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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 receptors do first generation anti histamines block?
Inhibits it
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
4 - 4 - 9
Integration of viral DNA into genome of host hepatocytes

2. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Appetite suppressants
Hexokinase
Adductor

3. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
When it invades the bm; carcinoma in situ
I is more benign and can present later in adulthood
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Bile soluble which means they are bile sensitive

4. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
200-500
Turners`

5. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Bile soluble which means they are bile sensitive
In ER of bile canaliculi
Think Hb deformation diseases
No (unlike adenomyosis); yes

6. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
(urine PAH x urine flow rate)/plasma PAH
Integration of viral DNA into genome of host hepatocytes
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

7. What are two common side effects of both acute and long acting nitrates? What causes them?
RBF= PAH clearance/(1- hematocrit)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Headaches and facial flushing; vasodilation in meninges and skin
SSRI; erectile dysfunction

8. What is the Na/Ca exchange used for?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
To pump calcium out in cardiac myocytes so that relaxation occurs
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

9. What is the immune deficinecy seen in ataxia telangactasia?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Bronchogenic carcinoma
Ig A deficiency

10. What can long term leg cast wearing cause?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Strength of cell mediated immune response
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
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

11. What is a cell surface marker seen in liver angiosarcoma?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Brief psychotic disorder; schizophreniform; schizophrenia
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Trauma to stereociliated hair cells of the organ of corti

12. How do bradykinin - C3a and C5a cause edema?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
By vascular permeability and vasodilation
Serum FFA and serum triglyceride levels
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

13. What are the lab findings in poststreptococcal GN?
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
Primary
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Prostate tumor and increased osteoclast activity

14. What are some of the permissive effects of cortisol?
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
low in serum
IgE
Increases bronchial and vascular smooth muscle reactivity to catecholamines

15. why are beta thal major patients asymptomatic at birth?
liver specific
Increase lymphatic drainage!
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Because gamma chains replace beta chains and then gamma chain formation wanes

16. What is the mcc of elevated AFP leves in pregnancy>
Valproate
Sarcoid
GI malignancies and Insulin resistance (acromegal for ex)
Underestimation of gestational age

17. What is the presentation of sever aortic stenosis?
PDA open
LT (LTD4 - E4 - C4) - and Ach
TSh (in testicular tumors can cause hyperthyroidism)
Syncope - angina - dyspnea (SAD)

18. metabolism of 1 gram of protein produces How many calories? carb? fat?
4 - 4 - 9
Hypothyroidism
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)

19. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
RER; copper
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

20. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Inhaled animal dander allergens
Southern - western
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

21. what diseases can vit A be used to treat?
Measles and M3 AML`
Bile salt accumulation in urine
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
Pulmonic and systemic!

22. What is a common complication of acute pancreatitis? What is it?
GI malignancies and Insulin resistance (acromegal for ex)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Chorda tympani branch
Squatting - sitting - lying supine - passive leg raising

23. what protein is increased in Crohns disease? What does it do?
Duration and extent of disease
NF- KB; responsible for cytokine production
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Circular - outside nucleus; transport proteins - rRNA - tRNA

24. in the LV and aorta - What are the pressures?
In the extracellular space
Aromatase deficiency in child
Normally close to systolic
HSV ( also in utero: chlymadia - neisseria - group B strep)

25. What are the long term consequences of hydrocephalus?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Anti cholinergic effects of pupil dilation and lack of accomodation
<1% - 55% - concentration dependent

26. What does protein M do in Group A strep<
Prevent phagocytosis
Biphosphonate
TCAs and prazosin
Enterococci (e. faecalis)- found on genitalia area

27. What are the acute effects of corticosteroids on the CBC?
Turners`
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Well
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

28. Where does conjugation of bilirubin take place?
Ceftriaxone; azithromycin
In ER of bile canaliculi
Regular insulin (Not fast acting - regular better)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

29. What causes curlings ulcers?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
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
Around 70 (normal measured diastolic pressures); 9--

30. what phase do adenosine and acetylcholine act on? doing what?
P450 mitochondrial monooxygenase
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

31. What is somatomedin C?
Pulmonary hypertension
25; 25
Insulin like growth factor 1 (just another name)
Prevent phagocytosis

32. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
INTRApartum Abs (ampicillin/penicillin)
Syncope - angina - dyspnea (SAD)
Pulmonic and systemic!

33. What does VIP do to gastric acid secretion?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Paramyxo and influenza
Pulmonic and systemic!
Inhibits it

34. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

35. what defines hypoxemia?
ZDV or AZT
SaO2 <92%
Dissolved in plasma and attached to Hgb
RBC mass; epo levels (secondary has high)

36. What is the presentation of angioedema? Where is most commonly affected?
11 aa polypeptide; pain NT in CNS and PNS
Gluteus maximus; difficulty getting up from seated position and climbing chair
Trochlear nerve (IV); abducens nerve (VI)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

37. at four years of age - What are the social - fine motor - gross motor - and language developments?
P450 mitochondrial monooxygenase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
women
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

38. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
RER; copper
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Reiter syndrome; B27

39. What does L/S stand for in fetal lung maturity? When does maturity occur?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Excessive collagen formation during tissue repair in susceptible individuals
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

40. 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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41. What is easiest way to treat nephrolithiasis?
SVC and IVC; right below the aortic knob
To pump calcium out in cardiac myocytes so that relaxation occurs
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Drink plenty of fluids

42. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Serum creatine kinase; reperfusion injury causes necrosis
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Primary
RER; RER

43. What is the most common cause of pyelonephritis in both adults and childre?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
No
E. coli
As a CO2 carrier with the carboxylase enzyme

44. What is used to prevent vertical transmission of HIV?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
indomethacin
ZDV or AZT
Neisseria induced small cell vasculitis (including hands and soles)

45. What are the first generation anti histamines?
4 - 4 - 9
Chlorpheniramine and diphenhydramine
Ketone body production by preventing fatty acids into the mitochondria
Skin flushing and warmth; prostaglandins; give with aspirin

46. What actions increase venous return?
Bile soluble which means they are bile sensitive
Relfex tachycardia; giving beta blockers
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
Squatting - sitting - lying supine - passive leg raising

47. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
facultative intracellular
Increased reticulocytes
Tissue redistribution (out of plasma) rather than metabolism
Circular - outside nucleus; transport proteins - rRNA - tRNA

48. 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)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Echinococcus granulosus; anaphylaxis
Reticulocytes

49. a patient fearing all white coats is a phenomenon of what?
Duration and extent of disease
Covalent (between two cysteines)- allows protein to withstand denaturation
Purkinje system; AV node
Classical conditioning

50. 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
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system