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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. which RPGN is also called pauci immune GN? why?
ANCA because of lack of Ig and C3 deposits on IF
Elastance
Integration of viral DNA into genome of host hepatocytes
Extrinsic def; instrinsic def; platelet def

2. What causes congenital QT prolongation syndrome? What is death caused by? in one of the syndromes - What is a common other symptom?
Medullary
TSh (in testicular tumors can cause hyperthyroidism)
Mesolimbic - mesocortical (behavior); nigrostriatal (coordination of voluntary movements); tuberoinfundibular (inhibition of prolactin); resp: schizophrenia - parkinsonism - hyperprolactinemia
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness

3. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
SVC and IVC; right below the aortic knob
Hgb concentration - PaO2 (pp of O2 dissolved in blood) - and SaO2
Both sides

4. at four years of age - What are the social - fine motor - gross motor - and language developments?
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Cooperative play - toilet use; dresses self with help; running without difficulty; complex sentences with pronoun and plural use
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
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

5. What type of bond is a disulfide bond?
Syncope - angina - dyspnea (SAD)
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
SVC and IVC; right below the aortic knob
Covalent (between two cysteines)- allows protein to withstand denaturation

6. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Normally close to systolic
P53 mutation; AD

7. What causes release of myosin head from the actin filament?
Superior larygeal; cricothyroid; recurrent laryngeal
Tryptophan; pellagra (diarrhea - dementia - dermatitis)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
ATP binding (resets the myosin head to contract again for next binding)

8. If a patient has higher levels of HbF - What does this mean?
Echinococcus granulosus; anaphylaxis
Think Hb deformation diseases
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Classical conditioning

9. metabolism of 1 gram of protein produces How many calories? carb? fat?
Increase in permeability of two ions with equal and opposite equilibrium potentials
4 - 4 - 9
Fat - fertile - forty - female
Normal; low

10. which staphylococci can do mannitol fermaentation?
CGD; t cell dysfxn (diGeorge)
S. aureus
E. coli
Little effect on cell and no change

11. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
E. coli; staphylococcus saprophyticus
Minimal change disease
Because gamma chains replace beta chains and then gamma chain formation wanes
Relfex tachycardia; giving beta blockers

12. what immune deficiency causes recurrent neisseria infections?
MAC complex (C5b - C9 complement deficiency)
No; yes
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin
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

13. What causes alpha helical proteins in alzheimers to become insoluble and prone to aggregating?
GI malignancies and Insulin resistance (acromegal for ex)
Leukotriene precursor and does neutrophil chemotaxis
Become beta pleated and then form neurofibrillary tangle!
Vascular endothelium; protease

14. other than proteinuria - What can cause foamy froathy urine?
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
Minimal change disease
Mean greater than median greater than mode
Bile salt accumulation in urine

15. when do ghon complexes form - primary or secondary TB?
transcription activation/suppression
Amiloride - spironolactone - triamterene
On cardiac tissue and renal juxtaglomerular cells
Primary

16. which virus inactivates both Rb and p53?
Cluster
facultative intracellular
Demargination of neutrophils from the vessel walls
E6 and E7 of HPV knock off p53 and Rb suppressor genes

17. What almost exclusively causes Epliglottitis?What type of capsule does it have? What are the symptoms?

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18. What causes curlings ulcers?
Atrial
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Boiling - bleach - formalin - UV irradiation
Pulmonary hypertension

19. What does extended consumption of appetite suppressants lead to?
Cluster
Increase; decreased
Increases
Pulmonary hypertension

20. in the LV and aorta - What are the pressures?
8 (myc protein) with 2 - 14 - 22 (iG chains)
Normally close to systolic
Spongiosis
Primary

21. What is capacitance inversely proportional to?
Brief psychotic disorder; schizophreniform; schizophrenia
Elastance
Decreases both
When it invades the bm; carcinoma in situ

22. 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)
Ether and other organic solvents
Atrial
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD

23. What is a major risk factor for progression ARDS? What is the pathology seen in ARDS- d/t what?
I is more benign and can present later in adulthood
NF- KB; responsible for cytokine production
Atrial
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)

24. 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?
Lateral; RV; RA; LV
Anti centromere; anti DNA topoisomerase
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
Vancomycin

25. What is a primary HSV 1 infection like?
Reticulocytes
Spongiosis
Become beta pleated and then form neurofibrillary tangle!
More systemic with cervical lymphadenopathy and fever (in comparison to reactivation)

