Usmle Wrong Ones- Uworld

Front 1

EBV is associated with Burkitt's Lymphoma and what are dz ( nasal sinusitis, nasal symptoms)

Back 1

Nasopharygneal Carcinoma
#1 MCC of adult epithelial cancer ( wiki)

Front 2

What two bugs have exotoxin that blocks protein synthesis by inhibiting elongation factor?

Back 2

1. Corynebacteria diphteriae ( see grey pseudomembrane)
2. Pseudomonas ( assoc. w/ CF, fruity smell, Gram Negative!!)

Front 3

Kid presents with Acute Rheumatic Fever ( fever, arthritis, blowing holosystolic murmur), what treatment is effective against the microbe?

Back 3

It's strep pyogenes, sensitive against BACITRACIN!!!

Front 4

vomiting relaxes sphincters but contracts?

Back 4

abdominal muscles and diaphragm, helps propel food up!

Front 5

What the heck is PPD?

Back 5

PPD = tuberculin ( outer surface protein of TB) + mycolic acid ( part of cell membrane)

Front 6

How does cocaine cause HTN?

Back 6

blocks NE reuptake, so increases availability of NE--> vasoconstricts smooth vessels.

Front 7

What is the pathologic finding of a swan neck deformity in RA?

Back 7

see fibrinoid necrosis surrounded by palisading epithelioid cells

Front 8

What is difference in CXR between Primary TB vs. Reactivation TB

Back 8

Reactivation TB @ apices of lung, primary TB is at lung adjacent to pleura ( lower part of upper lobe) + mediastinal involvement

Front 9

Fetus has 46 XY genotype. Leydig cells are normal but there's no Sertoli cells. What phenotype is most likely ? ( TRICKY BASTARDS)

Back 9

SRY gene on Y chr --> TDF --> Develops Testes ( Two major cell types)
1. Leydig --> testosterone --> DHT ( drives Genital Tubercle -->Male external genitalia, penis and prostate gland)
2. Sertoli --> MIF --> causes involution of the paramesonephric ducts ( Mullerian ducts)

Answer: Both male and female internal genitalia ( fallopian tubes and uterus) + external male genitalia

This question is asking: Did you know the the Sertoli cells secrete MULLERIAN INHIBITING FACTOR!!

KNOW I DO!!!

Since the sertoli cells are jacked up, there's no MIF, so the paramesonephric ducts persist and you get the fallopian tubes and uterus.

So RECAP:

IF they have XY, meaning specifically Y chromosome = they get testes ( which has both sertoli + leydig)

If sertoli jacked up , no MIF, so they get fallopian tubes/uterus, + male external genitalia since Leydig cells are ok, can make testosterone and get external genitalia + secondary sex characteristics.

What if Leydig cells were missing but Sertoli's were ok and still had XY. Then they'd get testes, have no uterus/fallopian tubes since ( Sertoli cells are able to secrete MIF). They'd have feminized external genitalia and have female secondary sex characteristics. ( Like a klinefelters, or a cryptorchid).

Front 10

Female @ 35th week gestation has serum prolactin higher than preconception level. What hormone blocks lactation?

Back 10

@ First trimester: Progesterone and Estradiol made by Corpus Luteum, then placenta takes over.
Prolactin is blocked by gestational levels of estrogen and progesterone since as pregnancy progresses, the prolactin takes over.

So have to know that
ESTROGEN and PROGESTERONE block LACTOGENESIS while also promoting breast development during pregnancy.

what about LH? how are it's levels during pregnancy?
LH is low during pregnancy because of progesterone induced feedback at anterior pituitary gland.

Front 11

What nerve is anesthitized in pregnant women by lidocaine @ ischial spine?

Back 11

pudendal nerve is anesthetized during childbirth! S2-S4, sensory to perineum/genitalia + motor ( sphincter urethrae and external anal sphincter).

Front 12

Which lymph node does a testicular mass met to?

Back 12

General concept:$Lymph drainage follows arterial supply to that site.

Where did testes come from? Retroperitoneal abdomen, so that's where it's arterial supply is, remember the testicular artery follows down into the inguinal canal. So lymph drainage would go to the retroperitoneal lymph nodes. Lymph to the scrotum goes to the inguinal lymph nodes.

Front 13

Where are androgens converted to estradiol in females?

Back 13

@ Granulosa cells

Here's the story:
LH stimulates the Theca interna cells is the site of androgen synthesis. Theca interna is like the Leydig cells. They make androgens from a cholesterol precursor. Then the androgens travel to the granulosa cells. The Granulosa cells have the enzyme aromatase to convert androgens --> the very potent (ESTRADIOL!) This is stimulated by FSH.

Front 14

Right after ovulation, oocytes are in what stage?

Back 14

Metaphase II as secondary oocytes.

but stuck in prophase I as primary oocytes right after birth.

Know arrest stages!

Prophase I
Metaphase II

Front 15

What is hCG elevated right after fertilization?

Back 15

hCG is only elevated after the blastocyst implants, implantation is 6 days after fertilization, so the best answer is 8 days! 8 days after ovulation!

Front 16

What are two types of interference w/ Chattels?

Back 16

[1] Intermeddling or

[2] dispossession

Front 17

Histo section, see coiled arteries, vacuolated, see lots of glycogen rich mucus. What stage of endometrium am I and what part of hormone chart does this correspond with?

Back 17

THis is the the mid secretory phase, the hormones stage is at the rise of the progesterone since progesterone stimulates the uterine glands to secrete glycogen rich mucus.

Front 18

What is the histological cell type associated with the different features of the reproductive system?

Back 18

Ovary = simple cuboidal ( aka germina epithelium, it transitions to peritoneum -it's continuous at the broad ligament) SPECIAL @ OVARY - SIMPLE CUBOIDAL GERMINAL EPITHELIUM!!!


Fallopian = simple columnar
Uterus = Simple ( pseudostratified) columnar

( these are visceral smooth muscle structures so simple columnar, you get endometrial CA's)

Cervix = Simple columnar ( endocervix) stratified squamous
Vagina = stratified squamous non-keritines ( has glycogen)- it's just like skin on the nose ( so you get squamous cell cancers)