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Usmle > Block 5 > Flashcards

Block 5 Flashcards

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USMLE® Step 1 flashcards
1
Q

Lung mass, dyspnea, hiccups and referred pain to the shoulder

A

Phrenic nerve compression C3-C5

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2
Q

Epidermal growth factor receptor mutation

A

ERBB1 –> lung cancer
ERBB2 (known as HER2)–> breast
Also ovarian and gastric cancer

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3
Q

N.gonnorrhea and N. meningitidis grow in

A

-choclate agar based medium called thayer martin agar -contains vancomycin, colistin, nysatin and trimethoprim

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4
Q

Problems in cross-linking in collagen synthesis

A

Ehlers danolos syndrome and menkes disease

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5
Q

Central herniation can lead to

A

Abducens nerve palsy

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6
Q

Dyskeratosis is found in

A

SCC of the skin

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7
Q

Vitamin C deficiency clinical

A
  • most oftenly seen in malnourished people
  • decreased connective tissue strength
  • capillary walls are fragile –> easy bruising,mucosal bleeding and petechial hemorrhage.
  • periodontal disease (gum swelling, loosening of teeth and infection)
  • poor wound healing
  • hyperkeratotic follicles with corecscrew hair
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8
Q

Ketoconazole effect on males

A

It a weak anti-androgen that decrease the synthesis of testosterone in leydig cells of testes, also inhibit steroid hormone synthesis by adrenals

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9
Q

Eosinophillic vs basophillic neurons

A

Eosinophillic neurons –> red neurons –> dead –> 12-24 hrs after stroke
Basohpillic neurons–> blue –> normal neurons

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10
Q

Left main coronary artery occlusion (ECG localization)

A

V1-V4 and V5-V6, I and aVL

LAD and LCX arteries

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11
Q

PCOS increase the risk for what cancer

A

Endometrial hyperplasia and adenocarcinoma

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12
Q

C.diphteriae leads to

A

-pseudomembrenous exudate
-absorption into blood stream leads to systemic symptoms such as :
Myocarditis, neurological symptoms such as coma and paralysis.

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13
Q

Problems in making triple helix in collagen

A

Osteogenesis imperfecta

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14
Q

Translocation in 15:17 chromosome

A

Acute protomyoletic leukemia- abnormal retinoic acid receptors
- translocation of retinoic acid receptor alpha (RARA) from chromosome 17 and the prolyelocytic leukemia gene (PML) on chromosome 15 leads to PML/RARA. A fusion gene which inhibit the differentiation of mylolblast and triggers APML

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15
Q

Bladder carcinomas:
arise from,,
presentation
Prognostic marker

A
  • They arise from transitional epithelium lining the bladder
  • in most cases the neoplastic cells resemble those of normal bladder epithelium
  • tumors are called urothelial carcinoma (transitional cell)
  • squamous cell carcinoma and adenocarcinoma of bladder are rare
  • presentation: painless gross hematuria.
  • prognostic factors: tumor stage is the most important and depends on degree of invasion.
  • muscular layer involvment is an important prognostic factor.
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16
Q

Auer rods is seen in

A

Acute myelogenous leukemia (especially APML)

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17
Q

APML is treated using

A

all trans retinoic acid

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18
Q

PCOS diagnostic criteria

A

2 of 3 at least

  1. hyperandrogenism
  2. Irregular periods
  3. Polycystic ovaries on ultrasound
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19
Q

Urticaria is

A

Common H.S reaction, charactrized by intense pruritus.
Most often cause by IGE mediated degranulation of Mast cells.(sometimes not)
Its due to increased permeability of microcvasculature, leading to edema of superficial dermis.

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20
Q

Scant inflammatory cells and interstitial fibrosis after transplant

A

Chronic rejection

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21
Q

Togaviruses are responsible for

A

Rubella (german measles) and eastern and western equine encephalitis.

