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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. How do you explain the selective proteinuria of loss to albumin only in MCD?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
chronic urticaria and allergic symptoms

2. What does TGF beta do? What produces it?
Fibrosis; macrophages
Nonsense; mRNA processing
Both sides
HSV and VZV

3. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
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)
AV node slowest - to allow time for diastole

4. What can cause virilization of a mother during pregnancy?
Leukotriene precursor and does neutrophil chemotaxis
Hydrogen bonds dictate alpha or beta structure
Aromatase deficiency in child
RBC mass; epo levels (secondary has high)

5. what composes the superior and inferior borders of the right side of the cardiac silouhette in a CXR? Where is the pulm arter?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Drug induced interstitial nephritis
SVC and IVC; right below the aortic knob

6. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Normal; low
When it invades the bm; carcinoma in situ
LT (LTD4 - E4 - C4) - and Ach
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

7. Which nerve lies in close proximity to the inferior thyroid artery?
Recurrent larygneal
RBF= PAH clearance/(1- hematocrit)
Spongiosis
Adeno

8. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Adeno
RBC mass; epo levels (secondary has high)
Inhibits it
Inactivates kallikrein which activates kininogen into bradykinin

9. What is 5- HETE and What does it do?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Octreotide
Leukotriene precursor and does neutrophil chemotaxis
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

10. there are mucus secreting cells in the bronchioles...
Pulmonary hypertension
Spongiosis
only up to bronchi
Covalent (between two cysteines)- allows protein to withstand denaturation

11. How do you calculate excretion rate of a substance? How do you calculate the filtration rate of a substance? clearance of what substance estimates the GFR?
Pulmonary hypertension
Closer to head; closer to diaphragm
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Hexokinase

12. How can renal blood flow be calculated from RPF?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
RBF= PAH clearance/(1- hematocrit)
Sarcoid
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

13. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
SS +rNA
Amiloride - spironolactone - triamterene
Vancomycin

14. What are the three predominant symptoms of VHL? What is its mode of inheritance?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
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)

15. What is normal fibrinogen levels?
200-500
Boiling - bleach - formalin - UV irradiation
Decreases both
By vascular permeability and vasodilation

16. is strep pneumo optochin resistant or susceptible? bile soluble or insoluble?
Proteasome inhibitor; treatment for MM and waldenstroms
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Susceptible; soluble (unable to be cultured in bile)
Reticulocytes

17. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Radial nerve and deep brachial artery
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

18. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Relfex tachycardia; giving beta blockers
Appetite suppressants
gram positive organisms

19. how much percent of sodium is excreted? urea? glucose?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Intussusception
<1% - 55% - concentration dependent
IgE

20. 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?
Prostate tumor and increased osteoclast activity
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Apocrine; eccrine
When it invades the bm; carcinoma in situ

21. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
46 - 4N; 23 2N
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

22. What is acanthosis nigricans associated with?
Chlorpheniramine and diphenhydramine
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
GI malignancies and Insulin resistance (acromegal for ex)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

23. what disease causes hypoxia induced hemolysis? oxidant induced hemolysis?
SS +rNA
Sickle cell; G6PD
Pulmonary hypertension
DIC; TTP- HUS dont bleed that much

24. In What type of nephritis would you see high serum eos count?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Drug induced interstitial nephritis
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Not lined by epithelium

25. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Covalent (between two cysteines)- allows protein to withstand denaturation
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Intussusception
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

26. What is mcc of death pre hospital phase of MI? in hospital phase?
Brief psychotic disorder; schizophreniform; schizophrenia
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
NF- KB; responsible for cytokine production
V fib; v. failure

27. what happens to capacitance with age?
...
Boiling - bleach - formalin - UV irradiation
Terminal bronchioles; small bronchi
Pulmonary hypertension

28. What is the mc manifestation of CMV in HIV patient? immunocompetent?
Apocrine; eccrine
(urine PAH x urine flow rate)/plasma PAH
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Retinitis; mononucleosis

29. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Prevent phagocytosis
Biphosphonate

30. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Closer to head; closer to diaphragm
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Kallmans

31. What is congestive hepatomegaly specific for?
P53 mutation; AD
Right heart failure
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

32. in B12 deficiency - what levels in blood rise very quickly and then drop?
Chrom 8
frameshift mutations (missense is substitution)
Reticulocytes
Brief psychotic disorder; schizophreniform; schizophrenia

33. What is damaged in early syringomelia? later?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Paramyxo and influenza
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

34. How do left sided colon adenocarcinomas present? right sided?
Extrinsic def; instrinsic def; platelet def
Sydenham chorea
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
APP on chrom 21 (this is why downs more susceptible)

35. why does neutrophila occur with corticosteroids?
SSRI
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Purkinje system; AV node
Demargination of neutrophils from the vessel walls

36. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Downs; regurgitant AV valves - ASDs
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
E6 and E7 of HPV knock off p53 and Rb suppressor genes

37. Is there edema in primary Conns? secondary hyperaldosteronism? why?
OCPs - multiparity - breast feeding
As a CO2 carrier with the carboxylase enzyme
Appetite suppressants
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

38. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Sydenham chorea
Excessive collagen formation during tissue repair in susceptible individuals
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
When it invades the bm; carcinoma in situ

39. What is medullary sponge kidney disease and how does it present? What does it lead to?
Another type of aldosterone antagonist (like spironolactone)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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)
Inhaled animal dander allergens

40. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Kallmans
Squatting - sitting - lying supine - passive leg raising
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

41. 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?
Tissue redistribution (out of plasma) rather than metabolism
facultative intracellular
Superior larygeal; cricothyroid; recurrent laryngeal
Integration of viral DNA into genome of host hepatocytes

42. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Fibronectin - laminin - collagen
Right heart failure
Enterococci (e. faecalis)- found on genitalia area
LT (LTD4 - E4 - C4) - and Ach

43. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Ketone body production by preventing fatty acids into the mitochondria
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

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

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45. what dissolves the lipid bilayer of a viral envelope?
Sarcoid
Downs; regurgitant AV valves - ASDs
Ether and other organic solvents
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

46. what organ would an activating mutation in PRPP synthetase effect?
IgE
Minimal change disease
HSV and VZV
Joints d/t increased purine production and thus uric acid production

47. What is the preferred treatment for DKA?
Mean greater than median greater than mode
Prostate tumor and increased osteoclast activity
Regular insulin (Not fast acting - regular better)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

48. prostaglandin synthesis keeps...
PDA open
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Prevent phagocytosis
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

49. What is the best indicator for the severity of mitral stenosis?
The time interval between S2 and OS- the shorter the interval - the more intense
Elastance
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Susceptible; soluble (unable to be cultured in bile)

50. What is an abortive viral infection?
When it invades the bm; carcinoma in situ
Little effect on cell and no change
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Serum FFA and serum triglyceride levels