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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. name three pathological states that present with large tongues.
TCAs and prazosin
Congenital hypothyroidism - downs - amyloidosis - acromegaly
only up to bronchi
Normal; low

2. why does neutrophila occur with corticosteroids?
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
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
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Demargination of neutrophils from the vessel walls

3. What is a common complication of acute pancreatitis? What is it?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
NF- KB; responsible for cytokine production
Trochlear nerve (IV); abducens nerve (VI)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

4. What is hyaline arteriosclerosis usually a sign of ?
Diabetic microangiopathy
Barium enema
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

5. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Barium enema
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
HSV and VZV

6. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
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
Octreotide
Inhibits it

7. other than proteinuria - What can cause foamy froathy urine?
Nonsense; mRNA processing
Kallmans
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)
Bile salt accumulation in urine

8. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Measure of depth invasion (vertical!)

9. What is pickwickian syndrome? What are the lab findings?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Hyperkalemia; potassium sparing diuretics - potassium supplements
Because gamma chains replace beta chains and then gamma chain formation wanes
200-500

10. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
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
Bile soluble which means they are bile sensitive
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

11. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
S3 gallop; S2 to opening snap interval
facultative intracellular
Chlorpheniramine and diphenhydramine

12. what locations of UC increase the risk of Colon cancer?
Because of the low output from heart failure - they will have increased aldosterone levels
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Pan colitis and right sided colitis (more than left sided and proctitis)

13. sporadic colon cancer tend to arise From what type of polyps?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Single adenomatous ones
Anti cholinergic effects of pupil dilation and lack of accomodation
PDA open

14. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Chrom 8
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Dihydropyridine sensitive Ca channels (L type)

15. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
II; I (I more abundant)
SVC and IVC; right below the aortic knob
low in serum
Apocrine; eccrine

16. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Amiloride - spironolactone - triamterene
Minimal change disease
Reticulocytes
Dissolved in plasma and attached to Hgb

17. what protects the resting heart from arrhythmias?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Highly negative resting potential
Thymic tumor
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

18. What is a primary HSV 1 infection like?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
SVC and IVC; right below the aortic knob
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

19. What is the most common cause of pyelonephritis in both adults and childre?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Anterior nares
Increase; decreased
E. coli

20. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Turners`
Gluteus medius and minimus; positive trendelenberg
Increases cytokine production
Nonsense; mRNA processing

21. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Dissolved in plasma and attached to Hgb
Drug induced interstitial nephritis
Sarcoid
Little effect on cell and no change

22. Where is the base of the heart? apex?
Closer to head; closer to diaphragm
Classical conditioning
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

23. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
facultative intracellular
Right before diastole (filling begins)
Reticulocytes

24. What does Rb protein do? what chrom is it on?
Intussusception
Syncope - angina - dyspnea (SAD)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

25. What is a clara cell?
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
Class I
ZDV or AZT
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

26. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Right before diastole (filling begins)
In ER of bile canaliculi
RER; copper

27. how long is substance P? What does it do?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
11 aa polypeptide; pain NT in CNS and PNS
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Ig A deficiency

28. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
Joints d/t increased purine production and thus uric acid production
46 - 4N; 23 2N
No
Standing suddenly from supine position; valsalva maneuver

29. h1 receptor anatagonists are not effective in treatment of asthma only for...
RR-1/RR
Susceptible; soluble (unable to be cultured in bile)
Fibrosis; macrophages
chronic urticaria and allergic symptoms

30. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
E. coli
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Bile soluble which means they are bile sensitive
Hereditary angioedema; ACE inhibitors

31. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Increases
Vascular endothelium; protease
Hypothyroidism
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

32. What is a cord factor and Which bugs have it? How do they appear on culture?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Increased reticulocytes
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Intussusception

33. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
11
Elastance
Increase; decreased
C3 decreased after 5-10 days; sulfonamides

34. What are the two coagulase negative staphylococci? How do you distinguish them?
HSV ( also in utero: chlymadia - neisseria - group B strep)
S. saprophyticus - and s. epidermidis; novobiocin
Myasthenia gravis
Common peroneal; bony fractures and compression; sciatic

35. What does extended consumption of appetite suppressants lead to?
Vascular endothelium; protease
Terminal bronchioles; small bronchi
Pulmonary hypertension
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

36. What is the presentation of angioedema? Where is most commonly affected?
RER; RER
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Standing suddenly from supine position; valsalva maneuver

37. which virus inactivates both Rb and p53?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
transcription activation/suppression

38. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Anti centromere; anti DNA topoisomerase
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Purkinje system; AV node

39. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
TSh (in testicular tumors can cause hyperthyroidism)
Purkinje system; AV node
Chorda tympani branch

40. how does achalasia present? What does barium swallow show on dilated esophagus?
Ig A deficiency
Initiation - pointing; pincer grasp; walking; mama/dada
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Dissolved in plasma and attached to Hgb

41. how does eos release MBP to kill protozoa etc?
ANCA because of lack of Ig and C3 deposits on IF
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Acute interstitial nephritis
chronic urticaria and allergic symptoms

42. what diseases can vit A be used to treat?
Southern - western
Measles and M3 AML`
Fibrosis; macrophages
Ceftriaxone; azithromycin

43. What is the fibrinogen level in patient with TTP- HUS? DIC?
Large stroke volumes with ventricular contraction; aortic regurg
Normal; low
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Sydenham chorea

44. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
Valproate
Raphe
...

45. What is a keloid?
Brief psychotic disorder; schizophreniform; schizophrenia
Excessive collagen formation during tissue repair in susceptible individuals
only up to bronchi
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

46. Where is conduction in heart fastest? slowest?
Purkinje system; AV node
Thymic tumor
Squatting - sitting - lying supine - passive leg raising
Medullary

47. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Squatting - sitting - lying supine - passive leg raising
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Demargination of neutrophils from the vessel walls

48. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption
Brief psychotic disorder; schizophreniform; schizophrenia
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Terminal bronchioles; small bronchi

49. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Reiter syndrome; B27
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Pain reliever - reduces pain by locking substance P in the PNS

50. non ceruloplasmin deposition - ceruloplasmin is...
low in serum
glycerol kinase
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Anti cholinergic effects of pupil dilation and lack of accomodation