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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 are some of the permissive effects of cortisol?
No; MRI
200-500
Enterococci (e. faecalis)- found on genitalia area
Increases bronchial and vascular smooth muscle reactivity to catecholamines

2. when do ghon complexes form - primary or secondary TB?
Primary
8 (myc protein) with 2 - 14 - 22 (iG chains)
Strength of cell mediated immune response
TSh (in testicular tumors can cause hyperthyroidism)

3. In what view of CXR is anterior part of heart best seen? anterior part of heart is formed by?right border of heart is formed by? left border?
ATP binding (resets the myosin head to contract again for next binding)
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting
Lateral; RV; RA; LV
CGD; t cell dysfxn (diGeorge)

4. What is the mc location for avascular necrosis? What is it associated with?
Vagus (auricular branch); vasovagal syncope!
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -

5. what vessel would a fracture to the neck of the of the humerus damage?
Extrinsic def; instrinsic def; platelet def
Purkinje system; AV node
Not lined by epithelium
Anterior circumflex (and axillary nerve)

6. which anti epileptic is preferred in patients with both absence and tonic clonic seizures?
Tibial
Valproate
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
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage

7. lipid filled plaques in which arteries does thigh claudication suggest? difficulty sustaining an erection?
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
Enterococci (e. faecalis)- found on genitalia area
Barium enema
ANCA because of lack of Ig and C3 deposits on IF

8. What causes vertical diplopia? horizontal?
8; 12
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Trochlear nerve (IV); abducens nerve (VI)
Fibronectin - laminin - collagen

9. What is the diagnosis in delayed puberty plus anosmia?
Kallmans
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Neisseria induced small cell vasculitis (including hands and soles)
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

10. is Rifampin ever used as monotherapY? why either way?
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Enterococci (e. faecalis)- found on genitalia area
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
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

11. What is the neurologic manifestation of ADPKD?
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Tzanck smear
women
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)

12. What is the inherited defect in LiFraumeni syndrome? What is the mode of inheritance?
Little effect on cell and no change
TSh (in testicular tumors can cause hyperthyroidism)
P53 mutation; AD
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

13. What are the three dopaminergic systems and What are they responsible for? disease?
HSV and VZV
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
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Chrom 8

14. What are three symptoms in s.typhi?
INTRApartum Abs (ampicillin/penicillin)
Folic acid treatment!
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects
Rose spots on abdomen - hepatosplenomegaly - hemorrhagic enteritis (with possible perforation)

15. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
Gluteus medius and minimus; positive trendelenberg
Serum FFA and serum triglyceride levels
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
Turbulence

16. What aa is NAD+ coenyzme synthesized endogenously from? What does def cause?
OCPs - multiparity - breast feeding
Bile soluble which means they are bile sensitive
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Demargination of neutrophils from the vessel walls

17. what happens to capacitance with age?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
No; MRI
...
Proteasome inhibitor; treatment for MM and waldenstroms

18. do patients with cor pulmonale have increased or decreased levels of aldosterone?
Because of the low output from heart failure - they will have increased aldosterone levels
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Around 70 (normal measured diastolic pressures); 9--
Medial circumflex artery; avascular necrosis

19. What is the sole neurologic manifestation of acute rheumatic fever?
Boiling - bleach - formalin - UV irradiation
Aortic root dilation or bicuspid aortic valve; diastolic murmur (right sternal border(
Sydenham chorea
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

20. What is medullary sponge kidney disease and how does it present? What does it lead to?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
Fibronectin - laminin - collagen
Serum FFA and serum triglyceride levels
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)

21. What is damaged in early syringomelia? later?
Folic acid treatment!
Retinitis; mononucleosis
Highly negative resting potential
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities

22. What does the inferior gluteal nerve innervate? how does damage to this nerve manifest?
Gluteus maximus; difficulty getting up from seated position and climbing chair
Tissue redistribution (out of plasma) rather than metabolism
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Undesirable effects that cause myocardial ischemia (increased HR and increased O2 consumption) are less (still there tho)

23. What is mcc of death pre hospital phase of MI? in hospital phase?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
V fib; v. failure
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system

24. What does TGF beta do? What produces it?
Susceptible; soluble (unable to be cultured in bile)
Amiadarone
Integration of viral DNA into genome of host hepatocytes
Fibrosis; macrophages

25. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
4 - 4 - 9
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Sarcoid

26. What is low levels of C1 esterase inhibitor diagnostic of? how can this be acquired?
Right heart failure
gram positive organisms
Hereditary angioedema; ACE inhibitors
Echinococcus granulosus; anaphylaxis

27. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
MAC complex (C5b - C9 complement deficiency)
Demargination of neutrophils from the vessel walls
Phencyclidine (PCP)
Elevated GGT and macrocytosis

28. which antiarrythmic is associated with blue gray discoloration ?
S. aureus
Amiadarone
At cochlear base near round and oval window; near apex of cochlea - helioctrema; high frequency sound
In the extracellular space

29. why should you not use ACE inhibitors with someone who had hereditary angioedema?
Rabies encephalitis from cave bats; rabies killed vaccines
Medullary
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol

30. What is suggestive of complete central DI?
Obstruction because they infiltrate the intestinal wall and encircle causing decrease in size of lumen - constipation - abdominal distension - abdominal pain - changes in stool caliber; right sided are often exophytic masses iron def anemia and syste
HSV and VZV
Tibial
Increase by 50% in urine osmolality

31. Where is conduction in heart fastest? slowest?
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Purkinje system; AV node
Octreotide
Classical conditioning

32. What do you treat s. epidermidis with?
Vancomycin
Well
The time interval between S2 and OS- the shorter the interval - the more intense
SSRI; erectile dysfunction

33. What is the most common congenital adrenal hyperplasia? What does the enzyme convert What to what? and What is the presentation?
Fibronectin - laminin - collagen
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Hydrogen bonds dictate alpha or beta structure
21 hydroxylase deficiency; progesterone to 11 deoxycorticosterone; ambiguous genitalia in females and salt wasting

34. 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?
Downs; regurgitant AV valves - ASDs
Hyperkalemia; potassium sparing diuretics - potassium supplements
Single adenomatous ones
10-14 days; coagulation and marginal contraction band necrosis; collagen formation; coagulation necrosis and neutrophilic infiltrate; nothing to see; 4-12 hours

35. on What part of the clavicle does the SCM attach?
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Increases bronchial and vascular smooth muscle reactivity to catecholamines
Around 70 (normal measured diastolic pressures); 9--
Medial part

36. which viruses require a protease?
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
SS +rNA
RBC mass; epo levels (secondary has high)
Hypothyroidism

37. prostaglandin synthesis keeps...
Common peroneal; bony fractures and compression; sciatic
PDA open
Both sides
Another type of aldosterone antagonist (like spironolactone)

38. What is the mainstay treatment for acute mania?
Classical conditioning
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Aromatase deficiency in child
OCPs - multiparity - breast feeding

39. What causes release of myosin head from the actin filament?
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
ATP binding (resets the myosin head to contract again for next binding)
Close but purkinje system to ensure contraction in a bottom up fashion
Drink plenty of fluids

40. Where does vit C act in the hydroxylation of lysine residues for collagen? What is the cofactor required?
RER; copper
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
OCPs - multiparity - breast feeding
Octreotide

41. sporadic colon cancer tend to arise From what type of polyps?
Single adenomatous ones
Turners`
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
Inactivates kallikrein which activates kininogen into bradykinin

42. What effects does cortisol have on catecholamines?
IgE
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
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
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

43. what indicates the severity of a mitral regurg ? mitral stenosis?
S3 gallop; S2 to opening snap interval
Primary
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Joints d/t increased purine production and thus uric acid production

44. within the right ventricle - What are maximum pressures? the pulm arter?
Increase in permeability of two ions with equal and opposite equilibrium potentials
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
25; 25
TSh (in testicular tumors can cause hyperthyroidism)

45. what clinical findings help distinguish small cell carcinoma?
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
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

46. in essential fructosuria - what enzyme do patients use to metabolize fructose?
CMV - HSV 1 - Candida
Squatting - sitting - lying supine - passive leg raising
Vertical diplopia
Hexokinase

47. hemaglobin and hematocrit levels cannot __________ between relative and absolute erythrocytosis
differentiate
Prevents hepatic VLDL production
Excessive collagen formation during tissue repair in susceptible individuals
Vancomycin

48. What is omalizumab and What is it used for?
The term used to describe decreased drug responsiveness with repeated administration
Relfex tachycardia; giving beta blockers
MAB to igE antibodies; sever allergic asthma - effectivein reducing dependency on both oral and inhaled steroids
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

49. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Clindamycin; covers anaerobic oral flora and aerobic bacteria
11
Boiling - bleach - formalin - UV irradiation
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)

50. what pathology is found around the illeo cecal valve and presents in 2 year old children with colicky abdominal pain and currant jelly stools?
Intussusception
Sarcoid
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Boiling - bleach - formalin - UV irradiation