs; regurgitant AV valves - ASDs
Adeno
Rabies encephalitis from cave bats; rabies killed vaccines

30. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
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
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Apocrine; eccrine
Pulmonary hypertension

31. IL4 is used for isotypye switching to what?
Excessive collagen formation during tissue repair in susceptible individuals
11 aa polypeptide; pain NT in CNS and PNS
IgE
Clindamycin; covers anaerobic oral flora and aerobic bacteria

32. What type of drug is alendronate?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Biphosphonate

33. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Thymic tumor
liver specific
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

34. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Common peroneal; bony fractures and compression; sciatic
facultative intracellular
Increase; decreased
Reiter syndrome; B27

35. which viruses require a protease?
Pulmonic and systemic!
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SS +rNA
Nocardia

36. what drugs causes the red man syndrome? how does it occur?
Prevent phagocytosis
No; yes
Fibrosis; macrophages
Vancomycin; histamine mediated

37. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Highly negative resting potential
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
IgE

38. What is contraindicated in toxic mega colon?
Ether and other organic solvents
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
The time interval between S2 and OS- the shorter the interval - the more intense
No

39. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Tzanck smear
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
RER; RER
8; 12

40. What does 'oxygen' content in blood refer to?
Ether and other organic solvents
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)
Amiadarone
Dissolved in plasma and attached to Hgb

41. What type of mutation does aflatoxin cause? what cancer does this increase for?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Multiple miscarriages d/t hypercoaguability
Dihydropyridine sensitive Ca channels (L type)
G to T in p53; HCC

42. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Decreases both
Medial circumflex artery; avascular necrosis
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By vascular permeability and vasodilation

43. Would alpha 1 agonists cause flushing? muscarinic antagonist?
AV node slowest - to allow time for diastole
Syncope - angina - dyspnea (SAD)
No; yes
By vascular permeability and vasodilation

44. What does sustained hand grip do to the C/V system?
Localized dermatologic pain that persists for more than one month after zoster eruption
Vancomycin; histamine mediated
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

45. What is the triad seen in pre eclampsia?
Acute gastric mucosal defects (superficial or full thickness)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Hypertension - edema - and proteinuria
Excessive collagen formation during tissue repair in susceptible individuals

46. What are some side effects seen in TCAs?
SSRI
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
200-500
OCPs - multiparity - breast feeding

47. When does opening snap begin?
Anti centromere; anti DNA topoisomerase
Demargination of neutrophils from the vessel walls
Acute gastric mucosal defects (superficial or full thickness)
Right before diastole (filling begins)

48. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
low in serum
Gluteus medius and minimus; positive trendelenberg
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

49. What are three symptoms in s.typhi?
Hyperkalemia; potassium sparing diuretics - potassium supplements
In ER of bile canaliculi
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

50. when do ghon complexes form - primary or secondary TB?
200-500
Primary
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
SVT; increases vagal tone; rectus abdominis