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USMLE Prep 2

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Answer 50 questions in 15 minutes.
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1. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
No; yes
gram positive organisms
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
differentiate

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

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3. Where does conjugation of bilirubin take place?
In ER of bile canaliculi
Reticulocytes
low in serum
Multiple miscarriages d/t hypercoaguability

4. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
4 - 4 - 9
Decreases both
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity

5. other than proteinuria - What can cause foamy froathy urine?
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Bile salt accumulation in urine
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia

6. What are the three causes of acute MI in context of normal coronary arteries ?
Atrial
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Barium enema
Fibrosis; macrophages

7. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Lateral; RV; RA; LV
Medial circumflex artery; avascular necrosis
Curlings ulcers
8 (myc protein) with 2 - 14 - 22 (iG chains)

8. What does nitroprusside do to afterload? preload?
Pan colitis and right sided colitis (more than left sided and proctitis)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Decreases both
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords

9. after a thrombus extraction - what serum enzyme shoots up and why?
SS +rNA
Pan colitis and right sided colitis (more than left sided and proctitis)
Varying; erythema nodosum is common
Serum creatine kinase; reperfusion injury causes necrosis

10. why is glucagon used in beta blocker toxicitiy?
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
(urine PAH x urine flow rate)/plasma PAH
low in serum
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

11. where are neurons lost in huntingtons disease? What are two mc presenting symptoms?
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Closer to head; closer to diaphragm
Amiloride - spironolactone - triamterene
Brief psychotic disorder; schizophreniform; schizophrenia

12. What is the mcc of extrinsic allergic asthma?
Medial part
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Inhaled animal dander allergens
Gluteus maximus; difficulty getting up from seated position and climbing chair

13. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Hypo or hyper pigmentations; after tanning
Reticulocytes
Prostate tumor and increased osteoclast activity
indomethacin

14. Which is slower AV node or ventricular muscle?
Sydenham chorea
AV node slowest - to allow time for diastole
FGF and VEGF
Single adenomatous ones

15. Would alpha 1 agonists cause flushing? muscarinic antagonist?
RER; copper
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Not lined by epithelium
No; yes

16. What is extraocular muscle weakness a common symptom of?
In ER of bile canaliculi
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
SSRI
Myasthenia gravis

17. in the fluid running along the PT - what happens to PAH - inulin - urea - creatinine? how about glucose - aa - bicarb?
Atrial
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
8; 12
Increase; decreased

18. which antiarrythmic is associated with blue gray discoloration ?
Multiple miscarriages d/t hypercoaguability
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
8 (myc protein) with 2 - 14 - 22 (iG chains)
Amiadarone

19. why should you not use ACE inhibitors with someone who had hereditary angioedema?
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
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
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
transcription activation/suppression

20. how can HAV be inactivated?
Boiling - bleach - formalin - UV irradiation
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Insulin like growth factor 1 (just another name)

21. why does neutrophila occur with corticosteroids?
Demargination of neutrophils from the vessel walls
Prepatellar
Measure of depth invasion (vertical!)
only up to bronchi

22. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
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
Biphosphonate
To pump calcium out in cardiac myocytes so that relaxation occurs
Lateral; RV; RA; LV

23. what hernia has a similar mechanism to hydrocele?
CGD; t cell dysfxn (diGeorge)
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Kallmans
Because gamma chains replace beta chains and then gamma chain formation wanes

24. What can long term leg cast wearing cause?
Because gamma chains replace beta chains and then gamma chain formation wanes
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
Initiation - pointing; pincer grasp; walking; mama/dada
Fibronectin - laminin - collagen

25. Where is high frequency sound best recepted? low frequency sound? Which is lost more in elderly?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
women
Dihydropyridine sensitive Ca channels (L type)

26. What three factors effect total oxygen content of blood?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
CGD; t cell dysfxn (diGeorge)
Hexokinase
Faulty positioning of the genital tubercle