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22
Q

Anti Anticoagulants methods

A
  1. Warfarin overdoes :
    - VIT K is effective but take a few days
    - fresh frozen plasma( FFP).
    - Protamine - ineffective
    - prothrombin complex concentrates –> contain vitamin K dependent factors (II,VII,IX,X) can be used
  2. Heparin overdose:
    - VIT K is ineffective
    - FFP is ineffective (it contains antithrombin III which enhances heparin effect)
    - Protamine is heparin specific antidote
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23
Q

Creutzfeldt jakob disease and prions features

A

Its rare disease, most of transmitted cases are iatrogenic seen in patients recieving contaminated corneal transplants, implantable electrodes or preperation of growth hormone.

  • prion diseases have common features:
    1. long incubation periods however rapid progressive after onset
    2. Associated with abnormal prion protein
    3. No treatment
    4. Characterstic morphologic changes are described as spongiform encephalopathy. Vacuoles form in the cytoplasm of the neutrophils and neurons. As the disease progresses, the vacuolated areas transform into cyst and no inflammatory changes present.(important)
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24
Q

Pancoast tumor

A

Tumor in the lung apex , can lead to horner syndrome or brachial plexus compression (C5-T1 ) and lead to shoulder pain.

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25
Q

Chrons disease composition of inflammatory infiltrates

A

Lymphocytes and monocytes

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26
Q

Proteasome inhibitors - used for

Mechanism of action

A
  • in multiple myeloma, neoplastic B cells mature into plasma cells –> synthesize large amounts of monoclonal Ig or Ig fragment (light chain) –> as a result of increased protein production –> plasma cells are susceptible to the effect of proteasome inhibitors.

Bortezomib, boronic acid containing dipeptide

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27
Q

AML presentation

A
  • anemia(fatigue, pallor)
  • thrombocytopenia(petechiae, hemorrhage)
  • neutropenia(fever, infection)
  • DIC
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28
Q

Functional Hypothalamic amenorrhea

A

Excessive weight loss/sternous exercise/chronic illness/eatin disorder —> decrease adipose tissue/fat reserves and decreased leptin production –> hypothalamus decreases GnRH secretion –> pituitary decrease of LH and FSH –> ovaries doesnt produce Estrogen –> amenorrhea and bone loss

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29
Q

Subacute sclerosing panencephalitis

A

Causes progressive demantia, spasticity and seziures. Its linked to abnormal ,easles virus that persits in the CNS of these patients after years of recovery from measles.

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30
Q

C.diphtheriea pathogenesis

A
  • colonization of respiratory tract and secretion of diphtheria toxin (the primarily virulence factor).
  • diphtheria toxin is an AB exotoxin that inhibits protein synthesis by ADP ribosylation of EF-2
  • toxin act locally causing respiratory cell necrosis with formation of fibrinous, exudate
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31
Q

Acantholysis is seen in

A

Pemphigus disorders, its loss of cohesion between keratinocytes in the epidermis

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32
Q

12 -24 hrs after stroke microscopic changes

A
  1. Red neurons-> eosinophilic staining of the cytoplasm
  2. Nissl substance disappears
  3. Nuclei becomes pyknotic (shrunkens and becomes basophillic) and undergoes fragmentation (karyorrhexis).
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33
Q

Absolute Vs relative erythrocytosis

A
  • direct RBC mass is necessary. An increased in total RBC mass indicates absolute while normal RBC mass indicates relative.
  • this is measured through 51Cr-tagged RBC infusion
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34
Q

Warfarin induced skin necrosis

A

Transient hyper-coagulable state that occur during the first days of warfarin therapy.
- the overall anticoagulant effect of warfarin is due to the inhibition of Vitamin K dependent Gamma-carboxylation of clotting factors II, VII, IX, and X. However it also decreases carboxylation of protein C and S. Rather earlier than the others –> hyper-coagulable state

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35
Q

Cushing triad

A

Hypertension, bradycardia, and bradypnea

= increased intracranial pressure

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36
Q

Primary amenorrhea is defined

A

Failure of menarche prior to age of 15

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37
Q

Angioedema causes

A 
1.Due to mast cell activation :
Type I HS reaction --> IGE mediated
Direct mast cell activation 
Both associated with urticaria and pruritus
2. Excess bradykinin 
ACE inhibitors 
C1 esterase deficiency (usually occurs in childhood or young adults) 
No pruritus or urticaria
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38
Q

Flutamide

A

Its used to treat metastatic prostate cancer(not BPH due to excessive anti androgenic effect).
- it inhibits the interaction of DHT and testosterone with their receptors.

