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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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1. 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
Aromatase deficiency in child
glycerol kinase
Minimal change disease

2. What is a malignant pustule? What is it usually caused by? What type of capsule does it have?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Measles and M3 AML`
S. aureus
(urine PAH x urine flow rate)/plasma PAH

3. what would be a sign of absence of cardiogenic pulm edem?
INTRApartum Abs (ampicillin/penicillin)
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Squatting - sitting - lying supine - passive leg raising

4. why should you not use ACE inhibitors with someone who had hereditary angioedema?
25; 25
8; 12
Prostate tumor and increased osteoclast activity
Because ACE blocks breakdown of bradykinin and hereditary angioedema patients have high levels of bradykinin; high levels of bradykinin - C3a - and C5a mediate edema by increasing vascular permeability and vasodilation

5. What is the preferred treatment for DKA?
Regular insulin (Not fast acting - regular better)
Protamine sulfate
Bile soluble which means they are bile sensitive
Prepatellar

6. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
Vascular endothelium; protease
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)
Pain reliever - reduces pain by locking substance P in the PNS
Sickle cell; G6PD

7. What is the mc malignancy in asbestosis?
Raphe
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Adeno
Bronchogenic carcinoma

8. 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?
Nonsense; mRNA processing
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Apocrine; eccrine
Brief psychotic disorder; schizophreniform; schizophrenia

9. What type of vision is myopia? In What type of patients does it improve?
SVT; increases vagal tone; rectus abdominis
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Tibial
Tissue redistribution (out of plasma) rather than metabolism

10. the rate of blood flow of which two circulations must equal each other at all times?
When it invades the bm; carcinoma in situ
Pulmonic and systemic!
RR-1/RR
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

11. what bursa is affected when on knees like a maid/gardner?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Prepatellar
Faulty positioning of the genital tubercle

12. What triggers the neoplastic changes that are associated with HBV infecton?
Well trained athletes and children
Standing suddenly from supine position; valsalva maneuver
Demargination of neutrophils from the vessel walls
Integration of viral DNA into genome of host hepatocytes

13. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
RBC mass; epo levels (secondary has high)
Thymic tumor
Echinococcus granulosus; anaphylaxis
No; MRI

14. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Medullary
Reiter syndrome; B27
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

15. why is there only minor blood pressure increase during exercise if sympathetic activity is high (to increase CO and HR)?
Sydenham chorea
Varying; erythema nodosum is common
Large stroke volumes with ventricular contraction; aortic regurg
Because of vasodiation to skeletal muscles

16. how does achalasia present? What does barium swallow show on dilated esophagus?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Large stroke volumes with ventricular contraction; aortic regurg
Initiation - pointing; pincer grasp; walking; mama/dada
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

17. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Barium enema
Protamine sulfate
Increase in permeability of two ions with equal and opposite equilibrium potentials

18. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Another type of aldosterone antagonist (like spironolactone)
Hypothyroidism
Intussusception
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

19. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
ANCA because of lack of Ig and C3 deposits on IF
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

20. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
S. aureus
SVC and IVC; right below the aortic knob
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

21. what dictates the resting membrane potential of most cells?
Integration of viral DNA into genome of host hepatocytes
High potassium conductance and some sodium conductance
Elastance
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

22. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Radial nerve and deep brachial artery
Hexokinase
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
As a CO2 carrier with the carboxylase enzyme

23. What is achalasia and how would this correlate on the esophageal mannometry?
11
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Standing suddenly from supine position; valsalva maneuver

24. carnitine deficiency impairs production of What and how?
Ketone body production by preventing fatty acids into the mitochondria
No only for prophylaxis (even for treating staphylococcal endocarditis its as multi drug); this is to prevent drug resistance from spontaneous mutations by DNA dependent RNA polymerase
Underestimation of gestational age
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)

25. What is the mc location of brain germinomas?What are the classic symptoms?
Barium enema
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
MAO inhibitors; wine and cheese
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

26. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
ANCA because of lack of Ig and C3 deposits on IF

27. When does opening snap begin?
SS +rNA
Bronchogenic carcinoma
Diabetic microangiopathy
Right before diastole (filling begins)

28. What does glycosylase do to DNA? endonuclease? lyase? What does the order here of enzymes represent? what other enzymes are needed?

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29. why does variocele occur more in left side?
No (unlike adenomyosis); yes
GI malignancies and Insulin resistance (acromegal for ex)
Raphe
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

30. What type of bond is a disulfide bond?
Insulin like growth factor 1 (just another name)
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
Well
Covalent (between two cysteines)- allows protein to withstand denaturation

31. 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?
Superior larygeal; cricothyroid; recurrent laryngeal
Inhaled animal dander allergens
Insulin like growth factor 1 (just another name)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

32. What causes vertical diplopia? horizontal?
Trochlear nerve (IV); abducens nerve (VI)
Diabetic microangiopathy
Radial nerve damage
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration

33. What is the cause of fixed splitting of S2? why?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
4 - 4 - 9
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
only up to bronchi

34. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Well
Pan colitis and right sided colitis (more than left sided and proctitis)
Sickle cell; G6PD

35. What does VIP do to gastric acid secretion?
Inhibits it
200-500
Vagus (auricular branch); vasovagal syncope!
indomethacin

36. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Fibrosis; macrophages
Another type of aldosterone antagonist (like spironolactone)
Drug induced interstitial nephritis

37. What are examples of action that decrease venous return to the heart?
Hereditary angioedema; ACE inhibitors
Standing suddenly from supine position; valsalva maneuver
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Superior larygeal; cricothyroid; recurrent laryngeal

38. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Atrial
women
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
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

39. In What type of nephritis would you see high serum eos count?
Nonsense; mRNA processing
Well trained athletes and children
Drug induced interstitial nephritis
Both sides

40. at one year of age - What are the social - fine motor - gross motor and language developments?
Trauma to stereociliated hair cells of the organ of corti
Mean greater than median greater than mode
Initiation - pointing; pincer grasp; walking; mama/dada
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

41. What can cause aortic regurg? What is the heart sound you hear?
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
E. coli; staphylococcus saprophyticus
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Medial part

42. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Standing suddenly from supine position; valsalva maneuver
E6 and E7 of HPV knock off p53 and Rb suppressor genes

43. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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
Trauma to stereociliated hair cells of the organ of corti
Think Hb deformation diseases

44. What is used to treat heparin toxicity?
(urine PAH x urine flow rate)/plasma PAH
Drink plenty of fluids
Protamine sulfate
Increase; decreased

45. What are fenfluramine - phentermine?
No; yes
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
ANCA because of lack of Ig and C3 deposits on IF
Appetite suppressants

46. What does Rb protein do? what chrom is it on?
Ether and other organic solvents
low in serum
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
glycerol kinase

47. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Standing suddenly from supine position; valsalva maneuver
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
CGD; t cell dysfxn (diGeorge)
Joints d/t increased purine production and thus uric acid production

48. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Hypo or hyper pigmentations; after tanning
Ketone body production by preventing fatty acids into the mitochondria

49. on What part of the clavicle does the SCM attach?
Coagulation factors are made in the liver
Reiter syndrome; B27
Medial part
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

50. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
SVC and IVC; right below the aortic knob
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
OCPs - multiparity - breast feeding
When it invades the bm; carcinoma in situ

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