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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 color pigmentations are caused by malassezia furfur? when do they become more visible?
Spongiosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
P53 mutation; DCC is also required for adenoma to carcinoma
Hypo or hyper pigmentations; after tanning

2. If a patient has higher levels of HbF - What does this mean?
Think Hb deformation diseases
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Amiadarone

3. What triggers the neoplastic changes that are associated with HBV infecton?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Minimal change disease
Integration of viral DNA into genome of host hepatocytes
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

4. what presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Chorda tympani branch
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Measles and M3 AML`
Hypothyroidism

5. why does variocele occur more in left side?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
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

6. What is the mc outcome of a patient acutely infected with Hep C? 2nd mc?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Echinococcus granulosus; anaphylaxis
IgE
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

7. What is capsaicin? Where does it work?
Pain reliever - reduces pain by locking substance P in the PNS
E. coli
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

8. What can nitrates lead to that is bad for angina therapy? How do you counter this?
PDA open
Aromatase deficiency in child
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Relfex tachycardia; giving beta blockers

9. metabolism of 1 gram of protein produces How many calories? carb? fat?
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Become beta pleated and then form neurofibrillary tangle!
Prostate tumor and increased osteoclast activity
4 - 4 - 9

10. what happens to capacitance with age?
Smoking
...
CGD; t cell dysfxn (diGeorge)
Headaches and facial flushing; vasodilation in meninges and skin

11. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
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)
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Prevent phagocytosis
Increased reticulocytes

12. within the right atrium - What is the maximum pressure? left atrium?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
8; 12
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression

13. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
CMV - HSV 1 - Candida
Hexokinase
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

14. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Sarcoid
Fibronectin - laminin - collagen
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
No and yes

15. what has the greatest effect on prognosis when treating c. diptheriae?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Anterior nares
Smoking
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

16. facial pain and headache in a patient with diabetic ketoacidosis is highly suggestive of what? How do you diagnose? What is a char finding?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Leukotriene precursor and does neutrophil chemotaxis
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Susceptible; soluble (unable to be cultured in bile)

17. Metronidizaole does not cover...
V fib; v. failure
Env genes (for getting into target cells)
gram positive organisms
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

18. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Medial circumflex artery; avascular necrosis
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
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
Dihydropyridine sensitive Ca channels (L type)

19. how does eos release MBP to kill protozoa etc?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Selective alpha 1 (increases SVR)
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Serum FFA and serum triglyceride levels

20. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
Common peroneal; bony fractures and compression; sciatic
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
RBC mass; epo levels (secondary has high)

21. What does C1 esterase do other than inhibiting complement pathway?
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Classical conditioning
Inactivates kallikrein which activates kininogen into bradykinin
Dihydropyridine sensitive Ca channels (L type)

22. how does neisseria cause a petechial rash?
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Enterococci (e. faecalis)- found on genitalia area
Neisseria induced small cell vasculitis (including hands and soles)
Abnormal closing of the urethral folds

23. what nerve and artery course along the posterior aspect of the humerus?
HSV and VZV
Radial nerve and deep brachial artery
GI malignancies and Insulin resistance (acromegal for ex)
P53 mutation; AD

24. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Amiloride - spironolactone - triamterene
Prostate tumor and increased osteoclast activity
25; 25

25. within the right ventricle - What are maximum pressures? the pulm arter?
AV node slowest - to allow time for diastole
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
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
25; 25

26. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
In the extracellular space
MAO inhibitors; wine and cheese
Increased reticulocytes
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

27. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Well
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
ZDV or AZT
RER; RER

28. What is Tzanck smear used to detect?
V fib; v. failure
HSV and VZV
Recurrent larygneal
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

29. erythema nodosum - elevated ACE - scattered granulomas - arthralgias - hilar lymphadenoapthy are indicative of what?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Inactivates kallikrein which activates kininogen into bradykinin
Sarcoid
Appetite suppressants

30. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
No; MRI
When it invades the bm; carcinoma in situ
E6 and E7 of HPV knock off p53 and Rb suppressor genes

31. what enzymes is lipoic acid a cofactor for? What does a mutation in it result in?
Inactivates kallikrein which activates kininogen into bradykinin
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
Normally close to systolic
indomethacin

32. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Faulty positioning of the genital tubercle
Increase; decreased
No; yes
Biphosphonate

33. What causes curlings ulcers?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
On cardiac tissue and renal juxtaglomerular cells
GI malignancies and Insulin resistance (acromegal for ex)
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

34. What is the stabilizing force for the secondary structure of proteins?
Hydrogen bonds dictate alpha or beta structure
Vancomycin; histamine mediated
Southern - western
25; 25

35. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
Brief psychotic disorder; schizophreniform; schizophrenia
ATP binding (resets the myosin head to contract again for next binding)
Phencyclidine (PCP)

36. What is the Na/Ca exchange used for?
Underestimation of gestational age
Amiadarone
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
To pump calcium out in cardiac myocytes so that relaxation occurs

37. What antibiotic is best to treat alcoholic pulm infections? why?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
LT (LTD4 - E4 - C4) - and Ach
APP on chrom 21 (this is why downs more susceptible)
Spongiosis

38. What are examples of action that decrease venous return to the heart?
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Standing suddenly from supine position; valsalva maneuver
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
Anti cholinergic effects of pupil dilation and lack of accomodation

39. What can cause aortic regurg? What is the heart sound you hear?
Hereditary angioedema; ACE inhibitors
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
No; yes
SSRI

40. niacin used for hyperlipidemia - What are its side effects? why do they occur? how can you prevent them?
Skin flushing and warmth; prostaglandins; give with aspirin
MAC complex (C5b - C9 complement deficiency)
On cardiac tissue and renal juxtaglomerular cells
Acute interstitial nephritis

41. What is epispadias caused by?
Faulty positioning of the genital tubercle
Hexokinase
In the extracellular space for collagen cross linking; zinc
Normally close to systolic

42. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
Varying; erythema nodosum is common
P53 mutation; DCC is also required for adenoma to carcinoma
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

43. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Demargination of neutrophils from the vessel walls
In the extracellular space for collagen cross linking; zinc
Not lined by epithelium

44. What is the immune deficinecy seen in ataxia telangactasia?
Selective alpha 1 (increases SVR)
As a CO2 carrier with the carboxylase enzyme
Ig A deficiency
Increases

45. What type of vision is myopia? In What type of patients does it improve?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
In the extracellular space
Increased reticulocytes

46. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
E6 and E7 of HPV knock off p53 and Rb suppressor genes
low in serum
Become beta pleated and then form neurofibrillary tangle!
Another type of aldosterone antagonist (like spironolactone)

47. which cells produce surfactant? which ones mediate gas exchange?
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
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)
II; I (I more abundant)
Barium enema

48. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Turners`
Abnormal closing of the urethral folds
ANCA because of lack of Ig and C3 deposits on IF

49. What antibodies are present in CREST? What is the most specific?
SSRI; erectile dysfunction
Anti centromere; anti DNA topoisomerase
Hyperkalemia; potassium sparing diuretics - potassium supplements
Trauma to stereociliated hair cells of the organ of corti

50. how much percent of sodium is excreted? urea? glucose?
Env genes (for getting into target cells)
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
<1% - 55% - concentration dependent
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

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USMLE Prep 2

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