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Usmle > Block 4 > Flashcards

Block 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

Diastolic heart sound heard shortly after the second heart sound

A

S3 gallop, usually present in decompensated heart failure.

Heard when the patient lies in left lateral decubitus position.

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2
Q

Dense interstitial mononuclear infiltrates in kidney

A

Acute cellular rejection, occurs <6 months after transplant, especially in pts who stopped immunosuppressant

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3
Q

Pralidoxime

A

Anti cholinergic used in organophosphate poisoning, better than atropine because it can act on both muscarinic and nicotinic receptors

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4
Q

Persistent tachypnea leads to

A

Respiratory muscle fatigue

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5
Q

Pigment gallstones

A

Composed of Ca+2 salts of unconjugated bilirubin are comparatively soft and are dark brown to black.
- brown pigment stones typically arise secondary to bacterial (E.coli)or helminthic infrction (ascaris lumbricoides), infection to billiary tract, which results in the release of “beta-glucuronidase” by injured hepatocytes and bacteria.

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6
Q

IL-12 role

A

If antigen is presented by a Macrophage(MAC), MAC will produce IL-12 that stimulate the differentiation into TH1 subset.

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7
Q

What is D-xylose

A

Monosaccharide that is absorbed directly without the action of pancreatic enzymes and can be used to test for brush border absorptive function independent of pancreatic function.
- it can be decreased with bacterial overgrowth of small intestine

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8
Q

Interscalene nerve block

A

is regional anesthesia technique used for procedures involving the shoulder and upper arm. This is done injecting anesthesia to the scalene triangle–> blocking Brachial plexus roots and trunks.
Important side effect :-> it causes transient ipsilateral diaphrgamatic paralysis in nearly all patients.(this method shouldn’t be done in COPD and contralateral phrenic nerve dysfunction )

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9
Q

Degradation of polysaccharide to monosaccharide requires?>

A

Pancreatic amylase

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10
Q

beta-glucuronidase in gallstones

A

It leads to brown pigmented soft stones. Arises from infection to biliary tract,. It hydrolyzes bilirubin glucuronides and increases the amount of unconjugated billirubin.

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11
Q

Monosaccharide transport in small intestine

A

Sodium dependent cotransporter or facilitated diffusion

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12
Q

Intrapleural pressure fall during inspiration is derived from

A

Diaphragm contraction

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13
Q

Naive TH0 cells differentaiton

A

TH0–> TH1 : it need IL-12 and IFN-¥

TH) –> TH2 : it needs IL-4, IL-5

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14
Q

Amyl nitrite inhalation effect on heart

A

Leads to vasodilation, resulting in transient decrease in venous return and BP.

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15
Q

What are chromaffin cells

A

Postganglionic sympathetic neurons derived from neural crest cells that receive sympathetic input (neuroendocrine cells)

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16
Q

A1 receptor is what G protein class

A

q-class–>Gq->phospolipase C-> acts on PIP2–> produces DAG and IP3 –> IP3 –> increase smooth muscle contraction by increasing calcium

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17
Q

Trapezius muscle is innervated by

A

Accessory nerve (CNXI), also sternocleidomastoid.

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18
Q

Lipoatrophy ,

Drugs that causes it

A

Refers to loss of subcutaneous fat, especially from face

Common side effect of stavudine and zidovudine (RT inhibitors)

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19
Q

Chronic renal allograft rejection - pathogenesis

A
  • it begins with graft endothelial damage mediated by low grade cellular and humoral immune responses directed against alloantigens.
  • this results in obliterative fibrous intimal thickening and scattered mononuclear infiltration of the surrounding tissues.
  • consequent renal ischemia and chronic inflammation causes shrinkage of renal parenchyma with tubular atrophy and interstitial fibrosis.
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20
Q

Myasthenia gravis, treated with AChE inhibitors exacerbation

A
  • myasthenia crisis: under treatment (low dose)- responsive to edrophonium
  • cholinergic crisis: over treatment (high dose)-irresponsive to edrophonium
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21
Q

Lactobacilli is

A

Present in the vagina, its a gram positive bacteria.

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22
Q

S3 sound

A

Ventricular gallop sound, after S2, heard during rapid passive filling of ventricles in diastole. Due to sudden cessation of filling as ventricular reaches its elastic limit.
- its best heard with the bell of stethoscope over the cardiac apex while the patient is in left lateral decubitus. Listening at end expiration makes the sound even more audible by decreasing lung volume and bringing the heart closer to chest wall

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23
Q

Common hepatic artery branches

A
  1. Proper hepatic
  2. Gastrodudenal
  3. Right gastric artery
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24
Q

Chromaffin cells in the adrenal medulla are stimulated by

A

Acetylcholine ,released by sympathetic preganglionic neurons and secrete catecholamine (80% E and 20% NE) into blood stream.

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25
Q

Lidocaine side effects

A
  • neurological signs such as tremor, drowiness, and changes in the mental status, although it can lead to generalized seziures
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26
Q

Differences between TH1 and TH2

A 
TH1 is responsible for cell mediated response, it activates MAC and CT-cells. It secretes IL-2, IFN-¥, and lymphotoxin ß, and result in cytotoxic immune response.
TH2 is responsible for humoral mediated respones, it activates B cells and promotes class switching, it secretes IL-5, IL-4, 10, and 13. Its results end in secretion of antibodies.
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27
Q

Drug induced lupus erythematous

A

-new onset lupus symptoms
-ANA and Anti-histone antibodies (specific) (>95% of cases)
Exposure to:->
1. Hydralazine
2. Procainamide
3. Isoniazid
4. Minocycline
5. Quinidine

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28
Q

Primary infection with HSV-1 results in

A

Gingiovomastitis .

  • peak age for primary infection is 6 months - 5 years.
  • prodromal symptoms (fever, malaise, chills )–> after 1 week.
  • painful vesicles, extensive covering the lips and gingiva, may include the palate and tongue.
  • pain often result in dehydration
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29
Q

Pyruvate kinase(PK) enzyme

A
  • Pyruvate kinase is a glycolytic pathway enzyme that converts phosphoenolpyruvate to pyruvate–> generation of ATP.
  • Allosteric stimulation of PK by F1,6bis, stimulate glycolysis.
  • RBC, which have no mitochondria rely on lactate as main metabolite for glycolysis.
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30
Q

Latent infection

A

During latent infection no virus is produced and no clinical course occurs

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31
Q

Exocrine pancreas deficiency

A

The exocrine pancreas has significant secretory reserve and >90% of glandular tissue must be destroyed before a patient will develop clinical malabsorption.

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32
Q

Hyper-acute kidney rejection

A
  • vascular fibrinoid necrosis
  • neutrophil infiltration of arterioles, glomeruli, and peritubular capillaries.
  • occurs within minutes to hours after donor-recipient vascular anastamosis.
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33
Q

clonorchis sinensis

A

This is a helmenthic infection, liver fluke, common cause of pigmented stone formation in east Asia, and can have long asymptomatic period before inducing a symptom

34
Q

Adrenal medulla on histology

A

Chromaffin cells with a deeply basophilic cytoplasm

35
Q

Target cells are seen in

A

ß-thalassemia

36
Q

Diastolic ventricular compliance

A

Conditions that decrease ventricular compliance are LVH, hypertrophic cardiomyopathy, and infiltrative disorder.
Its unaffected by EDV.(as crystalloid infusion in hypovolemic shock)

37
Q

Platysma is innervated by

A

Facial nerve, cervical branch

38
Q

How is bacterial overgrowth in small intestine is diagnosed

A

Decreased absorption of D-xylose

39
Q

Slow virus infection

A

Months to years

Example is measles in CNS–> subacute sclerosing panencephalitis

40
Q

Decreased amounts of glyocgen in epithelial cells of vagina

A

Postmenopausal , or lactating women

atrophic vaginitis

41
Q

Sodium bicarbonate therapy can be used in

A
  • widened QRS interval or ventricular arrythmia, in case of drug intoxication (TCA especially, and slicylates)
  • naHCO3 –> increase PH –> favors non-ionized form of the drug. Making it less accessible to bind to sodium channels.
  • it also increases extracellular sodium concentration which helps overcome competitive rapid sodium channel blockade.
42
Q

