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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. What is the precursor protein to beta amyloid and On what chromosome is it found?
Serum FFA and serum triglyceride levels
V fib; v. failure
Enterococci (e. faecalis)- found on genitalia area
APP on chrom 21 (this is why downs more susceptible)

2. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Close but purkinje system to ensure contraction in a bottom up fashion
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
Hereditary angioedema; ACE inhibitors

3. Where does terminal peptide cleavage of collagen fibrils take place?
ANCA because of lack of Ig and C3 deposits on IF
In the extracellular space
LT (LTD4 - E4 - C4) - and Ach
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)

4. What is medullary sponge kidney disease and how does it present? What does it lead to?
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
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)
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

5. What would a deflection of the membrane potential to near zero indicate?
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Increase in permeability of two ions with equal and opposite equilibrium potentials
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Anti - apoptotic (prevents going into apoptosis)- 18; 14

6. what hernia has a similar mechanism to hydrocele?
Increases
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
By vascular permeability and vasodilation

7. what makes bruits?
Turbulence
Cluster
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Bile salt accumulation in urine

8. What is a limiting factor when initiating ACE inhibitors? hwo do you prevent a really bad reaction?
Normal; low
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Classical conditioning
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

9. nucleotide deletions do not cause missense mutations - they cause...
Minimal change disease
frameshift mutations (missense is substitution)
Abnormal closing of the urethral folds
P450 mitochondrial monooxygenase

10. at three years of age What are social - fine motor - gross motor and language developments?
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
...
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

11. when arrested in prophase of meiosis I - What are primary oocytes chrom number? What about the secondary oocytes that are stuck in metaphase of Meiosis II?
46 - 4N; 23 2N
Ketone body production by preventing fatty acids into the mitochondria
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
PDA open

12. other than in pyelonephritis - where else are WBC casts seen?
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
Headaches and facial flushing; vasodilation in meninges and skin
Highly negative resting potential
Acute interstitial nephritis

13. in treating an anemia and erythropoiesis results - what would you expect to see in peripheral blood findings transiently?
Increased reticulocytes
Purkinje system; AV node
Headaches and facial flushing; vasodilation in meninges and skin
Drink plenty of fluids

14. When does neovascularization granulation tissue begin to form after severe ischemia and MI? what happens in 12-24 hours? 2 weeks to 2 months? 1-5 days? 0-4 hours? when do you see edema - hemorrhage - wavy fibers?
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Lateral; RV; RA; LV
Bile salt accumulation in urine
CGD; t cell dysfxn (diGeorge)

15. What does p53 do? what chrom is it on?
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
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Env genes (for getting into target cells)
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

16. What does VIP do to gastric acid secretion?
Normally close to systolic
Inhibits it
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Ether and other organic solvents

17. What is the mc location of brain germinomas?What are the classic symptoms?
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Reiter syndrome; B27

18. on What part of the clavicle does the SCM attach?
No
Medial part
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Because of the low output from heart failure - they will have increased aldosterone levels

19. What are diastolic (lowest) pressures in aorta? LV?
Around 70 (normal measured diastolic pressures); 9--
Terminal bronchioles; small bronchi
MAO inhibitors; wine and cheese
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

20. Would alpha 1 agonists cause flushing? muscarinic antagonist?
No; yes
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia

21. What does anti phospholipid syndrome in SLE patients predispose them to?
Adeno
Multiple miscarriages d/t hypercoaguability
TCAs and prazosin
Barium studies and colonoscopy can cause perforation just use plain abdominal xray

22. where are the vegetations on the valves of a libman sacks endocarditis?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Both sides
Increase by 50% in urine osmolality
low in serum

23. SIADH patients have normal blood volume but...
hyponatremia (aldosterone activation equilibrates body volume)
Around 70 (normal measured diastolic pressures); 9--
Env genes (for getting into target cells)
Lack of calcium to bind oxaloacetate; crohns prevents fat absorption from lack of bile reabsorption in the terminal illeum which leads to fats pulling calcium and lack of calcium reabsorption

24. What is the presentation of sever aortic stenosis?
On cardiac tissue and renal juxtaglomerular cells
Bile soluble which means they are bile sensitive
Syncope - angina - dyspnea (SAD)
Sodium escape due to ANP activation results in no edema; edema is the precipitating factor

25. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Appetite suppressants
No (unlike adenomyosis); yes
Protamine sulfate
S. aureus

26. What type of antiarrythmics can protect against both atrial and ventricular arrythmias?
Thymic tumor
ZDV or AZT
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Class I

27. why does liver dysfunction cause coagulation disorders?
Inhibits it
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Coagulation factors are made in the liver

28. what chromosome is c - myc found on?
Rabies encephalitis from cave bats; rabies killed vaccines
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
P53 mutation; AD
Chrom 8

29. What is cataplexy and When is it seen?
Sudden loss of muscle tone without loss of consciousness; narcolepsy
Drink plenty of fluids
Right heart failure
only up to bronchi

30. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Tissue redistribution (out of plasma) rather than metabolism
Hypothalamus and pituitary; dopaminergic tonic inhibition of prolactin
Fat - fertile - forty - female
Because of the low output from heart failure - they will have increased aldosterone levels

31. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
Trochlear nerve (IV); abducens nerve (VI)
Joints d/t increased purine production and thus uric acid production
RER; RER
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

32. which type of glands produce an initially odorless secretion but can become malodorous secondary to bacterial decompisition on the skin surface? which glands are present throughout the skin except on lips and glans penis?
Apocrine; eccrine
Paramyxo and influenza
E6 and E7 of HPV knock off p53 and Rb suppressor genes
SVC and IVC; right below the aortic knob

33. how does eos release MBP to kill protozoa etc?
Rabies encephalitis from cave bats; rabies killed vaccines
S. saprophyticus - and s. epidermidis; novobiocin
Integration of viral DNA into genome of host hepatocytes
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC

34. What is achalasia and how would this correlate on the esophageal mannometry?
Both sides
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
RBC mass; epo levels (secondary has high)
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

35. What are the primary determinants of colon cancer risk in UC patients
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours
Duration and extent of disease
4 - 4 - 9
Raphe

36. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
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
Terminal bronchioles; small bronchi
Not lined by epithelium

37. In What type of nephritis would you see high serum eos count?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Drug induced interstitial nephritis
4 - 4 - 9
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities

38. What is it called if psychotic symptoms last less than one month? one to six months? more than six months?
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Brief psychotic disorder; schizophreniform; schizophrenia
Abnormal closing of the urethral folds
Normal pulmonary capillary wedge pressure (used for LA pressure measurement)

39. What can worse neurologic dysfunction in cobalamic def?
Folic acid treatment!
Serum FFA and serum triglyceride levels
ZDV or AZT
transcription activation/suppression

40. why is glucagon used in beta blocker toxicitiy?
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
11
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)

41. why are beta thal major patients asymptomatic at birth?
Because gamma chains replace beta chains and then gamma chain formation wanes
V fib; v. failure
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
ZDV or AZT

42. What are the first generation anti histamines?
Hypo or hyper pigmentations; after tanning
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)
Chlorpheniramine and diphenhydramine
No; yes

43. What is the difference between paranoid personality disorder and delusional disorder?
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Barium studies and colonoscopy can cause perforation just use plain abdominal xray
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
(urine PAH x urine flow rate)/plasma PAH

44. What are the two growth factors associated with angiogenesis?
Cluster
FGF and VEGF
NF- KB; responsible for cytokine production
Vascular endothelium; protease

45. What is the most important prognostic indicator in patients with malignant melanoma?
Cluster
Measure of depth invasion (vertical!)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
transcription activation/suppression

46. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Chorda tympani branch

47. What three things can reduce the risk of non hereditary ovarian and endometrial cancer?
OCPs - multiparity - breast feeding
Pan colitis and right sided colitis (more than left sided and proctitis)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Susceptible; soluble (unable to be cultured in bile)

48. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
S3 gallop; S2 to opening snap interval
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Hyperkalemia; potassium sparing diuretics - potassium supplements
Gluteus maximus; difficulty getting up from seated position and climbing chair

49. does congenital renal hypoplasia cause secondary hypertension? how about unilateral renal artery stenosis?
Enterococci (e. faecalis)- found on genitalia area
Retinitis; mononucleosis
No and yes
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases

50. What is used to prevent vertical transmission of HIV?
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Dihydropyridine sensitive Ca channels (L type)
Sydenham chorea
ZDV or AZT

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