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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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1. What does anti phospholipid syndrome in SLE patients predispose them to?
Multiple miscarriages d/t hypercoaguability
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Not lined by epithelium
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

2. What is the most common neurologic complication of VZV reactivation?
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
Localized dermatologic pain that persists for more than one month after zoster eruption
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Highly negative resting potential

3. What triggers the neoplastic changes that are associated with HBV infecton?
Localized dermatologic pain that persists for more than one month after zoster eruption
Pulmonary hypertension
Integration of viral DNA into genome of host hepatocytes
Acute gastric mucosal defects (superficial or full thickness)

4. What is normal fibrinogen levels?
TSh (in testicular tumors can cause hyperthyroidism)
200-500
Adductor
Sarcoid

5. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Hyperkalemia; potassium sparing diuretics - potassium supplements
In the extracellular space
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

6. Metronidizaole does not cover...
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
gram positive organisms
Apocrine; eccrine
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

7. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
SSRI; erectile dysfunction
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Normally close to systolic
Radial nerve damage

8. What is the presentation of sever aortic stenosis?
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
Syncope - angina - dyspnea (SAD)
facultative intracellular
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

9. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Because of vasodiation to skeletal muscles
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
In the extracellular space for collagen cross linking; zinc

10. What does NF- KB do?
Increases cytokine production
Sydenham chorea
Single adenomatous ones
Amiadarone

11. What is the difference between additive and synergistic?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
No; yes
46 - 4N; 23 2N
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

12. What is extraocular muscle weakness a common symptom of?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Myasthenia gravis
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Valproate

13. What is a clara cell?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Prepatellar
Measles and M3 AML`

14. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Extrinsic def; instrinsic def; platelet def
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

15. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Bile salt accumulation in urine
S. aureus
Recurrent larygneal

16. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Large stroke volumes with ventricular contraction; aortic regurg
Sickle cell; G6PD
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Not lined by epithelium

17. What does Rb protein do? what chrom is it on?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
In ER of bile canaliculi
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Smoking

18. when do ghon complexes form - primary or secondary TB?
facultative intracellular
Primary
Pain reliever - reduces pain by locking substance P in the PNS
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

19. What are the acute effects of corticosteroids on the CBC?
Tzanck smear
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Extrinsic def; instrinsic def; platelet def
To pump calcium out in cardiac myocytes so that relaxation occurs

20. metabolism of 1 gram of protein produces How many calories? carb? fat?
In the extracellular space
On cardiac tissue and renal juxtaglomerular cells
Measles and M3 AML`
4 - 4 - 9

21. if there are keratin swirls does that mean well or poorly differentiated?
Right heart failure
Faulty positioning of the genital tubercle
Well
Intussusception

22. What is the cause of fixed splitting of S2? why?
Raphe
Amiloride - spironolactone - triamterene
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
When it invades the bm; carcinoma in situ

23. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Boiling - bleach - formalin - UV irradiation
Vancomycin
Susceptible; soluble (unable to be cultured in bile)

24. What is the most important prognostic indicator in patients with malignant melanoma?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Measure of depth invasion (vertical!)
Inactivates kallikrein which activates kininogen into bradykinin

25. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Hypo or hyper pigmentations; after tanning
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
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)

26. What is congestive hepatomegaly specific for?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Radial nerve damage
Right heart failure
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

27. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Mean greater than median greater than mode
Retinitis; mononucleosis
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

28. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Cluster
E. coli
Fibronectin - laminin - collagen
Turners`

29. What is hypospadias caused by?
Reticulocytes
Abnormal closing of the urethral folds
Common peroneal; bony fractures and compression; sciatic
manifestations - congenital (stretching of periventricular pyrimadal fibers)

30. What does VIP do to gastric acid secretion?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Inhibits it
Echinococcus granulosus; anaphylaxis
only up to bronchi

31. What does the tuberoinfundibular pathway connect? What is it responsible for?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
No and yes

32. which viruses require a protease?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
SS +rNA
Pan colitis and right sided colitis (more than left sided and proctitis)
Faulty positioning of the genital tubercle

33. What is the stabilizing force for the secondary structure of proteins?
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Hydrogen bonds dictate alpha or beta structure
S3 gallop; S2 to opening snap interval
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

34. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Think Hb deformation diseases
Brief psychotic disorder; schizophreniform; schizophrenia
Dihydropyridine sensitive Ca channels (L type)

35. nucleotide deletions do not cause missense mutations - they cause...
Sydenham chorea
Rare complication of measles (years later)- thought to be d/t certain type that doesnt have surface M protein antigen so goes unseen into CNS
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
frameshift mutations (missense is substitution)

36. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
V fib; v. failure
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Vagus nerve stimulation

37. What type of disease has selective proteinuria? What is found in urine? What is not?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Anterior circumflex (and axillary nerve)
Normally close to systolic
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

38. why is glucagon used in beta blocker toxicitiy?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Radial nerve damage

39. how does noise induced hearing loss occur?
Hypo or hyper pigmentations; after tanning
transcription activation/suppression
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Trauma to stereociliated hair cells of the organ of corti

40. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Relfex tachycardia; giving beta blockers
Myasthenia gravis
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

41. what should you think of with coarctation of aorta - bicuspid valves and horseshoe kidney?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Vancomycin; histamine mediated
Turners`
Elevated GGT and macrocytosis

42. 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?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Apocrine; eccrine
IgE
Phase 4 (sodium current); reducing the rate of spontaneous depolarization

43. What agonists reduce the gradient across the LV outflow tract?
Vancomycin
indomethacin
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Selective alpha 1 (increases SVR)

44. What is the difference between paranoid personality disorder and delusional disorder?
Both sides
Radial nerve damage
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

45. there are mucus secreting cells in the bronchioles...
Well
Prevent phagocytosis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
only up to bronchi

46. PDAs are often asymptomatic. How do you treat?
TCAs and prazosin
women
indomethacin
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

47. What pulmonary structural change can kartageners syndrome cause?
Measles and M3 AML`
Initiation - pointing; pincer grasp; walking; mama/dada
Bronchial dilation (bronchiectasis)
Valproate

48. What is acanthosis nigricans associated with?
Normal; low
facultative intracellular
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
GI malignancies and Insulin resistance (acromegal for ex)

49. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
transcription activation/suppression
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

50. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Folic acid treatment!
Because of the low output from heart failure - they will have increased aldosterone levels
V fib; v. failure

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USMLE Prep 2

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