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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 clinical findings help distinguish small cell carcinoma?
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

2. what drugs causes the red man syndrome? how does it occur?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
ATP binding (resets the myosin head to contract again for next binding)
Vancomycin; histamine mediated
Southern - western

3. What type of vision is myopia? In What type of patients does it improve?
ZDV or AZT
...
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

4. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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
Biphosphonate
women

5. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Large stroke volumes with ventricular contraction; aortic regurg
Fat - fertile - forty - female
No; yes

6. 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
II; I (I more abundant)
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
Nonsense; mRNA processing

7. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
Acute interstitial nephritis
Highly negative resting potential
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

8. 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
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)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
ANCA because of lack of Ig and C3 deposits on IF

9. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Closer to head; closer to diaphragm
gram positive organisms
Paramyxo and influenza

10. What antibodies are present in CREST? What is the most specific?
Localized dermatologic pain that persists for more than one month after zoster eruption
Anti centromere; anti DNA topoisomerase
Serum FFA and serum triglyceride levels
High potassium conductance and some sodium conductance

11. What is normal fibrinogen levels?
Integration of viral DNA into genome of host hepatocytes
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
200-500

12. 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?
Headaches and facial flushing; vasodilation in meninges and skin
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Because of the low output from heart failure - they will have increased aldosterone levels
Tzanck smear

13. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
ATP binding (resets the myosin head to contract again for next binding)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

14. What is capacitance inversely proportional to?
Proteasome inhibitor; treatment for MM and waldenstroms
Normal; low
Elastance
In ER of bile canaliculi

15. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vagus (auricular branch); vasovagal syncope!
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Brief psychotic disorder; schizophreniform; schizophrenia

16. how does increased ICP result in curlings ulcers?
Normally close to systolic
Vagus nerve stimulation
Initiation - pointing; pincer grasp; walking; mama/dada
Reiter syndrome; B27

17. What causes wrist drop?
Radial nerve damage
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)
Increases
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)

18. how does noise induced hearing loss occur?
Susceptible; soluble (unable to be cultured in bile)
Right before diastole (filling begins)
Trauma to stereociliated hair cells of the organ of corti
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

19. 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
Headaches and facial flushing; vasodilation in meninges and skin
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

20. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
APP on chrom 21 (this is why downs more susceptible)
SS +rNA
Strength of cell mediated immune response

21. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Inactivates kallikrein which activates kininogen into bradykinin
HSV and VZV
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

22. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
liver specific
Fibrosis; macrophages
TCAs and prazosin
transcription activation/suppression

23. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
When it invades the bm; carcinoma in situ
Retinitis; mononucleosis
Amiloride - spironolactone - triamterene

24. which trisomy is associated with endocardial cushion defects? What does thsi mean>
MAO inhibitors; wine and cheese
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Downs; regurgitant AV valves - ASDs
S3 gallop; S2 to opening snap interval

25. What type of drug is alendronate?
indomethacin
Biphosphonate
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
Sarcoid

26. what makes bruits?
Inactivates kallikrein which activates kininogen into bradykinin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Turbulence
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

27. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Measure of depth invasion (vertical!)
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
II; I (I more abundant)
Intussusception

28. What is the most common location of colonization of all s. aureus types?
Underestimation of gestational age
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Anterior nares
Serum FFA and serum triglyceride levels

29. why are beta thal major patients asymptomatic at birth?
Amiadarone
low in serum
Chrom 8
Because gamma chains replace beta chains and then gamma chain formation wanes

30. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Increase lymphatic drainage!
11 aa polypeptide; pain NT in CNS and PNS
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

31. What is the difference between additive and synergistic?
Demargination of neutrophils from the vessel walls
In the extracellular space for collagen cross linking; zinc
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
To pump calcium out in cardiac myocytes so that relaxation occurs

32. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Octreotide
Standing suddenly from supine position; valsalva maneuver
Because gamma chains replace beta chains and then gamma chain formation wanes

33. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Tzanck smear
SaO2 <92%

34. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Recurrent larygneal
SVT; increases vagal tone; rectus abdominis
Reiter syndrome; B27
SVC and IVC; right below the aortic knob

35. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
Anti centromere; anti DNA topoisomerase
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

36. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Syringomelia
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
P53 mutation; AD
Increase; decreased

37. What type of disease has selective proteinuria? What is found in urine? What is not?
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
Susceptible; soluble (unable to be cultured in bile)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Integration of viral DNA into genome of host hepatocytes

38. do Class IC agents prolong the QT interval?
G to T in p53; HCC
Faulty positioning of the genital tubercle
No
Adeno

39. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Drug induced interstitial nephritis
As a CO2 carrier with the carboxylase enzyme
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

40. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Boiling - bleach - formalin - UV irradiation
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
<1% - 55% - concentration dependent
Headaches and facial flushing; vasodilation in meninges and skin

41. Which is slower AV node or ventricular muscle?
SSRI
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Rabies encephalitis from cave bats; rabies killed vaccines
AV node slowest - to allow time for diastole

42. In What type of nephritis would you see high serum eos count?
Hyperkalemia; potassium sparing diuretics - potassium supplements
SaO2 <92%
Drug induced interstitial nephritis
Tibial

43. what diseases can vit A be used to treat?
Measles and M3 AML`
Prostate tumor and increased osteoclast activity
TSh (in testicular tumors can cause hyperthyroidism)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

44. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Hereditary angioedema; ACE inhibitors
Folic acid treatment!

45. when do ghon complexes form - primary or secondary TB?
Close but purkinje system to ensure contraction in a bottom up fashion
Become beta pleated and then form neurofibrillary tangle!
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Primary

46. What is a common complication of acute pancreatitis? What is it?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

47. What is extraocular muscle weakness a common symptom of?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Increase lymphatic drainage!
Myasthenia gravis
TSh (in testicular tumors can cause hyperthyroidism)

48. What is used to prevent vertical transmission of HIV?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
ZDV or AZT
Both sides
Insulin like growth factor 1 (just another name)

49. 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
Fibrosis; macrophages
Hypo or hyper pigmentations; after tanning
In the extracellular space for collagen cross linking; zinc

50. ___________ is liver specific
PDA open
As a CO2 carrier with the carboxylase enzyme
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
glycerol kinase

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