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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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1. in essential fructosuria - what enzyme do patients use to metabolize fructose?
Excessive collagen formation during tissue repair in susceptible individuals
Minimal change disease
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Hexokinase

2. what dictates the resting membrane potential of most cells?
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Chlorpheniramine and diphenhydramine
High potassium conductance and some sodium conductance
Leukotriene precursor and does neutrophil chemotaxis

3. which two drug types can cause orthostatic hypotension (think depression and BPH)?
Increased reticulocytes
Reticulocytes
4 - 4 - 9
TCAs and prazosin

4. What antibodies are present in CREST? What is the most specific?
Acute interstitial nephritis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Prevents hepatic VLDL production
Anti centromere; anti DNA topoisomerase

5. where are the vegetations on the valves of a libman sacks endocarditis?
RR-1/RR
MAO inhibitors; wine and cheese
Both sides
Ceftriaxone; azithromycin

6. What is the immune deficinecy seen in ataxia telangactasia?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Reiter syndrome; B27
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
Ig A deficiency

7. integrin mediated adhesion of cells to ECM (and BM) involves integrin binding to what?
Hypertension - edema - and proteinuria
Fibronectin - laminin - collagen
Amiadarone
RR-1/RR

8. what drugs causes the red man syndrome? how does it occur?
Inactivates kallikrein which activates kininogen into bradykinin
Vancomycin; histamine mediated
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Joints d/t increased purine production and thus uric acid production

9. What does C1 esterase do other than inhibiting complement pathway?
Inactivates kallikrein which activates kininogen into bradykinin
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
SVT; increases vagal tone; rectus abdominis
Standing suddenly from supine position; valsalva maneuver

10. What is normal fibrinogen levels?
Extrinsic def; instrinsic def; platelet def
AV node slowest - to allow time for diastole
200-500
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC

11. What does nitroprusside do to afterload? preload?
Decreases both
differentiate
NF- KB; responsible for cytokine production
II; I (I more abundant)

12. when do ghon complexes form - primary or secondary TB?
Raphe
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Primary
Ketone body production by preventing fatty acids into the mitochondria

13. How do you explain the selective proteinuria of loss to albumin only in MCD?
Hyperkalemia; potassium sparing diuretics - potassium supplements
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Sarcoid

14. 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!)
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Hyperkalemia; potassium sparing diuretics - potassium supplements
CGD; t cell dysfxn (diGeorge)

15. When is acid phosphatase elevated (Name two times)?
Skin flushing and warmth; prostaglandins; give with aspirin
Anterior nares
Prostate tumor and increased osteoclast activity
Increase lymphatic drainage!

16. What is the precursor protein to beta amyloid and On what chromosome is it found?
Hypertension - edema - and proteinuria
MAO inhibitors; wine and cheese
Env genes (for getting into target cells)
APP on chrom 21 (this is why downs more susceptible)

17. What test would be best to determine if a gene is being transcribed? translated?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
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
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Southern - western

18. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Close but purkinje system to ensure contraction in a bottom up fashion
Acute gastric mucosal defects (superficial or full thickness)

19. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Brief psychotic disorder; schizophreniform; schizophrenia
Class I
Nocardia

20. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Pain reliever - reduces pain by locking substance P in the PNS
differentiate
No and yes

21. in the LV and aorta - What are the pressures?
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Normally close to systolic
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)

22. which two virus families have hemagluttinin on their surface?
Paramyxo and influenza
4 - 4 - 9
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Class I

23. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
Class I
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Large stroke volumes with ventricular contraction; aortic regurg
V fib; v. failure

24. What is used to compare means? categorical outcomes?
low in serum
T test; chi squared
<1% - 55% - concentration dependent
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR

25. What are some of the permissive effects of cortisol?
Hypothyroidism
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
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
Increases bronchial and vascular smooth muscle reactivity to catecholamines

26. which viruses require a protease?
Sickle cell; G6PD
SS +rNA
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
II; I (I more abundant)

27. a patient fearing all white coats is a phenomenon of what?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
CMV - HSV 1 - Candida
Classical conditioning

28. which nerve provides innervation for plantar flexion and inversion?
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Tibial
Vagus (auricular branch); vasovagal syncope!
Smoking

29. What is the presentation of angioedema? Where is most commonly affected?
Coagulation factors are made in the liver
200-500
I is more benign and can present later in adulthood
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

30. What three factors effect total oxygen content of blood?
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
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
P53 mutation; DCC is also required for adenoma to carcinoma
Circular - outside nucleus; transport proteins - rRNA - tRNA

31. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
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
Because gamma chains replace beta chains and then gamma chain formation wanes
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

32. what phase do adenosine and acetylcholine act on? doing what?
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
25; 25
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Vagus (auricular branch); vasovagal syncope!

33. What can too much IgA in serum produces?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
S3 gallop; S2 to opening snap interval
Close but purkinje system to ensure contraction in a bottom up fashion
Southern - western

34. What is the most common initital symptom of ADPKD? what else?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
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

35. how does achalasia present? What does barium swallow show on dilated esophagus?
GI tract; mood!
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
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
Joints d/t increased purine production and thus uric acid production

36. in B12 deficiency - what levels in blood rise very quickly and then drop?
C3 decreased after 5-10 days; sulfonamides
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
GI tract; mood!
Reticulocytes

37. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
No (unlike adenomyosis); yes
Become beta pleated and then form neurofibrillary tangle!
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)

38. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Elastance
Valproate
Curlings ulcers
Gluteus maximus; difficulty getting up from seated position and climbing chair

39. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Right before diastole (filling begins)
C3 decreased after 5-10 days; sulfonamides
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Superior larygeal; cricothyroid; recurrent laryngeal

40. which cells produce surfactant? which ones mediate gas exchange?
Measles and M3 AML`
Bronchogenic carcinoma
II; I (I more abundant)
liver specific

41. what dissolves the lipid bilayer of a viral envelope?
Ether and other organic solvents
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Retinitis; mononucleosis

42. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Vascular endothelium; protease
High potassium conductance and some sodium conductance
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

43. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
SaO2 <92%
Atrial
Increase by 50% in urine osmolality

44. which trisomy is associated with endocardial cushion defects? What does thsi mean>
Downs; regurgitant AV valves - ASDs
Circular - outside nucleus; transport proteins - rRNA - tRNA
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
INTRApartum Abs (ampicillin/penicillin)

45. other than proteinuria - What can cause foamy froathy urine?
Bile salt accumulation in urine
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
V fib; v. failure
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

46. what color pigmentations are caused by malassezia furfur? when do they become more visible?
Anterior nares
Decreases both
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Hypo or hyper pigmentations; after tanning

47. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
P450 mitochondrial monooxygenase
Prepatellar
RBC mass; epo levels (secondary has high)
SSRI

48. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Fibronectin - laminin - collagen
Vagus nerve stimulation
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

49. What does 'oxygen' content in blood refer to?
Dissolved in plasma and attached to Hgb
Acute gastric mucosal defects (superficial or full thickness)
Tissue redistribution (out of plasma) rather than metabolism
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)

50. what Cardiac condition does the valsalva maneuver abolish? how? what muscle is most important?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Think Hb deformation diseases
SVT; increases vagal tone; rectus abdominis
Tzanck smear

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USMLE Prep 2

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