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39
Q

Inhibit fibrinolysis by inhibiting plasminogen activation = 2 drugs

A

Aminocaporic acid and tranexamic acid

40
Q

Vaginal adenosis

A

Persistance of glandular coulmnar epithelium in vagina is a precursor of clear cell adenocarcinoma. Female offspring exposed to diethylstilbestrol in utero are at increased risk and may present with vaginal discharge or vaginal cysts/fleshy colored lesions.

41
Q

Platlet derived growth factor receptor mutation leads to

A

Cancer , especially ovarian

42
Q

Red neurons shows in microscopy as

A

Eosinophilic cytoplasm

43
Q

Calicivruses

A

Norwalk virus responsible for gastroenteritis

44
Q

What is St john worts

A

OTC medicinal herb that have both anti inflammatory and anti depressant proporties. It induces hepatic CYP450 resulting in increased substrate metabolism (warfarin, OCPS, antiepileptic, theophyline), –> decreases drug levels.

45
Q

Dilated pupils =

A

Oculomotor nerve palsy

46
Q

Acanthosis

A

Diffuse increase in thickness of stratum spinosum, seen in psoriasis, seborrheic dermatitis, and acanthosis nigricans.

47
Q

Spongiosis is

A

Intracellular epidermal edema that histologically appears as an increase in the width of spaces between cells.
Seen in spongiotic dermatitis

48
Q

Down syndrome cardiac congenital anomalies

A
  • ASD

- VSD

49
Q

ECG localization of MI : lead I and aVL

A

Lateral –> LCX

50
Q

Hydrocele

A

Failure of obliteration of the processus vaginalis leads to persistant connection between the scrotum and the peritoneal cavity through the inguinal canal. If opening is small –> fluid leakage –> hydrocele . If communication is large –> indirect hernia.
Indirect inguinal hernia is common in children.

51
Q

Ebstein anomaly

A

Lithium exposure in utero
-charactrized by apical displacment of tricuspid valve leaflets decreased volume of the right ventricle and artializtion of right ventricle.

52
Q

Amniotic fluid embolism

A

Its rare catastrophic complication.
Amniotic fluid containing arachidonic acid metabolites is thought to enter maternal circulation through sites of uterine trauma of cervial laceration.
-this result in anaphylactoid reaction- >caused by metabolites.
-It causes occlusion and vasospasm of the maternal pulmonary circulation –> left ventricular failure –> decreased CO, –> severe V/Q mismatch –> hypoxia and hypotensive shock –> cardiopulmonary arrest.
- tissue factors thromboplastin is also released from amniotic fluid and triggers DIC
-histology shows fetal squamous cells and mucin in maternal pulmonary arteries
-

53
Q

Cp450 inducers

A
  1. Alcohol use
  2. St. John wort
  3. Phenoytoin
  4. Phenobarbital
  5. Carbamazepine
  6. Rifampin
  7. Griesofluvin.
54
Q

Acute rejection in biopsy

A

Dense infiltrates of mononuclear cells usually composed primarily of T lymphocytes

55
Q

Low serum sodium, diarrhea , high fever, pneumonia , headache

A

Legionella

Exposure to : recent travel(cruise) , hospital/nursing home stay

56
Q

General paresis

A

Form of neurosyphillis

57
Q

Alcohol abuse and chronic mental ilness

A

Korsakoff psychosis wernicke encephalopathy

Thiamine deficiency

58
Q

ECG localization of MI :
V3-V4
V5-V6

A

V3-V4 (distal LAD) anteroapical

V5-V6 (LAD or LCX) anterolateral

59
Q

Contrast ct angiography should be avoided in

A

Renal insufficiency (elevated creatinine) due to the increased risk of contrast induced nephropathy

60
Q

Promoter region contains?

