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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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1. What is the neurologic manifestation of ADPKD?
Integration of viral DNA into genome of host hepatocytes
Sickle cell; G6PD
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

2. What is the mc location for avascular necrosis? What is it associated with?
Purkinje system; AV node
Inhaled animal dander allergens
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
transcription activation/suppression

3. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Vagus (auricular branch); vasovagal syncope!
Increases
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Rabies encephalitis from cave bats; rabies killed vaccines

4. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Because of the low output from heart failure - they will have increased aldosterone levels
SSRI
The term used to describe decreased drug responsiveness with repeated administration
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

5. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
indomethacin
Multiple miscarriages d/t hypercoaguability
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

6. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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7. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
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
HSV ( also in utero: chlymadia - neisseria - group B strep)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

8. what dissolves the lipid bilayer of a viral envelope?
(urine PAH x urine flow rate)/plasma PAH
Ether and other organic solvents
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Tissue redistribution (out of plasma) rather than metabolism

9. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Lateral; RV; RA; LV
Increased reticulocytes
Closer to head; closer to diaphragm

10. if there are keratin swirls does that mean well or poorly differentiated?
Amiloride - spironolactone - triamterene
Well
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Underestimation of gestational age

11. Where does complement bind on the Fc region of Ig chains?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Fibronectin - laminin - collagen
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

12. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Because gamma chains replace beta chains and then gamma chain formation wanes
Chrom 8
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

13. which staphylococci can do mannitol fermaentation?
Chorda tympani branch
S. aureus
Prostate tumor and increased osteoclast activity
Diabetic microangiopathy

14. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Proteasome inhibitor; treatment for MM and waldenstroms
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

15. What is extraocular muscle weakness a common symptom of?
Myasthenia gravis
No
facultative intracellular
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

16. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Purkinje system; AV node
HSV and VZV
manifestations - congenital (stretching of periventricular pyrimadal fibers)

17. sporadic colon cancer tend to arise From what type of polyps?
Hypo or hyper pigmentations; after tanning
Single adenomatous ones
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Reticulocytes

18. What does nitroprusside do to afterload? preload?
...
Decreases both
Biphosphonate
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

19. How do you calculate RPF from urine PAH?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Vancomycin
hyponatremia (aldosterone activation equilibrates body volume)
(urine PAH x urine flow rate)/plasma PAH

20. What type of vision is myopia? In What type of patients does it improve?
C3 decreased after 5-10 days; sulfonamides
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
P53 mutation; AD

21. What are fenfluramine - phentermine?
Right heart failure
Appetite suppressants
Inhibits it
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

22. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
ANCA because of lack of Ig and C3 deposits on IF
Tissue redistribution (out of plasma) rather than metabolism

23. What three factors effect total oxygen content of blood?
Sickle cell; G6PD
Rabies encephalitis from cave bats; rabies killed vaccines
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2

24. What does the tuberoinfundibular pathway connect? What is it responsible for?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Medial part
Increases cytokine production
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

25. Would alpha 1 agonists cause flushing? muscarinic antagonist?
ANCA because of lack of Ig and C3 deposits on IF
frameshift mutations (missense is substitution)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
No; yes

26. neisseria are...
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
High potassium conductance and some sodium conductance
facultative intracellular

27. What is the difference between paranoid personality disorder and delusional disorder?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Squatting - sitting - lying supine - passive leg raising
On cardiac tissue and renal juxtaglomerular cells
NF- KB; responsible for cytokine production

28. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Vancomycin
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
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)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

29. Which is faster purkinje system or atrial muscle?
Anti centromere; anti DNA topoisomerase
Brief psychotic disorder; schizophreniform; schizophrenia
Close but purkinje system to ensure contraction in a bottom up fashion
SS +rNA

30. Where does vasopressin act - on the medullary or cortical segment of collecting tubule?
P450 mitochondrial monooxygenase
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Medullary
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

31. which cells produce surfactant? which ones mediate gas exchange?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
II; I (I more abundant)
Downs; regurgitant AV valves - ASDs

32. What is the best indicator for the severity of mitral stenosis?
By vascular permeability and vasodilation
Downs; regurgitant AV valves - ASDs
The time interval between S2 and OS- the shorter the interval - the more intense
25; 25

33. What is a clara cell?
P450 mitochondrial monooxygenase
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
C3 decreased after 5-10 days; sulfonamides
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

34. Where does lysyl oxidase act? What is the cofactor for that?
HSV and VZV
In the extracellular space for collagen cross linking; zinc
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

35. What are the two coagulase negative staphylococci? How do you distinguish them?
Right heart failure
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
S. saprophyticus - and s. epidermidis; novobiocin
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

36. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
IgE
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Rabies encephalitis from cave bats; rabies killed vaccines
C3 decreased after 5-10 days; sulfonamides

37. which two virus families have hemagluttinin on their surface?
G to T in p53; HCC
Paramyxo and influenza
PDA open
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

38. What type of bond is a disulfide bond?
SaO2 <92%
Covalent (between two cysteines)- allows protein to withstand denaturation
Hexokinase
Coagulation factors are made in the liver

39. what induces bronchial squamous metaplasia?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
ANCA because of lack of Ig and C3 deposits on IF
Smoking
Prostate tumor and increased osteoclast activity

40. What are some side effects seen in TCAs?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Hereditary angioedema; ACE inhibitors
E. coli

41. 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)
Hereditary angioedema; ACE inhibitors
Lateral; RV; RA; LV
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

42. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Purkinje system; AV node
Superior larygeal; cricothyroid; recurrent laryngeal
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Hypertension - edema - and proteinuria

43. biotin is used By what in tissues responsible for gluconeogenesis
Vascular endothelium; protease
Standing suddenly from supine position; valsalva maneuver
As a CO2 carrier with the carboxylase enzyme
S. aureus

44. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Terminal bronchioles; small bronchi
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

45. what hormone is structurally similar to hCG?
P53 mutation; DCC is also required for adenoma to carcinoma
TSh (in testicular tumors can cause hyperthyroidism)
Hypertension - edema - and proteinuria
HSV and VZV

46. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Ketone body production by preventing fatty acids into the mitochondria

47. What type of calcium channels dictate the plateau in cardiac myocyte?
Dihydropyridine sensitive Ca channels (L type)
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
Hydrogen bonds dictate alpha or beta structure
Drink plenty of fluids

48. What is the difference between additive and synergistic?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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
E6 and E7 of HPV knock off p53 and Rb suppressor genes

49. What is diagnostic (and possible therapeutic for intussusception)?
Pulmonary hypertension
Fibrosis; macrophages
Pan colitis and right sided colitis (more than left sided and proctitis)
Barium enema

50. What is the mcc of elevated AFP leves in pregnancy>
Prostate tumor and increased osteoclast activity
DIC; TTP- HUS dont bleed that much
SaO2 <92%
Underestimation of gestational age

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