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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 is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Abnormal closing of the urethral folds
MAO inhibitors; wine and cheese
4 - 4 - 9
Syringomelia

2. what chromosome is c - myc found on?
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
Chrom 8
S. saprophyticus - and s. epidermidis; novobiocin

3. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Radial nerve and deep brachial artery
Increase lymphatic drainage!
Ig A deficiency
No and yes

4. What is mcc of death pre hospital phase of MI? in hospital phase?
V fib; v. failure
Headaches and facial flushing; vasodilation in meninges and skin
Downs; regurgitant AV valves - ASDs
Inhibits it

5. What is the mutation type in thalassemias? what process is defective because of this?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Nonsense; mRNA processing
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
Increased reticulocytes

6. Where is aromatase used?
Vancomycin
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Chorda tympani branch
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

7. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Dissolved in plasma and attached to Hgb
frameshift mutations (missense is substitution)
Pulmonic and systemic!

8. What is a cell surface marker seen in liver angiosarcoma?
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Diabetic microangiopathy

9. How do you calculate atributable risk percent?
Chrom 8
RR-1/RR
only up to bronchi
P53 mutation; AD

10. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Paramyxo and influenza
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Abnormal closing of the urethral folds
RBF= PAH clearance/(1- hematocrit)

11. What is tachyphylaxis?
Increases
The term used to describe decreased drug responsiveness with repeated administration
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Faulty positioning of the genital tubercle

12. Which is faster atrial muscle or ventricular muscle?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
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
Atrial
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

13. What is the most common cause of pyelonephritis in both adults and childre?
Intussusception
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Selective alpha 1 (increases SVR)
E. coli

14. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
low in serum
Thymic tumor
In the extracellular space for collagen cross linking; zinc
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

15. other than mycobacterim wha other bacteria is acid fast?
Vascular endothelium; protease
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Hexokinase
Nocardia

16. What is suggestive of complete central DI?
Increase by 50% in urine osmolality
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
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

17. What is epispadias caused by?
Selective alpha 1 (increases SVR)
Faulty positioning of the genital tubercle
Gluteus medius and minimus; positive trendelenberg
indomethacin

18. What is the most common initital symptom of ADPKD? what else?
Octreotide
Single adenomatous ones
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

19. neisseria are...
Pulmonary hypertension
facultative intracellular
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
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

20. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Vagus (auricular branch); vasovagal syncope!
S. saprophyticus - and s. epidermidis; novobiocin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

21. what dissolves the lipid bilayer of a viral envelope?
glycerol kinase
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
Ether and other organic solvents
Bile salt accumulation in urine

22. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Fat - fertile - forty - female
Large stroke volumes with ventricular contraction; aortic regurg
Little effect on cell and no change
To pump calcium out in cardiac myocytes so that relaxation occurs

23. what dictates the resting membrane potential of most cells?
Bile soluble which means they are bile sensitive
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Drug induced interstitial nephritis
High potassium conductance and some sodium conductance

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

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25. What is the mainstay treatment for acute mania?
Bile salt accumulation in urine
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Dissolved in plasma and attached to Hgb
Increase by 50% in urine osmolality

26. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
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)
Radial nerve damage
indomethacin

27. which opponens muscle does ulnar innervate?
Adductor
No and yes
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

28. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Southern - western
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Reticulocytes
RBF= PAH clearance/(1- hematocrit)

29. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
No and yes
DIC; TTP- HUS dont bleed that much
Localized dermatologic pain that persists for more than one month after zoster eruption

30. a patient fearing all white coats is a phenomenon of what?
Classical conditioning
Think Hb deformation diseases
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
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

31. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
G to T in p53; HCC
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Retinitis; mononucleosis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

32. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Hypothyroidism
Leukotriene precursor and does neutrophil chemotaxis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

33. in B12 deficiency - what levels in blood rise very quickly and then drop?
No and yes
<1% - 55% - concentration dependent
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Reticulocytes

34. What is used to treat heparin toxicity?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Tibial
Protamine sulfate
Diabetic microangiopathy

35. What are the two growth factors associated with angiogenesis?
FGF and VEGF
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)
gram positive organisms
Measure of depth invasion (vertical!)

36. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Sickle cell; G6PD
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

37. What does anti phospholipid syndrome in SLE patients predispose them to?
Common peroneal; bony fractures and compression; sciatic
Bile soluble which means they are bile sensitive
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
Multiple miscarriages d/t hypercoaguability

38. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Chorda tympani branch

39. What are the two coagulase negative staphylococci? How do you distinguish them?
S. saprophyticus - and s. epidermidis; novobiocin
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Demargination of neutrophils from the vessel walls
Medullary

40. What is used to prevent vertical transmission of HIV?
ZDV or AZT
Fibronectin - laminin - collagen
Paramyxo and influenza
E6 and E7 of HPV knock off p53 and Rb suppressor genes

41. SIADH patients have normal blood volume but...
Gluteus medius and minimus; positive trendelenberg
hyponatremia (aldosterone activation equilibrates body volume)
11 aa polypeptide; pain NT in CNS and PNS
Closer to head; closer to diaphragm

42. What is easiest way to treat nephrolithiasis?
Drink plenty of fluids
Reiter syndrome; B27
High potassium conductance and some sodium conductance
INTRApartum Abs (ampicillin/penicillin)

43. What is a keloid?
Excessive collagen formation during tissue repair in susceptible individuals
P53 mutation; AD
T test; chi squared
As a CO2 carrier with the carboxylase enzyme

44. What is acanthosis nigricans associated with?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Amiadarone
In ER of bile canaliculi
GI malignancies and Insulin resistance (acromegal for ex)

45. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Drug induced interstitial nephritis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

46. What torch causes an intrapartum infection (as opposed to the rest which are in utero)?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Lateral; RV; RA; LV
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
HSV ( also in utero: chlymadia - neisseria - group B strep)

47. within the right ventricle - What are maximum pressures? the pulm arter?
Syncope - angina - dyspnea (SAD)
Anti centromere; anti DNA topoisomerase
Mean greater than median greater than mode
25; 25

48. What pulmonary structural change can kartageners syndrome cause?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
When it invades the bm; carcinoma in situ
Bronchial dilation (bronchiectasis)
Strength of cell mediated immune response

49. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Tissue redistribution (out of plasma) rather than metabolism
S. saprophyticus - and s. epidermidis; novobiocin
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

50. What type of calcium channels dictate the plateau in cardiac myocyte?
Integration of viral DNA into genome of host hepatocytes
Dihydropyridine sensitive Ca channels (L type)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)