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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. What are the three dopaminergic systems and What are they responsible for? disease?
NF- KB; responsible for cytokine production
Turners`
only up to bronchi
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

2. What antibodies are present in CREST? What is the most specific?
Anti centromere; anti DNA topoisomerase
Terminal bronchioles; small bronchi
Superior larygeal; cricothyroid; recurrent laryngeal
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)

3. hypertonicity and hyperreflexity are ________________ of hydrocephalus
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor
Congenital hypothyroidism - downs - amyloidosis - acromegaly
S. saprophyticus - and s. epidermidis; novobiocin
manifestations - congenital (stretching of periventricular pyrimadal fibers)

4. what diseases can vit A be used to treat?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Chrom 8
Measles and M3 AML`
Common peroneal; bony fractures and compression; sciatic

5. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
OCPs - multiparity - breast feeding
Drug induced interstitial nephritis
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
25; 25

6. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
low in serum
Sickle cell; G6PD
Joints d/t increased purine production and thus uric acid production
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)

7. How do you treat gonococcal infection? chlymadia?
Strength of cell mediated immune response
To pump calcium out in cardiac myocytes so that relaxation occurs
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Ceftriaxone; azithromycin

8. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
No (unlike adenomyosis); yes
Hypothyroidism
<1% - 55% - concentration dependent
Single adenomatous ones

9. How do you calculate RPF from urine PAH?
(urine PAH x urine flow rate)/plasma PAH
Drink plenty of fluids
NF- KB; responsible for cytokine production
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

10. What can long term leg cast wearing cause?
C3 decreased after 5-10 days; sulfonamides
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
P450 mitochondrial monooxygenase
Relfex tachycardia; giving beta blockers

11. Which is slower AV node or ventricular muscle?
Anterior nares
Serum FFA and serum triglyceride levels
AV node slowest - to allow time for diastole
manifestations - congenital (stretching of periventricular pyrimadal fibers)

12. within the right atrium - What is the maximum pressure? left atrium?
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
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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)
8; 12

13. why are pregnant predisposed to cholelithiasis?
Myasthenia gravis
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
Neisseria induced small cell vasculitis (including hands and soles)
Vagus (auricular branch); vasovagal syncope!

14. What can too much IgA in serum produces?
V fib; v. failure
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
Amiloride - spironolactone - triamterene
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

15. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Curlings ulcers
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
E. coli; staphylococcus saprophyticus
facultative intracellular

16. what receptors do first generation anti histamines block?
GI malignancies and Insulin resistance (acromegal for ex)
200-500
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
Env genes (for getting into target cells)

17. What is used to compare means? categorical outcomes?
T test; chi squared
I is more benign and can present later in adulthood
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)
Relfex tachycardia; giving beta blockers

18. What type of drug is alendronate?
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
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)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Biphosphonate

19. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Little effect on cell and no change
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Demargination of neutrophils from the vessel walls

20. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Gluteus maximus; difficulty getting up from seated position and climbing chair
No; MRI
Covalent (between two cysteines)- allows protein to withstand denaturation
Vagus (auricular branch); vasovagal syncope!

21. What is somatomedin C?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Insulin like growth factor 1 (just another name)
Acute gastric mucosal defects (superficial or full thickness)
Well

22. what immune deficiency causes recurrent neisseria infections?
PDA open
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
MAC complex (C5b - C9 complement deficiency)
Minimal change disease

23. What are the three predominant symptoms of VHL? What is its mode of inheritance?
TSh (in testicular tumors can cause hyperthyroidism)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

24. What can nitrates lead to that is bad for angina therapy? How do you counter this?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Relfex tachycardia; giving beta blockers
Squatting - sitting - lying supine - passive leg raising
Hexokinase

25. who bleed more DIC or TTP- HUS patients?
RER; RER
DIC; TTP- HUS dont bleed that much
Bronchial dilation (bronchiectasis)
II; I (I more abundant)

26. ___________ is liver specific
glycerol kinase
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Acute interstitial nephritis

27. 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)
Because of the low output from heart failure - they will have increased aldosterone levels
Localized dermatologic pain that persists for more than one month after zoster eruption
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

28. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Headaches and facial flushing; vasodilation in meninges and skin
Hypo or hyper pigmentations; after tanning
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
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)

29. What does L/S stand for in fetal lung maturity? When does maturity occur?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
G to T in p53; HCC
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

30. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
Minimal change disease
Well trained athletes and children
By vascular permeability and vasodilation

31. What is the mc malignancy in asbestosis?
Acute interstitial nephritis
25; 25
Tibial
Bronchogenic carcinoma

32. What is capacitance inversely proportional to?
Susceptible; soluble (unable to be cultured in bile)
Intussusception
Cluster
Elastance

33. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
FGF and VEGF
differentiate
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Around 70 (normal measured diastolic pressures); 9--

34. what phase do adenosine and acetylcholine act on? doing what?
G to T in p53; HCC
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Decreases both
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)

35. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
ATP binding (resets the myosin head to contract again for next binding)
Right before diastole (filling begins)
Increased reticulocytes

36. Which is faster purkinje system or atrial muscle?
Southern - western
Close but purkinje system to ensure contraction in a bottom up fashion
In ER of bile canaliculi
APP on chrom 21 (this is why downs more susceptible)

37. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Reiter syndrome; B27
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Chorda tympani branch

38. what enzyme converts procarcinogens into carcinogens?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
P450 mitochondrial monooxygenase
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
Normal; low

39. How do left sided colon adenocarcinomas present? right sided?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
TSh (in testicular tumors can cause hyperthyroidism)

40. Where does complement bind on the Fc region of Ig chains?
Env genes (for getting into target cells)
Susceptible; soluble (unable to be cultured in bile)
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
manifestations - congenital (stretching of periventricular pyrimadal fibers)

41. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Lateral; RV; RA; LV
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Clindamycin; covers anaerobic oral flora and aerobic bacteria

42. what protein is increased in Crohns disease? What does it do?
NF- KB; responsible for cytokine production
11
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)
No; yes

43. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Smoking
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
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase

44. what nerve and artery course along the posterior aspect of the humerus?
Reiter syndrome; B27
Radial nerve and deep brachial artery
Terminal bronchioles; small bronchi
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

45. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
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
Chrom 8
OCPs - multiparity - breast feeding
SSRI

46. What is a clara cell?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
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
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
8 (myc protein) with 2 - 14 - 22 (iG chains)

47. which RPGN is also called pauci immune GN? why?
Localized dermatologic pain that persists for more than one month after zoster eruption
ATP binding (resets the myosin head to contract again for next binding)
Headaches and facial flushing; vasodilation in meninges and skin
ANCA because of lack of Ig and C3 deposits on IF

48. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Abnormal closing of the urethral folds
Relfex tachycardia; giving beta blockers
Large stroke volumes with ventricular contraction; aortic regurg

49. What is the primary histologic finding in patients with eczematous dermatitis?
Atrial
Increases
Spongiosis
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

50. What pulmonary structural change can kartageners syndrome cause?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Close but purkinje system to ensure contraction in a bottom up fashion
Bronchial dilation (bronchiectasis)
Tibial