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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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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 virus inactivates both Rb and p53?
Femoral head; sickle cell - SLE - alcoholism - high steroid therapy
Hexokinase
E6 and E7 of HPV knock off p53 and Rb suppressor genes
Episodes of painless - well circumscribed pitting edema; face - lips - neck - and tongue - tracheobronchial tree can cause respiration obstruction

2. What are ulcers arising in the proximal duodenum in association with severe trauma or burns called?
Shock symptoms (blood loss); amennorhea history; decidualized stroma (hormone changes are exactly the same) but no chorionic villi
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Acute necrotizing pancreatitis; alveolar hyaline membranes; leaky capillary alveolar membrane (proteins deposit)
Curlings ulcers

3. What is the stabilizing force for the secondary structure of proteins?
Enterococci (e. faecalis)- found on genitalia area
Coagulation factors are made in the liver
Hydrogen bonds dictate alpha or beta structure
Well

4. What are the primary determinants of colon cancer risk in UC patients
Duration and extent of disease
Phase 4 (sodium current); reducing the rate of spontaneous depolarization
Leukotriene precursor and does neutrophil chemotaxis
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher

5. What are the three top bacterial causes of acute otitis media - sinusitis - and conjuctivitis?
APP on chrom 21 (this is why downs more susceptible)
Elevated GGT and macrocytosis
Turbulence
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis

6. what makes bruits?
Turbulence
Prevent phagocytosis
Primary
Increases the systemic vascular resistance and thus reduces the gradient across the LV outflow tract

7. What is the mcc of extrinsic allergic asthma?
In the extracellular space for collagen cross linking; zinc
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
Spongiosis
Inhaled animal dander allergens

8. What is used to prevent vertical transmission of HIV?
Hypothyroidism
The time interval between S2 and OS- the shorter the interval - the more intense
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
ZDV or AZT

9. What is the most common initital symptom of ADPKD? what else?
Atrial
Pain and discomfort from dilation and stretching of the renal capsule from all the cysts!; hypertension - hematuria
Ceftriaxone; azithromycin
T test; chi squared

10. What are biphosphanate drugs structurally similar to? What are they used in the treatment of?
Squatting - sitting - lying supine - passive leg raising
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Pyrophosphate (important comp of hydroxyapatite); osteoporosis - Pagets disease of the bone - malignancy induced hypercalcemia
Ig A deficiency

11. What can inhaled anesthetics (like halothane) cause post operatively? what virus does it immitate? What are the presenting symptoms?
SS +rNA
Increases cytokine production
Highly lethal fulminant hepatits; acute viral hepatitis (cant be distinguished clinically); significantly elevated ALT and AST an prolonged prothrombin time - and eosinophilia
Measles and M3 AML`

12. What is the mc location of brain germinomas?What are the classic symptoms?
Medial part
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Integration of viral DNA into genome of host hepatocytes

13. within the right ventricle - What are maximum pressures? the pulm arter?
Vertical diplopia
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
Hexokinase
25; 25

14. why does neutrophila occur with corticosteroids?
Valproate
Demargination of neutrophils from the vessel walls
AFP (HCC marker - produced in fetal liver and yolk sac!)- more specific than sensitive unfortunately
Ceftriaxone; azithromycin

15. How do you calculate RPF from urine PAH?
Obesity prevents expansion of wall and lungs for breathing; chronically elevated (all the time not just sleep) PaCO2 and decreased PaO2
Proteasome inhibitor; treatment for MM and waldenstroms
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)
(urine PAH x urine flow rate)/plasma PAH

16. what induces bronchial squamous metaplasia?
Smoking
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Selective alpha 1 (increases SVR)
Southern - western

17. What pulmonary structural change can kartageners syndrome cause?
Indirect inguinal hernia (persistent connection between peritoneum and tunica vaginalis)
women
Bronchial dilation (bronchiectasis)
Raphe

18. Which nerve lies in close proximity to the inferior thyroid artery?
Vascular endothelium; protease
Recurrent larygneal
Folic acid treatment!
Inhaled animal dander allergens

