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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 pulmonary structural change can kartageners syndrome cause?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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
Bronchial dilation (bronchiectasis)

2. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus medius and minimus; positive trendelenberg
Apocrine; eccrine
CGD; t cell dysfxn (diGeorge)
Because of the low output from heart failure - they will have increased aldosterone levels

3. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
As a CO2 carrier with the carboxylase enzyme
PDA open
Bile salt accumulation in urine

4. What is the difference between additive and synergistic?
Spongiosis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
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
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)

5. What is intussusception? how does ischemia and necrosis occur?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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
Anti centromere; anti DNA topoisomerase
CGD; t cell dysfxn (diGeorge)

6. PDAs are often asymptomatic. How do you treat?
Highly negative resting potential
Dissolved in plasma and attached to Hgb
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
indomethacin

7. what locations of UC increase the risk of Colon cancer?
Relfex tachycardia; giving beta blockers
SS +rNA
Inhibits it
Pan colitis and right sided colitis (more than left sided and proctitis)

8. What is the difference between paranoid personality disorder and delusional disorder?
Extrinsic def; instrinsic def; platelet def
Strength of cell mediated immune response
Covalent (between two cysteines)- allows protein to withstand denaturation
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

9. Acyl coA synthetase is not...
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
liver specific
Downs; regurgitant AV valves - ASDs
Intussusception

10. What test would be best to determine if a gene is being transcribed? translated?
RBF= PAH clearance/(1- hematocrit)
Paramyxo and influenza
differentiate
Southern - western

11. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Anti centromere; anti DNA topoisomerase
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

12. What is the fibrinogen level in patient with TTP- HUS? DIC?
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Normal; low
Terminal bronchioles; small bronchi
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)

13. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Inhaled animal dander allergens
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Turners`

14. What is the difference between Acyl CoA carboxylase and Acyl CoA dehydrogenase?
Varying; erythema nodosum is common
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
No; MRI

15. at one year of age - What are the social - fine motor - gross motor and language developments?
HSV and VZV
Initiation - pointing; pincer grasp; walking; mama/dada
Prepatellar
Pan colitis and right sided colitis (more than left sided and proctitis)

16. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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)
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
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

17. after a thrombus extraction - what serum enzyme shoots up and why?
Criggler Najjar (UGT enzyme in bilirubin glucoronidation) ; Dubin Johnson (transport protein lacking - Black liver) and Rotor syndrome - defects in hepatic uptake and excretion of bile (numerous defect)
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
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Serum creatine kinase; reperfusion injury causes necrosis

18. prostaglandin synthesis keeps...
Nocardia
Phencyclidine (PCP)
Neisseria induced small cell vasculitis (including hands and soles)
PDA open

19. why does neutrophila occur with corticosteroids?
To pump calcium out in cardiac myocytes so that relaxation occurs
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Elevated GGT and macrocytosis
Demargination of neutrophils from the vessel walls

20. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
frameshift mutations (missense is substitution)
SSRI; erectile dysfunction
Right heart failure
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

21. who bleed more DIC or TTP- HUS patients?
DIC; TTP- HUS dont bleed that much
Measles and M3 AML`
To pump calcium out in cardiac myocytes so that relaxation occurs
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

22. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
RBC mass; epo levels (secondary has high)
Excessive collagen formation during tissue repair in susceptible individuals
CGD; t cell dysfxn (diGeorge)
Because gamma chains replace beta chains and then gamma chain formation wanes

23. What is pickwickian syndrome? What are the lab findings?
Hexokinase
SSRI; erectile dysfunction
GI tract; mood!
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

24. What does L/S stand for in fetal lung maturity? When does maturity occur?
Think Hb deformation diseases
Relfex tachycardia; giving beta blockers
Raphe
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

25. Where is conduction in heart fastest? slowest?
Elastance
Enterococci (e. faecalis)- found on genitalia area
200-500
Purkinje system; AV node

26. at three years of age What are social - fine motor - gross motor and language developments?
gram positive organisms
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
RER; copper

27. What is the mutation type in thalassemias? what process is defective because of this?
Standing suddenly from supine position; valsalva maneuver
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Nonsense; mRNA processing

28. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Extrinsic def; instrinsic def; platelet def
No; yes
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
APP on chrom 21 (this is why downs more susceptible)

29. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Brief psychotic disorder; schizophreniform; schizophrenia
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

30. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Anterior nares
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

31. What are examples of action that decrease venous return to the heart?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Southern - western
Standing suddenly from supine position; valsalva maneuver

32. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Think Hb deformation diseases
E6 and E7 of HPV knock off p53 and Rb suppressor genes

33. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Skin flushing and warmth; prostaglandins; give with aspirin
Turners`
ATP binding (resets the myosin head to contract again for next binding)

34. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
Standing suddenly from supine position; valsalva maneuver
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Chorda tympani branch

35. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Classical conditioning
NF- KB; responsible for cytokine production
Class I
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

36. in the LV and aorta - What are the pressures?
T test; chi squared
Normally close to systolic
Syringomelia
Ig A deficiency

37. What is medullary sponge kidney disease and how does it present? What does it lead to?
CGD; t cell dysfxn (diGeorge)
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)
Ether and other organic solvents
Inhaled animal dander allergens

38. What is tachyphylaxis?
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
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
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
The term used to describe decreased drug responsiveness with repeated administration

39. 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?
Localized dermatologic pain that persists for more than one month after zoster eruption
Normally close to systolic
Hydrogen bonds dictate alpha or beta structure
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

40. What are the first generation anti histamines?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
S. saprophyticus - and s. epidermidis; novobiocin
Chlorpheniramine and diphenhydramine
Adductor

41. 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?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Medial circumflex artery; avascular necrosis
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Cluster

42. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
Hyperkalemia; potassium sparing diuretics - potassium supplements
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
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

43. What is a keloid?
8; 12
11 aa polypeptide; pain NT in CNS and PNS
Measure of depth invasion (vertical!)
Excessive collagen formation during tissue repair in susceptible individuals

44. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Pulmonic and systemic!
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Chlorpheniramine and diphenhydramine
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

45. Which nerve lies in close proximity to the inferior thyroid artery?
Anterior nares
Recurrent larygneal
Sickle cell; G6PD
Circular - outside nucleus; transport proteins - rRNA - tRNA

46. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
E. coli
Phencyclidine (PCP)
AV node slowest - to allow time for diastole
Right before diastole (filling begins)

47. other than parvo B19 - what else is associated with red cell aplasia?
...
Squatting - sitting - lying supine - passive leg raising
Aromatase deficiency in child
Thymic tumor

48. What is capacitance inversely proportional to?
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Elastance
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)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

49. in B12 deficiency - what levels in blood rise very quickly and then drop?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Reticulocytes
Multiple miscarriages d/t hypercoaguability

50. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Hypothyroidism
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Relfex tachycardia; giving beta blockers

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USMLE Prep 2

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