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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. What are the lab findings in poststreptococcal GN?
IgE
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Abnormal closing of the urethral folds

2. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Think Hb deformation diseases
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Because of vasodiation to skeletal muscles

3. What type of endocarditis is cytoscopy induced?
RBC mass; epo levels (secondary has high)
INTRApartum Abs (ampicillin/penicillin)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Enterococci (e. faecalis)- found on genitalia area

4. what dictates the resting membrane potential of most cells?
INTRApartum Abs (ampicillin/penicillin)
High potassium conductance and some sodium conductance
Hydrogen bonds dictate alpha or beta structure
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

5. What type of drug is alendronate?
Biphosphonate
Turners`
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Bile soluble which means they are bile sensitive

6. in B12 deficiency - what levels in blood rise very quickly and then drop?
Multiple miscarriages d/t hypercoaguability
Reticulocytes
No
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

7. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Headaches and facial flushing; vasodilation in meninges and skin
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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

8. what drugs causes the red man syndrome? how does it occur?
No; MRI
Increase in permeability of two ions with equal and opposite equilibrium potentials
Vancomycin; histamine mediated
Cluster

9. metabolism of 1 gram of protein produces How many calories? carb? fat?
Circular - outside nucleus; transport proteins - rRNA - tRNA
4 - 4 - 9
Acute gastric mucosal defects (superficial or full thickness)
Strength of cell mediated immune response

10. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Drug induced interstitial nephritis
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Normal; low

11. what makes bruits?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Turbulence
Demargination of neutrophils from the vessel walls

12. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Aromatase deficiency in child
Hypo or hyper pigmentations; after tanning
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
(urine PAH x urine flow rate)/plasma PAH

13. why are pregnant predisposed to cholelithiasis?
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
manifestations - congenital (stretching of periventricular pyrimadal fibers)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Bile salt accumulation in urine

14. When is acid phosphatase elevated (Name two times)?
Increase by 50% in urine osmolality
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
ATP binding (resets the myosin head to contract again for next binding)
Prostate tumor and increased osteoclast activity

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

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16. What are the skin presentation in sarcoid?
Varying; erythema nodosum is common
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Syncope - angina - dyspnea (SAD)
Increases cytokine production

17. Where does lysyl oxidase act? What is the cofactor for that?
Measure of depth invasion (vertical!)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
No (unlike adenomyosis); yes
In the extracellular space for collagen cross linking; zinc

18. Which is slower AV node or ventricular muscle?
Raphe
SSRI
II; I (I more abundant)
AV node slowest - to allow time for diastole

19. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Extrinsic def; instrinsic def; platelet def
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
C3 decreased after 5-10 days; sulfonamides
Not lined by epithelium

20. what hormone is structurally similar to hCG?
TSh (in testicular tumors can cause hyperthyroidism)
Standing suddenly from supine position; valsalva maneuver
Myasthenia gravis
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

21. What is Bortezomib and What is it used for?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Proteasome inhibitor; treatment for MM and waldenstroms
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)

22. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Adeno
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Medial circumflex artery; avascular necrosis

23. What causes vertical diplopia? horizontal?
Increase; decreased
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Trochlear nerve (IV); abducens nerve (VI)
P53 mutation; AD

24. Where does 90% of serotonin lie? What is this NT responsible?
Medullary
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
GI tract; mood!
Mean greater than median greater than mode

25. how does increased ICP result in curlings ulcers?
Vagus nerve stimulation
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
indomethacin
Inactivates kallikrein which activates kininogen into bradykinin

26. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Bile salt accumulation in urine
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Susceptible; soluble (unable to be cultured in bile)

27. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
Prostate tumor and increased osteoclast activity
Right heart failure
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

28. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Folic acid treatment!
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Terminal bronchioles; small bronchi
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

29. What causes curlings ulcers?
S3 gallop; S2 to opening snap interval
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Fibronectin - laminin - collagen
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

30. Where is conduction in heart fastest? slowest?
Tibial
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
Prevents hepatic VLDL production
Purkinje system; AV node

31. What are fenfluramine - phentermine?
Trochlear nerve (IV); abducens nerve (VI)
Vagus (auricular branch); vasovagal syncope!
Appetite suppressants
Bronchial dilation (bronchiectasis)

32. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
Pulmonic and systemic!
Amiadarone
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Bile soluble which means they are bile sensitive

33. 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
High potassium conductance and some sodium conductance
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
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

34. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Intussusception
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
IgE
C3 decreased after 5-10 days; sulfonamides

35. why does hypothyroidism cause increased CPK levels?
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)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Ceftriaxone; azithromycin
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

36. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
differentiate
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
<1% - 55% - concentration dependent

37. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Relfex tachycardia; giving beta blockers
MAC complex (C5b - C9 complement deficiency)
Proteasome inhibitor; treatment for MM and waldenstroms
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

38. what diseases can vit A be used to treat?
Insulin like growth factor 1 (just another name)
Measles and M3 AML`
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ketone body production by preventing fatty acids into the mitochondria

39. why are beta thal major patients asymptomatic at birth?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Measles and M3 AML`
Because gamma chains replace beta chains and then gamma chain formation wanes
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

40. What is the most important prognostic indicator in patients with malignant melanoma?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Prepatellar
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Measure of depth invasion (vertical!)

41. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Vascular endothelium; protease
Aromatase deficiency in child
Elastance
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

42. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
S3 gallop; S2 to opening snap interval
Intussusception
8; 12
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

43. what protects the resting heart from arrhythmias?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Highly negative resting potential
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Medial circumflex artery; avascular necrosis

44. What is normal fibrinogen levels?
No and yes
200-500
Localized dermatologic pain that persists for more than one month after zoster eruption
Demargination of neutrophils from the vessel walls

45. What is the cause of rapid plasma decay of thiopental?
Tissue redistribution (out of plasma) rather than metabolism
Chrom 8
SSRI; erectile dysfunction
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

46. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
LT (LTD4 - E4 - C4) - and Ach
Measles and M3 AML`
GI tract; mood!

47. why is crohns disease associated with oxaloacetate kidney stones?
Ceftriaxone; azithromycin
Drink plenty of fluids
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
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

48. within the right ventricle - What are maximum pressures? the pulm arter?
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
25; 25
Amiadarone
differentiate

49. how does neisseria cause a petechial rash?
Kallmans
Ig A deficiency
Neisseria induced small cell vasculitis (including hands and soles)
Cluster

50. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Proteasome inhibitor; treatment for MM and waldenstroms
Smoking
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis