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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 hernia has a similar mechanism to hydrocele?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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)
Faulty positioning of the genital tubercle
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

2. What does protein M do in Group A strep<
Initiation - pointing; pincer grasp; walking; mama/dada
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
In the extracellular space for collagen cross linking; zinc
Prevent phagocytosis

3. 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?
P53 mutation; AD
Cluster
liver specific
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

4. at 2 years of age - What are the social - fine motor - gross motor and language developments?
differentiate
Trochlear nerve (IV); abducens nerve (VI)
Amiloride - spironolactone - triamterene
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

5. What is contraindicated in toxic mega colon?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Joints d/t increased purine production and thus uric acid production
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

6. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
Downs; regurgitant AV valves - ASDs
E. coli; staphylococcus saprophyticus
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

7. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
To pump calcium out in cardiac myocytes so that relaxation occurs
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
ATP binding (resets the myosin head to contract again for next binding)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

8. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Well
Increases
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Intussusception

9. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Because of vasodiation to skeletal muscles
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Bile salt accumulation in urine

10. what happens with LDL receptor density in statin therapy?
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)
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Increases
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

11. What are some of the permissive effects of cortisol?
Brief psychotic disorder; schizophreniform; schizophrenia
Increases bronchial and vascular smooth muscle reactivity to catecholamines
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Hypothyroidism

12. What are some side effects seen in TCAs?
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
Classical conditioning
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

13. What is pickwickian syndrome? What are the lab findings?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Apocrine; eccrine
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

14. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Anti cholinergic effects of pupil dilation and lack of accomodation
Standing suddenly from supine position; valsalva maneuver
Intussusception
HSV and VZV

15. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Amiloride - spironolactone - triamterene
ZDV or AZT

16. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
SVT; increases vagal tone; rectus abdominis
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
Increased reticulocytes
Adeno

17. What is the mc location of brain germinomas?What are the classic symptoms?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
11

18. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Become beta pleated and then form neurofibrillary tangle!
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
only up to bronchi
Underestimation of gestational age

19. where are Beta 1 receptors found?
No and yes
Inactivates kallikrein which activates kininogen into bradykinin
S. saprophyticus - and s. epidermidis; novobiocin
On cardiac tissue and renal juxtaglomerular cells

20. What is the mcc of elevated AFP leves in pregnancy>
Prepatellar
P53 mutation; DCC is also required for adenoma to carcinoma
Underestimation of gestational age
Terminal bronchioles; small bronchi

21. What is achalasia and how would this correlate on the esophageal mannometry?
No (unlike adenomyosis); yes
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Vancomycin; histamine mediated
Sydenham chorea

22. 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
II; I (I more abundant)
Injury to common peroneal nerve (d/t trauma or sustained pressure to neck of fibula) causing pain and numbness on dorsum of foot and inability to dorsiflex
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

23. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Multiple miscarriages d/t hypercoaguability
Regular insulin (Not fast acting - regular better)
Increased reticulocytes
RBC mass; epo levels (secondary has high)

24. are there signs of inflammation in avascular necrosis? then How do you diagnose?
No; MRI
Chlorpheniramine and diphenhydramine
Circular - outside nucleus; transport proteins - rRNA - tRNA
Amiadarone

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

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26. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Southern - western
Closer to head; closer to diaphragm
Intussusception

27. What test would be best to determine if a gene is being transcribed? translated?
RR-1/RR
Mean greater than median greater than mode
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Southern - western

28. Which nerve lies in close proximity to the inferior thyroid artery?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Selective alpha 1 (increases SVR)
Recurrent larygneal
Classical conditioning

29. Where does terminal peptide cleavage of collagen fibrils take place?
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
In the extracellular space
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
TSh (in testicular tumors can cause hyperthyroidism)

30. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Turners`
Aromatase deficiency in child
Hyperkalemia; potassium sparing diuretics - potassium supplements
Covalent (between two cysteines)- allows protein to withstand denaturation

31. When is acid phosphatase elevated (Name two times)?
Decreases both
liver specific
Prostate tumor and increased osteoclast activity
Integration of viral DNA into genome of host hepatocytes

32. How do you calculate RPF from urine PAH?
Hyperkalemia; potassium sparing diuretics - potassium supplements
S. saprophyticus - and s. epidermidis; novobiocin
(urine PAH x urine flow rate)/plasma PAH
Pulmonic and systemic!

33. What do you treat s. epidermidis with?
Inhibits it
Integration of viral DNA into genome of host hepatocytes
Measure of depth invasion (vertical!)
Vancomycin

34. What is subacute sclerosisng encephalitis caused by?
Inactivates kallikrein which activates kininogen into bradykinin
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
Bronchial dilation (bronchiectasis)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

35. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Hydrogen bonds dictate alpha or beta structure
Retinitis; mononucleosis
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

36. Which is slower AV node or ventricular muscle?
When it invades the bm; carcinoma in situ
AV node slowest - to allow time for diastole
MAO inhibitors; wine and cheese
Duration and extent of disease

37. What can too much IgA in serum produces?
RER; copper
RER; RER
Southern - western
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

38. What does 'oxygen' content in blood refer to?
Thymic tumor
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Increases
Dissolved in plasma and attached to Hgb

39. What is the most common location of colonization of all s. aureus types?
No
Anterior nares
Single adenomatous ones
G to T in p53; HCC

40. what clinical findings help distinguish small cell carcinoma?
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
Regular insulin (Not fast acting - regular better)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

41. Acyl coA synthetase is not...
8 (myc protein) with 2 - 14 - 22 (iG chains)
liver specific
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
RBC mass; epo levels (secondary has high)

42. What is the cause of rapid plasma decay of thiopental?
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)
In the extracellular space for collagen cross linking; zinc
Chlorpheniramine and diphenhydramine
Tissue redistribution (out of plasma) rather than metabolism

43. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Ig A deficiency
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

44. Where does complement bind on the Fc region of Ig chains?
Ig A deficiency
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
25; 25
liver specific

45. What is the mc malignancy in asbestosis?
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
Susceptible; soluble (unable to be cultured in bile)
Underestimation of gestational age
Bronchogenic carcinoma

46. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
P53 mutation; DCC is also required for adenoma to carcinoma
Underestimation of gestational age
DIC; TTP- HUS dont bleed that much

47. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Myasthenia gravis
Vascular endothelium; protease
Bile salt accumulation in urine

48. what locations of UC increase the risk of Colon cancer?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Another type of aldosterone antagonist (like spironolactone)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Pan colitis and right sided colitis (more than left sided and proctitis)

49. What pulmonary structural change can kartageners syndrome cause?
Acute interstitial nephritis
ATP binding (resets the myosin head to contract again for next binding)
E. coli; staphylococcus saprophyticus
Bronchial dilation (bronchiectasis)

50. What is a cord factor and Which bugs have it? How do they appear on culture?
Dissolved in plasma and attached to Hgb
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Appetite suppressants
Highly negative resting potential