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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 is the mc location for avascular necrosis? What is it associated with?
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
Acute interstitial nephritis
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Varying; erythema nodosum is common

2. why does liver dysfunction cause coagulation disorders?
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
T test; chi squared
Coagulation factors are made in the liver
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

3. What are the two coagulase negative staphylococci? How do you distinguish them?
Aromatase deficiency in child
Ketone body production by preventing fatty acids into the mitochondria
Dissolved in plasma and attached to Hgb
S. saprophyticus - and s. epidermidis; novobiocin

4. What is the mcc of elevated AFP leves in pregnancy>
Underestimation of gestational age
Nocardia
Paramyxo and influenza
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

5. What does the severity of leprosy depend on?
Strength of cell mediated immune response
Fibronectin - laminin - collagen
4 - 4 - 9
Closer to head; closer to diaphragm

6. What are the two growth factors associated with angiogenesis?
FGF and VEGF
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Superior larygeal; cricothyroid; recurrent laryngeal
Thymic tumor

7. What is Tzanck smear used to detect?
Bile salt accumulation in urine
HSV and VZV
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
Ceftriaxone; azithromycin

8. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
RER; copper
Gluteus medius and minimus; positive trendelenberg
gram positive organisms
Radial nerve damage

9. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Common peroneal; bony fractures and compression; sciatic
Because gamma chains replace beta chains and then gamma chain formation wanes

10. what provides some cutaneous sensation to the posterior external auditory canal? What can happen if pressure is put there?
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
Vagus (auricular branch); vasovagal syncope!
Env genes (for getting into target cells)
Mean greater than median greater than mode

11. What does prolonged PT indicated? aPTT? bleeding time?
Extrinsic def; instrinsic def; platelet def
Class I
Underestimation of gestational age
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)

12. which RPGN is also called pauci immune GN? why?
E. coli
Varying; erythema nodosum is common
Medullary
ANCA because of lack of Ig and C3 deposits on IF

13. what receptors do first generation anti histamines block?
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
frameshift mutations (missense is substitution)
Vancomycin; histamine mediated
Medial part

14. 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
Measles and M3 AML`
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Demargination of neutrophils from the vessel walls

15. What are the three dopaminergic systems and What are they responsible for? disease?
Another type of aldosterone antagonist (like spironolactone)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
INTRApartum Abs (ampicillin/penicillin)

16. What is the mc malignancy in asbestosis?
Bronchogenic carcinoma
Mean greater than median greater than mode
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
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

17. What antibodies are present in CREST? What is the most specific?
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)
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
Anti centromere; anti DNA topoisomerase

18. in overweight individuals What is thought to contribute to insulin resistance?
Curlings ulcers
Integration of viral DNA into genome of host hepatocytes
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Serum FFA and serum triglyceride levels

19. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Become beta pleated and then form neurofibrillary tangle!
Well trained athletes and children

20. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Susceptible; soluble (unable to be cultured in bile)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
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

21. What does nitroprusside do to afterload? preload?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Reiter syndrome; B27
Decreases both
By vascular permeability and vasodilation

22. which two virus families have hemagluttinin on their surface?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Chorda tympani branch
Paramyxo and influenza
8 (myc protein) with 2 - 14 - 22 (iG chains)

23. Where does terminal peptide cleavage of collagen fibrils take place?
In the extracellular space
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Turbulence

24. what hormone is structurally similar to hCG?
Gluteus medius and minimus; positive trendelenberg
TSh (in testicular tumors can cause hyperthyroidism)
LT (LTD4 - E4 - C4) - and Ach
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound

25. What is the diagnosis in delayed puberty plus anosmia?
C3 decreased after 5-10 days; sulfonamides
Vagus (auricular branch); vasovagal syncope!
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)
Kallmans

26. Increase in lung cancer incidence and mortality has been observed in _____ over last four decades
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
Medullary
women
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

27. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
Clindamycin; covers anaerobic oral flora and aerobic bacteria
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)
differentiate

28. why does variocele occur more in left side?
chronic urticaria and allergic symptoms
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Terminal bronchioles; small bronchi

29. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
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
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

30. What agonists reduce the gradient across the LV outflow tract?
Decreases both
Echinococcus granulosus; anaphylaxis
Selective alpha 1 (increases SVR)
T test; chi squared

31. What do you treat s. epidermidis with?
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Vancomycin
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
Tryptophan; pellagra (diarrhea - dementia - dermatitis)

32. What is dobutamine? What is it used for?how it is it most helpful? What is bad about it?
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
Increase in permeability of two ions with equal and opposite equilibrium potentials
Biphosphonate
S3 gallop; S2 to opening snap interval

33. When is acid phosphatase elevated (Name two times)?
Vancomycin; histamine mediated
Increases cytokine production
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Prostate tumor and increased osteoclast activity

34. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
P53 mutation; DCC is also required for adenoma to carcinoma
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
C3 decreased after 5-10 days; sulfonamides

35. What is the mcc of nephrotic syndrome in children and can occur in adults as wel?
Minimal change disease
Anti centromere; anti DNA topoisomerase
Around 70 (normal measured diastolic pressures); 9--
Because gamma chains replace beta chains and then gamma chain formation wanes

36. What is a cardiac cause of head pounding with exertion and nocturnal palpitations? What can cause this?
(urine PAH x urine flow rate)/plasma PAH
Large stroke volumes with ventricular contraction; aortic regurg
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

37. What type of vision is myopia? In What type of patients does it improve?
Syringomelia
Coagulation factors are made in the liver
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
indomethacin

38. What is the presentation of sever aortic stenosis?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Syncope - angina - dyspnea (SAD)
Squatting - sitting - lying supine - passive leg raising

39. How do you calculate atributable risk percent?
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
RR-1/RR
Thymic tumor
Turbulence

40. What is achalasia and how would this correlate on the esophageal mannometry?
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
(urine PAH x urine flow rate)/plasma PAH
Purkinje system; AV node
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

41. What are the primary determinants of colon cancer risk in UC patients
Anterior circumflex (and axillary nerve)
Excessive collagen formation during tissue repair in susceptible individuals
Duration and extent of disease
Phencyclidine (PCP)

42. What are some side effects seen in TCAs?
Common peroneal; bony fractures and compression; sciatic
Multiple miscarriages d/t hypercoaguability
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

43. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Medullary
Intussusception
Hexokinase
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use

44. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
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
RR-1/RR
In ER of bile canaliculi

45. What does protein M do in Group A strep<
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Drink plenty of fluids
Prevent phagocytosis
Dihydropyridine sensitive Ca channels (L type)

46. What is diphenoxylate and What is it used for? what drug is it structurally similar to? What allows for potent anti diarrheal effect without signigicant opiate effects?
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)
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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Circular - outside nucleus; transport proteins - rRNA - tRNA

47. Which is faster purkinje system or atrial muscle?
Biphosphonate
Retinitis; mononucleosis
Close but purkinje system to ensure contraction in a bottom up fashion
Coagulation factors are made in the liver

48. What would a deflection of the membrane potential to near zero indicate?
ANCA because of lack of Ig and C3 deposits on IF
Selective alpha 1 (increases SVR)
Increase in permeability of two ions with equal and opposite equilibrium potentials
Vertical diplopia

49. What is the stabilizing force for the secondary structure of proteins?
low in serum
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Hydrogen bonds dictate alpha or beta structure
Folic acid treatment!

50. which nucleus releases serotonin?
Lateral; RV; RA; LV
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Raphe
Multiple miscarriages d/t hypercoaguability