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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 omalizumab and What is it used for?
glycerol kinase
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Minimal change disease
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids

2. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
women
Congenital hypothyroidism - downs - amyloidosis - acromegaly
E. coli; staphylococcus saprophyticus
G to T in p53; HCC

3. What are two common side effects of both acute and long acting nitrates? What causes them?
Headaches and facial flushing; vasodilation in meninges and skin
ATP binding (resets the myosin head to contract again for next binding)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Little effect on cell and no change

4. What is the Na/Ca exchange used for?
200-500
Octreotide
AV node slowest - to allow time for diastole
To pump calcium out in cardiac myocytes so that relaxation occurs

5. What is hypospadias caused by?
Tissue redistribution (out of plasma) rather than metabolism
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
Abnormal closing of the urethral folds
only up to bronchi

6. what happens to sperm count and semineferous tubules in patient with cryptoorchidism? hormonal function? why do they need to be surgically descended?
Underestimation of gestational age
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
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
Drug induced interstitial nephritis

7. what nerve and artery course along the posterior aspect of the humerus?
Localized dermatologic pain that persists for more than one month after zoster eruption
Permissive - sensitizes vasoconstrictive response from catecholamines - doesnt actually act on them but increases transcription of some genes that creates permissive effect (not additive or synergistic becuase cortisol alone doesnt have any effect on
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Radial nerve and deep brachial artery

8. What translocations can cause c - myc overexpression?
Tzanck smear
8 (myc protein) with 2 - 14 - 22 (iG chains)
Strength of cell mediated immune response
Underestimation of gestational age

9. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Large stroke volumes with ventricular contraction; aortic regurg
Reticulocytes
No; yes
Gluteus medius and minimus; positive trendelenberg

10. What is tachyphylaxis?
S. aureus
II; I (I more abundant)
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
The term used to describe decreased drug responsiveness with repeated administration

11. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
Congenital hypothyroidism - downs - amyloidosis - acromegaly
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
Turbulence

12. what happens to PaO2 - % sat - and O2 content in: Anemia - polycythemia - CO poisoning?
Leukotriene precursor and does neutrophil chemotaxis
Normal - normal - decreased; normal - normal - increased; normal - decreased - decreased
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
Around 70 (normal measured diastolic pressures); 9--

13. what commonly happens in GI in response to acute physiologic stress?
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
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)
Acute gastric mucosal defects (superficial or full thickness)
Hyperkalemia; potassium sparing diuretics - potassium supplements

14. What is easiest way to treat nephrolithiasis?
Elevated GGT and macrocytosis
Drink plenty of fluids
Thymic tumor
Integration of viral DNA into genome of host hepatocytes

15. which trisomy is associated with endocardial cushion defects? What does thsi mean>
SS +rNA
Circular - outside nucleus; transport proteins - rRNA - tRNA
Downs; regurgitant AV valves - ASDs
Leukotriene precursor and does neutrophil chemotaxis

16. What is the mc location of brain germinomas?What are the classic symptoms?
women
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
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

17. at one year of age - What are the social - fine motor - gross motor and language developments?
GI malignancies and Insulin resistance (acromegal for ex)
Initiation - pointing; pincer grasp; walking; mama/dada
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
chronic urticaria and allergic symptoms

18. What is the diagnosis in delayed puberty plus anosmia?
Measles and M3 AML`
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Kallmans
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

19. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
No (unlike adenomyosis); yes
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
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)
200-500

20. In what form are mitochondrial DNA? What do they transcribe?
Dihydropyridine sensitive Ca channels (L type)
25; 25
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
Circular - outside nucleus; transport proteins - rRNA - tRNA

21. Where does the aorta lie in relation to the pulmonary artery in transposition of the great arteries (is this right to left or left to right shunt?)?
Elevates ASO titers; elevated anti DNAase B titers; decreased C3 and total complement levels and presence of cryoglobulins (C4 normal)
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
ANCA because of lack of Ig and C3 deposits on IF
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt

22. other than mycobacterim wha other bacteria is acid fast?
Nocardia
Localized dermatologic pain that persists for more than one month after zoster eruption
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
S3 gallop; S2 to opening snap interval

23. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Coagulation factors are made in the liver
MAO inhibitors; wine and cheese
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Apocrine; eccrine

