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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 presents congenitally as macroglossia - generalized hypotonia - and an umbilical hernia?
Hydrogen bonds dictate alpha or beta structure
Hypothyroidism
NF- KB; responsible for cytokine production
I is more benign and can present later in adulthood

2. When does opening snap begin?
Medial circumflex artery; avascular necrosis
Because of the low output from heart failure - they will have increased aldosterone levels
Right before diastole (filling begins)
Tibial

3. What are pancreatic pseudocysts called pseudo rather than true cysts?
Not lined by epithelium
200-500
indomethacin
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis

4. what indicates the severity of a mitral regurg ? mitral stenosis?
Echinococcus granulosus; anaphylaxis
S3 gallop; S2 to opening snap interval
Painless ulcer with black eschar and local edema; b. anthracis; D glutamate
Downs; regurgitant AV valves - ASDs

5. What is the primary histologic finding in patients with eczematous dermatitis?
Raphe
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures
P53 mutation; AD
Spongiosis

6. how will ectopic pregnancy rupture present? What is key history question for diagnosis? what would a uterine biopsy show?
Multiple miscarriages d/t hypercoaguability
Intracranial berry aneurysms and when rupture can cause subarachnoid hemorrhage
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi

7. What is acanthosis nigricans associated with?
Southern - western
External illiac - superficial femora - or common femoral or profunda femoris (ipsilateral); pudendal branches of internal illiac
GI malignancies and Insulin resistance (acromegal for ex)
LT (LTD4 - E4 - C4) - and Ach

8. What is a common complication of acute pancreatitis? What is it?
Pancreatic pseduocyst (d/t proteolytic enzyme release); collection of fluid rich in enzymes and inflammatory debris - with granulation tissue and fibrosis
Medial circumflex artery; avascular necrosis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
No; yes

9. What does nitroprusside do to afterload? preload?
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Hydrogen bonds dictate alpha or beta structure
Decreases both
Hypothyroid myopathy (thyroid is required for maintaining a lot!)

10. what defines hypoxemia?
Because of vasodiation to skeletal muscles
SaO2 <92%
Squatting - sitting - lying supine - passive leg raising
Nocardia

11. What type of gene is bcl 2 ? On what chromosome is it? what chromosome is IgG heavy chain on?
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
Multiple infections with bugs like neisseria becuase they block igM and IgG from binding and activating MAC
Anti - apoptotic (prevents going into apoptosis)- 18; 14
Highly negative resting potential

12. What is the only cranial nerve that comes out dorsally? What does this mean clinically?
Normally close to systolic
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
Inactivates kallikrein which activates kininogen into bradykinin
Minimal change disease; lmw proteins: albumin and transferrin; IgG or alpha 2 microglobulin

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

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14. What causes curlings ulcers?
Pain reliever - reduces pain by locking substance P in the PNS
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Well
Cardiac arrhthymias (quinidine like long QT) - orthostatic hypotension (antagonism of alpha adrenergic receptors) - urinary retention (d/t anticholinergic effects) - seizures

15. are strep pneumo bile sensitive or bile resistant? bile soluble or insoluble?
In the extracellular space for collagen cross linking; zinc
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Bile soluble which means they are bile sensitive
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences

16. What are the two growth factors associated with angiogenesis?
Pain reliever - reduces pain by locking substance P in the PNS
FGF and VEGF
P53 suppressor gene phosphorylates cyclin dependent kinase so that it does not phosphorylate Rb protein; chrom 17
Octreotide

17. why is glucagon used in beta blocker toxicitiy?
Medial circumflex artery; avascular necrosis
Drink plenty of fluids
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Aromatase deficiency in child

18. Where does glycolsylation occur of alpha procollagen chains occur? disulfide bond formation at the C terminus?
HSV and VZV
Brief psychotic disorder; schizophreniform; schizophrenia
RER; RER
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13

19. What is the mcc of cystitis and and acute pyelonephritis? mcc of UTI in sexually active women?
Because increases intracellular cAMP independent of adrenergic receptors (does it via G proteins)
Vertical diplopia
CGD; t cell dysfxn (diGeorge)
E. coli; staphylococcus saprophyticus

20. What type of endocarditis is cytoscopy induced?
Hexokinase
RBC mass; epo levels (secondary has high)
Trauma to stereociliated hair cells of the organ of corti
Enterococci (e. faecalis)- found on genitalia area

21. What are some of the permissive effects of cortisol?
RBC mass; epo levels (secondary has high)
Folic acid treatment!
low in serum
Increases bronchial and vascular smooth muscle reactivity to catecholamines

22. What is the most common neurologic complication of VZV reactivation?
Integration of viral DNA into genome of host hepatocytes
Localized dermatologic pain that persists for more than one month after zoster eruption
(urine PAH x urine flow rate)/plasma PAH
Ig A deficiency

23. Metronidizaole does not cover...
Mucor - rhizopus infection (Mucormycosis); mucosal biopsy; black necrotic eschar in nasal cavity
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
<1% - 55% - concentration dependent
gram positive organisms

24. what murmur is enhanced by decreased blood flow to the heart?
Systolic ejection murmur caused by hypertrophic cardiomyopathy (decreases in LVEDV causes an increase in obstruction)
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
Medial part
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)

25. What is the triad seen in pre eclampsia?
Hypertension - edema - and proteinuria
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
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

