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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. What is subacute sclerosisng encephalitis caused by?
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
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
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

2. what enzyme converts procarcinogens into carcinogens?
The term used to describe decreased drug responsiveness with repeated administration
P450 mitochondrial monooxygenase
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)
Prevent phagocytosis

3. What causes curlings ulcers?
Because of the low output from heart failure - they will have increased aldosterone levels
To pump calcium out in cardiac myocytes so that relaxation occurs
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

4. Where does lysyl oxidase act? What is the cofactor for that?
Fibronectin - laminin - collagen
Phencyclidine (PCP)
In the extracellular space for collagen cross linking; zinc
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

5. What can cause aortic regurg? What is the heart sound you hear?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Vagus nerve stimulation
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

6. name three pathological states that present with large tongues.
indomethacin
Hereditary angioedema; ACE inhibitors
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Congenital hypothyroidism - downs - amyloidosis - acromegaly

7. 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?
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)
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)
Prostate tumor and increased osteoclast activity
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

8. when do ghon complexes form - primary or secondary TB?
Primary
Brief psychotic disorder; schizophreniform; schizophrenia
11 aa polypeptide; pain NT in CNS and PNS
Minimal change disease

9. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Atrial
Inhaled animal dander allergens
Chlorpheniramine and diphenhydramine

10. what dissolves the lipid bilayer of a viral envelope?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Ether and other organic solvents
Covalent (between two cysteines)- allows protein to withstand denaturation
Serum creatine kinase; reperfusion injury causes necrosis

11. what drugs causes the red man syndrome? how does it occur?
Brief psychotic disorder; schizophreniform; schizophrenia
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Vancomycin; histamine mediated
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

12. what color pigmentations are caused by malassezia furfur? when do they become more visible?
gram positive organisms
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Because gamma chains replace beta chains and then gamma chain formation wanes
Hypo or hyper pigmentations; after tanning

13. What is Tzanck smear used to detect?
Primary
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
HSV and VZV
RBF= PAH clearance/(1- hematocrit)

14. why does hypothyroidism cause increased CPK levels?
Valproate
Tissue redistribution (out of plasma) rather than metabolism
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)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

15. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Think Hb deformation diseases
Prostate tumor and increased osteoclast activity

16. What translocations can cause c - myc overexpression?
Primary
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

17. how does achalasia present? What does barium swallow show on dilated esophagus?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Acute interstitial nephritis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hypo or hyper pigmentations; after tanning

18. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Fibrosis; macrophages
Drink plenty of fluids
The term used to describe decreased drug responsiveness with repeated administration
Lateral; RV; RA; LV

19. What are the primary determinants of colon cancer risk in UC patients
indomethacin
Duration and extent of disease
In the extracellular space for collagen cross linking; zinc
SaO2 <92%

20. What are the acute effects of corticosteroids on the CBC?
frameshift mutations (missense is substitution)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Think Hb deformation diseases
Reticulocytes

21. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Large stroke volumes with ventricular contraction; aortic regurg
Myasthenia gravis
The term used to describe decreased drug responsiveness with repeated administration

22. What is the mcc of elevated AFP leves in pregnancy>
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
V fib; v. failure
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Underestimation of gestational age

23. at 2 years of age - What are the social - fine motor - gross motor and language developments?
IgE
Headaches and facial flushing; vasodilation in meninges and skin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
46 - 4N; 23 2N

24. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Because of vasodiation to skeletal muscles
Barium enema
Appetite suppressants

25. What agonists reduce the gradient across the LV outflow tract?
Mean greater than median greater than mode
11
Another type of aldosterone antagonist (like spironolactone)
Selective alpha 1 (increases SVR)

26. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Prevent phagocytosis
Valproate
Fibronectin - laminin - collagen
T test; chi squared

27. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Hydrogen bonds dictate alpha or beta structure
Lateral; RV; RA; LV
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

28. where exactly is ACE expressed in the lungs? What type of enzyme is it?
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)
Increased reticulocytes
Vascular endothelium; protease
Ether and other organic solvents

29. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Turbulence
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

30. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Mean greater than median greater than mode
Southern - western

31. how does eos release MBP to kill protozoa etc?
Measure of depth invasion (vertical!)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Apocrine; eccrine
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

32. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
46 - 4N; 23 2N
Tzanck smear
Duration and extent of disease
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

33. How do left sided colon adenocarcinomas present? right sided?
hyponatremia (aldosterone activation equilibrates body volume)
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
Primary
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

34. in overweight individuals What is thought to contribute to insulin resistance?
RR-1/RR
Serum FFA and serum triglyceride levels
By vascular permeability and vasodilation
Selective alpha 1 (increases SVR)

35. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Amiloride - spironolactone - triamterene
LT (LTD4 - E4 - C4) - and Ach
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
No; MRI

36. What is the most common neurologic complication of VZV reactivation?
Integration of viral DNA into genome of host hepatocytes
Raphe
Localized dermatologic pain that persists for more than one month after zoster eruption
Hereditary angioedema; ACE inhibitors

37. what kind of drug is sertraline? What is a common side effect?
Bile soluble which means they are bile sensitive
Appetite suppressants
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
SSRI; erectile dysfunction

38. What are the lab findings in poststreptococcal GN?
In the extracellular space
Not lined by epithelium
Skin flushing and warmth; prostaglandins; give with aspirin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

39. 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?
Diabetic microangiopathy
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Common peroneal; bony fractures and compression; sciatic
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

40. What are two common side effects of both acute and long acting nitrates? What causes them?
DIC; TTP- HUS dont bleed that much
The time interval between S2 and OS- the shorter the interval - the more intense
AV node slowest - to allow time for diastole
Headaches and facial flushing; vasodilation in meninges and skin

41. Where does 90% of serotonin lie? What is this NT responsible?
Acute interstitial nephritis
Because gamma chains replace beta chains and then gamma chain formation wanes
Sarcoid
GI tract; mood!

42. What are some side effects seen in TCAs?
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
Turners`
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

43. What is mcc of death pre hospital phase of MI? in hospital phase?
only up to bronchi
46 - 4N; 23 2N
Vagus (auricular branch); vasovagal syncope!
V fib; v. failure

44. what happens with LDL receptor density in statin therapy?
Tzanck smear
Increases
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

45. What actions increase venous return?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Multiple miscarriages d/t hypercoaguability
Squatting - sitting - lying supine - passive leg raising
E6 and E7 of HPV knock off p53 and Rb suppressor genes

46. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
RBC mass; epo levels (secondary has high)
Prevent phagocytosis
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

47. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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48. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
S. aureus
Southern - western
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)
Chrom 8

49. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
glycerol kinase

50. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Prostate tumor and increased osteoclast activity
Vertical diplopia
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
E. coli; staphylococcus saprophyticus

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USMLE Prep 2

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