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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 is the presentation of sever aortic stenosis?
liver specific
Syncope - angina - dyspnea (SAD)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Large stroke volumes with ventricular contraction; aortic regurg

2. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
MAO inhibitors; wine and cheese
Increase lymphatic drainage!
Duration and extent of disease
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

3. How do you explain the selective proteinuria of loss to albumin only in MCD?
Prevent phagocytosis
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

4. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Echinococcus granulosus; anaphylaxis
Anterior nares

5. What effects does cortisol have on catecholamines?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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
Barium enema
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)

6. what hernia has a similar mechanism to hydrocele?
11 aa polypeptide; pain NT in CNS and PNS
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
RR-1/RR
Hyperkalemia; potassium sparing diuretics - potassium supplements

7. What is extraocular muscle weakness a common symptom of?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Myasthenia gravis

8. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
RR-1/RR
Bronchogenic carcinoma
No; MRI

9. within the right atrium - What is the maximum pressure? left atrium?
frameshift mutations (missense is substitution)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
8; 12

10. What are the two coagulase negative staphylococci? How do you distinguish them?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Fibronectin - laminin - collagen
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
S. saprophyticus - and s. epidermidis; novobiocin

11. what immune deficiency causes recurrent neisseria infections?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
MAC complex (C5b - C9 complement deficiency)
Bronchogenic carcinoma

12. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
As a CO2 carrier with the carboxylase enzyme
Prostate tumor and increased osteoclast activity
Covalent (between two cysteines)- allows protein to withstand denaturation

13. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Sydenham chorea
In ER of bile canaliculi
Octreotide

14. where are the vegetations on the valves of a libman sacks endocarditis?
Prostate tumor and increased osteoclast activity
Appetite suppressants
Both sides
Amiadarone

15. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
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)
E. coli
Spongiosis
Syringomelia

16. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

17. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Folic acid treatment!
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

18. What is achalasia and how would this correlate on the esophageal mannometry?
The time interval between S2 and OS- the shorter the interval - the more intense
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
Inhibits it
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)

19. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
P53 mutation; DCC is also required for adenoma to carcinoma
RER; RER
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Intussusception

20. What are some of the permissive effects of cortisol?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Extrinsic def; instrinsic def; platelet def
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Increases bronchial and vascular smooth muscle reactivity to catecholamines

21. What is the mc malignancy in asbestosis?
facultative intracellular
Bronchogenic carcinoma
Tibial
Become beta pleated and then form neurofibrillary tangle!

22. What is the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
NF- KB; responsible for cytokine production
Thymic tumor

23. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
FGF and VEGF
Normal; low
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

24. What is somatomedin C?
Reticulocytes
Insulin like growth factor 1 (just another name)
Boiling - bleach - formalin - UV irradiation
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)

25. what drug is useful for secretory diarrhea?
glycerol kinase
Octreotide
Raphe
Drug induced interstitial nephritis

26. What are the two mcc of focal brain lesions in HIV positive patients?
Inhibits it
FGF and VEGF
Serum FFA and serum triglyceride levels
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

27. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Folic acid treatment!
ZDV or AZT
Relfex tachycardia; giving beta blockers

28. what commonly happens in GI in response to acute physiologic stress?
C3 decreased after 5-10 days; sulfonamides
Acute gastric mucosal defects (superficial or full thickness)
Regular insulin (Not fast acting - regular better)
Prevent phagocytosis

29. why is crohns disease associated with oxaloacetate kidney stones?
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
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
Echinococcus granulosus; anaphylaxis
Localized dermatologic pain that persists for more than one month after zoster eruption

30. 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
FGF and VEGF
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Mean greater than median greater than mode

31. in the LV and aorta - What are the pressures?
ZDV or AZT
Normally close to systolic
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
No; MRI

32. SIADH patients have normal blood volume but...
P53 mutation; DCC is also required for adenoma to carcinoma
hyponatremia (aldosterone activation equilibrates body volume)
Standing suddenly from supine position; valsalva maneuver
Gluteus medius and minimus; positive trendelenberg

33. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Thymic tumor
Amiloride - spironolactone - triamterene
gram positive organisms
manifestations - congenital (stretching of periventricular pyrimadal fibers)

34. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
MAC complex (C5b - C9 complement deficiency)
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
MAO inhibitors; wine and cheese

35. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Medullary
Another type of aldosterone antagonist (like spironolactone)
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

36. What is the mc location for avascular necrosis? What is it associated with?
Syringomelia
Adductor
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
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

37. what diseases can vit A be used to treat?
Measles and M3 AML`
Medial circumflex artery; avascular necrosis
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Amiadarone

38. how does increased ICP result in curlings ulcers?
Amiadarone
Boiling - bleach - formalin - UV irradiation
Vagus nerve stimulation
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

39. which are the only glycosylated proteins in HIV virus?
Coagulation factors are made in the liver
Env genes (for getting into target cells)
Neisseria induced small cell vasculitis (including hands and soles)
Prevent phagocytosis

40. What is gardeners mydriasis? How is it treated?
Inhibits it
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
SSRI
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

41. What agonists reduce the gradient across the LV outflow tract?
Kallmans
Selective alpha 1 (increases SVR)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Lateral; RV; RA; LV

42. What is a cell surface marker seen in liver angiosarcoma?
Normally close to systolic
Tissue redistribution (out of plasma) rather than metabolism
Mean greater than median greater than mode
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

43. ___________ is liver specific
only up to bronchi
HSV and VZV
glycerol kinase
Pulmonary hypertension

44. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Sickle cell; G6PD
Because gamma chains replace beta chains and then gamma chain formation wanes
Recurrent larygneal
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

45. What is the precursor protein to beta amyloid and On what chromosome is it found?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Right heart failure
APP on chrom 21 (this is why downs more susceptible)

46. What is the best indicator for the severity of mitral stenosis?
INTRApartum Abs (ampicillin/penicillin)
In the extracellular space
Increased reticulocytes
The time interval between S2 and OS- the shorter the interval - the more intense

47. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Radial nerve and deep brachial artery

48. why is glucagon used in beta blocker toxicitiy?
DIC; TTP- HUS dont bleed that much
Enterococci (e. faecalis)- found on genitalia area
Purkinje system; AV node
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

49. What is epispadias caused by?
As a CO2 carrier with the carboxylase enzyme
Faulty positioning of the genital tubercle
...
No

50. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
No
Inhibits it
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
Terminal bronchioles; small bronchi

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USMLE Prep 2

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