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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. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
GI tract; mood!
Minimal change disease
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

2. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Myasthenia gravis
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
<1% - 55% - concentration dependent

3. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Skin flushing and warmth; prostaglandins; give with aspirin
Reticulocytes

4. What type of drug is alendronate?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
ZDV or AZT
Biphosphonate
SVC and IVC; right below the aortic knob

5. what clinical findings help distinguish small cell carcinoma?
Increase in permeability of two ions with equal and opposite equilibrium potentials
In the extracellular space
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

6. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Myasthenia gravis
Gluteus maximus; difficulty getting up from seated position and climbing chair

7. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Fibrosis; macrophages
Syringomelia
low in serum
chronic urticaria and allergic symptoms

8. why are beta thal major patients asymptomatic at birth?
HSV ( also in utero: chlymadia - neisseria - group B strep)
GI tract; mood!
Because gamma chains replace beta chains and then gamma chain formation wanes
Syncope - angina - dyspnea (SAD)

9. What are fenfluramine - phentermine?
Joints d/t increased purine production and thus uric acid production
Highly negative resting potential
Appetite suppressants
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

10. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Brief psychotic disorder; schizophreniform; schizophrenia

11. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hypo or hyper pigmentations; after tanning
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

12. What is a cord factor and Which bugs have it? How do they appear on culture?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Well trained athletes and children
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

13. what dissolves the lipid bilayer of a viral envelope?
RER; RER
Ether and other organic solvents
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Octreotide

14. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
S. saprophyticus - and s. epidermidis; novobiocin
Turners`
Thymic tumor
Brief psychotic disorder; schizophreniform; schizophrenia

15. what hernia has a similar mechanism to hydrocele?
Atrial
Superior larygeal; cricothyroid; recurrent laryngeal
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

16. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
GI tract; mood!
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
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

17. What does sustained hand grip do to the C/V system?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
HSV and VZV
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

18. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
Susceptible; soluble (unable to be cultured in bile)
TSh (in testicular tumors can cause hyperthyroidism)
Elastance

19. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
RER; copper
differentiate
frameshift mutations (missense is substitution)

20. What is the difference between additive and synergistic?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Biphosphonate
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
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

21. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
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
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Dissolved in plasma and attached to Hgb
hyponatremia (aldosterone activation equilibrates body volume)

22. What effects does cortisol have on catecholamines?
Turbulence
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
Measles and M3 AML`
Hypertension - edema - and proteinuria

23. What type of disease has selective proteinuria? What is found in urine? What is not?
200-500
SSRI
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Fibronectin - laminin - collagen

24. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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

25. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
IgE
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Prostate tumor and increased osteoclast activity

26. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Skin flushing and warmth; prostaglandins; give with aspirin
Pulmonic and systemic!

27. what marker should be followed in a patient with cirrhosis?
MAC complex (C5b - C9 complement deficiency)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
E6 and E7 of HPV knock off p53 and Rb suppressor genes

28. What are the potassium sparing diuretics?
Paramyxo and influenza
Amiloride - spironolactone - triamterene
Susceptible; soluble (unable to be cultured in bile)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

29. What is diagnostic (and possible therapeutic for intussusception)?
Hereditary angioedema; ACE inhibitors
Anti cholinergic effects of pupil dilation and lack of accomodation
IgE
Barium enema

30. What does VIP do to gastric acid secretion?
Dihydropyridine sensitive Ca channels (L type)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Inhibits it

31. which virus inactivates both Rb and p53?
Diabetic microangiopathy
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Underestimation of gestational age
8 (myc protein) with 2 - 14 - 22 (iG chains)

32. 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
SS +rNA
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
RR-1/RR

33. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Amiadarone
Prostate tumor and increased osteoclast activity
Pan colitis and right sided colitis (more than left sided and proctitis)

34. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Paramyxo and influenza
Amiloride - spironolactone - triamterene
No and yes
Increased reticulocytes

35. What does hypocapnia cause in teh brain? What is hypocapnia?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
46 - 4N; 23 2N
Measure of depth invasion (vertical!)
High potassium conductance and some sodium conductance

36. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Increases cytokine production
On cardiac tissue and renal juxtaglomerular cells
Fibronectin - laminin - collagen

37. what enzyme converts procarcinogens into carcinogens?
P450 mitochondrial monooxygenase
Kallmans
Sarcoid
S. saprophyticus - and s. epidermidis; novobiocin

38. What are two indicators of chronic alcohol consumption?
Reticulocytes
Vascular endothelium; protease
Elevated GGT and macrocytosis
Rabies encephalitis from cave bats; rabies killed vaccines

39. which nucleus releases serotonin?
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
Trochlear nerve (IV); abducens nerve (VI)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Raphe

40. which has better side effect profile - SSRI or TCA?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SSRI
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Kallmans

41. which trisomy is associated with endocardial cushion defects? What does thsi mean>
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
Downs; regurgitant AV valves - ASDs
GI malignancies and Insulin resistance (acromegal for ex)
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

42. What is hyaline arteriosclerosis usually a sign of ?
Minimal change disease
Fibronectin - laminin - collagen
Diabetic microangiopathy
The term used to describe decreased drug responsiveness with repeated administration

43. What is best to prevent GBS infection in a baby?
Increases cytokine production
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
INTRApartum Abs (ampicillin/penicillin)

44. What type of bond is a disulfide bond?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Susceptible; soluble (unable to be cultured in bile)
Covalent (between two cysteines)- allows protein to withstand denaturation
Elevated GGT and macrocytosis

45. What is an abortive viral infection?
No; yes
Hypertension - edema - and proteinuria
Little effect on cell and no change
Adductor

46. What can long term leg cast wearing cause?
Multiple miscarriages d/t hypercoaguability
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
CMV - HSV 1 - Candida
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

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 three pathogens cause infectious esophagitis in HIV positive patients?
Common peroneal; bony fractures and compression; sciatic
CMV - HSV 1 - Candida
Because gamma chains replace beta chains and then gamma chain formation wanes
Medial part

49. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Single adenomatous ones
Hypothyroidism
Because of the low output from heart failure - they will have increased aldosterone levels
CMV - HSV 1 - Candida

50. at four years of age - What are the social - fine motor - gross motor - and language developments?
Medial part
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use