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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. why is glucagon used in beta blocker toxicitiy?
Extrinsic def; instrinsic def; platelet def
FGF and VEGF
Skin flushing and warmth; prostaglandins; give with aspirin
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

2. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
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)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

3. why does liver dysfunction cause coagulation disorders?
ATP binding (resets the myosin head to contract again for next binding)
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Coagulation factors are made in the liver
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

4. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Syringomelia
Dihydropyridine sensitive Ca channels (L type)
Around 70 (normal measured diastolic pressures); 9--

5. Where does 90% of serotonin lie? What is this NT responsible?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
GI tract; mood!
CMV - HSV 1 - Candida
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

6. What is the most common location of colonization of all s. aureus types?
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
GI malignancies and Insulin resistance (acromegal for ex)
Anterior nares
ZDV or AZT

7. What does prolonged PT indicated? aPTT? bleeding time?
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
Extrinsic def; instrinsic def; platelet def
11
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

8. What type of drug is alendronate?
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)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Biphosphonate

9. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Dihydropyridine sensitive Ca channels (L type)
Hypothyroidism
Reticulocytes
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

10. do Class IC agents prolong the QT interval?
RER; RER
No
Protamine sulfate
Strength of cell mediated immune response

11. What does Rb protein do? what chrom is it on?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
When it invades the bm; carcinoma in situ

12. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
OCPs - multiparity - breast feeding
Dissolved in plasma and attached to Hgb
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
RER; RER

13. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
SVC and IVC; right below the aortic knob
Myasthenia gravis
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

14. What is cataplexy and When is it seen?
DIC; TTP- HUS dont bleed that much
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Sudden loss of muscle tone without loss of consciousness; narcolepsy
SS +rNA

15. what induces bronchial squamous metaplasia?
T test; chi squared
Smoking
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
Class I

16. if there are keratin swirls does that mean well or poorly differentiated?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Increase lymphatic drainage!
Well
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

17. where are the two classical places that the ulnar nerve can be injured?

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18. what murmur is enhanced by decreased blood flow to the heart?
LT (LTD4 - E4 - C4) - and Ach
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Measure of depth invasion (vertical!)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

19. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
transcription activation/suppression
Amiadarone
When it invades the bm; carcinoma in situ
Drink plenty of fluids

20. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Thymic tumor
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Phencyclidine (PCP)

21. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
To pump calcium out in cardiac myocytes so that relaxation occurs
When it invades the bm; carcinoma in situ

22. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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
Kallmans
E. coli; staphylococcus saprophyticus
When it invades the bm; carcinoma in situ

23. What are the lab findings in poststreptococcal GN?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Right before diastole (filling begins)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

24. which RPGN is also called pauci immune GN? why?
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
ANCA because of lack of Ig and C3 deposits on IF
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
E6 and E7 of HPV knock off p53 and Rb suppressor genes

25. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
E. coli
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
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
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)

26. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Nonsense; mRNA processing
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
transcription activation/suppression
Sickle cell; G6PD

27. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Headaches and facial flushing; vasodilation in meninges and skin
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
TCAs and prazosin
Gluteus medius and minimus; positive trendelenberg

28. at three years of age What are social - fine motor - gross motor and language developments?
Purkinje system; AV node
SVC and IVC; right below the aortic knob
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
No (unlike adenomyosis); yes

29. non ceruloplasmin deposition - ceruloplasmin is...
Fibrosis; macrophages
low in serum
Hereditary angioedema; ACE inhibitors
Pulmonary hypertension

30. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Inhibits it
Prostate tumor and increased osteoclast activity
Syringomelia

31. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Rabies encephalitis from cave bats; rabies killed vaccines
Underestimation of gestational age
Adductor
Chorda tympani branch

32. What is a primary HSV 1 infection like?
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Myasthenia gravis
Hydrogen bonds dictate alpha or beta structure
Insulin like growth factor 1 (just another name)

33. What does NF- KB do?
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
Increases cytokine production
Headaches and facial flushing; vasodilation in meninges and skin
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

34. When is an S4 sound normal?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Vertical diplopia
Minimal change disease
Well trained athletes and children

35. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Smoking
No (unlike adenomyosis); yes
Nocardia
Hydrogen bonds dictate alpha or beta structure

36. who bleed more DIC or TTP- HUS patients?
By vascular permeability and vasodilation
C3 decreased after 5-10 days; sulfonamides
DIC; TTP- HUS dont bleed that much
Classical conditioning

37. What are examples of action that decrease venous return to the heart?
Increased reticulocytes
Standing suddenly from supine position; valsalva maneuver
<1% - 55% - concentration dependent
Prostate tumor and increased osteoclast activity

38. What is achalasia and how would this correlate on the esophageal mannometry?
liver specific
The LES is supposed to relax when food comes its way (from above) and in achalasia - a motor dysfunction - LES doesnt relax and seen as elevated pressure on the esophageal mannometry
Tibial
Primary

39. In What type of nephritis would you see high serum eos count?
Drug induced interstitial nephritis
hyponatremia (aldosterone activation equilibrates body volume)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

40. What is the difference between additive and synergistic?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
S. aureus
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
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

41. What causes curlings ulcers?
Squatting - sitting - lying supine - passive leg raising
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Anti cholinergic effects of pupil dilation and lack of accomodation
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

42. Where is aromatase used?
Prevent phagocytosis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Tissue redistribution (out of plasma) rather than metabolism
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

43. when do ghon complexes form - primary or secondary TB?
8; 12
Gluteus maximus; difficulty getting up from seated position and climbing chair
Vertical diplopia
Primary

44. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Tibial
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
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)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

45. What is medullary sponge kidney disease and how does it present? What does it lead to?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
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)

46. What are the two growth factors associated with angiogenesis?
CMV - HSV 1 - Candida
FGF and VEGF
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

47. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Myasthenia gravis
Curlings ulcers
Hypo or hyper pigmentations; after tanning
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

48. What is pickwickian syndrome? What are the lab findings?
Increased reticulocytes
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Retinitis; mononucleosis
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

49. What is the primary histologic finding in patients with eczematous dermatitis?
Spongiosis
TSh (in testicular tumors can cause hyperthyroidism)
AV node slowest - to allow time for diastole
Vancomycin; histamine mediated

50. which staphylococci can do mannitol fermaentation?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Kallmans
S. aureus
Fat - fertile - forty - female

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USMLE Prep 2

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