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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. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Anterior circumflex (and axillary nerve)
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Underestimation of gestational age

2. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
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
Primary
Bronchial dilation (bronchiectasis)

3. is Rifampin ever used as monotherapY? why either way?
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
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
8 (myc protein) with 2 - 14 - 22 (iG chains)

4. What can worse neurologic dysfunction in cobalamic def?
TCAs and prazosin
Prevent phagocytosis
Folic acid treatment!
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

5. What does nitroprusside do to afterload? preload?
Lateral; RV; RA; LV
Medial part
AV node slowest - to allow time for diastole
Decreases both

6. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
No and yes
Circular - outside nucleus; transport proteins - rRNA - tRNA
Medullary

7. What causes the blurry vision side effects in first generation anti histamines?
Prepatellar
GI malignancies and Insulin resistance (acromegal for ex)
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
Anti cholinergic effects of pupil dilation and lack of accomodation

8. What is achalasia and how would this correlate on the esophageal mannometry?
Right before diastole (filling begins)
To pump calcium out in cardiac myocytes so that relaxation occurs
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
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

9. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
women
Tzanck smear
Env genes (for getting into target cells)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

10. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

11. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
SVT; increases vagal tone; rectus abdominis
Retinitis; mononucleosis
No and yes

12. What does C1 esterase do other than inhibiting complement pathway?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Inactivates kallikrein which activates kininogen into bradykinin
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
MAC complex (C5b - C9 complement deficiency)

13. What is a common complication of acute pancreatitis? What is it?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Leukotriene precursor and does neutrophil chemotaxis
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
25; 25

14. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
II; I (I more abundant)
Apocrine; eccrine

15. name three pathological states that present with large tongues.
Congenital hypothyroidism - downs - amyloidosis - acromegaly
chronic urticaria and allergic symptoms
Close but purkinje system to ensure contraction in a bottom up fashion
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

16. What type of mutation does aflatoxin cause? what cancer does this increase for?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
G to T in p53; HCC
Closer to head; closer to diaphragm
Bronchial dilation (bronchiectasis)

17. What is the mcc of extrinsic allergic asthma?
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
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Inhaled animal dander allergens
11

18. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Chrom 8
Localized dermatologic pain that persists for more than one month after zoster eruption
(urine PAH x urine flow rate)/plasma PAH

19. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Coagulation factors are made in the liver
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

20. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Nonsense; mRNA processing
Leukotriene precursor and does neutrophil chemotaxis

21. 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?
Relfex tachycardia; giving beta blockers
46 - 4N; 23 2N
The time interval between S2 and OS- the shorter the interval - the more intense
ANCA because of lack of Ig and C3 deposits on IF

22. what dictates the resting membrane potential of most cells?
AV node slowest - to allow time for diastole
RER; RER
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
High potassium conductance and some sodium conductance

23. 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?
Because of vasodiation to skeletal muscles
Faulty positioning of the genital tubercle
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

24. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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. which RPGN is also called pauci immune GN? why?
Prostate tumor and increased osteoclast activity
HSV ( also in utero: chlymadia - neisseria - group B strep)
Inhibits it
ANCA because of lack of Ig and C3 deposits on IF

26. What is used to prevent vertical transmission of HIV?
Vascular endothelium; protease
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
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
ZDV or AZT

27. What is the most important prognostic indicator in patients with malignant melanoma?
Measure of depth invasion (vertical!)
RBC mass; epo levels (secondary has high)
Because of vasodiation to skeletal muscles
Hypo or hyper pigmentations; after tanning

28. Where is aromatase used?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

29. Where does 90% of serotonin lie? What is this NT responsible?
Duration and extent of disease
Downs; regurgitant AV valves - ASDs
GI tract; mood!
8; 12

30. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Hydrogen bonds dictate alpha or beta structure
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Selective alpha 1 (increases SVR)
E. coli; staphylococcus saprophyticus

31. why does liver dysfunction cause coagulation disorders?
Coagulation factors are made in the liver
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Sydenham chorea

32. prostaglandin synthesis keeps...
Hypothyroidism
PDA open
II; I (I more abundant)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

33. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
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)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Folic acid treatment!

34. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
E. coli
Diabetic microangiopathy

35. Acyl coA synthetase is not...
Tzanck smear
liver specific
11
S. aureus

36. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Turbulence
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

37. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Common peroneal; bony fractures and compression; sciatic
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Drug induced interstitial nephritis

38. What is 5- HETE and What does it do?
Leukotriene precursor and does neutrophil chemotaxis
differentiate
In the extracellular space for collagen cross linking; zinc
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

39. after a thrombus extraction - what serum enzyme shoots up and why?
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
TCAs and prazosin
Serum creatine kinase; reperfusion injury causes necrosis
INTRApartum Abs (ampicillin/penicillin)

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

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41. what would be a sign of absence of cardiogenic pulm edem?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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
Acute gastric mucosal defects (superficial or full thickness)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

42. what color pigmentations are caused by malassezia furfur? when do they become more visible?
I is more benign and can present later in adulthood
V fib; v. failure
Hypo or hyper pigmentations; after tanning
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

43. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Large stroke volumes with ventricular contraction; aortic regurg
Tzanck smear
Ketone body production by preventing fatty acids into the mitochondria
Skin flushing and warmth; prostaglandins; give with aspirin

44. What are the lab findings in poststreptococcal GN?
<1% - 55% - concentration dependent
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Amiadarone
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

45. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
Bronchogenic carcinoma
Adeno
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

46. neisseria are...
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Anti cholinergic effects of pupil dilation and lack of accomodation
facultative intracellular
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

47. at four years of age - What are the social - fine motor - gross motor - and language developments?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Chorda tympani branch
Hypertension - edema - and proteinuria
DIC; TTP- HUS dont bleed that much

48. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Bile soluble which means they are bile sensitive
Appetite suppressants

49. what virus causes pharyngoconjuctival fever?
RER; RER
Serum FFA and serum triglyceride levels
RBF= PAH clearance/(1- hematocrit)
Adeno

50. What is intussusception? how does ischemia and necrosis occur?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

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USMLE Prep 2

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