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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.
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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 can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
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
Normally close to systolic
Well trained athletes and children
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

2. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Barium enema
Another type of aldosterone antagonist (like spironolactone)
Trochlear nerve (IV); abducens nerve (VI)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

3. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Fibronectin - laminin - collagen
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

4. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Rabies encephalitis from cave bats; rabies killed vaccines
Prepatellar
Radial nerve damage
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

5. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Underestimation of gestational age
25; 25
Increase lymphatic drainage!

6. Where does lysyl oxidase act? What is the cofactor for that?
Fat - fertile - forty - female
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
In the extracellular space for collagen cross linking; zinc
Nocardia

7. when do ghon complexes form - primary or secondary TB?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
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
Primary

8. How do left sided colon adenocarcinomas present? right sided?
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
Think Hb deformation diseases
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
C3 decreased after 5-10 days; sulfonamides

9. What is omalizumab and What is it used for?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
APP on chrom 21 (this is why downs more susceptible)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

10. What antibiotic is best to treat alcoholic pulm infections? why?
Ether and other organic solvents
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Prevents hepatic VLDL production
Another type of aldosterone antagonist (like spironolactone)

11. What are some of the permissive effects of cortisol?
SS +rNA
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Highly negative resting potential

12. what diseases can vit A be used to treat?
In the extracellular space for collagen cross linking; zinc
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Measles and M3 AML`
Syncope - angina - dyspnea (SAD)

13. what hormone is structurally similar to hCG?
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
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
facultative intracellular
TSh (in testicular tumors can cause hyperthyroidism)

14. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
S3 gallop; S2 to opening snap interval
Sydenham chorea
Protamine sulfate

15. where are the vegetations on the valves of a libman sacks endocarditis?
Both sides
Large stroke volumes with ventricular contraction; aortic regurg
Demargination of neutrophils from the vessel walls
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

16. other than parvo B19 - what else is associated with red cell aplasia?
Syncope - angina - dyspnea (SAD)
Thymic tumor
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
P53 mutation; AD

17. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Skin flushing and warmth; prostaglandins; give with aspirin
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

18. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Octreotide
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
transcription activation/suppression

19. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Highly negative resting potential
Fibronectin - laminin - collagen
RBF= PAH clearance/(1- hematocrit)
Hexokinase

20. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Syncope - angina - dyspnea (SAD)

21. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
SaO2 <92%
P53 mutation; DCC is also required for adenoma to carcinoma
Bile salt accumulation in urine
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

22. What does Rb protein do? what chrom is it on?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Retinitis; mononucleosis

23. What does TGF beta do? What produces it?
The time interval between S2 and OS- the shorter the interval - the more intense
Radial nerve and deep brachial artery
Acute interstitial nephritis
Fibrosis; macrophages

24. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Inactivates kallikrein which activates kininogen into bradykinin
MAO inhibitors; wine and cheese
Increase; decreased
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

25. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Echinococcus granulosus; anaphylaxis
MAC complex (C5b - C9 complement deficiency)
Purkinje system; AV node

26. other than proteinuria - What can cause foamy froathy urine?
Sarcoid
Bile salt accumulation in urine
Decreases both
PDA open

27. What is the difference between additive and synergistic?
ZDV or AZT
GI tract; mood!
Retinitis; mononucleosis
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

28. What three pathogens cause infectious esophagitis in HIV positive patients?
CMV - HSV 1 - Candida
Prostate tumor and increased osteoclast activity
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Leukotriene precursor and does neutrophil chemotaxis

29. 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?
As a CO2 carrier with the carboxylase enzyme
Cluster
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
On cardiac tissue and renal juxtaglomerular cells

30. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

31. what murmur is enhanced by decreased blood flow to the heart?
Fibronectin - laminin - collagen
Large stroke volumes with ventricular contraction; aortic regurg
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Tzanck smear

32. What does the tuberoinfundibular pathway connect? What is it responsible for?
No; MRI
Anti cholinergic effects of pupil dilation and lack of accomodation
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Pulmonic and systemic!

33. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Sarcoid
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
Regular insulin (Not fast acting - regular better)

34. How do you calculate atributable risk percent?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
RR-1/RR
Congenital hypothyroidism - downs - amyloidosis - acromegaly
S. saprophyticus - and s. epidermidis; novobiocin

35. What translocations can cause c - myc overexpression?
PDA open
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
8 (myc protein) with 2 - 14 - 22 (iG chains)
Atrial

36. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Little effect on cell and no change

37. What is a keloid?
Selective alpha 1 (increases SVR)
CGD; t cell dysfxn (diGeorge)
Excessive collagen formation during tissue repair in susceptible individuals
Integration of viral DNA into genome of host hepatocytes

38. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
GI tract; mood!
Sickle cell; G6PD
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

39. What are the first generation anti histamines?
Chlorpheniramine and diphenhydramine
Medullary
Vancomycin
CGD; t cell dysfxn (diGeorge)

40. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Trochlear nerve (IV); abducens nerve (VI)
Hypothyroidism
Intussusception
Syringomelia

41. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Myasthenia gravis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Hexokinase

42. What is the mc location of brain germinomas?What are the classic symptoms?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Drink plenty of fluids
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Ceftriaxone; azithromycin

43. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
chronic urticaria and allergic symptoms
RER; RER
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Retinitis; mononucleosis

44. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
Sydenham chorea
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Serum FFA and serum triglyceride levels

45. When is an S4 sound normal?
Well trained athletes and children
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Bile salt accumulation in urine

46. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Increase in permeability of two ions with equal and opposite equilibrium potentials
Bronchogenic carcinoma
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

47. What is the immune deficinecy seen in ataxia telangactasia?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Medial part
Ig A deficiency
Dihydropyridine sensitive Ca channels (L type)

48. What type of disease has selective proteinuria? What is found in urine? What is not?
Trauma to stereociliated hair cells of the organ of corti
Nonsense; mRNA processing
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
SaO2 <92%

49. where are the two classical places that the ulnar nerve can be injured?

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50. which two virus families have hemagluttinin on their surface?
Syringomelia
Paramyxo and influenza
Dissolved in plasma and attached to Hgb
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13