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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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1. What does protein M do in Group A strep<
Adductor
Close but purkinje system to ensure contraction in a bottom up fashion
Prevent phagocytosis
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

2. what immune deficiency causes recurrent neisseria infections?
Right before diastole (filling begins)
MAC complex (C5b - C9 complement deficiency)
Vertical diplopia
Classical conditioning

3. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Drug induced interstitial nephritis
Folic acid treatment!
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
RBC mass; epo levels (secondary has high)

4. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Rabies encephalitis from cave bats; rabies killed vaccines
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Syringomelia

5. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Protamine sulfate
AV node slowest - to allow time for diastole
II; I (I more abundant)

6. In what form are mitochondrial DNA? What do they transcribe?
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
Leukotriene precursor and does neutrophil chemotaxis
Circular - outside nucleus; transport proteins - rRNA - tRNA

7. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
In ER of bile canaliculi
E. coli

8. What three pathogens cause infectious esophagitis in HIV positive patients?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
I is more benign and can present later in adulthood
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
CMV - HSV 1 - Candida

9. 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?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Headaches and facial flushing; vasodilation in meninges and skin
Superior larygeal; cricothyroid; recurrent laryngeal

10. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Recurrent larygneal
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
When it invades the bm; carcinoma in situ
RER; copper

11. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)

12. at three years of age What are social - fine motor - gross motor and language developments?
SSRI; erectile dysfunction
Gluteus maximus; difficulty getting up from seated position and climbing chair
ZDV or AZT
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

13. what indicates the severity of a mitral regurg ? mitral stenosis?
Inactivates kallikrein which activates kininogen into bradykinin
LT (LTD4 - E4 - C4) - and Ach
25; 25
S3 gallop; S2 to opening snap interval

14. how can HAV be inactivated?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
INTRApartum Abs (ampicillin/penicillin)
Boiling - bleach - formalin - UV irradiation
On cardiac tissue and renal juxtaglomerular cells

15. 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
Measles and M3 AML`
LT (LTD4 - E4 - C4) - and Ach
Class I

16. Acyl coA synthetase is not...
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
G to T in p53; HCC
Spongiosis
liver specific

17. which are the only glycosylated proteins in HIV virus?
Pulmonary hypertension
Env genes (for getting into target cells)
glycerol kinase
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

18. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Lateral; RV; RA; LV
Enterococci (e. faecalis)- found on genitalia area
46 - 4N; 23 2N
Drug induced interstitial nephritis

19. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Raphe
SVT; increases vagal tone; rectus abdominis
Echinococcus granulosus; anaphylaxis
RER; copper

20. What is best to prevent GBS infection in a baby?
Neisseria induced small cell vasculitis (including hands and soles)
INTRApartum Abs (ampicillin/penicillin)
Retinitis; mononucleosis
Ketone body production by preventing fatty acids into the mitochondria

21. What is extraocular muscle weakness a common symptom of?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Myasthenia gravis
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

22. What type of calcium channels dictate the plateau in cardiac myocyte?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Think Hb deformation diseases
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Dihydropyridine sensitive Ca channels (L type)

23. how does eos release MBP to kill protozoa etc?
Nocardia
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
HSV and VZV
Amiadarone

24. What is the triad seen in pre eclampsia?
As a CO2 carrier with the carboxylase enzyme
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Spongiosis
Hypertension - edema - and proteinuria

25. which two virus families have hemagluttinin on their surface?
Pain reliever - reduces pain by locking substance P in the PNS
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Paramyxo and influenza
SSRI

26. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
MAO inhibitors; wine and cheese
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

27. why should you not use ACE inhibitors with someone who had hereditary angioedema?
GI tract; mood!
Extrinsic def; instrinsic def; platelet def
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
indomethacin

28. in overweight individuals What is thought to contribute to insulin resistance?
25; 25
Phencyclidine (PCP)
Serum FFA and serum triglyceride levels
Prostate tumor and increased osteoclast activity

29. the rate of blood flow of which two circulations must equal each other at all times?
Pulmonic and systemic!
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Excessive collagen formation during tissue repair in susceptible individuals
Medullary

30. what phase do adenosine and acetylcholine act on? doing what?
APP on chrom 21 (this is why downs more susceptible)
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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)

31. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
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
46 - 4N; 23 2N
Prepatellar

32. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Leukotriene precursor and does neutrophil chemotaxis
facultative intracellular
Not lined by epithelium

33. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Aromatase deficiency in child
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
When it invades the bm; carcinoma in situ
S. aureus

34. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Valproate
Echinococcus granulosus; anaphylaxis
Increases cytokine production
CGD; t cell dysfxn (diGeorge)

35. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Trauma to stereociliated hair cells of the organ of corti
Dihydropyridine sensitive Ca channels (L type)

36. What is the most important prognostic indicator in patients with malignant melanoma?
Underestimation of gestational age
Measure of depth invasion (vertical!)
Skin flushing and warmth; prostaglandins; give with aspirin
Curlings ulcers

37. which viruses require a protease?
SVC and IVC; right below the aortic knob
SS +rNA
Thymic tumor
RER; copper

38. how much percent of sodium is excreted? urea? glucose?
Increase lymphatic drainage!
The time interval between S2 and OS- the shorter the interval - the more intense
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
<1% - 55% - concentration dependent

39. What causes curlings ulcers?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Acute gastric mucosal defects (superficial or full thickness)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

40. what chromosome is c - myc found on?
ST become atrophic and hyalinized (temp induced damage) and depressed sperm count becuase of that; hormonal function not impaired (test and LH levels normal) because Leydig cells not as temp sensitive so secondary sexual characteristics and sexual pe
Chrom 8
Covalent (between two cysteines)- allows protein to withstand denaturation
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

41. What are the acute effects of corticosteroids on the CBC?
Joints d/t increased purine production and thus uric acid production
Dissolved in plasma and attached to Hgb
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

42. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
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
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)
P53 mutation; AD
Medullary

43. 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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44. IL4 is used for isotypye switching to what?
Multiple miscarriages d/t hypercoaguability
IgE
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)
Because of the low output from heart failure - they will have increased aldosterone levels

45. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
RER; copper
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
SVC and IVC; right below the aortic knob
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

46. sporadic colon cancer tend to arise From what type of polyps?
Amiadarone
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Single adenomatous ones
Extrinsic def; instrinsic def; platelet def

47. What is Tzanck smear used to detect?
Classical conditioning
HSV and VZV
(urine PAH x urine flow rate)/plasma PAH
Both sides

48. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Standing suddenly from supine position; valsalva maneuver
No and yes
Raphe
SS +rNA

49. What actions increase venous return?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Squatting - sitting - lying supine - passive leg raising
46 - 4N; 23 2N
Clindamycin; covers anaerobic oral flora and aerobic bacteria

50. what protects the resting heart from arrhythmias?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Phencyclidine (PCP)
Recurrent larygneal
Highly negative resting potential

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