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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. What is the most common cause of pyelonephritis in both adults and childre?
Integration of viral DNA into genome of host hepatocytes
E. coli
Inactivates kallikrein which activates kininogen into bradykinin
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

2. which nerve provides innervation for plantar flexion and inversion?
Tibial
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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)
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

3. Which is faster atrial muscle or ventricular muscle?
Atrial
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 of vasodiation to skeletal muscles
TCAs and prazosin

4. at three years of age What are social - fine motor - gross motor and language developments?
APP on chrom 21 (this is why downs more susceptible)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Rabies encephalitis from cave bats; rabies killed vaccines
In the extracellular space for collagen cross linking; zinc

5. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
No and yes
MAO inhibitors; wine and cheese
46 - 4N; 23 2N

6. how can HAV be inactivated?
Dihydropyridine sensitive Ca channels (L type)
Boiling - bleach - formalin - UV irradiation
Right before diastole (filling begins)
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

7. Would alpha 1 agonists cause flushing? muscarinic antagonist?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
No; yes
Acute gastric mucosal defects (superficial or full thickness)
RBC mass; epo levels (secondary has high)

8. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Excessive collagen formation during tissue repair in susceptible individuals
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
Single adenomatous ones
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin

9. What are some of the permissive effects of cortisol?
Smoking
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Large stroke volumes with ventricular contraction; aortic regurg

10. which two virus families have hemagluttinin on their surface?
Anterior nares
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Chlorpheniramine and diphenhydramine
Paramyxo and influenza

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Sudden loss of muscle tone without loss of consciousness; narcolepsy
11
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

12. why does neutrophila occur with corticosteroids?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Purkinje system; AV node
Demargination of neutrophils from the vessel walls
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

13. What type of vision is myopia? In What type of patients does it improve?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Diabetic microangiopathy
Valproate

14. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
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
Right before diastole (filling begins)
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

15. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Vertical diplopia
RER; copper
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Serum FFA and serum triglyceride levels

16. What is the most common location of colonization of all s. aureus types?
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Radial nerve and deep brachial artery
Prevents hepatic VLDL production
Anterior nares

17. What does C1 esterase do other than inhibiting complement pathway?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Relfex tachycardia; giving beta blockers
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Inactivates kallikrein which activates kininogen into bradykinin

18. What can long term leg cast wearing cause?
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
Because of the low output from heart failure - they will have increased aldosterone levels
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
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

19. What are the potassium sparing diuretics?
Amiloride - spironolactone - triamterene
No (unlike adenomyosis); yes
Regular insulin (Not fast acting - regular better)
Reticulocytes

20. What causes release of myosin head from the actin filament?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
ATP binding (resets the myosin head to contract again for next binding)
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)

21. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
CGD; t cell dysfxn (diGeorge)
Syncope - angina - dyspnea (SAD)
Valproate
Regular insulin (Not fast acting - regular better)

22. what defines hypoxemia?
Barium enema
Circular - outside nucleus; transport proteins - rRNA - tRNA
SaO2 <92%
8; 12

23. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
8; 12
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Duration and extent of disease

24. a patient fearing all white coats is a phenomenon of what?
Amiadarone
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
Classical conditioning
Echinococcus granulosus; anaphylaxis

25. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Adductor
11 aa polypeptide; pain NT in CNS and PNS
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

26. What is the cause of rapid plasma decay of thiopental?
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
No and yes
Tissue redistribution (out of plasma) rather than metabolism
Fibrosis; macrophages

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

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28. why does liver dysfunction cause coagulation disorders?
Medial part
ANCA because of lack of Ig and C3 deposits on IF
Neisseria induced small cell vasculitis (including hands and soles)
Coagulation factors are made in the liver

29. What is the diagnosis in a patient with bilateral upper extremity hyporeflexia and bilateral lower extremity hyperreflexia?
Syringomelia
Covalent (between two cysteines)- allows protein to withstand denaturation
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

30. What type of disease has selective proteinuria? What is found in urine? What is not?
low in serum
Biphosphonate
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
IgE

31. When does opening snap begin?
GI malignancies and Insulin resistance (acromegal for ex)
Bile salt accumulation in urine
Right before diastole (filling begins)
Covalent (between two cysteines)- allows protein to withstand denaturation

32. What is the mcc of extrinsic allergic asthma?
Prepatellar
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Inhaled animal dander allergens

33. in the LV and aorta - What are the pressures?
MAO inhibitors; wine and cheese
Normally close to systolic
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
Adeno

34. other than in pyelonephritis - where else are WBC casts seen?
Acute interstitial nephritis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Minimal change disease
Anterior nares

35. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Increase lymphatic drainage!
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Amiloride - spironolactone - triamterene
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

36. ___________ is liver specific
DIC; TTP- HUS dont bleed that much
Ketone body production by preventing fatty acids into the mitochondria
Bronchogenic carcinoma
glycerol kinase

37. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Localized dermatologic pain that persists for more than one month after zoster eruption
Integration of viral DNA into genome of host hepatocytes

38. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Because gamma chains replace beta chains and then gamma chain formation wanes
Large stroke volumes with ventricular contraction; aortic regurg
AV node slowest - to allow time for diastole

39. which nucleus releases serotonin?
Raphe
<1% - 55% - concentration dependent
Little effect on cell and no change
Smoking

40. what clinical findings help distinguish small cell carcinoma?
Chorda tympani branch
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Covalent (between two cysteines)- allows protein to withstand denaturation

41. What is subacute sclerosisng encephalitis caused by?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
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
SVT; increases vagal tone; rectus abdominis

42. How do you treat gonococcal infection? chlymadia?
Ceftriaxone; azithromycin
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Right heart failure

43. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
C3 decreased after 5-10 days; sulfonamides
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Aromatase deficiency in child
frameshift mutations (missense is substitution)

44. after a thrombus extraction - what serum enzyme shoots up and why?
Increase by 50% in urine osmolality
RER; RER
Bronchial dilation (bronchiectasis)
Serum creatine kinase; reperfusion injury causes necrosis

45. What is acanthosis nigricans associated with?
Acute gastric mucosal defects (superficial or full thickness)
Ether and other organic solvents
GI malignancies and Insulin resistance (acromegal for ex)
P450 mitochondrial monooxygenase

46. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Vancomycin; histamine mediated
S3 gallop; S2 to opening snap interval
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)
Underestimation of gestational age

47. in B12 deficiency - what levels in blood rise very quickly and then drop?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Reticulocytes
Sickle cell; G6PD
MAO inhibitors; wine and cheese

48. What are the two growth factors associated with angiogenesis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
FGF and VEGF
Barium enema

49. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
SSRI; erectile dysfunction
Vertical diplopia
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Sydenham chorea

50. What are the lab findings in poststreptococcal GN?
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
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Underestimation of gestational age

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USMLE Prep 2

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