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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. prostaglandin synthesis keeps...
Hexokinase
PDA open
In the extracellular space for collagen cross linking; zinc
Kallmans

2. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Class I
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Normal; low
differentiate

3. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Become beta pleated and then form neurofibrillary tangle!
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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
Smoking

4. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Squatting - sitting - lying supine - passive leg raising
Gluteus maximus; difficulty getting up from seated position and climbing chair
Boiling - bleach - formalin - UV irradiation
Measure of depth invasion (vertical!)

5. what defines hypoxemia?
Well trained athletes and children
SaO2 <92%
Chlorpheniramine and diphenhydramine
Spongiosis

6. what has the greatest effect on prognosis when treating c. diptheriae?
Hereditary angioedema; ACE inhibitors
Another type of aldosterone antagonist (like spironolactone)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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

7. What is easiest way to treat nephrolithiasis?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Drink plenty of fluids
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Inhaled animal dander allergens

8. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Amiadarone
Initiation - pointing; pincer grasp; walking; mama/dada
P53 mutation; AD
I is more benign and can present later in adulthood

9. Where does lysyl oxidase act? What is the cofactor for that?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
In the extracellular space for collagen cross linking; zinc
Vertical diplopia
Raphe

10. neisseria are...
facultative intracellular
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
No and yes
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

11. What are some of the permissive effects of cortisol?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
S3 gallop; S2 to opening snap interval
Smoking
46 - 4N; 23 2N

12. why does hypothyroidism cause increased CPK levels?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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

13. other than proteinuria - What can cause foamy froathy urine?
Increased reticulocytes
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Bile salt accumulation in urine
Fat - fertile - forty - female

14. What can cause virilization of a mother during pregnancy?
women
P53 mutation; DCC is also required for adenoma to carcinoma
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Aromatase deficiency in child

15. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
RR-1/RR
TSh (in testicular tumors can cause hyperthyroidism)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
ZDV or AZT

16. What pulmonary structural change can kartageners syndrome cause?
No; yes
ATP binding (resets the myosin head to contract again for next binding)
Bronchial dilation (bronchiectasis)
Smoking

17. which RPGN is also called pauci immune GN? why?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
ANCA because of lack of Ig and C3 deposits on IF
hyponatremia (aldosterone activation equilibrates body volume)
Excessive collagen formation during tissue repair in susceptible individuals

18. What are fenfluramine - phentermine?
MAC complex (C5b - C9 complement deficiency)
Appetite suppressants
Aromatase deficiency in child
FGF and VEGF

19. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
46 - 4N; 23 2N
Vagus nerve stimulation
Sickle cell; G6PD
Lateral; RV; RA; LV

20. what organ would an activating mutation in PRPP synthetase effect?
8; 12
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Joints d/t increased purine production and thus uric acid production
Drink plenty of fluids

21. What is suggestive of complete central DI?
C3 decreased after 5-10 days; sulfonamides
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Increase by 50% in urine osmolality
Adeno

22. What are the two mcc of focal brain lesions in HIV positive patients?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Ether and other organic solvents
Dihydropyridine sensitive Ca channels (L type)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

23. What is the difference between additive and synergistic?
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
Chlorpheniramine and diphenhydramine
Aromatase deficiency in child
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

24. other than in pyelonephritis - where else are WBC casts seen?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Pulmonary hypertension
Acute interstitial nephritis
Hyperkalemia; potassium sparing diuretics - potassium supplements

25. If a patient has higher levels of HbF - What does this mean?
Enterococci (e. faecalis)- found on genitalia area
Measles and M3 AML`
Think Hb deformation diseases
RBF= PAH clearance/(1- hematocrit)

26. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
E. coli; staphylococcus saprophyticus
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
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Turbulence

27. at four years of age - What are the social - fine motor - gross motor - and language developments?
Chlorpheniramine and diphenhydramine
PDA open
GI tract; mood!
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

28. nucleotide deletions do not cause missense mutations - they cause...
Downs; regurgitant AV valves - ASDs
frameshift mutations (missense is substitution)
Syringomelia
Because of the low output from heart failure - they will have increased aldosterone levels

29. why does neutrophila occur with corticosteroids?
Elevated GGT and macrocytosis
Demargination of neutrophils from the vessel walls
chronic urticaria and allergic symptoms
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

30. 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?
...
Covalent (between two cysteines)- allows protein to withstand denaturation
46 - 4N; 23 2N
Vagus (auricular branch); vasovagal syncope!

31. what induces bronchial squamous metaplasia?
Phencyclidine (PCP)
Hypo or hyper pigmentations; after tanning
Smoking
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

32. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
TCAs and prazosin
Mean greater than median greater than mode
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

33. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Ceftriaxone; azithromycin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

34. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Hypo or hyper pigmentations; after tanning
PDA open
FGF and VEGF

35. What is used to treat heparin toxicity?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Proteasome inhibitor; treatment for MM and waldenstroms
Protamine sulfate
Terminal bronchioles; small bronchi

36. Where does complement bind on the Fc region of Ig chains?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
I is more benign and can present later in adulthood
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

37. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Ether and other organic solvents
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

38. What is somatomedin C?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Trochlear nerve (IV); abducens nerve (VI)
Vertical diplopia
Insulin like growth factor 1 (just another name)

39. What is tachyphylaxis?
Well
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
Trauma to stereociliated hair cells of the organ of corti
The term used to describe decreased drug responsiveness with repeated administration

40. What does sustained hand grip do to the C/V system?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
46 - 4N; 23 2N
Increase in permeability of two ions with equal and opposite equilibrium potentials
Increases

41. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Ceftriaxone; azithromycin
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
C3 decreased after 5-10 days; sulfonamides

42. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Duration and extent of disease
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Bronchogenic carcinoma

43. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
SS +rNA
Valproate

44. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Chorda tympani branch
Measles and M3 AML`

45. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
I is more benign and can present later in adulthood
4 - 4 - 9
Fibronectin - laminin - collagen

46. What are the acute effects of corticosteroids on the CBC?
Drink plenty of fluids
Fibronectin - laminin - collagen
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Curlings ulcers

47. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Hypo or hyper pigmentations; after tanning
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

48. on which chromosome is wilms tumor found?
11
Curlings ulcers
Recurrent larygneal
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

49. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Sickle cell; G6PD
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
C3 decreased after 5-10 days; sulfonamides

50. which opponens muscle does ulnar innervate?
APP on chrom 21 (this is why downs more susceptible)
Adductor
P53 mutation; DCC is also required for adenoma to carcinoma
Reticulocytes

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USMLE Prep 2

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