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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 are the three predominant symptoms of VHL? What is its mode of inheritance?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Strength of cell mediated immune response
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Anterior nares

2. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Hyperkalemia; potassium sparing diuretics - potassium supplements
only up to bronchi
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

3. neisseria are...
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Increase by 50% in urine osmolality
facultative intracellular
Amiadarone

4. What is the mc location for avascular necrosis? What is it associated with?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
P53 mutation; DCC is also required for adenoma to carcinoma
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

5. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
frameshift mutations (missense is substitution)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

6. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Large stroke volumes with ventricular contraction; aortic regurg
Increases cytokine production

7. What are the common causes of metabolic alkalosis? How do you differentiate between them?
gram positive organisms
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Southern - western
Ketone body production by preventing fatty acids into the mitochondria

8. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Reiter syndrome; B27
Normal; low
In the extracellular space for collagen cross linking; zinc

9. what marker should be followed in a patient with cirrhosis?
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)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Medial part

10. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
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
Raphe
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

11. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Around 70 (normal measured diastolic pressures); 9--

12. Which is faster atrial muscle or ventricular muscle?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Atrial
Duration and extent of disease

13. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
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
APP on chrom 21 (this is why downs more susceptible)
women
Gluteus maximus; difficulty getting up from seated position and climbing chair

14. What is gardeners mydriasis? How is it treated?
Ether and other organic solvents
Proteasome inhibitor; treatment for MM and waldenstroms
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

15. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Trochlear nerve (IV); abducens nerve (VI)
HSV and VZV
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

16. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Appetite suppressants
P53 mutation; AD
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

17. at three years of age What are social - fine motor - gross motor and language developments?
Well trained athletes and children
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Extrinsic def; instrinsic def; platelet def
transcription activation/suppression

18. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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19. Where does terminal peptide cleavage of collagen fibrils take place?
4 - 4 - 9
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
In the extracellular space
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

20. why does hypothyroidism cause increased CPK levels?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Increase by 50% in urine osmolality

21. What does p53 do? what chrom is it on?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
11
HSV ( also in utero: chlymadia - neisseria - group B strep)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

22. What causes wrist drop?
Radial nerve damage
No; MRI
Right heart failure
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

23. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
As a CO2 carrier with the carboxylase enzyme
46 - 4N; 23 2N
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

24. what diseases can vit A be used to treat?
Relfex tachycardia; giving beta blockers
Measles and M3 AML`
No; MRI
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

25. Which nerve lies in close proximity to the inferior thyroid artery?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Right heart failure
Recurrent larygneal
Anterior circumflex (and axillary nerve)

26. what dissolves the lipid bilayer of a viral envelope?
OCPs - multiparity - breast feeding
Retinitis; mononucleosis
SVC and IVC; right below the aortic knob
Ether and other organic solvents

27. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Apocrine; eccrine
Anterior nares
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

28. What are the lab findings in poststreptococcal GN?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Vancomycin
Not lined by epithelium

29. What type of mutation does aflatoxin cause? what cancer does this increase for?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
G to T in p53; HCC
Not lined by epithelium
Lateral; RV; RA; LV

30. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Kallmans
Barium enema
Ether and other organic solvents

31. what nerve and artery course along the posterior aspect of the humerus?
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
Because of vasodiation to skeletal muscles
Drug induced interstitial nephritis
Radial nerve and deep brachial artery

32. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Because of vasodiation to skeletal muscles
Decreases both
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Strength of cell mediated immune response

33. What can long term leg cast wearing cause?
Because of the low output from heart failure - they will have increased aldosterone levels
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Leukotriene precursor and does neutrophil chemotaxis

34. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
Elastance
APP on chrom 21 (this is why downs more susceptible)
HSV ( also in utero: chlymadia - neisseria - group B strep)
No (unlike adenomyosis); yes

35. Acyl coA synthetase is not...
NF- KB; responsible for cytokine production
4 - 4 - 9
liver specific
Serum FFA and serum triglyceride levels

36. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Syringomelia
Drug induced interstitial nephritis
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

37. How do you treat gonococcal infection? chlymadia?
Echinococcus granulosus; anaphylaxis
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
indomethacin
Ceftriaxone; azithromycin

38. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
INTRApartum Abs (ampicillin/penicillin)
Susceptible; soluble (unable to be cultured in bile)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

39. what murmur is enhanced by decreased blood flow to the heart?
(urine PAH x urine flow rate)/plasma PAH
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Increase; decreased
The time interval between S2 and OS- the shorter the interval - the more intense

40. why is glucagon used in beta blocker toxicitiy?
8; 12
Extrinsic def; instrinsic def; platelet def
II; I (I more abundant)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

41. What is hyaline arteriosclerosis usually a sign of ?
An invagination of portion of intestine into the lumen of the adjacent intestinal segment; can lead to impaired venous return from the invaginated segment of the bowel which can cause ischemia and subsequent necrosis
INTRApartum Abs (ampicillin/penicillin)
Superior larygeal; cricothyroid; recurrent laryngeal
Diabetic microangiopathy

42. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Closer to head; closer to diaphragm
Bronchial dilation (bronchiectasis)
Reiter syndrome; B27
RER; RER

43. What are two indicators of chronic alcohol consumption?
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
Elevated GGT and macrocytosis
Increases cytokine production
Sickle cell; G6PD

44. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
ATP binding (resets the myosin head to contract again for next binding)
Paramyxo and influenza
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

45. What is Tzanck smear used to detect?
Well trained athletes and children
Proteasome inhibitor; treatment for MM and waldenstroms
H. influenzae type B; polyribosyl phosphate (PRP); cherry red uvula - dysphagia - stridor (sometimes) - difficulty breathing - fever - drooling - positive 'thumbs up sign' on lateral xray of cervical region d/t swollen epiglottis
HSV and VZV

46. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Apocrine; eccrine
E. coli; staphylococcus saprophyticus
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Because of vasodiation to skeletal muscles

47. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Downs; regurgitant AV valves - ASDs

48. what hernia has a similar mechanism to hydrocele?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Inactivates kallikrein which activates kininogen into bradykinin
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

49. How do you calculate atributable risk percent?
RR-1/RR
Both sides
Ig A deficiency
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)

50. What triggers the neoplastic changes that are associated with HBV infecton?
Integration of viral DNA into genome of host hepatocytes
Joints d/t increased purine production and thus uric acid production
Increases
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic