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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 the most common initital symptom of ADPKD? what else?
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
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
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Minimal change disease

2. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
RBF= PAH clearance/(1- hematocrit)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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)

3. When is an S4 sound normal?
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Extrinsic def; instrinsic def; platelet def
Well trained athletes and children
GI tract; mood!

4. What are the three dopaminergic systems and What are they responsible for? disease?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
TCAs and prazosin
T test; chi squared

5. What is the precursor protein to beta amyloid and On what chromosome is it found?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Thymic tumor
Think Hb deformation diseases
APP on chrom 21 (this is why downs more susceptible)

6. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Duration and extent of disease
Reiter syndrome; B27
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Paramyxo and influenza

7. What is the mainstay treatment for acute mania?
Drink plenty of fluids
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
E. coli; staphylococcus saprophyticus
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic

8. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Neisseria induced small cell vasculitis (including hands and soles)
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
No and yes

9. What does hypocapnia cause in teh brain? What is hypocapnia?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Prevent phagocytosis
Proteasome inhibitor; treatment for MM and waldenstroms

10. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Standing suddenly from supine position; valsalva maneuver
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Pulmonic and systemic!
Gluteus maximus; difficulty getting up from seated position and climbing chair

11. What is subacute sclerosisng encephalitis caused by?
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
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
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

12. What is epispadias caused by?
Faulty positioning of the genital tubercle
To pump calcium out in cardiac myocytes so that relaxation occurs
RER; copper
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

13. Axillary lymph node dissection is a risk factor for the development of chronic lymphedema of the ipsilateral arm. What does chronic lymphedema predispose to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

14. What does extended consumption of appetite suppressants lead to?
Common peroneal; bony fractures and compression; sciatic
Pulmonary hypertension
In the extracellular space for collagen cross linking; zinc
Chorda tympani branch

15. why are pregnant predisposed to cholelithiasis?
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
Amiloride - spironolactone - triamterene
S. saprophyticus - and s. epidermidis; novobiocin
frameshift mutations (missense is substitution)

16. Which is faster purkinje system or atrial muscle?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
TSh (in testicular tumors can cause hyperthyroidism)
Close but purkinje system to ensure contraction in a bottom up fashion
Tibial

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

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18. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Folic acid treatment!
Underestimation of gestational age
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

19. what bursa is affected when on knees like a maid/gardner?
Inactivates kallikrein which activates kininogen into bradykinin
Hypo or hyper pigmentations; after tanning
Prepatellar
V fib; v. failure

20. What is mcc of death pre hospital phase of MI? in hospital phase?
CMV - HSV 1 - Candida
V fib; v. failure
Turners`
MAO inhibitors; wine and cheese

21. which opponens muscle does ulnar innervate?
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
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
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Adductor

22. What are the common causes of metabolic alkalosis? How do you differentiate between them?
Kallmans
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
Brief psychotic disorder; schizophreniform; schizophrenia
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

23. if there are keratin swirls does that mean well or poorly differentiated?
Vancomycin
Acute gastric mucosal defects (superficial or full thickness)
Well
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

24. What is a clara cell?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Relatively selective B1 adrenergic agonist; acute heart failure with decreased myocardial contractility (cardiogenic shock); increases myocardial contractility; can induce arrhythmias because increases cardiac conduction velocity
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

25. What is tachyphylaxis?
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
The term used to describe decreased drug responsiveness with repeated administration
Inhibits it
Increase in permeability of two ions with equal and opposite equilibrium potentials

26. What is somatomedin C?
Sydenham chorea
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
Insulin like growth factor 1 (just another name)
Increases

27. What can chronic vit A toxicity cause?
facultative intracellular
Dihydropyridine sensitive Ca channels (L type)
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

28. What does the clinical presentation of restlessness - agitation - dysphagia - and progression to coma 30-50 days after cave exploring? hwo do you prevent?
Rabies encephalitis from cave bats; rabies killed vaccines
Sydenham chorea
Acute gastric mucosal defects (superficial or full thickness)
Reiter syndrome; B27

29. What is extraocular muscle weakness a common symptom of?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Elevated GGT and macrocytosis
Myasthenia gravis
E6 and E7 of HPV knock off p53 and Rb suppressor genes

30. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Classical conditioning
Faulty positioning of the genital tubercle
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

31. what increases turbulence and thus causes bruits? (specifically in terms of viscosity and velocity)
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Decreased viscosity (anemia) - increased velocity (narrowing of vessel)
Ceftriaxone; azithromycin
P53 mutation; DCC is also required for adenoma to carcinoma

32. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Vertical diplopia
Bile salt accumulation in urine
Curlings ulcers
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

33. which nerve provides innervation for plantar flexion and inversion?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tibial
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
No

34. What is the primary histologic finding in patients with eczematous dermatitis?
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration
SVT; increases vagal tone; rectus abdominis
Spongiosis
Anti cholinergic effects of pupil dilation and lack of accomodation

35. In what form are mitochondrial DNA? What do they transcribe?
Circular - outside nucleus; transport proteins - rRNA - tRNA
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Drug induced interstitial nephritis
Underestimation of gestational age

36. What type of mutation does aflatoxin cause? what cancer does this increase for?
Retinitis; mononucleosis
Fibronectin - laminin - collagen
G to T in p53; HCC
SVC and IVC; right below the aortic knob

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

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38. What is the mc location of brain germinomas?What are the classic symptoms?
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
Superior larygeal; cricothyroid; recurrent laryngeal
Common peroneal; bony fractures and compression; sciatic

39. which virus inactivates both Rb and p53?
Medial circumflex artery; avascular necrosis
No (unlike adenomyosis); yes
Elevated GGT and macrocytosis
E6 and E7 of HPV knock off p53 and Rb suppressor genes

40. What is the presentation of angioedema? Where is most commonly affected?
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Syncope - angina - dyspnea (SAD)
No; yes

41. How do you calculate atributable risk percent?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Highly negative resting potential
RR-1/RR
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis

42. What is the neurologic manifestation of ADPKD?
CGD; t cell dysfxn (diGeorge)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
HSV ( also in utero: chlymadia - neisseria - group B strep)
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage

43. within the right ventricle - What are maximum pressures? the pulm arter?
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Hypothyroidism
25; 25
Amiloride - spironolactone - triamterene

44. there are mucus secreting cells in the bronchioles...
only up to bronchi
Skin flushing and warmth; prostaglandins; give with aspirin
AV node slowest - to allow time for diastole
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

45. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Hereditary angioedema; ACE inhibitors
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease
SSRI; erectile dysfunction
Because gamma chains replace beta chains and then gamma chain formation wanes

46. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
200-500
Classical conditioning
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Anti - apoptotic (prevents going into apoptosis)- 18; 14

47. What translocations can cause c - myc overexpression?
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Gluteus maximus; difficulty getting up from seated position and climbing chair
11
8 (myc protein) with 2 - 14 - 22 (iG chains)

48. which headaches are seen mostly in men - are severe - unilateral - periorbital - episodic (around same time every day) - temporal pain - with lacrimation - nasal congestion and ptosis?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Cluster

49. which antiarrythmic is associated with blue gray discoloration ?
Apocrine; eccrine
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Amiadarone
I is more benign and can present later in adulthood

50. What are the two pharmacologic antagonists that offer clear benefit in allergic asthma?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Dihydropyridine sensitive Ca channels (L type)
Underestimation of gestational age
LT (LTD4 - E4 - C4) - and Ach

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