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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. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Because of the low output from heart failure - they will have increased aldosterone levels
Gluteus maximus; difficulty getting up from seated position and climbing chair
Headaches and facial flushing; vasodilation in meninges and skin

2. 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?
E. coli
Regular insulin (Not fast acting - regular better)
46 - 4N; 23 2N
GI malignancies and Insulin resistance (acromegal for ex)

3. why does hypothyroidism cause increased CPK levels?
Radial nerve and deep brachial artery
Prevent phagocytosis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

4. What is the mc location of brain germinomas?What are the classic symptoms?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Superior larygeal; cricothyroid; recurrent laryngeal
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

5. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Not lined by epithelium
Common and benign congenital disorder characterized by cystic dilation of the medullary collecting ducts (cortex is spared); painless hematuria or asymptomatic; mc is development of kidney stones (benign disease)
liver specific

6. What is omalizumab and What is it used for?
Chrom 8
SVC and IVC; right below the aortic knob
Superior larygeal; cricothyroid; recurrent laryngeal
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

7. what has the greatest effect on prognosis when treating c. diptheriae?
(urine PAH x urine flow rate)/plasma PAH
OCPs - multiparity - breast feeding
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Bile salt accumulation in urine

8. What is hypospadias caused by?
Abnormal closing of the urethral folds
Tzanck smear
HSV and VZV
Sarcoid

9. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Increase; decreased

10. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
S. aureus
Trochlear nerve (IV); abducens nerve (VI)
Lateral; RV; RA; LV

11. 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?
Faulty positioning of the genital tubercle
Cluster
Smoking
Sudden loss of muscle tone without loss of consciousness; narcolepsy

12. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Gluteus maximus; difficulty getting up from seated position and climbing chair
Multiple miscarriages d/t hypercoaguability

13. What is the immune deficinecy seen in ataxia telangactasia?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
8 (myc protein) with 2 - 14 - 22 (iG chains)
Ig A deficiency
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

14. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Fat - fertile - forty - female
Become beta pleated and then form neurofibrillary tangle!
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)

15. name three pathological states that present with large tongues.
Prostate tumor and increased osteoclast activity
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
SVT; increases vagal tone; rectus abdominis
Congenital hypothyroidism - downs - amyloidosis - acromegaly

16. who bleed more DIC or TTP- HUS patients?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
11
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
DIC; TTP- HUS dont bleed that much

17. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Around 70 (normal measured diastolic pressures); 9--
Relfex tachycardia; giving beta blockers
Large stroke volumes with ventricular contraction; aortic regurg

18. What are some of the permissive effects of cortisol?
Folic acid treatment!
Increases bronchial and vascular smooth muscle reactivity to catecholamines
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
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)

19. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Echinococcus granulosus; anaphylaxis
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
Elastance
AV node slowest - to allow time for diastole

20. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
TCAs and prazosin
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Vancomycin

21. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Fibronectin - laminin - collagen
Recurrent larygneal
Chlorpheniramine and diphenhydramine
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

22. What are the two mcc of focal brain lesions in HIV positive patients?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Varying; erythema nodosum is common
Echinococcus granulosus; anaphylaxis
Duration and extent of disease

23. When is acid phosphatase elevated (Name two times)?
Insulin like growth factor 1 (just another name)
APP on chrom 21 (this is why downs more susceptible)
Prostate tumor and increased osteoclast activity
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

24. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
APP on chrom 21 (this is why downs more susceptible)
Gluteus maximus; difficulty getting up from seated position and climbing chair
C3 decreased after 5-10 days; sulfonamides
Duration and extent of disease

25. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
I is more benign and can present later in adulthood
11
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

26. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
G to T in p53; HCC
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vertical diplopia

27. What three pathogens cause infectious esophagitis in HIV positive patients?
Prevents hepatic VLDL production
CMV - HSV 1 - Candida
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
No

28. why does neutrophila occur with corticosteroids?
When it invades the bm; carcinoma in situ
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Demargination of neutrophils from the vessel walls
Vagus (auricular branch); vasovagal syncope!

29. Where does terminal peptide cleavage of collagen fibrils take place?
Fibronectin - laminin - collagen
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Medial circumflex artery; avascular necrosis
In the extracellular space

30. What type of vision is myopia? In What type of patients does it improve?
Fibrosis; macrophages
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
low in serum
Hereditary angioedema; ACE inhibitors

31. What does VIP do to gastric acid secretion?
Dissolved in plasma and attached to Hgb
Inhibits it
Because gamma chains replace beta chains and then gamma chain formation wanes
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

32. how does achalasia present? What does barium swallow show on dilated esophagus?
frameshift mutations (missense is substitution)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Large stroke volumes with ventricular contraction; aortic regurg

33. Acyl coA synthetase is not...
liver specific
frameshift mutations (missense is substitution)
No
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

34. What is pickwickian syndrome? What are the lab findings?
Bile soluble which means they are bile sensitive
Chrom 8
Closer to head; closer to diaphragm
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

35. What antibodies are present in CREST? What is the most specific?
facultative intracellular
Prepatellar
Anti centromere; anti DNA topoisomerase
Underestimation of gestational age

36. 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
indomethacin
Lateral; RV; RA; LV
Abnormal closing of the urethral folds

37. What does hypocapnia cause in teh brain? What is hypocapnia?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
(urine PAH x urine flow rate)/plasma PAH
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
frameshift mutations (missense is substitution)

38. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes
As a CO2 carrier with the carboxylase enzyme

39. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

40. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Chlorpheniramine and diphenhydramine
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Trauma to stereociliated hair cells of the organ of corti

41. 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
Env genes (for getting into target cells)
Chrom 8
ZDV or AZT

42. What is used to treat heparin toxicity?
Protamine sulfate
RR-1/RR
liver specific
Clindamycin; covers anaerobic oral flora and aerobic bacteria

43. What translocations can cause c - myc overexpression?
Bronchial dilation (bronchiectasis)
Tzanck smear
8 (myc protein) with 2 - 14 - 22 (iG chains)
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

44. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
NF- KB; responsible for cytokine production
Standing suddenly from supine position; valsalva maneuver
Inhibits it

45. What is the difference between additive and synergistic?
Increase; decreased
Proteasome inhibitor; treatment for MM and waldenstroms
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
Turners`

46. What does C1 esterase do other than inhibiting complement pathway?
Bronchial dilation (bronchiectasis)
By vascular permeability and vasodilation
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Inactivates kallikrein which activates kininogen into bradykinin

47. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
RR-1/RR

48. What can cause aortic regurg? What is the heart sound you hear?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Pulmonic and systemic!
Raphe

49. which cells produce surfactant? which ones mediate gas exchange?
TCAs and prazosin
II; I (I more abundant)
Rabies encephalitis from cave bats; rabies killed vaccines
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

50. which nerve provides innervation for plantar flexion and inversion?
200-500
Close but purkinje system to ensure contraction in a bottom up fashion
Medullary
Tibial