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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 a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Integration of viral DNA into genome of host hepatocytes
Hyperkalemia; potassium sparing diuretics - potassium supplements
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Primary

2. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Increase by 50% in urine osmolality
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
Increase; decreased
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

3. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
glycerol kinase
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

4. Which is faster purkinje system or atrial muscle?
Pan colitis and right sided colitis (more than left sided and proctitis)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Close but purkinje system to ensure contraction in a bottom up fashion
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

5. what hormone is structurally similar to hCG?
Reiter syndrome; B27
Pulmonic and systemic!
TSh (in testicular tumors can cause hyperthyroidism)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

6. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Susceptible; soluble (unable to be cultured in bile)
Pulmonary hypertension
G to T in p53; HCC
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

7. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Bile soluble which means they are bile sensitive
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Aromatase deficiency in child

8. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Hypothyroidism

9. within the right ventricle - What are maximum pressures? the pulm arter?
200-500
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Amiadarone
25; 25

10. the rate of blood flow of which two circulations must equal each other at all times?
Radial nerve and deep brachial artery
Pulmonic and systemic!
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)
Well

11. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Smoking
Leukotriene precursor and does neutrophil chemotaxis
Vancomycin

12. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Atrial
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Downs; regurgitant AV valves - ASDs

13. What three factors effect total oxygen content of blood?
glycerol kinase
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Nocardia
11

14. What is the cause of fixed splitting of S2? why?
To pump calcium out in cardiac myocytes so that relaxation occurs
Syringomelia
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Gluteus medius and minimus; positive trendelenberg

15. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
S3 gallop; S2 to opening snap interval
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
Retinitis; mononucleosis

16. What causes vertical diplopia? horizontal?
By vascular permeability and vasodilation
Trochlear nerve (IV); abducens nerve (VI)
Normal; low
Echinococcus granulosus; anaphylaxis

17. What are three symptoms in s.typhi?
E. coli; staphylococcus saprophyticus
Increased reticulocytes
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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

18. What is the triad seen in pre eclampsia?
In ER of bile canaliculi
TCAs and prazosin
Hypertension - edema - and proteinuria
RER; RER

19. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
...
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)
25; 25

20. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Chorda tympani branch
Phencyclidine (PCP)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

21. What is Tzanck smear used to detect?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Sarcoid
HSV and VZV
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

22. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Prevents hepatic VLDL production
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Sydenham chorea

23. What are two indicators of chronic alcohol consumption?
transcription activation/suppression
Sickle cell; G6PD
Elevated GGT and macrocytosis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

24. What does VIP do to gastric acid secretion?
200-500
Inhibits it
Turbulence
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

25. what dictates the resting membrane potential of most cells?
Close but purkinje system to ensure contraction in a bottom up fashion
High potassium conductance and some sodium conductance
Class I
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

26. non ceruloplasmin deposition - ceruloplasmin is...
Secretin stimulates the exocrine pancrease; S enteroendocrine cells in duodenal mucosa in response to acid secrete secretin (HCL is most potent stimulus for secretin release)
Trauma to stereociliated hair cells of the organ of corti
RER; RER
low in serum

27. why does neutrophila occur with corticosteroids?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Demargination of neutrophils from the vessel walls
E6 and E7 of HPV knock off p53 and Rb suppressor genes

28. on What part of the clavicle does the SCM attach?
GI tract; mood!
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Medial part

29. 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?
Tzanck smear
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
High potassium conductance and some sodium conductance
Common peroneal; bony fractures and compression; sciatic

30. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Susceptible; soluble (unable to be cultured in bile)
Clindamycin; covers anaerobic oral flora and aerobic bacteria

31. what induces bronchial squamous metaplasia?
Become beta pleated and then form neurofibrillary tangle!
Barium enema
MAC complex (C5b - C9 complement deficiency)
Smoking

32. sporadic colon cancer tend to arise From what type of polyps?
CMV - HSV 1 - Candida
Single adenomatous ones
To pump calcium out in cardiac myocytes so that relaxation occurs
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

33. What are the primary determinants of colon cancer risk in UC patients
8 (myc protein) with 2 - 14 - 22 (iG chains)
Bile salt accumulation in urine
Duration and extent of disease
Echinococcus granulosus; anaphylaxis

34. how does achalasia present? What does barium swallow show on dilated esophagus?
Folic acid treatment!
chronic urticaria and allergic symptoms
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
To pump calcium out in cardiac myocytes so that relaxation occurs

35. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Insulin like growth factor 1 (just another name)
Prepatellar
Acute gastric mucosal defects (superficial or full thickness)

36. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
E. coli
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
TSh (in testicular tumors can cause hyperthyroidism)

37. What is epispadias caused by?
LT (LTD4 - E4 - C4) - and Ach
ANCA because of lack of Ig and C3 deposits on IF
Faulty positioning of the genital tubercle
only up to bronchi

38. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
No (unlike adenomyosis); yes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Env genes (for getting into target cells)

39. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
In ER of bile canaliculi
Well
S. aureus

40. What does anti phospholipid syndrome in SLE patients predispose them to?
SaO2 <92%
MAO inhibitors; wine and cheese
Octreotide
Multiple miscarriages d/t hypercoaguability

41. how does noise induced hearing loss occur?
Ig A deficiency
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Trauma to stereociliated hair cells of the organ of corti
PDA open

42. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Vertical diplopia
Terminal bronchioles; small bronchi
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
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)

43. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Boiling - bleach - formalin - UV irradiation
Well trained athletes and children
manifestations - congenital (stretching of periventricular pyrimadal fibers)

44. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Closer to head; closer to diaphragm
Close but purkinje system to ensure contraction in a bottom up fashion
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Spongiosis

45. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
No (unlike adenomyosis); yes
HSV and VZV
II; I (I more abundant)

46. How do bradykinin - C3a and C5a cause edema?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
TCAs and prazosin
Thymic tumor
By vascular permeability and vasodilation

47. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Hydrogen bonds dictate alpha or beta structure
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
glycerol kinase

48. What is the mcc of extrinsic allergic asthma?
Pulmonic and systemic!
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Inhaled animal dander allergens
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

49. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Drink plenty of fluids
Brief psychotic disorder; schizophreniform; schizophrenia
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

50. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Circular - outside nucleus; transport proteins - rRNA - tRNA
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

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USMLE Prep 2

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