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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. why does variocele occur more in left side?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Reiter syndrome; B27
11 aa polypeptide; pain NT in CNS and PNS
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

2. what makes bruits?
Turbulence
The term used to describe decreased drug responsiveness with repeated administration
Smoking
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

3. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
OCPs - multiparity - breast feeding
On cardiac tissue and renal juxtaglomerular cells
Barium enema
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

4. at four years of age - What are the social - fine motor - gross motor - and language developments?
Amiloride - spironolactone - triamterene
ZDV or AZT
E. coli
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

5. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Barium enema
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

6. what happens to capacitance with age?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
low in serum
...
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

7. What is subacute sclerosisng encephalitis caused by?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Elastance
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
When it invades the bm; carcinoma in situ

8. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Hydrogen bonds dictate alpha or beta structure
low in serum
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Circular - outside nucleus; transport proteins - rRNA - tRNA

9. what clinical findings help distinguish small cell carcinoma?
Southern - western
low in serum
Brief psychotic disorder; schizophreniform; schizophrenia
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

10. name three pathological states that present with large tongues.
G to T in p53; HCC
Boiling - bleach - formalin - UV irradiation
Diabetic microangiopathy
Congenital hypothyroidism - downs - amyloidosis - acromegaly

11. What is the cause of rapid plasma decay of thiopental?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Trauma to stereociliated hair cells of the organ of corti
Tissue redistribution (out of plasma) rather than metabolism
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)

12. What are some side effects seen in TCAs?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
ATP binding (resets the myosin head to contract again for next binding)
E. coli
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)

13. What is the immune deficinecy seen in ataxia telangactasia?
only up to bronchi
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Ig A deficiency
Reticulocytes

14. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Spongiosis
LT (LTD4 - E4 - C4) - and Ach
SSRI

15. other than proteinuria - What can cause foamy froathy urine?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Apocrine; eccrine
E. coli; staphylococcus saprophyticus
Bile salt accumulation in urine

16. What three factors effect total oxygen content of blood?
Covalent (between two cysteines)- allows protein to withstand denaturation
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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

17. what drugs causes the red man syndrome? how does it occur?
Because of the low output from heart failure - they will have increased aldosterone levels
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Vancomycin; histamine mediated
Tissue redistribution (out of plasma) rather than metabolism

18. sporadic colon cancer tend to arise From what type of polyps?
Little effect on cell and no change
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Single adenomatous ones
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

19. Where does terminal peptide cleavage of collagen fibrils take place?
Pan colitis and right sided colitis (more than left sided and proctitis)
Echinococcus granulosus; anaphylaxis
In the extracellular space
C3 decreased after 5-10 days; sulfonamides

20. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Skin flushing and warmth; prostaglandins; give with aspirin
MAC complex (C5b - C9 complement deficiency)

21. What is the preferred treatment for DKA?
Southern - western
Regular insulin (Not fast acting - regular better)
Insulin like growth factor 1 (just another name)
Anterior circumflex (and axillary nerve)

22. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Prostate tumor and increased osteoclast activity
Cluster
Reiter syndrome; B27
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

23. 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?
Hexokinase
Common peroneal; bony fractures and compression; sciatic
Sickle cell; G6PD
ZDV or AZT

24. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Amiadarone
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
MAO inhibitors; wine and cheese

25. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Large stroke volumes with ventricular contraction; aortic regurg
Selective alpha 1 (increases SVR)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Retinitis; mononucleosis

26. which has better side effect profile - SSRI or TCA?
Sydenham chorea
Around 70 (normal measured diastolic pressures); 9--
SSRI
Radial nerve damage

27. PDAs are often asymptomatic. How do you treat?
S. saprophyticus - and s. epidermidis; novobiocin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
indomethacin
Superior larygeal; cricothyroid; recurrent laryngeal

28. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Elevated GGT and macrocytosis
Folic acid treatment!
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

29. What does C1 esterase do other than inhibiting complement pathway?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Inactivates kallikrein which activates kininogen into bradykinin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Normally close to systolic

30. what hernia has a similar mechanism to hydrocele?
S. aureus
Right heart failure
In the extracellular space
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

31. What is a keloid?
SVT; increases vagal tone; rectus abdominis
Excessive collagen formation during tissue repair in susceptible individuals
HSV ( also in utero: chlymadia - neisseria - group B strep)
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

32. what marker should be followed in a patient with cirrhosis?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Intussusception
Leukotriene precursor and does neutrophil chemotaxis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

33. is Rifampin ever used as monotherapY? why either way?
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
Biphosphonate
Amiadarone
Tzanck smear

34. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Syringomelia
Large stroke volumes with ventricular contraction; aortic regurg
Hyperkalemia; potassium sparing diuretics - potassium supplements

35. What are the potassium sparing diuretics?
Right before diastole (filling begins)
Integration of viral DNA into genome of host hepatocytes
Amiloride - spironolactone - triamterene
Valproate

36. What effects does cortisol have on catecholamines?
Rabies encephalitis from cave bats; rabies killed vaccines
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
Squatting - sitting - lying supine - passive leg raising
Strength of cell mediated immune response

37. what chromosome is c - myc found on?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Chrom 8
Rabies encephalitis from cave bats; rabies killed vaccines
P53 mutation; AD

38. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
Insulin like growth factor 1 (just another name)
Trauma to stereociliated hair cells of the organ of corti
Anti centromere; anti DNA topoisomerase

39. What causes vertical diplopia? horizontal?
P53 mutation; DCC is also required for adenoma to carcinoma
Trochlear nerve (IV); abducens nerve (VI)
Both sides
chronic urticaria and allergic symptoms

40. what organ would an activating mutation in PRPP synthetase effect?
MAC complex (C5b - C9 complement deficiency)
Normal; low
Joints d/t increased purine production and thus uric acid production
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

41. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
DIC; TTP- HUS dont bleed that much
46 - 4N; 23 2N
ANCA because of lack of Ig and C3 deposits on IF

42. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Bronchial dilation (bronchiectasis)
Prostate tumor and increased osteoclast activity
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)
Leukotriene precursor and does neutrophil chemotaxis

43. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
DIC; TTP- HUS dont bleed that much
Rabies encephalitis from cave bats; rabies killed vaccines
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Closer to head; closer to diaphragm

44. what enzyme converts procarcinogens into carcinogens?
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
Acute gastric mucosal defects (superficial or full thickness)
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
P450 mitochondrial monooxygenase

45. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Around 70 (normal measured diastolic pressures); 9--
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Turners`
SVC and IVC; right below the aortic knob

46. Metronidizaole does not cover...
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Hypertension - edema - and proteinuria
Tissue redistribution (out of plasma) rather than metabolism
gram positive organisms

47. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
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
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)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

48. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
MAC complex (C5b - C9 complement deficiency)
Increase lymphatic drainage!
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Boiling - bleach - formalin - UV irradiation

49. if there are keratin swirls does that mean well or poorly differentiated?
Env genes (for getting into target cells)
CGD; t cell dysfxn (diGeorge)
Well
Around 70 (normal measured diastolic pressures); 9--

50. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
S3 gallop; S2 to opening snap interval
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
RBC mass; epo levels (secondary has high)

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