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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 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
Initiation - pointing; pincer grasp; walking; mama/dada
S. saprophyticus - and s. epidermidis; novobiocin
AV node slowest - to allow time for diastole

2. which has better side effect profile - SSRI or TCA?
Relfex tachycardia; giving beta blockers
SSRI
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

3. What is used to treat heparin toxicity?
Protamine sulfate
Trochlear nerve (IV); abducens nerve (VI)
Chorda tympani branch
RER; RER

4. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
To pump calcium out in cardiac myocytes so that relaxation occurs
S. saprophyticus - and s. epidermidis; novobiocin
Increase; decreased
I is more benign and can present later in adulthood

5. which are the only glycosylated proteins in HIV virus?
Env genes (for getting into target cells)
In the extracellular space for collagen cross linking; zinc
Joints d/t increased purine production and thus uric acid production
Valproate

6. Is there edema in primary Conns? secondary hyperaldosteronism? why?
Spongiosis
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
GI malignancies and Insulin resistance (acromegal for ex)

7. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
S3 gallop; S2 to opening snap interval
To pump calcium out in cardiac myocytes so that relaxation occurs
Vancomycin; histamine mediated
Intussusception

8. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Ceftriaxone; azithromycin
Vagus (auricular branch); vasovagal syncope!
women
No and yes

9. what drugs causes the red man syndrome? how does it occur?
Vancomycin; histamine mediated
Anti cholinergic effects of pupil dilation and lack of accomodation
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

10. why does neutrophila occur with corticosteroids?
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
200-500
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Demargination of neutrophils from the vessel walls

11. What is diagnostic (and possible therapeutic for intussusception)?
Brief psychotic disorder; schizophreniform; schizophrenia
No; MRI
Barium enema
Localized dermatologic pain that persists for more than one month after zoster eruption

12. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Intussusception
Become beta pleated and then form neurofibrillary tangle!
SVT; increases vagal tone; rectus abdominis
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

13. What is the mainstay treatment for acute mania?
Anterior nares
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Prevents hepatic VLDL production

14. after triglyceride metabolism - What is the fate of the glycerol? what enzyme is involved?
Vagus (auricular branch); vasovagal syncope!
By vascular permeability and vasodilation
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin

15. What are some side effects seen in TCAs?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Highly negative resting potential
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

16. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Vancomycin; histamine mediated
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

17. who bleed more DIC or TTP- HUS patients?
Prevent phagocytosis
DIC; TTP- HUS dont bleed that much
Drug induced interstitial nephritis
Serum creatine kinase; reperfusion injury causes necrosis

18. What does nitroprusside do to afterload? preload?
Become beta pleated and then form neurofibrillary tangle!
Decreases both
Amiadarone
Aromatase deficiency in child

19. What can worse neurologic dysfunction in cobalamic def?
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Folic acid treatment!
Serum creatine kinase; reperfusion injury causes necrosis
Leukotriene precursor and does neutrophil chemotaxis

20. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Anti centromere; anti DNA topoisomerase
Turners`
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
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

21. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
Recurrent larygneal
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
RER; copper
G to T in p53; HCC

22. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
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
C3 decreased after 5-10 days; sulfonamides
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Neisseria induced small cell vasculitis (including hands and soles)

23. in overweight individuals What is thought to contribute to insulin resistance?
Serum FFA and serum triglyceride levels
Sydenham chorea
CMV - HSV 1 - Candida
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

24. what locations of UC increase the risk of Colon cancer?
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Pan colitis and right sided colitis (more than left sided and proctitis)
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)
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

25. what hernia has a similar mechanism to hydrocele?
...
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Medial circumflex artery; avascular necrosis
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

26. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Duration and extent of disease
Hyperkalemia; potassium sparing diuretics - potassium supplements
8 (myc protein) with 2 - 14 - 22 (iG chains)
Increase lymphatic drainage!

27. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
OCPs - multiparity - breast feeding
Trochlear nerve (IV); abducens nerve (VI)

28. What is the most important prognostic indicator in patients with malignant melanoma?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Bronchial dilation (bronchiectasis)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Measure of depth invasion (vertical!)

29. SIADH patients have normal blood volume but...
RBC mass; epo levels (secondary has high)
Anterior circumflex (and axillary nerve)
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
hyponatremia (aldosterone activation equilibrates body volume)

30. what protects the resting heart from arrhythmias?
Trauma to stereociliated hair cells of the organ of corti
No; MRI
Highly negative resting potential
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

31. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
RER; RER
Duration and extent of disease
Elastance

32. What does hypocapnia cause in teh brain? What is hypocapnia?
Echinococcus granulosus; anaphylaxis
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
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
No; yes

33. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
GI malignancies and Insulin resistance (acromegal for ex)
Intussusception
Coagulation factors are made in the liver

34. What is epleronone?
Another type of aldosterone antagonist (like spironolactone)
Spongiosis
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
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased

35. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Normal; low
Relfex tachycardia; giving beta blockers
gram positive organisms

36. What is the presentation of angioedema? Where is most commonly affected?
Medial part
Regular insulin (Not fast acting - regular better)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

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

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38. What is the primary histologic finding in patients with eczematous dermatitis?
Increase lymphatic drainage!
Selective alpha 1 (increases SVR)
Trochlear nerve (IV); abducens nerve (VI)
Spongiosis

39. when do ghon complexes form - primary or secondary TB?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Primary
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2

40. Where does complement bind on the Fc region of Ig chains?
Integration of viral DNA into genome of host hepatocytes
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
Multiple miscarriages d/t hypercoaguability
SSRI

41. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Protamine sulfate
Increased reticulocytes
glycerol kinase
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy

42. What does L/S stand for in fetal lung maturity? When does maturity occur?
When it invades the bm; carcinoma in situ
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Duration and extent of disease
Tissue redistribution (out of plasma) rather than metabolism

43. what has the greatest effect on prognosis when treating c. diptheriae?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
CGD; t cell dysfxn (diGeorge)
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

44. 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
Myasthenia gravis
Covalent (between two cysteines)- allows protein to withstand denaturation
Extrinsic def; instrinsic def; platelet def

45. which viruses require a protease?
Downs; regurgitant AV valves - ASDs
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Selective alpha 1 (increases SVR)
SS +rNA

46. What is easiest way to treat nephrolithiasis?
Vancomycin; histamine mediated
Anterior nares
Smoking
Drink plenty of fluids

47. What can too much IgA in serum produces?
C3 decreased after 5-10 days; sulfonamides
Anti centromere; anti DNA topoisomerase
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

48. if there are keratin swirls does that mean well or poorly differentiated?
Env genes (for getting into target cells)
Amiloride - spironolactone - triamterene
Pulmonary hypertension
Well

49. what hormone is structurally similar to hCG?
Bronchogenic carcinoma
TSh (in testicular tumors can cause hyperthyroidism)
Increase; decreased
Bile salt accumulation in urine

50. What are fenfluramine - phentermine?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Abnormal closing of the urethral folds
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Appetite suppressants

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