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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. other than parvo B19 - what else is associated with red cell aplasia?
Turbulence
Skin flushing and warmth; prostaglandins; give with aspirin
Hyperkalemia; potassium sparing diuretics - potassium supplements
Thymic tumor

2. What are the two growth factors associated with angiogenesis?
Hypo or hyper pigmentations; after tanning
Because of the low output from heart failure - they will have increased aldosterone levels
Ig A deficiency
FGF and VEGF

3. What is the Na/Ca exchange used for?
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
Medullary
To pump calcium out in cardiac myocytes so that relaxation occurs
manifestations - congenital (stretching of periventricular pyrimadal fibers)

4. neisseria are...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
facultative intracellular
Demargination of neutrophils from the vessel walls
glycerol kinase

5. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Hereditary angioedema; ACE inhibitors
PDA open
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

6. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
Classical conditioning
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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

7. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
GI malignancies and Insulin resistance (acromegal for ex)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

8. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Faulty positioning of the genital tubercle
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
S3 gallop; S2 to opening snap interval

9. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Sarcoid
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
low in serum

10. What can long term leg cast wearing cause?
Circular - outside nucleus; transport proteins - rRNA - tRNA
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
Brief psychotic disorder; schizophreniform; schizophrenia
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

11. Which is faster purkinje system or atrial muscle?
S3 gallop; S2 to opening snap interval
Close but purkinje system to ensure contraction in a bottom up fashion
Adductor
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

12. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
INTRApartum Abs (ampicillin/penicillin)
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
Cluster

13. what dictates the resting membrane potential of most cells?
Radial nerve and deep brachial artery
Inhibits it
High potassium conductance and some sodium conductance
Protamine sulfate

14. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Vagus (auricular branch); vasovagal syncope!
Think Hb deformation diseases
Valproate
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

15. 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
Single adenomatous ones
Because of vasodiation to skeletal muscles
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

16. What does TGF beta do? What produces it?
Fibrosis; macrophages
Prostate tumor and increased osteoclast activity
CMV - HSV 1 - Candida
AV node slowest - to allow time for diastole

17. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Enterococci (e. faecalis)- found on genitalia area
Hexokinase
In the extracellular space for collagen cross linking; zinc
Leukotriene precursor and does neutrophil chemotaxis

18. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
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)
Minimal change disease
TSh (in testicular tumors can cause hyperthyroidism)
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

19. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Prevent phagocytosis
Because of the low output from heart failure - they will have increased aldosterone levels

20. What are the primary determinants of colon cancer risk in UC patients
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Folic acid treatment!
Diabetic microangiopathy
Duration and extent of disease

21. where are the two classical places that the ulnar nerve can be injured?

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22. What does extended consumption of appetite suppressants lead to?
Pulmonary hypertension
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
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hypo or hyper pigmentations; after tanning

23. What is intussusception? how does ischemia and necrosis occur?
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
Another type of aldosterone antagonist (like spironolactone)
SSRI; erectile dysfunction
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

24. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Increase; decreased
Smoking
Rabies encephalitis from cave bats; rabies killed vaccines
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

25. how long is substance P? What does it do?
Adductor
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
11 aa polypeptide; pain NT in CNS and PNS
SaO2 <92%

26. What is a primary HSV 1 infection like?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
High potassium conductance and some sodium conductance
11 aa polypeptide; pain NT in CNS and PNS
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

27. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Increase; decreased
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
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. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Relfex tachycardia; giving beta blockers
transcription activation/suppression
women

29. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Bile soluble which means they are bile sensitive
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
GI tract; mood!
Gluteus maximus; difficulty getting up from seated position and climbing chair

30. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Fibronectin - laminin - collagen
(urine PAH x urine flow rate)/plasma PAH
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

31. What is suggestive of complete central DI?
4 - 4 - 9
Decreases both
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Increase by 50% in urine osmolality

32. what defines hypoxemia?
Pan colitis and right sided colitis (more than left sided and proctitis)
SaO2 <92%
II; I (I more abundant)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

33. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Purkinje system; AV node
FGF and VEGF
transcription activation/suppression

34. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
Measles and M3 AML`
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
P53 mutation; DCC is also required for adenoma to carcinoma

35. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Appetite suppressants
Chorda tympani branch
Nocardia

36. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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
Chrom 8
P53 mutation; DCC is also required for adenoma to carcinoma

37. What translocations can cause c - myc overexpression?
ANCA because of lack of Ig and C3 deposits on IF
Multiple miscarriages d/t hypercoaguability
Ceftriaxone; azithromycin
8 (myc protein) with 2 - 14 - 22 (iG chains)

38. What does p53 do? what chrom is it on?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
G to T in p53; HCC
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

39. What are two common side effects of both acute and long acting nitrates? What causes them?
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
P53 mutation; DCC is also required for adenoma to carcinoma
Medial circumflex artery; avascular necrosis
Headaches and facial flushing; vasodilation in meninges and skin

40. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Prostate tumor and increased osteoclast activity
SS +rNA
25; 25

41. ___________ is liver specific
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Because of vasodiation to skeletal muscles
glycerol kinase
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

42. a patient fearing all white coats is a phenomenon of what?
LT (LTD4 - E4 - C4) - and Ach
Amiadarone
Classical conditioning
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

43. What causes curlings ulcers?
frameshift mutations (missense is substitution)
Vancomycin
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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

44. What can chronic vit A toxicity cause?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Aromatase deficiency in child
SSRI; erectile dysfunction

45. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Pulmonary hypertension
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
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

46. what locations of UC increase the risk of Colon cancer?
Pan colitis and right sided colitis (more than left sided and proctitis)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Ketone body production by preventing fatty acids into the mitochondria
frameshift mutations (missense is substitution)

47. in B12 deficiency - what levels in blood rise very quickly and then drop?
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)
Single adenomatous ones
Reticulocytes
...

48. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Aromatase deficiency in child
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Thymic tumor
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

49. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Not lined by epithelium
Chorda tympani branch
Neisseria induced small cell vasculitis (including hands and soles)
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry

50. which staphylococci can do mannitol fermaentation?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
S. aureus
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)