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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 three factors effect total oxygen content of blood?
Protamine sulfate
T test; chi squared
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Boiling - bleach - formalin - UV irradiation

2. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Standing suddenly from supine position; valsalva maneuver
RER; RER
Hypothyroidism
Skin flushing and warmth; prostaglandins; give with aspirin

3. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
only up to bronchi
INTRApartum Abs (ampicillin/penicillin)
Increase in permeability of two ions with equal and opposite equilibrium potentials
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

4. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Well
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

5. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Hypertension - edema - and proteinuria
Cluster
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

6. 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
Brief psychotic disorder; schizophreniform; schizophrenia
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

7. 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?
8; 12
46 - 4N; 23 2N
To pump calcium out in cardiac myocytes so that relaxation occurs
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

8. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Dihydropyridine sensitive Ca channels (L type)
Vagus nerve stimulation
S. saprophyticus - and s. epidermidis; novobiocin
SVT; increases vagal tone; rectus abdominis

9. What triggers the neoplastic changes that are associated with HBV infecton?
chronic urticaria and allergic symptoms
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
differentiate
Integration of viral DNA into genome of host hepatocytes

10. at one year of age - What are the social - fine motor - gross motor and language developments?
Initiation - pointing; pincer grasp; walking; mama/dada
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Measles and M3 AML`
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

11. When does opening snap begin?
Primary
Right before diastole (filling begins)
Drink plenty of fluids
Pan colitis and right sided colitis (more than left sided and proctitis)

12. What are two indicators of chronic alcohol consumption?
Elevated GGT and macrocytosis
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Underestimation of gestational age
<1% - 55% - concentration dependent

13. What is the sole neurologic manifestation of acute rheumatic fever?
Large stroke volumes with ventricular contraction; aortic regurg
Sydenham chorea
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Raphe

14. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Downs; regurgitant AV valves - ASDs
Echinococcus granulosus; anaphylaxis
T test; chi squared
(urine PAH x urine flow rate)/plasma PAH

15. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Close but purkinje system to ensure contraction in a bottom up fashion
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Turbulence

16. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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
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)
Normally close to systolic
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

17. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Pan colitis and right sided colitis (more than left sided and proctitis)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

18. What type of endocarditis is cytoscopy induced?
8; 12
Ig A deficiency
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Enterococci (e. faecalis)- found on genitalia area

19. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
gram positive organisms
Bile soluble which means they are bile sensitive
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

20. What translocations can cause c - myc overexpression?
8 (myc protein) with 2 - 14 - 22 (iG chains)
P450 mitochondrial monooxygenase
Hyperkalemia; potassium sparing diuretics - potassium supplements
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

21. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
...
Spongiosis
S. saprophyticus - and s. epidermidis; novobiocin
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

22. In what population does cholelithiasis occur?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Fat - fertile - forty - female
Decreases both
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

23. how does neisseria cause a petechial rash?
Serum FFA and serum triglyceride levels
Neisseria induced small cell vasculitis (including hands and soles)
Reiter syndrome; B27
S. aureus

24. what locations of UC increase the risk of Colon cancer?
Measure of depth invasion (vertical!)
Pan colitis and right sided colitis (more than left sided and proctitis)
Vertical diplopia
Myasthenia gravis

25. What does 'oxygen' content in blood refer to?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Dissolved in plasma and attached to Hgb
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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)

26. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
When it invades the bm; carcinoma in situ
CGD; t cell dysfxn (diGeorge)
Regular insulin (Not fast acting - regular better)

27. what phase do adenosine and acetylcholine act on? doing what?
Multiple miscarriages d/t hypercoaguability
Another type of aldosterone antagonist (like spironolactone)
Coagulation factors are made in the liver
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

28. prostaglandin synthesis keeps...
RR-1/RR
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Increases cytokine production
PDA open

29. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Superior larygeal; cricothyroid; recurrent laryngeal
Vancomycin; histamine mediated
Duration and extent of disease
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

30. what happens to capacitance with age?
...
Trauma to stereociliated hair cells of the organ of corti
Vascular endothelium; protease
Because of vasodiation to skeletal muscles

31. What does NF- KB do?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
(urine PAH x urine flow rate)/plasma PAH
4 - 4 - 9
Increases cytokine production

32. how does achalasia present? What does barium swallow show on dilated esophagus?
Think Hb deformation diseases
Southern - western
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
FGF and VEGF

33. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Covalent (between two cysteines)- allows protein to withstand denaturation
Sarcoid
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)
Appetite suppressants

34. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
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
Anti - apoptotic (prevents going into apoptosis)- 18; 14
S. aureus
SVC and IVC; right below the aortic knob

35. What is capacitance inversely proportional to?
Initiation - pointing; pincer grasp; walking; mama/dada
Elastance
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

36. What are the two mcc of focal brain lesions in HIV positive patients?
Octreotide
Barium enema
frameshift mutations (missense is substitution)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

37. What are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Drug induced interstitial nephritis
Syringomelia
Acute gastric mucosal defects (superficial or full thickness)

38. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
IgE
Hereditary angioedema; ACE inhibitors
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

39. why does variocele occur more in left side?
only up to bronchi
Turbulence
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

40. what commonly happens in GI in response to acute physiologic stress?
HSV and VZV
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Acute gastric mucosal defects (superficial or full thickness)
LT (LTD4 - E4 - C4) - and Ach

41. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Radial nerve and deep brachial artery
Medial part
Intussusception

42. What is a primary HSV 1 infection like?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Minimal change disease
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
P53 mutation; DCC is also required for adenoma to carcinoma

43. What is used to prevent vertical transmission of HIV?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Inactivates kallikrein which activates kininogen into bradykinin
Proteasome inhibitor; treatment for MM and waldenstroms
ZDV or AZT

44. What is medullary sponge kidney disease and how does it present? What does it lead to?
Anterior nares
Ketone body production by preventing fatty acids into the mitochondria
SVC and IVC; right below the aortic knob
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)

45. which two drug types can cause orthostatic hypotension (think depression and BPH)?
TCAs and prazosin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
<1% - 55% - concentration dependent

46. Where is aromatase used?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
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
Increase by 50% in urine osmolality

47. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
GI malignancies and Insulin resistance (acromegal for ex)
In ER of bile canaliculi
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Class I

48. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
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)
Skin flushing and warmth; prostaglandins; give with aspirin
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

49. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Syringomelia
V fib; v. failure
Class I

50. What test would be best to determine if a gene is being transcribed? translated?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Southern - western
Kallmans
As a CO2 carrier with the carboxylase enzyme