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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. at 2 years of age - What are the social - fine motor - gross motor and language developments?
S. aureus
In the extracellular space
Ig A deficiency
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

2. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Normal; low
Medial circumflex artery; avascular necrosis

3. in B12 deficiency - what levels in blood rise very quickly and then drop?
Diabetic microangiopathy
Paramyxo and influenza
Tissue redistribution (out of plasma) rather than metabolism
Reticulocytes

4. What can long term leg cast wearing cause?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Phencyclidine (PCP)

5. What is congestive hepatomegaly specific for?
Class I
Insulin like growth factor 1 (just another name)
Right heart failure
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES

6. what diseases can vit A be used to treat?
Enterococci (e. faecalis)- found on genitalia area
HSV and VZV
Measles and M3 AML`
Well

7. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Octreotide
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

8. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Congenital hypothyroidism - downs - amyloidosis - acromegaly
APP on chrom 21 (this is why downs more susceptible)
200-500

9. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Adeno
Primary
Mean greater than median greater than mode
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

10. what drug is useful for secretory diarrhea?
SSRI; erectile dysfunction
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Ig A deficiency
Octreotide

11. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Duration and extent of disease
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Gluteus maximus; difficulty getting up from seated position and climbing chair
Diabetic microangiopathy

12. What is acanthosis nigricans associated with?
GI malignancies and Insulin resistance (acromegal for ex)
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
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Bile salt accumulation in urine

13. ___________ is liver specific
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
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
E6 and E7 of HPV knock off p53 and Rb suppressor genes
glycerol kinase

14. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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15. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
Rabies encephalitis from cave bats; rabies killed vaccines
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Aromatase deficiency in child

16. What does L/S stand for in fetal lung maturity? When does maturity occur?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
In ER of bile canaliculi
Right heart failure

17. What is tachyphylaxis?
The term used to describe decreased drug responsiveness with repeated administration
SVT; increases vagal tone; rectus abdominis
By vascular permeability and vasodilation
4 - 4 - 9

18. IL4 is used for isotypye switching to what?
Trauma to stereociliated hair cells of the organ of corti
Sickle cell; G6PD
Prostate tumor and increased osteoclast activity
IgE

19. What are examples of action that decrease venous return to the heart?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Standing suddenly from supine position; valsalva maneuver
200-500
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

20. What effects does cortisol have on catecholamines?
No and yes
Fibronectin - laminin - collagen
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

21. What are the lab findings in poststreptococcal GN?
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
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Appetite suppressants
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

22. in the LV and aorta - What are the pressures?
No
Normally close to systolic
SSRI; erectile dysfunction
Normal; low

23. how does noise induced hearing loss occur?
In ER of bile canaliculi
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Trauma to stereociliated hair cells of the organ of corti
Increased reticulocytes

24. who bleed more DIC or TTP- HUS patients?
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)
Pan colitis and right sided colitis (more than left sided and proctitis)
DIC; TTP- HUS dont bleed that much
MAO inhibitors; wine and cheese

25. What causes the blurry vision side effects in first generation anti histamines?
LT (LTD4 - E4 - C4) - and Ach
Anti cholinergic effects of pupil dilation and lack of accomodation
Gluteus medius and minimus; positive trendelenberg
Ether and other organic solvents

26. What type of drug is alendronate?
Biphosphonate
Because of vasodiation to skeletal muscles
CGD; t cell dysfxn (diGeorge)
Chlorpheniramine and diphenhydramine

27. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
TSh (in testicular tumors can cause hyperthyroidism)
Fat - fertile - forty - female

28. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Excessive collagen formation during tissue repair in susceptible individuals
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Prepatellar

29. What type of endocarditis is cytoscopy induced?
Enterococci (e. faecalis)- found on genitalia area
gram positive organisms
Sickle cell; G6PD
transcription activation/suppression

30. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Measles and M3 AML`
Anterior circumflex (and axillary nerve)
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

31. What is the difference between additive and synergistic?
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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
Minimal change disease

32. When does opening snap begin?
Hypo or hyper pigmentations; after tanning
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Right before diastole (filling begins)
GI tract; mood!

33. What is normal fibrinogen levels?
Tzanck smear
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
200-500
When it invades the bm; carcinoma in situ

34. How do you calculate atributable risk percent?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
RR-1/RR
Duration and extent of disease
RER; copper

35. Where does 90% of serotonin lie? What is this NT responsible?
GI tract; mood!
P53 mutation; AD
Ether and other organic solvents
Downs; regurgitant AV valves - ASDs

36. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Joints d/t increased purine production and thus uric acid production
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

37. What is the triad seen in pre eclampsia?
Increase by 50% in urine osmolality
Hypertension - edema - and proteinuria
I is more benign and can present later in adulthood
Thymic tumor

38. how does increased ICP result in curlings ulcers?
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
low in serum
CGD; t cell dysfxn (diGeorge)
Vagus nerve stimulation

39. Metronidizaole does not cover...
gram positive organisms
Tzanck smear
Inactivates kallikrein which activates kininogen into bradykinin
Trochlear nerve (IV); abducens nerve (VI)

40. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Around 70 (normal measured diastolic pressures); 9--
Brief psychotic disorder; schizophreniform; schizophrenia
SS +rNA
liver specific

41. What are the three causes of acute MI in context of normal coronary arteries ?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Measure of depth invasion (vertical!)
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
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

42. What is the difference between paranoid personality disorder and delusional disorder?
P53 mutation; DCC is also required for adenoma to carcinoma
Increase in permeability of two ions with equal and opposite equilibrium potentials
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

43. What is the sole neurologic manifestation of acute rheumatic fever?
Coagulation factors are made in the liver
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Sydenham chorea
Turners`

44. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Turners`
Radial nerve damage
Hyperkalemia; potassium sparing diuretics - potassium supplements

45. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Serum FFA and serum triglyceride levels
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Relfex tachycardia; giving beta blockers

46. How do left sided colon adenocarcinomas present? right sided?
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
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
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
No and yes

47. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Pulmonary hypertension
25; 25
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
8 (myc protein) with 2 - 14 - 22 (iG chains)

48. What are the two mcc of focal brain lesions in HIV positive patients?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Underestimation of gestational age

49. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Adeno
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
frameshift mutations (missense is substitution)

50. What are three symptoms in s.typhi?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Inactivates kallikrein which activates kininogen into bradykinin
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)