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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. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Anti centromere; anti DNA topoisomerase
RR-1/RR
When it invades the bm; carcinoma in situ

2. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
women
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Bronchogenic carcinoma

3. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
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
MAO inhibitors; wine and cheese
High potassium conductance and some sodium conductance
Clindamycin; covers anaerobic oral flora and aerobic bacteria

4. a patient fearing all white coats is a phenomenon of what?
Anti centromere; anti DNA topoisomerase
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Medullary
Classical conditioning

5. What is achalasia and how would this correlate on the esophageal mannometry?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
MAC complex (C5b - C9 complement deficiency)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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

6. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
The term used to describe decreased drug responsiveness with repeated administration
To pump calcium out in cardiac myocytes so that relaxation occurs

7. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
RER; copper
Radial nerve damage
Aromatase deficiency in child

8. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Spongiosis
Gluteus maximus; difficulty getting up from seated position and climbing chair
Duration and extent of disease
Class I

9. why is glucagon used in beta blocker toxicitiy?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
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
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

10. What is the mcc of extrinsic allergic asthma?
Inhaled animal dander allergens
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
By vascular permeability and vasodilation
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

11. how does achalasia present? What does barium swallow show on dilated esophagus?
Bronchogenic carcinoma
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Normally close to systolic

12. do Class IC agents prolong the QT interval?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
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
No
Pulmonary hypertension

13. What is a cell surface marker seen in liver angiosarcoma?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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
Aromatase deficiency in child

14. What is gardeners mydriasis? How is it treated?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
SSRI
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Pulmonic and systemic!

15. What is extraocular muscle weakness a common symptom of?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Ether and other organic solvents
Serum creatine kinase; reperfusion injury causes necrosis
Myasthenia gravis

16. What pulmonary structural change can kartageners syndrome cause?
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
Close but purkinje system to ensure contraction in a bottom up fashion
Bronchial dilation (bronchiectasis)
Radial nerve and deep brachial artery

17. Metronidizaole does not cover...
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
Intussusception
gram positive organisms
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

18. Where is the base of the heart? apex?
S. saprophyticus - and s. epidermidis; novobiocin
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Closer to head; closer to diaphragm

19. In What type of nephritis would you see high serum eos count?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Drug induced interstitial nephritis
Hereditary angioedema; ACE inhibitors
Smoking

20. What are two indicators of chronic alcohol consumption?
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
E. coli; staphylococcus saprophyticus
Elevated GGT and macrocytosis
Anterior nares

21. which viruses require a protease?
Medial part
SS +rNA
Anti cholinergic effects of pupil dilation and lack of accomodation
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

22. non ceruloplasmin deposition - ceruloplasmin is...
facultative intracellular
low in serum
Atrial
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

23. What is the primary histologic finding in patients with eczematous dermatitis?
Ig A deficiency
Spongiosis
I is more benign and can present later in adulthood
Trauma to stereociliated hair cells of the organ of corti

24. Where is conduction in heart fastest? slowest?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Purkinje system; AV node
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Ceftriaxone; azithromycin

25. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Barium enema
Cluster

26. which nerve in the lower leg is easily injured and causes foot drop ? What are common causes? From what nerve does it branch off or?
Close but purkinje system to ensure contraction in a bottom up fashion
Common peroneal; bony fractures and compression; sciatic
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

27. What is the stabilizing force for the secondary structure of proteins?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Medullary
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Hydrogen bonds dictate alpha or beta structure

28. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
E. coli
AV node slowest - to allow time for diastole
Neisseria induced small cell vasculitis (including hands and soles)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

29. biotin is used By what in tissues responsible for gluconeogenesis
As a CO2 carrier with the carboxylase enzyme
Both sides
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Radial nerve and deep brachial artery

30. What is epleronone?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
liver specific
Another type of aldosterone antagonist (like spironolactone)
Lateral; RV; RA; LV

31. what has the greatest effect on prognosis when treating c. diptheriae?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Coagulation factors are made in the liver
Leukotriene precursor and does neutrophil chemotaxis
Single adenomatous ones

32. Where does lysyl oxidase act? What is the cofactor for that?
In the extracellular space for collagen cross linking; zinc
Vertical diplopia
Ketone body production by preventing fatty acids into the mitochondria
Classical conditioning

33. who bleed more DIC or TTP- HUS patients?
Echinococcus granulosus; anaphylaxis
11 aa polypeptide; pain NT in CNS and PNS
Because of the low output from heart failure - they will have increased aldosterone levels
DIC; TTP- HUS dont bleed that much

34. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
RER; RER
Radial nerve and deep brachial artery
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Increased reticulocytes

35. at four years of age - What are the social - fine motor - gross motor - and language developments?
Chorda tympani branch
Localized dermatologic pain that persists for more than one month after zoster eruption
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Vancomycin

36. Which nerve lies in close proximity to the inferior thyroid artery?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
No and yes
Recurrent larygneal
Terminal bronchioles; small bronchi

37. What is the most important prognostic indicator in patients with malignant melanoma?
Bronchial dilation (bronchiectasis)
Tissue redistribution (out of plasma) rather than metabolism
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Measure of depth invasion (vertical!)

38. If a patient has higher levels of HbF - What does this mean?
GI malignancies and Insulin resistance (acromegal for ex)
Increase by 50% in urine osmolality
CGD; t cell dysfxn (diGeorge)
Think Hb deformation diseases

39. what commonly happens in GI in response to acute physiologic stress?
Dihydropyridine sensitive Ca channels (L type)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Acute gastric mucosal defects (superficial or full thickness)
Phencyclidine (PCP)

40. What are the skin presentation in sarcoid?
Folic acid treatment!
Varying; erythema nodosum is common
Acute interstitial nephritis
Echinococcus granulosus; anaphylaxis

41. the rate of blood flow of which two circulations must equal each other at all times?
SaO2 <92%
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)
E. coli
Pulmonic and systemic!

42. prostaglandin synthesis keeps...
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
Pan colitis and right sided colitis (more than left sided and proctitis)
PDA open

43. what protects the resting heart from arrhythmias?
hyponatremia (aldosterone activation equilibrates body volume)
...
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Highly negative resting potential

44. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
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
Highly negative resting potential
Increase lymphatic drainage!
Susceptible; soluble (unable to be cultured in bile)

45. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
11
Become beta pleated and then form neurofibrillary tangle!
Radial nerve and deep brachial artery
S. aureus

46. if there are keratin swirls does that mean well or poorly differentiated?
Well
DIC; TTP- HUS dont bleed that much
Amiadarone
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

47. what happens with LDL receptor density in statin therapy?
Increases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Both sides
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

48. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Reiter syndrome; B27
T test; chi squared
Downs; regurgitant AV valves - ASDs

49. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
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)
Intussusception
Increases

50. How do you explain the selective proteinuria of loss to albumin only in MCD?
gram positive organisms
TCAs and prazosin
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Susceptible; soluble (unable to be cultured in bile)

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USMLE Prep 2

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