19. what protein is increased in Crohns disease? What does it do?
facultative intracellular
IgE
NF- KB; responsible for cytokine production
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

20. What is epispadias caused by?
Adeno
Increases bronchial and vascular smooth muscle reactivity to catecholamines
1. s. pneumo 2. non typable h. influenzae and 3. moraxella cattarhalis
Faulty positioning of the genital tubercle

21. what receptors do first generation anti histamines block?
Octreotide
Squamous cell carcinoma; poor prognosis; smoking and alcohol (also plummer vinson syndrome - achalasia - and corrosive strictures)
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic
No; MRI

22. What is a side effect of ACE inhibitor that is more worrisome in patients with renal failure?who else is it worrisome in?
The first is involved in fatty acid synthesis; the other is involved in beta oxidation of fatty acids to make ketones (ketone synthesis)
Duration and extent of disease
transcription activation/suppression
Hyperkalemia; potassium sparing diuretics - potassium supplements

23. What is normal fibrinogen levels?
200-500
Varying; erythema nodosum is common
Dihydropyridine sensitive Ca channels (L type)
Increases cytokine production

24. Which is faster atrial muscle or ventricular muscle?
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Pineal region; precocious puberty and parinaud syndrome - obstructive hydrocephalus
Folic acid treatment!
Atrial

25. what vessel would a fracture to the neck of the of the humerus damage?
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
Anterior circumflex (and axillary nerve)
Aromatase deficiency in child
Become beta pleated and then form neurofibrillary tangle!

26. which congenital adrenal hyperplasia presents with all genotypes as phenotypically female and with salt retention and hypertension?
No and yes
GI malignancies and Insulin resistance (acromegal for ex)
II; I (I more abundant)
17 hydroxylase deficiency; pregnelone to 17 hydroxypregnelone

27. What is capacitance inversely proportional to?
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
Elastance
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Increases bronchial and vascular smooth muscle reactivity to catecholamines

28. What is the key lab finding seen in type III serum sickness? What are some drugs that can induce it?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
C3 decreased after 5-10 days; sulfonamides
Cerebellar hemangioblastomas - pheochromocytomas - renal cell carcinomas; AD
Neutrophilia (Up) - eosinopenia - lymphocytopenia (All The REST DOWN- monocytopenia - basophilopenia)

29. What is hypospadias caused by?
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)
Cerebral vasoconstriction and thus decreased blood flow; decreaed pCO2
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
Abnormal closing of the urethral folds

30. What are the three presentations of ataxia telangectasia? What does the mutation cause? What is the mode of inheritance?
Lower extremity spasticity due to stretching of periventricular pyrimadal tracts - visual disturbances and learning disabilities
Cerebellar ataxia - telangactasias (in sun exposed areas) - respiratory infections; DNA break repair is damaged; AR
Non ciliary secretory constituents of the terminal respiratory epithelium; play a role in detoxification of inhaled toxins with a p450 system
Belladonna alkaloids from weeds causes atropine poisoning; physostigmine

31. eukaryotes are often polycistronic (multiple genes per mRNA) so ____________ is linked
Trauma to stereociliated hair cells of the organ of corti
gram positive organisms
SSRI
transcription activation/suppression

32. where are the two classical places that the ulnar nerve can be injured?

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33. which congenital adrenal hyperplasia presents with ambiguous genitalia in females and salt retention?
11beta hydroxylase deficiency (11 deoxycortisol to cortisol)
RR-1/RR
Nonsense; mRNA processing
CN 4- superior oblique muscle; hydrocephauls and pineal germinomas and defects in that area cause vertical gaze issues (parinaud syndrome etc)

34. How do you explain the selective proteinuria of loss to albumin only in MCD?
OCPs - multiparity - breast feeding
Loss of negatively charged components in the GBM so that the loss of those particles destroys the negative - negative repulsion between GBM and albumin
In ER of bile canaliculi
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

35. which nucleus releases serotonin?
S3 gallop; S2 to opening snap interval
Raphe
Terminal bronchioles; small bronchi
Intussusception