26. What is capsaicin? Where does it work?
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Increase lymphatic drainage!
Abnormal closing of the urethral folds
Pain reliever - reduces pain by locking substance P in the PNS

27. what dissolves the lipid bilayer of a viral envelope?
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)
Faulty positioning of the genital tubercle
Ether and other organic solvents
Cluster

28. What is the presentation of angioedema? Where is most commonly affected?
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Little effect on cell and no change

29. which cells produce surfactant? which ones mediate gas exchange?
II; I (I more abundant)
Circular - outside nucleus; transport proteins - rRNA - tRNA
Anti centromere; anti DNA topoisomerase
Near sightedness; in elderly with lens sclerosis and loss of elasticity- leads to inability of lens to focus on near objects

30. What does C1 esterase do other than inhibiting complement pathway?
HSV and VZV
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)
In ER of bile canaliculi
Inactivates kallikrein which activates kininogen into bradykinin

31. on which chromosome - and which gene - are people with sporadic and hereditary renal cell carcinomas found to have mutations?
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)
Anterior and to the right (on the ECG!) of the pulmonary artery; right to left shunt
Chromosome 3- von hippel lindau gene (the disease itself is rare - but mutations of the gene are common)
AV node slowest - to allow time for diastole

32. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone
IgE
Relfex tachycardia; giving beta blockers
Coagulation factors are made in the liver

33. at 2 years of age - What are the social - fine motor - gross motor and language developments?
Downs; regurgitant AV valves - ASDs
Imitation of household tasks; page turning; jumping - standing on one foot; 2 word phrases
Mutations in membrane K+ ion channels; torsade de pointes; neurosensory deafness
gram positive organisms

34. 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
Rb suppressor protein prevents cells going from G1 to S phase - when phosphorylated by cdk it is inactivated - p53 prevents this phosphorylation; chrom 13
The time interval between S2 and OS- the shorter the interval - the more intense
SVT; increases vagal tone; rectus abdominis

35. What test would be best to determine if a gene is being transcribed? translated?
HSV and VZV
Southern - western
Terminal bronchioles; small bronchi
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

36. What type of mutation does aflatoxin cause? what cancer does this increase for?
G to T in p53; HCC
GI malignancies and Insulin resistance (acromegal for ex)
Underestimation of gestational age
SVT; increases vagal tone; rectus abdominis

37. other than parvo B19 - what else is associated with red cell aplasia?
Thymic tumor
HSV and VZV
Nucleus caudatus and putamen; random movement of extremities and personality abnormalities (getting angry!)
Enterococci (e. faecalis)- found on genitalia area

38. prostaglandin synthesis keeps...
Trauma to stereociliated hair cells of the organ of corti
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Echinococcus granulosus; anaphylaxis
PDA open

39. What does prolonged PT indicated? aPTT? bleeding time?
Single adenomatous ones
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Because of the low output from heart failure - they will have increased aldosterone levels
Extrinsic def; instrinsic def; platelet def

40. If a patient has higher levels of HbF - What does this mean?
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
Duration and extent of disease
Medial part
Think Hb deformation diseases

41. what nerve and artery course along the posterior aspect of the humerus?
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
Hypothyroid myopathy (thyroid is required for maintaining a lot!)
Radial nerve and deep brachial artery
RER; copper

42. What is suggestive of complete central DI?
Southern - western
Mean greater than median greater than mode
Increase by 50% in urine osmolality
glycerol kinase

43. on which chromosome is wilms tumor found?
Proteasome inhibitor; treatment for MM and waldenstroms
11
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)
SSRI; erectile dysfunction

44. what happens to capacitance with age?
Increase; decreased
Skin flushing and warmth; prostaglandins; give with aspirin
chronic urticaria and allergic symptoms
...

45. How do you explain the selective proteinuria of loss to albumin only in MCD?
Demargination of neutrophils from the vessel walls
Dry skin - papilledema - intracranial pressure - alopecia - hyperlipidemia - hepatoxicity - hepatosplenomegaly -
Measure of depth invasion (vertical!)
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin

46. What can long term leg cast wearing cause?
Filtration rate - tubular reabsorption rate; GFR x plasma concentration (of that substance); inulin
CGD; t cell dysfxn (diGeorge)
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
Prevent phagocytosis

47. What is the difference between additive and synergistic?
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
Mood stabilizer (lithium - valproate - carbamazepime) plus an atypical antipsychotic
Radial nerve and deep brachial artery
Angiosarcoma (infiltration of dermis with slit like abnormal vascular spaces)

48. What is usually teh last gene mutation in development of a carcinoma (from an adenoma for example)?
P53 mutation; DCC is also required for adenoma to carcinoma
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)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
IgE

49. What does the superior gluteal nerve innervate? how does damage to this nerve manifest?
Progressive dysphagia - chest pain - food regurg - and aspiration; birds beak deformity of the LES
CGD; t cell dysfxn (diGeorge)
Epinephrine; adrenal medulla; phenylethanolamine N methyltransferase; cortisol
Gluteus medius and minimus; positive trendelenberg

50. at three years of age What are social - fine motor - gross motor and language developments?
Parallel play; reproduce simple shapes; tricycle riding - stair climbing; simple sentences
Increases
Sudden loss of muscle tone without loss of consciousness; narcolepsy
MAO inhibitors; wine and cheese