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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. who bleed more DIC or TTP- HUS patients?
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
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
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
DIC; TTP- HUS dont bleed that much

2. what chromosome is c - myc found on?
Ig A deficiency
Chrom 8
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
(urine PAH x urine flow rate)/plasma PAH

3. Which nerve lies in close proximity to the inferior thyroid artery?
Dissolved in plasma and attached to Hgb
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Recurrent larygneal
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

4. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Tzanck smear
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Become beta pleated and then form neurofibrillary tangle!

5. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
RER; RER
Rabies encephalitis from cave bats; rabies killed vaccines

6. which virus inactivates both Rb and p53?
Elastance
E6 and E7 of HPV knock off p53 and Rb suppressor genes
The term used to describe decreased drug responsiveness with repeated administration
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

7. why are pregnant predisposed to cholelithiasis?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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
Acute interstitial nephritis
Trauma to stereociliated hair cells of the organ of corti

8. a patient fearing all white coats is a phenomenon of what?
C3 decreased after 5-10 days; sulfonamides
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Classical conditioning
HSV ( also in utero: chlymadia - neisseria - group B strep)

9. What is the most common location of colonization of all s. aureus types?
Primary
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Anterior nares
facultative intracellular

10. What is acanthosis nigricans associated with?
Superior larygeal; cricothyroid; recurrent laryngeal
Trochlear nerve (IV); abducens nerve (VI)
GI malignancies and Insulin resistance (acromegal for ex)
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

11. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Purkinje system; AV node
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

12. in overweight individuals What is thought to contribute to insulin resistance?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
I is more benign and can present later in adulthood
Serum FFA and serum triglyceride levels
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate

13. Which is faster purkinje system or atrial muscle?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Sarcoid
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Close but purkinje system to ensure contraction in a bottom up fashion

14. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Little effect on cell and no change
Minimal change disease
Because gamma chains replace beta chains and then gamma chain formation wanes

15. What type of drug is atropine? what else is needed in addition to atropine when treating organophosphate poison?
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Prostate tumor and increased osteoclast activity

16. What does p53 do? what chrom is it on?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

17. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
Dihydropyridine sensitive Ca channels (L type)
Classical conditioning
I is more benign and can present later in adulthood

18. How do you calculate atributable risk percent?
Primary
RR-1/RR
Bronchial dilation (bronchiectasis)
Myasthenia gravis

19. where exactly is ACE expressed in the lungs? What type of enzyme is it?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Vascular endothelium; protease
Diabetic microangiopathy
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

20. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Hexokinase
RER; copper
Reiter syndrome; B27
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

21. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
Hypertension - edema - and proteinuria
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

22. What are some of the permissive effects of cortisol?
Class I
Increases bronchial and vascular smooth muscle reactivity to catecholamines
liver specific
Ceftriaxone; azithromycin

23. Which is faster atrial muscle or ventricular muscle?
Ether and other organic solvents
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Atrial
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

24. What is the sole neurologic manifestation of acute rheumatic fever?
Sydenham chorea
Acute interstitial nephritis
Pan colitis and right sided colitis (more than left sided and proctitis)
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)

25. What is suggestive of complete central DI?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
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)
Increase by 50% in urine osmolality

26. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Closer to head; closer to diaphragm
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Abnormal closing of the urethral folds
GI tract; mood!

27. What is used to compare means? categorical outcomes?
Dissolved in plasma and attached to Hgb
T test; chi squared
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
By vascular permeability and vasodilation

28. what disease causes a lack of intracellular killing? lack of killing viruses and fungi?
Folic acid treatment!
gram positive organisms
CGD; t cell dysfxn (diGeorge)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

29. 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?
Syncope - angina - dyspnea (SAD)
Right heart failure
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Anti cholinergic effects of pupil dilation and lack of accomodation

30. What is medullary sponge kidney disease and how does it present? What does it lead to?
Amiadarone
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
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)
Retinitis; mononucleosis

31. why is glucagon used in beta blocker toxicitiy?
Medial part
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
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

32. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
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)
...
Primary

33. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Folic acid treatment!
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Localized dermatologic pain that persists for more than one month after zoster eruption
AV node slowest - to allow time for diastole

34. What does TGF beta do? What produces it?
Pulmonic and systemic!
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Fibrosis; macrophages
P53 mutation; DCC is also required for adenoma to carcinoma

35. What causes wrist drop?
Radial nerve damage
FGF and VEGF
S. aureus
only up to bronchi

36. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
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
Headaches and facial flushing; vasodilation in meninges and skin

37. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Inhibits it
Sydenham chorea
Chrom 8
Relfex tachycardia; giving beta blockers

38. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Initiation - pointing; pincer grasp; walking; mama/dada
GI malignancies and Insulin resistance (acromegal for ex)
Anti - apoptotic (prevents going into apoptosis)- 18; 14

39. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Chorda tympani branch
Regular insulin (Not fast acting - regular better)
S3 gallop; S2 to opening snap interval
frameshift mutations (missense is substitution)

40. which RPGN is also called pauci immune GN? why?
Sarcoid
ANCA because of lack of Ig and C3 deposits on IF
liver specific
Dihydropyridine sensitive Ca channels (L type)

41. What type of mutation does aflatoxin cause? what cancer does this increase for?
Skin flushing and warmth; prostaglandins; give with aspirin
INTRApartum Abs (ampicillin/penicillin)
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
G to T in p53; HCC

42. other than parvo B19 - what else is associated with red cell aplasia?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Thymic tumor

43. What is the difference between additive and synergistic?
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
Apocrine; eccrine
4 - 4 - 9
Bronchogenic carcinoma

44. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
No and yes
11 aa polypeptide; pain NT in CNS and PNS
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Prevent phagocytosis

45. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Around 70 (normal measured diastolic pressures); 9--
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
differentiate
Phencyclidine (PCP)

46. What is damaged in early syringomelia? later?
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
SaO2 <92%
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Prostate tumor and increased osteoclast activity

47. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Terminal bronchioles; small bronchi
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

48. 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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Hexokinase
Protamine sulfate

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

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50. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Valproate
Pulmonic and systemic!
(urine PAH x urine flow rate)/plasma PAH
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)