36. What is the most common location of colonization of all s. aureus types?
Leukotriene precursor and does neutrophil chemotaxis
Ulcers in esophagus - stomach - or duodenum and high ICP can cause perforation or ulcers in duodenum d/t acute physiologic stress
Because left renal vein passes between aorta and SMA and hardening of SMA can cause renal vein compression
Anterior nares

37. why are beta thal major patients asymptomatic at birth?
Centrally located - strong smoking association - neuroendocrine markers: enolase - chromogranin - synaptophysin
In the extracellular space for collagen cross linking; zinc
Congenital hypothyroidism - downs - amyloidosis - acromegaly
Because gamma chains replace beta chains and then gamma chain formation wanes

38. What does phosphoglycerate mutase produce? In what process - instead of what? what cells used this and why?
Stable chronic hepatitis; chronic hepatitis leading to cirrhosis
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
NF- KB; responsible for cytokine production
Anti Histaminic 1; anti cholinergic; antiseritoninergic;anti alpha adrenergic

39. what drug causes aggression - nystagmus - ataxia - slurred speech - exaggerated gait and involuntary movements?
Decreases both
Phencyclidine (PCP)
Drug induced interstitial nephritis
NF- KB; responsible for cytokine production

40. up to what level are ciliated cells present in the pulmonary system? mucus producing cells?
Terminal bronchioles; small bronchi
Mycoside (made of two mycolic acids) and is responsible for inactivating neutrophils - mit damage - and induced release of TNF; mycobacteria virulence; serpentine cords
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)
8; 12

41. What agonists reduce the gradient across the LV outflow tract?
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
Common peroneal; bony fractures and compression; sciatic
Coronary vasospasm (cocaine) - coronary arteritis - hypercoaguability with acute thrombosis
Selective alpha 1 (increases SVR)

42. What is damaged in early syringomelia? later?
Giving antitoxin (also give antibiotics and passive immunization but antitoxin has greatest effect on prognosis)
Ventral commisure (decussating spinothalamic tracts) and anterior horns causing upper extremity hyporeflexia and numbness to heat; lateral corticospinal tracts causing hyperreflexia in lower extremities
INTRApartum Abs (ampicillin/penicillin)
Trochlear nerve (IV); abducens nerve (VI)

43. What are the first line agents used in acute gouty arthritis? why not use colchicine? when would you use glucocorticoids?
Underestimation of gestational age
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
NSAIDs; nausea and diarrhea; when you have renal failure (cant have either NSAIDs or colchicine)
HSV and VZV

44. What effects does cortisol have on catecholamines?
Become beta pleated and then form neurofibrillary tangle!
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
Bile salt accumulation in urine
Medial part

45. h1 receptor anatagonists are not effective in treatment of asthma only for...
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
chronic urticaria and allergic symptoms
Prepatellar
Normally close to systolic

46. 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
OCPs - multiparity - breast feeding
Prevent phagocytosis
Neisseria induced small cell vasculitis (including hands and soles)

47. Is the uterus enlarged in endometriosis? does it cause dyspareunia?
Near the hinge point; site for attachment to phagocytic cells is at the very end (Fc receptor)
No (unlike adenomyosis); yes
Faulty positioning of the genital tubercle
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

48. What does L/S stand for in fetal lung maturity? When does maturity occur?
RER; copper
Lecithin (same as phosphatidylcholine)/sphingomyelin; by 35 weeks should be 2/1 or higher
Fibronectin - laminin - collagen
Muscarinic antagonist; pralidoxime because atropine doesnt work at nicotinc receptors and organophospates act at all cholinergic (muscle paralysis not solved with only atropine)

49. What is the general compensatory mechanism to prevent edema is situations with increased central venous pressure?
Tibial
ASD - causes increased pulmonary vascular blood flow which causes pulmonic vessel stenosis and damage
Increase lymphatic drainage!
Vagus nerve stimulation

50. What is the Na/Ca exchange used for?
To pump calcium out in cardiac myocytes so that relaxation occurs
Duration and extent of disease
Become beta pleated and then form neurofibrillary tangle!
Echinococcus granulosus; anaphylaxis

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USMLE Prep 2

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