26. h1 receptor anatagonists are not effective in treatment of asthma only for...
11 aa polypeptide; pain NT in CNS and PNS
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
chronic urticaria and allergic symptoms
Trauma to stereociliated hair cells of the organ of corti

27. the rate of blood flow of which two circulations must equal each other at all times?
Apocrine; eccrine
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Pulmonic and systemic!
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress

28. How do bradykinin - C3a and C5a cause edema?
By vascular permeability and vasodilation
Echinococcus granulosus; anaphylaxis
DIC; TTP- HUS dont bleed that much
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus

29. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
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
RBC mass; epo levels (secondary has high)
Trochlear nerve (IV); abducens nerve (VI)
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)

30. What is the immune deficinecy seen in ataxia telangactasia?
Ig A deficiency
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
only up to bronchi
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17

31. carnitine deficiency impairs production of What and how?
Syncope - angina - dyspnea (SAD)
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!
Localized dermatologic pain that persists for more than one month after zoster eruption
Ketone body production by preventing fatty acids into the mitochondria

32. 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)
CGD; t cell dysfxn (diGeorge)
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
C3 decreased after 5-10 days; sulfonamides

33. What is hyaline arteriosclerosis usually a sign of ?
Neisseria induced small cell vasculitis (including hands and soles)
Prepatellar
Headaches and facial flushing; vasodilation in meninges and skin
Diabetic microangiopathy

34. What is 5- HETE and What does it do?
11
Leukotriene precursor and does neutrophil chemotaxis
Ovaries - testes - placental and other peripheral tissue (ie dont just think fat!)
Squatting - sitting - lying supine - passive leg raising

35. what marker should be followed in a patient with cirrhosis?
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Thymic tumor
Medial circumflex artery; avascular necrosis
<1% - 55% - concentration dependent

36. What does the severity of leprosy depend on?
Increases
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Strength of cell mediated immune response
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

37. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
Think Hb deformation diseases
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Tibial
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia

38. What does nitroprusside do to afterload? preload?
transcription activation/suppression
Pain reliever - reduces pain by locking substance P in the PNS
Decreases both
Sickle cell; G6PD

39. which congenital hyperbilirubinemia actually presents with serious symptoms? which are less serious/
Multiple miscarriages d/t hypercoaguability
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)
Fat - fertile - forty - female
CD31 (endothelial cell marker)- a PECAM for leukocyte migration actually!

40. hypertonicity and hyperreflexity are ________________ of hydrocephalus
manifestations - congenital (stretching of periventricular pyrimadal fibers)
Turbulence
Vomitting - NG suctioning - diuretic use - hyperaldosteronism; urinary chloride concentration
First dose hypotension (severe hyponatremia and hypovolemia); by checking for other diuretics

41. What is the only catecholamine that is made in only one place? where? By what enzyme? controlled by what?
Octreotide
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Vancomycin; histamine mediated

42. What is medullary sponge kidney disease and how does it present? What does it lead to?
Serum creatine kinase; reperfusion injury causes necrosis
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
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)
Phencyclidine (PCP)

43. What agonists reduce the gradient across the LV outflow tract?
Selective alpha 1 (increases SVR)
Think Hb deformation diseases
Neisseria induced small cell vasculitis (including hands and soles)
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

44. What is used to prevent vertical transmission of HIV?
ZDV or AZT
IgE
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
Paranoid personality disorder is a distrust that pervades all parts of the patients life as opposed to delusional disorder Which is one fixed delusion

45. What triggers the neoplastic changes that are associated with HBV infecton?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
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)
Integration of viral DNA into genome of host hepatocytes
S3 gallop; S2 to opening snap interval

46. What is the presentation of sever aortic stenosis?
Syncope - angina - dyspnea (SAD)
Selective alpha 1 (increases SVR)
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Vancomycin; histamine mediated

47. What can long term leg cast wearing cause?
Minimal change disease
To pump calcium out in cardiac myocytes so that relaxation occurs
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
Abnormal closing of the urethral folds

48. why should you not use ACE inhibitors with someone who had hereditary angioedema?
S. saprophyticus - and s. epidermidis; novobiocin
Vascular endothelium; protease
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
Tibial

49. What is the most common cause of pyelonephritis in both adults and childre?
Acute interstitial nephritis
E. coli
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)
Mean greater than median greater than mode

50. how does neisseria cause a petechial rash?
Neisseria induced small cell vasculitis (including hands and soles)
Extrinsic def; instrinsic def; platelet def
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)