PPI side effects

A

Hypomagnesemia and increased risk for osteoporosis

43
Q

Chronic renal allograft rejection

A
  • gradual deterioration in graft function that occurs at least 3 months post transplant
  • characterized by worsening hypertension, progressive rise in serum creatinine and proteinuria, with normal urinary sediment.
44
Q

Biofilm producing bacteria

A

Biofilms functions as a barrier to antibiotic penetration and interferes with host defenses, including opsinization, neutrophils migration and even T lymphocyte activation.
These bacteria include:
1. S.epedrmidis (in prosthetic devices and Iv catheters)
2. S.mutans, S.sanguinis (dental plaques)
3. P.aeruginosa (CF pneumonia, contact lenses)
4. Viridans (endocarditis)
5. Non typable H.infleuenza(otitis media)

45
Q

Intracellular infection are cleared by

A

Cell mediated immunity: cytotoxic T cell which is stimulated by TH1 cell which in turn stimulated by IL-12 and IFN-¥

46
Q

Verapamil side effects

A

-negative inotropy, constipation and gingival hyperplasia

47
Q

ß-HCG is detectable in serum after

A

6-7 days of fertilization .

ß-hCG is detectable in serum at <5 IU/L.

48
Q

Burr cells and helmet cells are seen in

A

Traumatic hemolysis which can result either from microangiopathic hemolytic anemia or mechanical damage (prosthetic valve).

49
Q

Coffe ground emesis

A

Peptic ulcer

50
Q

Edrophonium is used in

A

Its an chilnergic agonist from the family of antochilnesterase, its used to diagnose mythsenia gravis.

51
Q

Heme degredation

A

Heme is converted to biliverdin by heme oxygenase, then biliverdin to unconjugated billirubin by biliveridin reductase.

52
Q

Abortive viral infection

A

Infection in which virus enters cells but cant successfully produce infective virus–> isn’t capable of making the disease

53
Q

S.epidermidis most important virulence mechanism

A

Synthesis of an extracellular polysaccharide matrix.
(Once attachment occurs, the bacteria multiply and communicate with one another to induce the synthesis of an extracellular polysaccharide, that encases the bacteria)

It usually associated with foreign body infections (eg. catheters) because its ability to form biofilm.

54
Q

Paroxysmal narrow QRS complex, supra-ventricular tachycardia

A

Wolf Parkinson white (WPW)

55
Q

WPW pathogenesis

Pre excitation syndrome

A

In pts with WPW, when there is no re-entrant tachycardia–> normal sinus impulses reach the ventricles first via accessory pathway and shortely afterword via AV node. (Accessory pathway –> pre-excites the ventricles ahead of normal conduction pathway –> hence the term “pre-excitation syndrome”. The result is shortned PR interval (often <0.12 seconds) with and early upslope (delta-wave) at the start of each QRS complex. The QRS complex is wider that normal as a result of delta wave.

56
Q

Cytoskeleton abnormalities anemia

A
  • herditery spherocytosis
  • elliptocytosis
  • stomatocytosis
57
Q

Iipodystrophy

A

It redistribution of fat from extremities to the trunk. Medication induced body fat redistribution s a common side effect of HAART (HIV-drugs). It results from 2 processes , wasting of fat from face and extremities and deposition of fat in trunk and viscera.

58
Q

Tzanck smear shows

A

Multinucleated giant cells

59
Q

Splenomegaly due to undegraded metabolite accumulation

A

Niemann pick disease and gaucher disease

60
Q

Alveolar hyperventilation signs

A
  • Acute dyspnea, hypocapnia and hypoxemia.
  • Arterial paCO2 is the main indicator for total alveolar ventilation.
  • It can occur due to V/P mismatch that causes decreased O2 and CO2 exchange (PE or pneumonia).
  • the resultant hypoxemia stimulates peripheral chemoreceptors and increase the respiratory drive above normal values.–> hyperventilation.
61
Q

Mysthenia gravis signs and symptoms

A
  • fluctuating weakness over the course of the day
  • ptosis
  • diplopia
  • fatiguable chewing, dysphagia
62
Q

ß-agonist acts on what receptor

A

G-stimulatory –> increase cAMP

63
Q

Deep inguinal ring and superfacial inguinal ring

A

Deep inguinal ring is formed by the transvalis fascia

Superficial inguinal ring is formed by the external oblique apounerosis.

