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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. hypertensive crises on food intake is typical of What antidepressant? what kind of food?
Anti cholinergic effects of pupil dilation and lack of accomodation
Biphosphonate
MAO inhibitors; wine and cheese
Sydenham chorea

2. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
P53 mutation; DCC is also required for adenoma to carcinoma
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

3. which nerve provides innervation for plantar flexion and inversion?
Insulin like growth factor 1 (just another name)
Tibial
Extrinsic def; instrinsic def; platelet def
RER; copper

4. What are the acute effects of corticosteroids on the CBC?
Dissolved in plasma and attached to Hgb
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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

5. which has better side effect profile - SSRI or TCA?
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)
SSRI
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
manifestations - congenital (stretching of periventricular pyrimadal fibers)

6. what bursa is affected when on knees like a maid/gardner?
Dissolved in plasma and attached to Hgb
Prevent phagocytosis
Prepatellar
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

7. why does hypothyroidism cause increased CPK levels?
46 - 4N; 23 2N
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
glycerol kinase
Medial part

8. What does protein M do in Group A strep<
Adeno
<1% - 55% - concentration dependent
Prevent phagocytosis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

9. What is difference between Arnold Chiari type I and II?
Not lined by epithelium
I is more benign and can present later in adulthood
RER; RER
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

10. carnitine deficiency impairs production of What and how?
Reiter syndrome; B27
Ketone body production by preventing fatty acids into the mitochondria
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Measles and M3 AML`

11. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
OCPs - multiparity - breast feeding

12. Metronidizaole does not cover...
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Drug induced interstitial nephritis
gram positive organisms

13. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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14. What is Bortezomib and What is it used for?
Acute interstitial nephritis
Hypertension - edema - and proteinuria
Proteasome inhibitor; treatment for MM and waldenstroms
Increase; decreased

15. What is damaged in early syringomelia? later?
Kallmans
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

16. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
II; I (I more abundant)
Atrial
Close but purkinje system to ensure contraction in a bottom up fashion

17. What are three symptoms in s.typhi?
Sickle cell; G6PD
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
Ig A deficiency
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

18. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
FGF and VEGF
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Sarcoid

19. What is omalizumab and What is it used for?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
200-500
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
II; I (I more abundant)

20. IL4 is used for isotypye switching to what?
IgE
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
G to T in p53; HCC

21. What are some side effects seen in TCAs?
Serum FFA and serum triglyceride levels
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
RER; RER
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

22. What causes curlings ulcers?
differentiate
Dihydropyridine sensitive Ca channels (L type)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
OCPs - multiparity - breast feeding

23. What is the mutation type in thalassemias? what process is defective because of this?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Nonsense; mRNA processing
HSV and VZV
Single adenomatous ones

24. how does noise induced hearing loss occur?
Trauma to stereociliated hair cells of the organ of corti
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Leukotriene precursor and does neutrophil chemotaxis
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

25. What is the most important prognostic indicator in patients with malignant melanoma?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Measure of depth invasion (vertical!)
SS +rNA
High potassium conductance and some sodium conductance

26. on What part of the clavicle does the SCM attach?
Sarcoid
Fibrosis; macrophages
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Medial part

27. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Think Hb deformation diseases
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Raphe
Right heart failure

28. How can renal blood flow be calculated from RPF?
RBF= PAH clearance/(1- hematocrit)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
GI malignancies and Insulin resistance (acromegal for ex)

29. What is 5- HETE and What does it do?
Ceftriaxone; azithromycin
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Leukotriene precursor and does neutrophil chemotaxis
HSV and VZV

30. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Common peroneal; bony fractures and compression; sciatic
Hypo or hyper pigmentations; after tanning
S3 gallop; S2 to opening snap interval
200-500

31. what virus causes pharyngoconjuctival fever?
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
SVC and IVC; right below the aortic knob
Adeno
LT (LTD4 - E4 - C4) - and Ach

32. What is diagnostic (and possible therapeutic for intussusception)?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
No (unlike adenomyosis); yes
T test; chi squared
Barium enema

33. What antibiotic is best to treat alcoholic pulm infections? why?
Hyperkalemia; potassium sparing diuretics - potassium supplements
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
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Localized dermatologic pain that persists for more than one month after zoster eruption

34. What is the precursor protein to beta amyloid and On what chromosome is it found?
APP on chrom 21 (this is why downs more susceptible)
Anterior circumflex (and axillary nerve)
Paramyxo and influenza
Hypothyroidism

35. What is the presentation of angioedema? Where is most commonly affected?
8; 12
P53 mutation; AD
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

36. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
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
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Ceftriaxone; azithromycin

37. What are the primary determinants of colon cancer risk in UC patients
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Duration and extent of disease
Strength of cell mediated immune response

38. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Ether and other organic solvents
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Hexokinase
Southern - western

39. How do you explain the selective proteinuria of loss to albumin only in MCD?
Pain reliever - reduces pain by locking substance P in the PNS
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Chlorpheniramine and diphenhydramine
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

40. in the LV and aorta - What are the pressures?
Normally close to systolic
Amiloride - spironolactone - triamterene
Medial circumflex artery; avascular necrosis
Anti cholinergic effects of pupil dilation and lack of accomodation

41. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Superior larygeal; cricothyroid; recurrent laryngeal
CGD; t cell dysfxn (diGeorge)
11 aa polypeptide; pain NT in CNS and PNS
Downs; regurgitant AV valves - ASDs

42. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
Cluster
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
When it invades the bm; carcinoma in situ
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

43. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
Medullary
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

44. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Proteasome inhibitor; treatment for MM and waldenstroms
Increased reticulocytes
HSV ( also in utero: chlymadia - neisseria - group B strep)
Class I

45. Where does lysyl oxidase act? What is the cofactor for that?
Folic acid treatment!
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
In the extracellular space for collagen cross linking; zinc
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

46. Where does 90% of serotonin lie? What is this NT responsible?
In ER of bile canaliculi
Folic acid treatment!
GI tract; mood!
I is more benign and can present later in adulthood

47. 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?
Faulty positioning of the genital tubercle
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Spongiosis
46 - 4N; 23 2N

48. which antiarrythmic is associated with blue gray discoloration ?
Medial circumflex artery; avascular necrosis
Large stroke volumes with ventricular contraction; aortic regurg
Amiadarone
Vertical diplopia

49. how much percent of sodium is excreted? urea? glucose?
Bile soluble which means they are bile sensitive
Not lined by epithelium
<1% - 55% - concentration dependent
Increase by 50% in urine osmolality

50. other than increasing HDL levels - what else does niacin do?
Because of the low output from heart failure - they will have increased aldosterone levels
P53 mutation; DCC is also required for adenoma to carcinoma
Neisseria induced small cell vasculitis (including hands and soles)
Prevents hepatic VLDL production

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USMLE Prep 2

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