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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 the presentation of sever aortic stenosis?
Protamine sulfate
Syncope - angina - dyspnea (SAD)
Vancomycin; histamine mediated
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

2. 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?
Raphe
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)
Hexokinase
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

3. name three pathological states that present with large tongues.
Primary
C3 decreased after 5-10 days; sulfonamides
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Think Hb deformation diseases

4. What is acanthosis nigricans associated with?
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)
GI malignancies and Insulin resistance (acromegal for ex)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Coagulation factors are made in the liver

5. in the LV and aorta - What are the pressures?
Normally close to systolic
OCPs - multiparity - breast feeding
Smoking
Syncope - angina - dyspnea (SAD)

6. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Turners`
Acute gastric mucosal defects (superficial or full thickness)
Chlorpheniramine and diphenhydramine
Purkinje system; AV node

7. What can too much IgA in serum produces?
(urine PAH x urine flow rate)/plasma PAH
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
GI malignancies and Insulin resistance (acromegal for ex)
In ER of bile canaliculi

8. What would a deflection of the membrane potential to near zero indicate?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Increase in permeability of two ions with equal and opposite equilibrium potentials

9. Where is aromatase used?
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 medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

10. what should you think of in 'smear of an oral ulcer base'?
hyponatremia (aldosterone activation equilibrates body volume)
MAO inhibitors; wine and cheese
Tzanck smear
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

11. What type of vision is myopia? In What type of patients does it improve?
Insulin like growth factor 1 (just another name)
Decreases both
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
2 -3 BPG; glycolysis - instead of ATP; erythrocytes because want to right shift the oxygen dissociation curve so that oxygen is released from RBCs into tissue

12. What is congestive hepatomegaly specific for?
Right heart failure
The time interval between S2 and OS- the shorter the interval - the more intense
Env genes (for getting into target cells)
Folic acid treatment!

13. In What type of nephritis would you see high serum eos count?
Relfex tachycardia; giving beta blockers
Amiadarone
No (unlike adenomyosis); yes
Drug induced interstitial nephritis

14. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Fibronectin - laminin - collagen
C3 decreased after 5-10 days; sulfonamides
Trochlear nerve (IV); abducens nerve (VI)

15. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Tzanck smear
Well
Paramyxo and influenza
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

16. other than mycobacterim wha other bacteria is acid fast?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Nocardia
Ig A deficiency
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

17. What is the cause of rapid plasma decay of thiopental?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
differentiate
Tissue redistribution (out of plasma) rather than metabolism
Syringomelia

18. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Dihydropyridine sensitive Ca channels (L type)
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Smoking
Fibrosis; macrophages

19. What is subacute sclerosisng encephalitis caused by?
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
Because of vasodiation to skeletal muscles
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Retinitis; mononucleosis

20. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Close but purkinje system to ensure contraction in a bottom up fashion
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

21. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Intussusception
Vertical diplopia
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

22. what happens to capacitance with age?
Reiter syndrome; B27
Sarcoid
Normal; low
...

23. which viruses require a protease?
Appetite suppressants
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Around 70 (normal measured diastolic pressures); 9--
SS +rNA

24. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Brief psychotic disorder; schizophreniform; schizophrenia
gram positive organisms
facultative intracellular
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

25. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
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
SSRI; erectile dysfunction
transcription activation/suppression
8 (myc protein) with 2 - 14 - 22 (iG chains)

26. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Sickle cell; G6PD
4 - 4 - 9

27. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Vancomycin; histamine mediated
Valproate
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)
Medullary

28. which staphylococci can do mannitol fermaentation?
LT (LTD4 - E4 - C4) - and Ach
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
S. aureus
Closer to head; closer to diaphragm

29. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Amiloride - spironolactone - triamterene
Prostate tumor and increased osteoclast activity

30. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Retinitis; mononucleosis
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Pulmonic and systemic!

31. What are the three dopaminergic systems and What are they responsible for? disease?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
S. aureus
Increase by 50% in urine osmolality
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

32. What does TGF beta do? What produces it?
The term used to describe decreased drug responsiveness with repeated administration
Paramyxo and influenza
Increase lymphatic drainage!
Fibrosis; macrophages

33. how does neisseria cause a petechial rash?
Tzanck smear
Neisseria induced small cell vasculitis (including hands and soles)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
ZDV or AZT

34. What is the mainstay treatment for acute mania?
Selective alpha 1 (increases SVR)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
PDA open

35. What is the most common initital symptom of ADPKD? what else?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
RER; RER
Radial nerve damage

36. after a thrombus extraction - what serum enzyme shoots up and why?
Ceftriaxone; azithromycin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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
Serum creatine kinase; reperfusion injury causes necrosis

37. What is the difference between paranoid personality disorder and delusional disorder?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
In ER of bile canaliculi

38. what marker should be followed in a patient with cirrhosis?
P53 mutation; DCC is also required for adenoma to carcinoma
46 - 4N; 23 2N
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

39. What is a keloid?
Diabetic microangiopathy
Radial nerve damage
Excessive collagen formation during tissue repair in susceptible individuals
Medial part

40. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
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
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

41. which antiarrythmic is associated with blue gray discoloration ?
Elastance
Amiadarone
Valproate
Recurrent larygneal

42. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
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
Increase; decreased
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
Boiling - bleach - formalin - UV irradiation

43. where are the vegetations on the valves of a libman sacks endocarditis?
Turners`
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
To pump calcium out in cardiac myocytes so that relaxation occurs
Both sides

44. What is the most common neurologic complication of VZV reactivation?
Chlorpheniramine and diphenhydramine
women
Selective alpha 1 (increases SVR)
Localized dermatologic pain that persists for more than one month after zoster eruption

45. What is achalasia and how would this correlate on the esophageal mannometry?
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
Measure of depth invasion (vertical!)
Leukotriene precursor and does neutrophil chemotaxis
TCAs and prazosin

46. What is the mc malignancy in asbestosis?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
RER; copper
SSRI
Bronchogenic carcinoma

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. what immune deficiency causes recurrent neisseria infections?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
MAC complex (C5b - C9 complement deficiency)
DIC; TTP- HUS dont bleed that much
SaO2 <92%

49. What antibiotic is best to treat alcoholic pulm infections? why?
Appetite suppressants
Clindamycin; covers anaerobic oral flora and aerobic bacteria
gram positive organisms
Elevated GGT and macrocytosis

50. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
chronic urticaria and allergic symptoms
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Prevents hepatic VLDL production

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