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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. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Curlings ulcers
Minimal change disease
No
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

2. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
DIC; TTP- HUS dont bleed that much
Hereditary angioedema; ACE inhibitors
Elastance
Inhibits it

3. which staphylococci can do mannitol fermaentation?
P450 mitochondrial monooxygenase
Regular insulin (Not fast acting - regular better)
S. aureus
Joints d/t increased purine production and thus uric acid production

4. What triggers the neoplastic changes that are associated with HBV infecton?
Highly negative resting potential
Curlings ulcers
Hypo or hyper pigmentations; after tanning
Integration of viral DNA into genome of host hepatocytes

5. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Phencyclidine (PCP)
Elevated GGT and macrocytosis
Atrial
Measles and M3 AML`

6. What is subacute sclerosisng encephalitis caused by?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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
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

7. which nerve is at risk when ligating the superior thyroid artery? Which is the only muscle this nerve innervates? what nerve innervates all the other laryngeal muscles?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Superior larygeal; cricothyroid; recurrent laryngeal
Normally close to systolic

8. What type of drug is alendronate?
Bronchial dilation (bronchiectasis)
Biphosphonate
differentiate
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

9. why does hypothyroidism cause increased CPK levels?
Elastance
Valproate
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Serum creatine kinase; reperfusion injury causes necrosis

10. what has the greatest effect on prognosis when treating c. diptheriae?
P450 mitochondrial monooxygenase
P53 mutation; DCC is also required for adenoma to carcinoma
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Gluteus medius and minimus; positive trendelenberg
Vagus (auricular branch); vasovagal syncope!
E. coli; staphylococcus saprophyticus
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

12. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
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
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Sickle cell; G6PD
Measure of depth invasion (vertical!)

13. why are beta thal major patients asymptomatic at birth?
Nocardia
Bronchial dilation (bronchiectasis)
4 - 4 - 9
Because gamma chains replace beta chains and then gamma chain formation wanes

14. What is somatomedin C?
Insulin like growth factor 1 (just another name)
Apocrine; eccrine
GI tract; mood!
Vagus nerve stimulation

15. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Sarcoid
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
Hexokinase

16. Where is the base of the heart? apex?
Inhibits it
Increase lymphatic drainage!
Closer to head; closer to diaphragm
Serum FFA and serum triglyceride levels

17. What is contraindicated in toxic mega colon?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Trochlear nerve (IV); abducens nerve (VI)
Env genes (for getting into target cells)

18. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Serum creatine kinase; reperfusion injury causes necrosis
Vagus (auricular branch); vasovagal syncope!
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

19. What is 5- HETE and What does it do?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Leukotriene precursor and does neutrophil chemotaxis

20. What type of bond is a disulfide bond?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Covalent (between two cysteines)- allows protein to withstand denaturation
Inactivates kallikrein which activates kininogen into bradykinin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

21. What is easiest way to treat nephrolithiasis?
Intussusception
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Drink plenty of fluids
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

22. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
I is more benign and can present later in adulthood
Clindamycin; covers anaerobic oral flora and aerobic bacteria
RER; copper

23. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
MAO inhibitors; wine and cheese
(urine PAH x urine flow rate)/plasma PAH

24. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
II; I (I more abundant)
Thymic tumor
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

25. 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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Hexokinase
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

26. What does prolonged PT indicated? aPTT? bleeding time?
Elevated GGT and macrocytosis
Extrinsic def; instrinsic def; platelet def
The term used to describe decreased drug responsiveness with repeated administration
Hypothyroidism

27. why does neutrophila occur with corticosteroids?
Tzanck smear
TCAs and prazosin
Demargination of neutrophils from the vessel walls
Mean greater than median greater than mode

28. What are the three predominant symptoms of VHL? What is its mode of inheritance?
Both sides
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
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

29. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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
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
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)

30. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Little effect on cell and no change

31. What are diastolic (lowest) pressures in aorta? LV?
E. coli
Increase in permeability of two ions with equal and opposite equilibrium potentials
Around 70 (normal measured diastolic pressures); 9--
Increases bronchial and vascular smooth muscle reactivity to catecholamines

32. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Pan colitis and right sided colitis (more than left sided and proctitis)
No and yes
Vagus (auricular branch); vasovagal syncope!

33. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Increases bronchial and vascular smooth muscle reactivity to catecholamines

34. what nerve and artery course along the posterior aspect of the humerus?
Vertical diplopia
Because of vasodiation to skeletal muscles
Radial nerve and deep brachial artery
Highly negative resting potential

35. What causes vertical diplopia? horizontal?
Vancomycin; histamine mediated
Trochlear nerve (IV); abducens nerve (VI)
Selective alpha 1 (increases SVR)
frameshift mutations (missense is substitution)

36. if there are keratin swirls does that mean well or poorly differentiated?
Well
GI tract; mood!
Increases cytokine production
Selective alpha 1 (increases SVR)

37. which nerve provides innervation for plantar flexion and inversion?
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
Tibial
Amiloride - spironolactone - triamterene
C3 decreased after 5-10 days; sulfonamides

38. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
differentiate
RBC mass; epo levels (secondary has high)
Hypothyroidism
Primary

39. What can chronic vit A toxicity cause?
Raphe
Increase by 50% in urine osmolality
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Not lined by epithelium

40. What is the most common initital symptom of ADPKD? what else?
V fib; v. failure
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

41. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
LT (LTD4 - E4 - C4) - and Ach
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
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
HSV and VZV

42. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Pulmonic and systemic!
OCPs - multiparity - breast feeding
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Medial part

43. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Measure of depth invasion (vertical!)
Mean greater than median greater than mode
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

44. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
8 (myc protein) with 2 - 14 - 22 (iG chains)
RER; copper
Increase by 50% in urine osmolality

45. What type of vision is myopia? In What type of patients does it improve?
GI malignancies and Insulin resistance (acromegal for ex)
Demargination of neutrophils from the vessel walls
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Southern - western

46. do Class IC agents prolong the QT interval?
Chorda tympani branch
46 - 4N; 23 2N
No
Trochlear nerve (IV); abducens nerve (VI)

47. What does L/S stand for in fetal lung maturity? When does maturity occur?
AV node slowest - to allow time for diastole
CGD; t cell dysfxn (diGeorge)
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
No and yes

48. What are the primary determinants of colon cancer risk in UC patients
Drink plenty of fluids
Duration and extent of disease
Increases cytokine production
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)

49. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
liver specific
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Thymic tumor
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

50. What is the stabilizing force for the secondary structure of proteins?
Anterior nares
E. coli
No (unlike adenomyosis); yes
Hydrogen bonds dictate alpha or beta structure

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USMLE Prep 2

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