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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. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Sarcoid
Vancomycin; histamine mediated
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

2. other than mycobacterim wha other bacteria is acid fast?
RER; copper
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
25; 25
Nocardia

3. what clinical findings help distinguish small cell carcinoma?
Relfex tachycardia; giving beta blockers
Echinococcus granulosus; anaphylaxis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

4. What can cause virilization of a mother during pregnancy?
Trochlear nerve (IV); abducens nerve (VI)
Aromatase deficiency in child
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Ceftriaxone; azithromycin

5. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
gram positive organisms
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Medullary

6. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Acute gastric mucosal defects (superficial or full thickness)
Acute interstitial nephritis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

7. What is medullary sponge kidney disease and how does it present? What does it lead to?
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)
Vascular endothelium; protease
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Duration and extent of disease

8. why is glucagon used in beta blocker toxicitiy?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Amiloride - spironolactone - triamterene
Sickle cell; G6PD
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

9. What are diastolic (lowest) pressures in aorta? LV?
Vagus (auricular branch); vasovagal syncope!
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Around 70 (normal measured diastolic pressures); 9--
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

10. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Retinitis; mononucleosis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Paramyxo and influenza

11. sporadic colon cancer tend to arise From what type of polyps?
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
Another type of aldosterone antagonist (like spironolactone)
Ig A deficiency
Single adenomatous ones

12. What is the mc malignancy in asbestosis?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Bronchogenic carcinoma
8; 12
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

13. What does NF- KB do?
PDA open
Increases cytokine production
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Syringomelia

14. What are the three dopaminergic systems and What are they responsible for? disease?
TCAs and prazosin
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Hypo or hyper pigmentations; after tanning

15. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
Right heart failure
SSRI
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

16. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Diabetic microangiopathy
Valproate
Chlorpheniramine and diphenhydramine
Increases bronchial and vascular smooth muscle reactivity to catecholamines

17. What does nitroprusside do to afterload? preload?
Decreases both
Normal; low
Enterococci (e. faecalis)- found on genitalia area
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

18. 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?
gram positive organisms
Normally close to systolic
Common peroneal; bony fractures and compression; sciatic
Sudden loss of muscle tone without loss of consciousness; narcolepsy

19. 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?
Inhibits it
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Cluster
Increase lymphatic drainage!

20. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
200-500
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
OCPs - multiparity - breast feeding

21. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Terminal bronchioles; small bronchi
To pump calcium out in cardiac myocytes so that relaxation occurs
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Reticulocytes

22. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
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
Leukotriene precursor and does neutrophil chemotaxis
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

23. what marker should be followed in a patient with cirrhosis?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Covalent (between two cysteines)- allows protein to withstand denaturation
Myasthenia gravis
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

24. What can cause aortic regurg? What is the heart sound you hear?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
No and yes
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Ether and other organic solvents

25. What is the mc location for avascular necrosis? What is it associated with?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Amiadarone
Around 70 (normal measured diastolic pressures); 9--
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

26. What causes the blurry vision side effects in first generation anti histamines?
On cardiac tissue and renal juxtaglomerular cells
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Anti cholinergic effects of pupil dilation and lack of accomodation
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

27. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
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)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
LT (LTD4 - E4 - C4) - and Ach
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

28. What is cataplexy and When is it seen?
Appetite suppressants
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Serum creatine kinase; reperfusion injury causes necrosis

29. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
When it invades the bm; carcinoma in situ
Inhaled animal dander allergens

30. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Turners`
Ceftriaxone; azithromycin
Squatting - sitting - lying supine - passive leg raising

31. 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?
In the extracellular space for collagen cross linking; zinc
Superior larygeal; cricothyroid; recurrent laryngeal
Ether and other organic solvents
Phencyclidine (PCP)

32. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Minimal change disease
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
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Drink plenty of fluids

33. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Because of vasodiation to skeletal muscles
No (unlike adenomyosis); yes
Pain reliever - reduces pain by locking substance P in the PNS

34. What is capacitance inversely proportional to?
Sickle cell; G6PD
Right heart failure
Elastance
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

35. 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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Strength of cell mediated immune response
Increases

36. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Classical conditioning
Reticulocytes
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
Prepatellar

37. what phase do adenosine and acetylcholine act on? doing what?
Another type of aldosterone antagonist (like spironolactone)
Chorda tympani branch
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

38. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Think Hb deformation diseases
Tzanck smear
No; yes
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

39. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
Amiloride - spironolactone - triamterene
ATP binding (resets the myosin head to contract again for next binding)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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)

40. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Terminal bronchioles; small bronchi
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)
Rabies encephalitis from cave bats; rabies killed vaccines
Primary

41. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
As a CO2 carrier with the carboxylase enzyme
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Hereditary angioedema; ACE inhibitors
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

42. in essential fructosuria - what enzyme do patients use to metabolize fructose?
The term used to describe decreased drug responsiveness with repeated administration
Increase by 50% in urine osmolality
ATP binding (resets the myosin head to contract again for next binding)
Hexokinase

43. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
SSRI
Abnormal closing of the urethral folds

44. 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?
Excessive collagen formation during tissue repair in susceptible individuals
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Standing suddenly from supine position; valsalva maneuver

45. what indicates the severity of a mitral regurg ? mitral stenosis?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
S3 gallop; S2 to opening snap interval
ANCA because of lack of Ig and C3 deposits on IF
TCAs and prazosin

46. What is the mc location of brain germinomas?What are the classic symptoms?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vertical diplopia
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

47. What are the three causes of acute MI in context of normal coronary arteries ?
SSRI
Medial part
Regular insulin (Not fast acting - regular better)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

48. What is a clara cell?
P53 mutation; DCC is also required for adenoma to carcinoma
G to T in p53; HCC
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Chorda tympani branch

49. What causes curlings ulcers?
Drug induced interstitial nephritis
Hyperkalemia; potassium sparing diuretics - potassium supplements
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

50. nucleotide deletions do not cause missense mutations - they cause...
Regular insulin (Not fast acting - regular better)
frameshift mutations (missense is substitution)
Well
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi