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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 are the acute effects of corticosteroids on the CBC?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
(urine PAH x urine flow rate)/plasma PAH
AV node slowest - to allow time for diastole
Coagulation factors are made in the liver

2. What are two indicators of chronic alcohol consumption?
Nocardia
Elevated GGT and macrocytosis
Dissolved in plasma and attached to Hgb
As a CO2 carrier with the carboxylase enzyme

3. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
CMV - HSV 1 - Candida
ATP binding (resets the myosin head to contract again for next binding)
SS +rNA
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

4. What is a cord factor and Which bugs have it? How do they appear on culture?
Retinitis; mononucleosis
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Bile soluble which means they are bile sensitive

5. what organ would an activating mutation in PRPP synthetase effect?
Joints d/t increased purine production and thus uric acid production
P53 mutation; AD
Chorda tympani branch
4 - 4 - 9

6. What is the primary histologic finding in patients with eczematous dermatitis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Spongiosis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Nonsense; mRNA processing

7. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
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
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

8. What causes wrist drop?
Neisseria induced small cell vasculitis (including hands and soles)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Radial nerve damage

9. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Folic acid treatment!
Atrial
Turbulence

10. prostaglandin synthesis keeps...
PDA open
When it invades the bm; carcinoma in situ
Turners`
Drink plenty of fluids

11. What is capacitance inversely proportional to?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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
Neisseria induced small cell vasculitis (including hands and soles)

12. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Coagulation factors are made in the liver
manifestations - congenital (stretching of periventricular pyrimadal fibers)

13. What is contraindicated in toxic mega colon?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Valproate
Excessive collagen formation during tissue repair in susceptible individuals
Relfex tachycardia; giving beta blockers

14. What is an abortive viral infection?
Little effect on cell and no change
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
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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

15. in the LV and aorta - What are the pressures?
Normally close to systolic
Measles and M3 AML`
Vagus nerve stimulation
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

16. What is used to compare means? categorical outcomes?
T test; chi squared
Inhibits it
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

17. which virus inactivates both Rb and p53?
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)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

18. at three years of age What are social - fine motor - gross motor and language developments?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Anti cholinergic effects of pupil dilation and lack of accomodation
Inhaled animal dander allergens

19. what vessel would a fracture to the neck of the of the humerus damage?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Anterior circumflex (and axillary nerve)
Coagulation factors are made in the liver

20. Which is faster purkinje system or atrial muscle?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Close but purkinje system to ensure contraction in a bottom up fashion
Hydrogen bonds dictate alpha or beta structure
IgE

21. What is capsaicin? Where does it work?
HSV and VZV
Pan colitis and right sided colitis (more than left sided and proctitis)
Pain reliever - reduces pain by locking substance P in the PNS
8 (myc protein) with 2 - 14 - 22 (iG chains)

22. What are the skin presentation in sarcoid?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
C3 decreased after 5-10 days; sulfonamides
women
Varying; erythema nodosum is common

23. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Duration and extent of disease
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
RBC mass; epo levels (secondary has high)

24. a patient fearing all white coats is a phenomenon of what?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Syringomelia
Classical conditioning
Closer to head; closer to diaphragm

25. What antibiotic is best to treat alcoholic pulm infections? why?
46 - 4N; 23 2N
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Vagus (auricular branch); vasovagal syncope!
Clindamycin; covers anaerobic oral flora and aerobic bacteria

26. What are some side effects seen in TCAs?
Classical conditioning
By vascular permeability and vasodilation
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Susceptible; soluble (unable to be cultured in bile)

27. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Thymic tumor
Relfex tachycardia; giving beta blockers
Spongiosis
Ig A deficiency

28. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Little effect on cell and no change
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Valproate
liver specific

29. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Sickle cell; G6PD
Nonsense; mRNA processing
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Large stroke volumes with ventricular contraction; aortic regurg

30. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Kallmans
Increase lymphatic drainage!
SVT; increases vagal tone; rectus abdominis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

31. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
Fibrosis; macrophages
Hexokinase
Anti centromere; anti DNA topoisomerase

32. What type of vision is myopia? In What type of patients does it improve?
Leukotriene precursor and does neutrophil chemotaxis
SVC and IVC; right below the aortic knob
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Another type of aldosterone antagonist (like spironolactone)

33. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Hypothyroidism
low in serum
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
No; MRI

34. What is epispadias caused by?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Faulty positioning of the genital tubercle
46 - 4N; 23 2N
Inactivates kallikrein which activates kininogen into bradykinin

35. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
TSh (in testicular tumors can cause hyperthyroidism)
Leukotriene precursor and does neutrophil chemotaxis
Hydrogen bonds dictate alpha or beta structure

36. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
High potassium conductance and some sodium conductance
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
P53 mutation; DCC is also required for adenoma to carcinoma

37. How do you treat gonococcal infection? chlymadia?
Octreotide
Ceftriaxone; azithromycin
ATP binding (resets the myosin head to contract again for next binding)
Hereditary angioedema; ACE inhibitors

38. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hypo or hyper pigmentations; after tanning
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

39. What is the triad seen in pre eclampsia?
Pulmonic and systemic!
FGF and VEGF
Hypertension - edema - and proteinuria
No; yes

40. What is the presentation of sever aortic stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Syncope - angina - dyspnea (SAD)
Lateral; RV; RA; LV

41. What is medullary sponge kidney disease and how does it present? What does it lead to?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Bronchogenic carcinoma
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)
In ER of bile canaliculi

42. What is the preferred treatment for DKA?
TSh (in testicular tumors can cause hyperthyroidism)
Regular insulin (Not fast acting - regular better)
Excessive collagen formation during tissue repair in susceptible individuals
The term used to describe decreased drug responsiveness with repeated administration

43. What is a keloid?
Because of the low output from heart failure - they will have increased aldosterone levels
Excessive collagen formation during tissue repair in susceptible individuals
Well
Terminal bronchioles; small bronchi

44. What is gardeners mydriasis? How is it treated?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Radial nerve damage
women
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

45. What is subacute sclerosisng encephalitis caused by?
Underestimation of gestational age
When it invades the bm; carcinoma in situ
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
Sarcoid

46. What is the mcc of extrinsic allergic asthma?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Inhaled animal dander allergens
facultative intracellular

47. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Env genes (for getting into target cells)
Increase in permeability of two ions with equal and opposite equilibrium potentials
TCAs and prazosin
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

48. what should you think of in 'smear of an oral ulcer base'?
Tzanck smear
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

49. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Cluster
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Initiation - pointing; pincer grasp; walking; mama/dada

50. nucleotide deletions do not cause missense mutations - they cause...
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
frameshift mutations (missense is substitution)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

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USMLE Prep 2

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