64
Q

Prior to fertilization oocyte is arrested in

A

Meiosis II metaphase

And before puberty arrested in prophase meiosis I

65
Q

Tensilon test

A

Infusion of short acting AcHE inhibitors such as edrophonium, increases neuromuscular transmission and can provide temporary improvement in symptoms. This is done in mysthenia gravis

66
Q

Ondines curse

A

Impairment of respiratory control centers in brainstem can result in decreased frequency and/or amplitude of involuntary respiration . Voulntary breathing would be unaffected .

67
Q

WPW , re-enterant pathway

A

In case of tachyarrythmia , the wide QRS complex converts into narrow QRS because the accessory pathway no longer preexcites the ventricles but instead forms a re-enterant circuit back to atria.

68
Q

ß-hCG is detectable in urine at

A

14 days after fetillization

69
Q

Gallstones- cholesterol stones

A

They are formed when the ability of bile salt to solubillize cholesterol is overwhelmed by high concentration of cholesterol in bile
They are yellow to pale gray and hard

70
Q

Reactivation of HSV leads to

A

Herpes labialis

71
Q

Adenosine

A

Chest burning, flushing and transient hypotension

72
Q

Infective endocarditis –> circulating immune complexes can lead to

A

Deposition in spleen –> splenomegaly

And deposition in kidney

73
Q

Mitochondrial myopathy

A
  • inabillity to use oxidative phosphorylation (mitochondrial defect)
  • myopathy, lactic acidosis, nervous system dysfunction.
  • muscle biopsy shows ragged red fibers.
74
Q

Pyruvate kinase deficiency

A

PK, is the second most common congenital hemolytic anemia

  • it results in insuffecient ATP –> water and K+ losses –> defective membrane architecture –> echinocytes –> hemolysis.
  • reticuloendothelial cells in the splenic red pulp are involved in the removal of damaged RBC,–> increase activity in PK deficiency –> red pulp hyperplasia –> splenomegaly.
75
Q

Crescent formation in glomerulus

A

Typically seen in:

  • anti-GBM
  • ANCA associated disease
  • immune complex mediated glomerulonephritis.
76
Q

Passive splenic congestion occurs in

A

Portal hypertension , splenic vein thrombosis , and congestive heart failure

77
Q

In case of hypovolemic shock managment

A

Rapid infusion of blood and crystalloid such as saline–> intravascular volume and ventricular preload increase rapidly –> the increase in preload stretches the myocardium and increase the end diastolic sarcomere length –> increase SV and CO

78
Q

Neuroleptic malignant syndrome

A 
Malignant FEVER:
F: fever
E:encephalopathy
V: unstable VVitals
E: increased Enzymes
R: Rigidity (muscle)(lead pipe)
79
Q

MS incidence

A

Its incidence in increased in people with certain HLA types
Envirnomental factors also important as its more common in tempreture latitudes. (More common in USA,canada, and northern europe)

80
Q

Clinical features of tricylic antidepressant overdose

A
  • CNS:mental status changes, seziures, respiratory depression
  • CVS:sinus tachycardia,hypotension,prolonged QT interval
  • anti-cholinergic: dry mouth, blurred vision, dilated pupils ,urinary retention, flushing and hyperthermia
81
Q

Candida vaginitis

A 
Gram + lactobacilli comprises a major part of the normal vaginal flora and exist in balance with other colonizers at normal vaginal PH of 3.8-4.5, changes in the vaginal flora can lead to overgrowth of candida.
This changes results usually from : 
- antibiotic use
-high estrogen
-systemic corticosteroid therapy
-uncontrolled diabetes 
-any other cuase of immunusupression
82
Q

shrinkage of renal parenchyma with tubular atrophy and interstitial fibrosis.

A

chronic renal graft

Usmle (45 decks)

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