A

Consensus sequence that are typically AT rich (TATA, or CAAT boxes) or GC rich (GC box)

61
Q

Typical chrons disease presentation

A

-20-30 y.o , weight loss , fatigue , low grade fever, and aphtous ulcers of oral mucosa

62
Q

What are proteasome

A

They act as recycling centers for proteins, breaking down misfolded, damaged and cytotoxic proteins into their component, building blocks for reuse in new proteins.

  • its inhibition results accumulation of toxic intracellular proteins.
  • they regulate the balance between pro and anti-apoptotic proteins–> their inhibition leads to excess in pro-apoptotic proteins
63
Q

Reye syndrome is charactrized by

A
  1. Hepatic dysfunction : vomiting, hepatomegaly, liver biopsy shows microvesicular steatosis, the presence of small fat vacuoles in the cytoplasm of hepatocytes.
  2. Encephalopathy:toxic effect of hyperammonemia on the CNS leading to cerberal edema.
64
Q

Progressive multifocal leukieencephalopathy (PML)

A
  • Jc virus
  • HIV patients
  • demyelination of oligodendrocytes is the primary pathologic effect. (Inflammatory)
65
Q

Squamous cell carcinoma of bladder is associated with

A

Schistosoma haematobium

66
Q

Several months to years after stroke

A

Appears after brain infarction the necrotic area appears as a cystic cavity surrounded by a wall of dense fibers formed astrocytic processes (glial scar)

67
Q

Uncal herniation may result in

A

Psilateral oculomotor nerve palsy with a fixed dilated pupil due to damage to preganglionic parasympathetic fibers.

68
Q

Polycystic ovary syndrome

A

Clinical features :
-androgen excess: hirsutism, acne, androgenic alopecia
-ovarian dysfunction: menustral irregularity, polycystic ovaries
-insulin resistance : acanthosis nigricans, glucose intolerance/DM
-obesity
Treatmet :
-weight loss
-combination hormonal contraceptives
-metoformin

69
Q

Calcineurin

A

Its a protein phosphate that is activated upon stimulation of the appropriate cell receptor.
Once activated, calcineurin dephophorylates nuclear factor of activated T cell (NFAT), which allows NFAT to enter the nucleus and bind to IL-2 promoter.
-IL-2 –> stimulate and proliferate T cell
-its the action site for TACROLIMUS and CYCLOSPORINE

70
Q

ECG localization of MI : V1-V2

A

Anteroseptal - LAD- (proximal also associated with V3-V4 elevation however distal spares V1-V2)

71
Q

Pathogenesis of atheromas

A
  • its thought to begin with endothelial injury –> increased endothelial permeability –> enhanced leukocytes adhesions –> altred gene expression. Endothelial dysfunction also promtes platelet adhesion, aggregation and release of growth factors and cytokines.
  • – PDGF –> promotes migration of smooth muscle cells from the media to the intima and increase smooth muscle cells proliferation.
  • platlets also release transforming growth factor beta (TGF-ß) which is chemotactic for Smooth muscle cells and induce interstitial collagen production.
72
Q

Alveolar ducts lined with hyaline membranes is characteristic of

A

ARDS

73
Q

Mitochondrial DNA

A

Nuclear chromosomes contain ,most of the DNA, however mitochondria also contain DNA called Cricular DNA (mtDNA).

  • overtime most of genes coding for mitochondrial protein have migrated to nuclear DNA
  • however mtDNA still codes for 14 proteins and the ribosomal and transfer RNA needed for mitochondrial protein synthesis.
74
Q

Injury to radial nerve results from

Leads to

A

It results from repetitive pronation/supination of forearm(frequent screwdriver use) (as the radial nerve passes from supinator canal,) direct trauma, or dislocation of radius.

  • it leads to weakness in the finger and thumb extension (“finger drop”).
  • triceps brachii and extensor carpi radialis are preserved as the branches are superior to the lesion.
  • cutaneous sensory branches are similarly preserved
75
Q

Centrilobular congestion in the liver occurs in

A

Right sided HF patients

76
Q

ECG localization of MI : V7-V9

A

Posterior PDA ( also ST depression in V1-V3 with tall R waves)

77
Q

Methionine synthesis requires

A

B12 - from homocysteine to methionine

78
Q

Ehlers danlos syndrome defect in ?

