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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. Where is aromatase used?
V fib; v. failure
CGD; t cell dysfxn (diGeorge)
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

2. at three years of age What are social - fine motor - gross motor and language developments?
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)
Covalent (between two cysteines)- allows protein to withstand denaturation
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Gluteus medius and minimus; positive trendelenberg

3. Where does terminal peptide cleavage of collagen fibrils take place?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
In the extracellular space
Selective alpha 1 (increases SVR)
Excessive collagen formation during tissue repair in susceptible individuals

4. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
11
Boiling - bleach - formalin - UV irradiation

5. why are beta thal major patients asymptomatic at birth?
Adductor
Because gamma chains replace beta chains and then gamma chain formation wanes
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)
Hypertension - edema - and proteinuria

6. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
In the extracellular space
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

7. What are the skin presentation in sarcoid?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Varying; erythema nodosum is common
25; 25
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

8. 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
Acute gastric mucosal defects (superficial or full thickness)
S. saprophyticus - and s. epidermidis; novobiocin
women

9. 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?
Minimal change disease
46 - 4N; 23 2N
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

10. Where does 90% of serotonin lie? What is this NT responsible?
Syncope - angina - dyspnea (SAD)
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Ketone body production by preventing fatty acids into the mitochondria
GI tract; mood!

11. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Dihydropyridine sensitive Ca channels (L type)
Increased reticulocytes
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

12. What does L/S stand for in fetal lung maturity? When does maturity occur?
Vancomycin; histamine mediated
Radial nerve and deep brachial artery
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

13. When is an S4 sound normal?
Chorda tympani branch
Well trained athletes and children
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Ketone body production by preventing fatty acids into the mitochondria

14. What triggers the neoplastic changes that are associated with HBV infecton?
...
Integration of viral DNA into genome of host hepatocytes
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

15. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Drink plenty of fluids
Not lined by epithelium
Squatting - sitting - lying supine - passive leg raising

16. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Superior larygeal; cricothyroid; recurrent laryngeal
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

17. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Medial circumflex artery; avascular necrosis
Prostate tumor and increased osteoclast activity
Covalent (between two cysteines)- allows protein to withstand denaturation

18. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Primary
Rabies encephalitis from cave bats; rabies killed vaccines
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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

19. which nerve provides innervation for plantar flexion and inversion?
RER; copper
Inactivates kallikrein which activates kininogen into bradykinin
<1% - 55% - concentration dependent
Tibial

20. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Nocardia
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Turbulence

21. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Demargination of neutrophils from the vessel walls
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
No; yes

22. What do you treat s. epidermidis with?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Vancomycin
Increase; decreased
Circular - outside nucleus; transport proteins - rRNA - tRNA

23. What is damaged in early syringomelia? later?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Because of vasodiation to skeletal muscles
Prostate tumor and increased osteoclast activity
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

24. what hernia has a similar mechanism to hydrocele?
Demargination of neutrophils from the vessel walls
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Standing suddenly from supine position; valsalva maneuver
Inhibits it

25. What is hyaline arteriosclerosis usually a sign of ?
Medullary
Diabetic microangiopathy
Serum FFA and serum triglyceride levels
Cluster

26. if there are keratin swirls does that mean well or poorly differentiated?
IgE
Vagus (auricular branch); vasovagal syncope!
No
Well

27. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Gluteus medius and minimus; positive trendelenberg
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
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
Thymic tumor

28. nucleotide deletions do not cause missense mutations - they cause...
Pain reliever - reduces pain by locking substance P in the PNS
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
frameshift mutations (missense is substitution)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

29. In what form are mitochondrial DNA? What do they transcribe?
Neisseria induced small cell vasculitis (including hands and soles)
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Sarcoid
Circular - outside nucleus; transport proteins - rRNA - tRNA

30. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Reiter syndrome; B27
Chlorpheniramine and diphenhydramine
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Sickle cell; G6PD

31. What is the fibrinogen level in patient with TTP- HUS? DIC?
Biphosphonate
Bile soluble which means they are bile sensitive
On cardiac tissue and renal juxtaglomerular cells
Normal; low

32. What is used to prevent vertical transmission of HIV?
In the extracellular space for collagen cross linking; zinc
ZDV or AZT
Biphosphonate
P53 mutation; DCC is also required for adenoma to carcinoma

33. What can long term leg cast wearing cause?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Regular insulin (Not fast acting - regular better)

34. what bursa is affected when on knees like a maid/gardner?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Prepatellar
Inhibits it

35. What is cataplexy and When is it seen?
In the extracellular space
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Sudden loss of muscle tone without loss of consciousness; narcolepsy

36. which antiarrythmic is associated with blue gray discoloration ?
Amiadarone
TCAs and prazosin
Prevent phagocytosis
Pulmonic and systemic!

37. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Inactivates kallikrein which activates kininogen into bradykinin
Duration and extent of disease
When it invades the bm; carcinoma in situ
Pulmonic and systemic!

38. a patient fearing all white coats is a phenomenon of what?
Raphe
Regular insulin (Not fast acting - regular better)
Classical conditioning
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

39. on which chromosome is wilms tumor found?
The time interval between S2 and OS- the shorter the interval - the more intense
P450 mitochondrial monooxygenase
11
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

40. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Squatting - sitting - lying supine - passive leg raising
Vascular endothelium; protease
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Bronchial dilation (bronchiectasis)

41. What does nitroprusside do to afterload? preload?
Turbulence
No; yes
Increases cytokine production
Decreases both

42. What is omalizumab and What is it used for?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Pulmonic and systemic!
Regular insulin (Not fast acting - regular better)
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

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

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44. How do you calculate RPF from urine PAH?
Syringomelia
(urine PAH x urine flow rate)/plasma PAH
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
No and yes

45. When is acid phosphatase elevated (Name two times)?
chronic urticaria and allergic symptoms
Prostate tumor and increased osteoclast activity
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)
Mean greater than median greater than mode

46. where are Beta 1 receptors found?
By vascular permeability and vasodilation
SVC and IVC; right below the aortic knob
On cardiac tissue and renal juxtaglomerular cells
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

47. What is hypospadias caused by?
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Abnormal closing of the urethral folds
S. aureus
Because gamma chains replace beta chains and then gamma chain formation wanes

48. What is medullary sponge kidney disease and how does it present? What does it lead to?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
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)
SVC and IVC; right below the aortic knob
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin

49. What is best to prevent GBS infection in a baby?
Tzanck smear
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
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
INTRApartum Abs (ampicillin/penicillin)

50. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
RBC mass; epo levels (secondary has high)
AV node slowest - to allow time for diastole
Nocardia

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