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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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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 diagnosis in delayed puberty plus anosmia?
Kallmans
8 (myc protein) with 2 - 14 - 22 (iG chains)
Bronchogenic carcinoma
Bronchial dilation (bronchiectasis)

2. What pulmonary structural change can kartageners syndrome cause?
Bronchial dilation (bronchiectasis)
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
chronic urticaria and allergic symptoms
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)

3. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
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; staphylococcus saprophyticus
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
women

4. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
SVT; increases vagal tone; rectus abdominis
Bile salt accumulation in urine
Thymic tumor

5. how does eos release MBP to kill protozoa etc?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Vertical diplopia
In the extracellular space for collagen cross linking; zinc

6. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
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
frameshift mutations (missense is substitution)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

7. What does L/S stand for in fetal lung maturity? When does maturity occur?
MAO inhibitors; wine and cheese
Medial part
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
OCPs - multiparity - breast feeding

8. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Serum FFA and serum triglyceride levels
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
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

9. what receptors do first generation anti histamines block?
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)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Clindamycin; covers anaerobic oral flora and aerobic bacteria
IgE

10. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Because gamma chains replace beta chains and then gamma chain formation wanes

11. What are two indicators of chronic alcohol consumption?
Anterior circumflex (and axillary nerve)
Elevated GGT and macrocytosis
S. aureus
Measles and M3 AML`

12. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
As a CO2 carrier with the carboxylase enzyme
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Around 70 (normal measured diastolic pressures); 9--
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

13. What is the cause of rapid plasma decay of thiopental?
Inactivates kallikrein which activates kininogen into bradykinin
Medial circumflex artery; avascular necrosis
Tissue redistribution (out of plasma) rather than metabolism
Chrom 8

14. What are the long term consequences of hydrocephalus?
Increases
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
RBC mass; epo levels (secondary has high)

15. why should you not use ACE inhibitors with someone who had hereditary angioedema?
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Trochlear nerve (IV); abducens nerve (VI)
Joints d/t increased purine production and thus uric acid production

16. are there signs of inflammation in avascular necrosis? then How do you diagnose?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
No; MRI
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)
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(

17. What is mcc of death pre hospital phase of MI? in hospital phase?
Mean greater than median greater than mode
Increase lymphatic drainage!
V fib; v. failure
Curlings ulcers

18. 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?
Cluster
Diabetic microangiopathy
Medial part
only up to bronchi

19. What would a deflection of the membrane potential to near zero indicate?
Anti cholinergic effects of pupil dilation and lack of accomodation
Increase in permeability of two ions with equal and opposite equilibrium potentials
(urine PAH x urine flow rate)/plasma PAH
GI tract; mood!

20. What type of mutation does aflatoxin cause? what cancer does this increase for?
Decreases both
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
G to T in p53; HCC
Bile salt accumulation in urine

21. how can HAV be inactivated?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Vagus (auricular branch); vasovagal syncope!
Boiling - bleach - formalin - UV irradiation
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

22. How is dobutamine better than dopamine?
Become beta pleated and then form neurofibrillary tangle!
ATP binding (resets the myosin head to contract again for next binding)
hyponatremia (aldosterone activation equilibrates body volume)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

23. why does hypothyroidism cause increased CPK levels?
Tissue redistribution (out of plasma) rather than metabolism
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

24. what hernia has a similar mechanism to hydrocele?
Elastance
Hypo or hyper pigmentations; after tanning
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
No; yes

25. What is the mc malignancy in asbestosis?
Trauma to stereociliated hair cells of the organ of corti
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Bronchogenic carcinoma

26. which has better side effect profile - SSRI or TCA?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Phencyclidine (PCP)
Large stroke volumes with ventricular contraction; aortic regurg
SSRI

27. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
LT (LTD4 - E4 - C4) - and Ach
Varying; erythema nodosum is common
Pulmonary hypertension
Large stroke volumes with ventricular contraction; aortic regurg

28. What does sustained hand grip do to the C/V system?
P53 mutation; AD
Inhibits it
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Radial nerve damage

29. What is the stabilizing force for the secondary structure of proteins?
SVC and IVC; right below the aortic knob
Fat - fertile - forty - female
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Hydrogen bonds dictate alpha or beta structure

30. in a positively skewed distribution is the mean greater than or equal to the median or the mode?
Acute interstitial nephritis
Mean greater than median greater than mode
Diabetic microangiopathy
Cluster

31. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Bile salt accumulation in urine

32. What is contraindicated in toxic mega colon?
RER; copper
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
gram positive organisms

33. How do you explain the selective proteinuria of loss to albumin only in MCD?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
(urine PAH x urine flow rate)/plasma PAH
HSV ( also in utero: chlymadia - neisseria - group B strep)
Octreotide

34. What is the presentation of sever aortic stenosis?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Syncope - angina - dyspnea (SAD)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Hyperkalemia; potassium sparing diuretics - potassium supplements

35. do patients with cor pulmonale have increased or decreased levels of aldosterone?
MAC complex (C5b - C9 complement deficiency)
Because of the low output from heart failure - they will have increased aldosterone levels
Insulin like growth factor 1 (just another name)
Both sides

36. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Medial part
Inhaled animal dander allergens
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2

37. What is an abortive viral infection?
SSRI
Little effect on cell and no change
Clindamycin; covers anaerobic oral flora and aerobic bacteria
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

38. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
E. coli
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
RBC mass; epo levels (secondary has high)

39. prostaglandin synthesis keeps...
Underestimation of gestational age
PDA open
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
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

40. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
E. coli; staphylococcus saprophyticus
Skin flushing and warmth; prostaglandins; give with aspirin
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Medullary

41. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Selective alpha 1 (increases SVR)
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

42. what nerve and artery course along the posterior aspect of the humerus?
HSV ( also in utero: chlymadia - neisseria - group B strep)
Radial nerve and deep brachial artery
Extrinsic def; instrinsic def; platelet def
Normally close to systolic

43. what locations of UC increase the risk of Colon cancer?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Pan colitis and right sided colitis (more than left sided and proctitis)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
S. aureus

44. What three factors effect total oxygen content of blood?
GI malignancies and Insulin resistance (acromegal for ex)
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Aromatase deficiency in child
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)

45. what happens to the cell body of a neuron after the axon has been severed? What is this called? What is it second to?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Headaches and facial flushing; vasodilation in meninges and skin
Pain reliever - reduces pain by locking substance P in the PNS

46. 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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
S. aureus
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

47. What does protein M do in Group A strep<
Not lined by epithelium
Prevent phagocytosis
Brief psychotic disorder; schizophreniform; schizophrenia
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

48. What is intussusception? how does ischemia and necrosis occur?
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
Prepatellar
GI tract; mood!
Syncope - angina - dyspnea (SAD)

49. What can worse neurologic dysfunction in cobalamic def?
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Tissue redistribution (out of plasma) rather than metabolism
Folic acid treatment!
Downs; regurgitant AV valves - ASDs

50. in the LV and aorta - What are the pressures?
Sarcoid
200-500
Normally close to systolic
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

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