A

Defective collagen synthesis –> deficiency in procollagen peptidase –> N-terminal pro-peptide removal inability.

79
Q

ECG localization of MI : lead II, III and aVF

A

Inferior - RCA

80
Q

Lens subluxation

A

Downward : homocystinuria

Upward: marfan syndrome

81
Q

Parvovirus

A

B19 virus

Erythema infectiosum, fifth disease, aplastic crisis in sickle cell and hydrops fetalis.

82
Q

Angioedema is

A

Rare and potentially serious adverse effect of ACE inhibtor therapy . Symptoms typicaly appears within days but can also appear after weeks to years.

  • it can affect anyplace in the body but usually affect the lips, tongue or eye lids. Laryngeal edema and difficulty breathing may also occur.
  • ACE inhibitor angioedema is due to bradykinin accumulation.
  • normally ACE is responsible for bradykinin breakdown. ACE prevents bradykinin degradation leading to increased levels.
83
Q

CCK is produced by

A

I- cells of dudenum and jujenum when fat-protein rich cheme enter the dudenum

84
Q

Bile duct proliferation is present in

A

Primary biliary cirrhosis

85
Q

Poly A is found on

A

Mature RNA, poly A protects the mRNA from degradation within the cytoplasm after it exits the nucleus
along with
1. 5’ capping : 7 methyl guanosine cap is added to end of mRNA
2. Splicing : the initial mRNA transcript contains sequences from coding and non coding regions of DNA, known as exons and introns respectively. Spliceosomes remove introns containing GU at the 5’ splice site and AG at the 3’ splice site

86
Q

Hypoxic Vs secondary erythrocytosis.

A

Meaurment of arterial oxygen saturation (SaO2) is important to exclude hypoxemia as a cause of erythrocytosis.

  • SaO2 <92% can cause secondary polycythemia.
  • SaO2<92% = PaO2 <65 mm Hg
87
Q

Erythrocytosis is defined as

A

Men Ht >52%
Women Ht >48%
It may result from true increase in the RBC mass (absolute) or from decrease in plasma volume (relative)

88
Q

Viral hepatitis, liver histology

A
  • apoptosis of hepatocytes

- acinar necrosis and periportal mononuclear inflammatory infiltration

89
Q

Vitamin C is necessary for

A

Hydroxylation of proline and lysine residues in collagen synthesis.
Hydroxyproline and hydroxylysine are essential for cross linking collagen molecules. In scruvey, collagen cross linking is compromised, theryby greatly reducing tensile strength

90
Q

Anaphylaxis following blood transfusion

A

IgA deficiency

91
Q

Brassy barking cough and breathing difficulty with a history of recent upper respiratory tract infection(URI) –?

A

Croup (acute layngiotracheitis )

  • the dyspnea associated with croup occurs when inflamed subglottic tissue obstruct the airway.
  • the characterstic stridor of croup is a sign of significant airway obstruction.
  • croup is typically caused by the standard URI viruses with parainfleuenza viruses most commonly responsible. (Paramyxoviridae)
92
Q

Aspiration pneumonia -> histology

A

Inflammation and foreign body response with giant cells. Usually in the right lower lobe

93
Q

Aspirin effect on the liver in children

A

Mivrocesicular steatosis.

Reye syndrome

94
Q

Multiple myeloma- clinical

A 
-bone pain, 
Fatigue
Anemia
Kidney disease 
And hypercalcemia
95
Q

Cp450 ihibitors

A
  1. Acute alcohol abuse
  2. Ritonavir
  3. Amiodarone
  4. Cimitidine
  5. Ketoconazole
  6. Sulfomaides
  7. Ketoconazole
  8. Isoniazid
  9. Grapefruit juice
  10. Quinidine.
  11. Macrolides.
96
Q

Risk factors for gallbladder disease

A
  1. forty
  2. Fat
  3. Female

Usmle (45 decks)

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