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USMLE-rx > Feb 20th > Flashcards

Feb 20th Flashcards

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USMLE® Step 1 flashcards
1
Q

What do muddy brown casts suggest on urinalysis?

A

Renal tubular necrosis

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2
Q

What is the mnemonic for drugs that cause acute interstitial nephritis? AKA tubularinterstitial nephritis

A

remember the P’s

  1. Pee (thiazides and sulfonamides)
  2. Pain Free (NSAIDs) (allopurinol) (Cimitidine)
    - think H2 blocker to help with stomach ulcer pain
  3. Penicillins, cephalosporins and cipro
  4. PPI
  5. rifaPin
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3
Q

A 42-year-old man taking ampicillin for acute cystitis presents with sudden onset of fever, oliguria, and a generalized skin rash. Lab findings include eosinophilia and a moderate proteinuria. Dx?

A

Acute interstitial nephritis

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4
Q

Classic triad of acute interstitial nephritis?

A

Low grade fever
Rash
Arthralgias
- usually with renal/urinary problems

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5
Q

What is a common fungal cause of diaper rash?

A

Candida

  • shows true hyphae
  • budding yeast
  • Pseudohyphae
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6
Q

What is characteristically found on severe combined immunodeficiency on physical exam?

A

Decreased thymic shadow

- where the T and B cells go to college. If it is not getting used for pos and neg selection then it starts to atrophy

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7
Q

What are some other history’s common to severe combined immunodef?

A

Diarrhea
Thrush
Recurrent infections of all pathogens
Failure to thrive

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8
Q

What is the common mutation in severe combined immunodef?

A

Adenosine deaminase deficiency (AR)

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9
Q

What is the result and problem with adenosine deaminase deficiency?

A

Build up of dATP

  • causes shut down of other purine and pyrimidine pathways. Thus we stop making cells that overturn rapidly
  • like gut epithelial cells–> diarrhea
  • T and B lymphocytes–> recurrent infections
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10
Q

What is the treatment for SCID?

A

Bone marrow transplant

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11
Q

What are the urinalysis findings in pre-renal azotemia?

A

> 500 mOsm
20 Serum Bun/Cr ratio
<20 urine Na
<1% FENa

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12
Q

What are the urinalysis findings in post renal azotemia?

A 
< 350 mOsm
> 40 Urine Na
>1% mild
> 2% severe
varies for serum Bun/Cr ratio
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13
Q

What is Octreotide and its MOA?

A

Long acting somatostatin analog

- inhibits secretion of various splanchnic vasodilatory hormones

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14
Q

What does octreotide prevent release of?

A

Serotonin

- important for treating carcinoid syndrome

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15
Q

What is the classic triad of Carcinoid syndrome?

A

Bronchospasms
Diarrhea
Tricuspid degradation
- of note serotonin is metabolized in lungs and thus you rarely see left sided heart pathology

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16
Q

What is the classic triad for rickettsial illness?

A

Fever
Rash
Headache

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17
Q

What is the Weil-felix reaction and what is it used to test?

A

Ricketsiall disease

- Agglutination test that detects antiricketsial antibodies

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18
Q

What is Kehr sign and what does it indicate?

A

Referred pain to the left shoulder

- classic example of splenic rupture and infarct

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19
Q

What do pts with splenic rupture or infarct present with?

A

N
V
Left shoulder pain
LUQ pain

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20
Q

What is the treatment for lead poisoning?

A

Dimercaperol
ca-EDMA
Succimer in children
- Sometimes Penicillamine

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21
Q

What is N acetylcysteine used for?

A

Tylenol OD

- Pushing you to make more glutathione to reduce the NAPQI

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22
Q

What is the mnemonic for sx’s involved with lead poisoning?

A

LEAD
Lead lines–> Bruton lines and Metaphysis dense lines
Encephalopahty and Erythrocyte basophilic stippling
Abdominal colic and sideroblastic Anemia
Drops (wrist and foot) and Dimercaperol and ca-EDMA for treatment

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23
Q

Which enzymes does lead affect?

A

Inhibits:
Ferochelatase
S-ALA dehydratase

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24
Q

What are the lab levels for osteoporosis?

A

Completely normal

- only thing that is abnormal is a bone density test

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25
Q

What is Samter’s triad?

A

Asthma
Aspirin sensitivity
Nasal polyp

26
Q

What are some agents that can bring along an asthma attack?

A

Aspirin
Yellow food dye
B-antagonists
Sulfating agents

27
Q

What is thought to be the cause of an ACE cough?

A

ACE inhibitors inhibit the degradation of bradykinin which can accumulate in the lungs and cause bronchoconstriction and vasodilation which leads to a cough

28
Q

What is the mechanism of action of theophylline?