27. within the right atrium - What is the maximum pressure? left atrium?
8; 12
Prevents hepatic VLDL production
RBF= PAH clearance/(1- hematocrit)
PDH - alpha ketoglutarate DH - branched chain DH; lactic acidosis and maple syrup urine disease

28. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
Ketone body production by preventing fatty acids into the mitochondria
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Vagus (auricular branch); vasovagal syncope!
E6 and E7 of HPV knock off p53 and Rb suppressor genes

29. at three years of age What are social - fine motor - gross motor and language developments?
Downs; regurgitant AV valves - ASDs
Near the medial epicondyle or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
indomethacin

30. When is acid phosphatase elevated (Name two times)?
Prostate tumor and increased osteoclast activity
<1% - 55% - concentration dependent
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Bronchial dilation (bronchiectasis)

31. What is the mc location of brain germinomas?What are the classic symptoms?
Radial nerve and deep brachial artery
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis

32. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Increase in permeability of two ions with equal and opposite equilibrium potentials
C3 decreased after 5-10 days; sulfonamides
Gluteus medius and minimus; positive trendelenberg
Echinococcus granulosus; anaphylaxis

33. 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?
25; 25
Inactivates kallikrein which activates kininogen into bradykinin
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
facultative intracellular

34. prostaglandin synthesis keeps...
PDA open
MAO inhibitors; wine and cheese
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
GI malignancies and Insulin resistance (acromegal for ex)

35. How do you calculate atributable risk percent?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
In the extracellular space
RR-1/RR

36. what organ would an activating mutation in PRPP synthetase effect?
Paramyxo and influenza
Joints d/t increased purine production and thus uric acid production
Gluteus medius and minimus; positive trendelenberg
Ketone body production by preventing fatty acids into the mitochondria

37. What does Rb protein do? what chrom is it on?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Smoking
RR-1/RR

38. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Well
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Common peroneal; bony fractures and compression; sciatic

39. which artery provides the majority of the blood supply to the head and neck of the femur? what happens in fracture of neck?
Sarcoid
Amiloride - spironolactone - triamterene
Medial circumflex artery; avascular necrosis
Hypothyroidism

40. What are the first generation anti histamines?
Little effect on cell and no change
Increase; decreased
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Chlorpheniramine and diphenhydramine

41. What would a deflection of the membrane potential to near zero indicate?
Increase in permeability of two ions with equal and opposite equilibrium potentials
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
Turners`
manifestations - congenital (stretching of periventricular pyrimadal fibers)

42. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Retinitis; mononucleosis
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Because of the low output from heart failure - they will have increased aldosterone levels

43. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
liver specific
Around 70 (normal measured diastolic pressures); 9--
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

44. what clinical findings help distinguish small cell carcinoma?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Cluster
<1% - 55% - concentration dependent

45. What test would be best to determine if a gene is being transcribed? translated?
Southern - western
Because of the low output from heart failure - they will have increased aldosterone levels
ATP binding (resets the myosin head to contract again for next binding)
Turners`

46. When does dysplasia become a carcinoma - in other words When does it nonreversible? What is high grade dysplasia synonymous with?
When it invades the bm; carcinoma in situ
Cleaves bases leaving apyrimidine and apurine sites; cleaves 5' end of DNA; cleaves 3' end of DNA; base excision repair; DNA polymerase - and ligase
Syringomelia
P53 mutation; AD

47. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Hyperkalemia; potassium sparing diuretics - potassium supplements
11 aa polypeptide; pain NT in CNS and PNS

48. on which chromosome is wilms tumor found?
Right before diastole (filling begins)
Medial part
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
11

49. why are beta thal major patients asymptomatic at birth?
Inhibits it
Because gamma chains replace beta chains and then gamma chain formation wanes
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Fibronectin - laminin - collagen

50. within the right ventricle - What are maximum pressures? the pulm arter?
25; 25
Think Hb deformation diseases
ZDV or AZT
Anti - apoptotic (prevents going into apoptosis)- 18; 14

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USMLE Prep 2

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