24. what marker should be followed in a patient with cirrhosis?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Prostate tumor and increased osteoclast activity
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Nuclei pushed to periphery and nissl susbstance widely dispersed (increased protein repair); axonal reaction; Wallerian degeneration

25. Which branch of the facial nerve provides taste from ant 2/3 of tongue?
<1% - 55% - concentration dependent
Serum creatine kinase; reperfusion injury causes necrosis
Chorda tympani branch
Right before diastole (filling begins)

26. What is the most common cause of hydatid cysts in humans? What does spilling of cysts cause?
Echinococcus granulosus; anaphylaxis
SVT; increases vagal tone; rectus abdominis
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Sickle cell; G6PD

27. What are pancreatic pseudocysts called pseudo rather than true cysts?
RBC mass; epo levels (secondary has high)
Not lined by epithelium
Prevents hepatic VLDL production
Reiter syndrome; B27

28. What three factors effect total oxygen content of blood?
Medullary
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Dihydropyridine sensitive Ca channels (L type)
Another type of aldosterone antagonist (like spironolactone)

29. What is it called when you see double vision when walking down stairs or looking at nose or reading newspaper?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
Vertical diplopia
Normally close to systolic
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

30. non ceruloplasmin deposition - ceruloplasmin is...
Increases cytokine production
II; I (I more abundant)
When it invades the bm; carcinoma in situ
low in serum

31. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Reiter syndrome; B27

32. which RPGN is also called pauci immune GN? why?
Medullary
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
ANCA because of lack of Ig and C3 deposits on IF
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

33. 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
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics
TSh (in testicular tumors can cause hyperthyroidism)
Regular insulin (Not fast acting - regular better)

34. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Extrinsic def; instrinsic def; platelet def
Intussusception
Spongiosis
SS +rNA

35. what stimulates bicarb secretion from the pancreas? Where is this hormone produced?
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)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Insulin like growth factor 1 (just another name)
Class I

36. What does C1 esterase do other than inhibiting complement pathway?
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Inactivates kallikrein which activates kininogen into bradykinin
Classical conditioning
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately

37. Metronidizaole does not cover...
Radial nerve and deep brachial artery
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
gram positive organisms
Spongiosis

38. What is the mcc of asymmetric inflammatory arthiritis of the lower extremities in young men? what HLA association?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Reiter syndrome; B27
By IgE activation (IgE binds to them as they are in the blood and then bind to Fc receptor on eos)- ADCC
Fibrosis; macrophages

39. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
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)
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Prevent phagocytosis
Integration of viral DNA into genome of host hepatocytes

40. what virus causes pharyngoconjuctival fever?
Adeno
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
Apocrine; eccrine
Smoking

41. What can differentiate between relative and absolute erythrocytosis? What can distinguish between primary and secondary erythrocytosis (both absolute mind you)?
In the extracellular space
RBC mass; epo levels (secondary has high)
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
Protamine sulfate

42. what happens to capacitance with age?
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Toxoplasmosis and primary CNS lymphoma (EBV B cell induced)
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
...

43. What is difference between Arnold Chiari type I and II?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Recurrent larygneal
I is more benign and can present later in adulthood
...

44. what hernia has a similar mechanism to hydrocele?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

45. What is the most common initital symptom of ADPKD? what else?
Terminal bronchioles; small bronchi
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria

46. What are the long term consequences of hydrocephalus?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
HSV ( also in utero: chlymadia - neisseria - group B strep)
Increase lymphatic drainage!
RBF= PAH clearance/(1- hematocrit)

47. what has the greatest effect on prognosis when treating c. diptheriae?
Pulmonary hypertension
S. saprophyticus - and s. epidermidis; novobiocin
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

48. What type of cancer is keratin swirls indicative of ? What is the prognosis of this cancer in the esophagus? What is it associated with?
Rabies encephalitis from cave bats; rabies killed vaccines
PDA open
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Radial nerve and deep brachial artery

49. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
11 aa polypeptide; pain NT in CNS and PNS
Hereditary angioedema; ACE inhibitors
Measles and M3 AML`
RBC mass; epo levels (secondary has high)

50. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
C3 decreased after 5-10 days; sulfonamides
Pan colitis and right sided colitis (more than left sided and proctitis)
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)
Selective alpha 1 (increases SVR)