A

Inhibits phosphodiesterase which is an enzyme that breaks down cAMP
- Increase cAMP leads to bronchodilation

29
Q

How does an increase in cAMP lead to bronchodilation?

A

It activated protein kinase A which serves to inhibit the contract of smooth muscle by inhibiting myosin light chain kinase

30
Q

Which disease present with ANCA, either P and C?

A

Small vessel vasculitis:
Wegeners
Churg-Struass
Microscopic Polyangiitis

31
Q

What are other names for Wegener’s and Churg-Strauss?

A

W- Granulomatosis with polyangiitis

C- Eosinophilic granulomatosis with polyangiitis

32
Q

What is a common serology found in Polyarteritis nodosa PAN?

A

30% of pts have Hep B positive serology

33
Q

Pt presents with Melena, weight loss and abdominal pain. She has a fever and is 34 years old. Her BP is 170/75. She has negative ANCA but a positive hep b serology? Dx?

A

Polyarteritis nodosa

34
Q

What are some diseases that can cause mononucleosis like syndromes?

A

CMV
HIV
Acute toxoplasmosis

35
Q

Can patients with mono have hepatomegaly?

A

Yes but it is far less common than splenomegaly

- Thus it should present as just splenomegaly or hepatosplenomegaly

36
Q

Pt has weight loss, smokes, has RA and has epigastric pain after eating. Likely dx?

A

Gastric ulcer

- Greater pain after eating

37
Q

Pt presents with weight gain, smokes, has RA and has epigastric pain several hours after eating. Likely dx?

A

Duodenal ulcer

- pain Decreases with eating

38
Q

What is another name for Meyer’s loop?

A

Geniculocalcarine tract

- Located in the temporal lobe

39
Q

Lesion to the right Meyer’s loop results in what?

A

Left upper quadrantic anopia

40
Q

What is the MOA of Etoposide?

A

Inhibits Topo II

41
Q

What is the clinical use for Etoposide?

A

Solid tumors of the lung and testicle

- also lymphomas and leukemias

42
Q

What are the adverse affects of Etoposide?

A

Alopecia and myelosuppression

- rapidly dividing cells

43
Q

What are Kulchitsky cells?

A

Neuroendocrine or enterochormaffin cells

- they make serotonin and can be responsible for carcinoid syndrome

44
Q

What doe Kulchitsky cells look like and what cancer are they commonly found?

A

Small cell carcinoma

- Small dark blue cells with scant cytoplasm

45
Q

Where does the radial nerve run and with what artery?

A

Radial groove of the humerus

- Radial colateral artery

46
Q

What should one suspect with a mid humerus break?

A

Radial nerve and Radial colateral artery invovlement

47
Q

What nerve is damaged in wrist drop and what does this supply cutaneously?

A

radial nerve

- supplies the posterior arm/forearm and digits 1,2,3 dorsum of hand

48
Q

What is the MOA of cyclophosphamide?

A

Calcineurin inhibitor and thus inhibits the release of IL-2

- Immunosuppresant

49
Q

What is one bad AE of cyclophosphamide?

A

Nephrotoxic

50
Q

What are some adverse affects of odancetron?

A

HA
Constipation
Prolonged QT

51
Q

Bleeding swollen gums on a homeless patient with multiple lesions and several bruises? DX?

A

Scurvy

- Vit C def

52
Q

What is the rash called in Rheumatic fever/

A

Erythema marginatum

53
Q

What heart defect occurs in Rheumatic fever/

A

Mitral stenosis

54
Q

how does a mitral stenosis murmur sound and where?

A

Apex of heart with an opening snap and a decresendo low pitched in late diastole

55
Q

Where is actinomyces found?

A

Normal flora of oral, Gi and reproductive tract

56
Q

Is there fructose in breast milk? Formula

A

No and yes respectively

- more like the that formula has table sugar which is sucrose which is glucose and fructose

57
Q

What is defective in hereditary fructose intolerance and what is its inheritance?

A

Aldolase B

- AR

58
Q

Why and when does hereditary fructose intolerance present with hypoglycemia?

A

After induction of fructose into a babies diet

  • Fructokinase phosphorylates fructose to keep it in the cell
  • using phosphate
  • If aldolase B is mutated Fructose 1 phosphate gets stuck in the hepatocytes which leads to decrease in phosphate
  • No phosphate means no gluconeogenesis of glycogen and thus leads to hypoglycemia
59
Q

What other symptoms other than hypoglycemia can hereditary fructose intolerance babies present with?

A

Vomiting
Lethargy
Jaundice
Cirrhosis

60
Q

What are hemoglobin Bart cells?

A

Gamma Hb tetramer due to complete dysfunction of alpha Hb

61
Q

What is hydrops fatalis?

A

Defect in alpha globin (all four alleles are defective

- incompatible with life

USMLE-rx (9 decks)

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