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USMLE Step 1 Random Facts > Final review > Flashcards

Final review Flashcards

1
Q

histones rich in what AA

A

lysine and arginine

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2
Q

uracil formed by

A

deamination of cytosine

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3
Q

AAs coded by only 1 codon

A

methionine (AUG)

tryptophan (UGG)

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4
Q

genetic code is NOT conserved in?

A

mitochondria

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5
Q

telomerase is what kind of enzyme

A

reverse transcriptase enzyme (RNA-dependent DNA polymerase)

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6
Q

eukaryotic DNA Polymerase alpha function

A

makes own primer

replicates lagging strand

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7
Q

eukaryotic DNA Polymerase beta function

A

replic leading strand

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8
Q

eukaryotic DNA Polymerase delta function

A

DNA repair

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9
Q

eukaryotic DNA Polymerase gamma function

A

replic mitochondrial DNA

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10
Q

NER vs BER

A

NER - endonuclease first

BER - glycosylase first

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11
Q

what does amanitin (mushroom poison) do

A

inhib RNA polymerase II

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12
Q

where does mRNA processing take place

A

nucleus

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13
Q

antibodies to spliceosomal snRNPs seen in what pts

A

Lupus

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14
Q

noncoding RNAs are

A

carry out out functions w/o first being translated
snRNA
rRNA
tRNA

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15
Q

tRNAs contain what anticodon @ 3’ end

A

CCA

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16
Q

tRNA charged via? and using?

A

aminoacyl-tRNA synthetase

using ATP

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17
Q

where does start codon first attach on ribosome

A

P site

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18
Q

aminoglycosides MOA

A

bind 30S + inhib formation of initiation complex causing mRNA misreading

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19
Q

tetracyclines MOA

A

bind 30S + block aminoacyl-tRNA for entering A site

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20
Q

chloramphenicol MOA

A

binds 50S + inhibit peptidyl transferase (23S rRNA)

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21
Q

macrolides MOA

A

binds 50S + prevent release of uncharged tRNA after it donates its AA (prevents TRANSLOCATION)

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22
Q

clindamycin + lincomycin MOA

A

bind 50S + block translocation

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23
Q

nissl bodies are

A

RER in neurons (seen in DENDRITES)

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24
Q

free ribosome function

A

synth of cytosolic + organellar proteins

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25
Q

RER rich areas =

A

mucus-secreting goblet cells of SI

AB-secreting plasma cells

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26
Q

SER rich areas =

A

liver hepatocytes

steroid-hormone producing cells in adrenal cortex

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27
Q

COPI vesicle trafficking

A

Golgi–>ER

retrograde Golgi transport

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28
Q

COPII vesicle trafficking

A

ER—>Golgi (cis)

anterograde Golgi transport

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29
Q

Clathrin vesicle trafficking

A

trans-Golgi –> lysosomes

plasma membrane –> endosomes (receptor-mediated endocytosis)

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30
Q

def in peroxisome function leads to

A

accum of VLCFA

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31
Q

protein translation initiation/termination depends on a

A

GTPase

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32
Q

dynein moves

A

retrograde (from +–>-)

towards nucleus

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33
Q

kinesin moves

A

anterograde (from - –> +)

towards axon/nerve terminal

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34
Q

axonemal dynein is an?

A

ATPase (causes bending of cilium)

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35
Q

ouabain binds to what

A

K+ site on Na/K ATPase

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36
Q

ligamentum flava connects

A

vertebrae

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37
Q

elastin is rich in what AAs

A

proline + glycine (NONhydroxylated)

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38
Q

indirect ELISA

A

use test antigen to find Ab

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39
Q

direct ELISA

A

use Ab to find antigen

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40
Q

Southern blot =

A

DNA sample and DNA probe

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41
Q

Nouthern blot =

A

RNA sample w/ DNA probe

useful for mRNA studies!

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42
Q

Western blot =

A

protein sample w/ Ab probe

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43
Q

Southwestern blot =

A

DNA-binding protein (TF) w/ oligonucleotide probe

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44
Q

fluorescence preferred to visualize

A

microdeletions! (things at a MOLECULAR level)

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45
Q

cDNA only contains

A

CODING portion of gene (exons)

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46
Q

AD diseases usually are

A

defects in structural genes

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47
Q

AR diseases are usually

A

enzyme deficiencies

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48
Q

folate and B12 stored in

A

liver

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49
Q

B1 required for enzymes:

A

alpha-ketoglutarate
transketolase
Pyruvate DH
branched-chain amino acid DH

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50
Q

B7 cofactor for enzymes:

A

in carboxylation!
pyruvate carboxylase (pyruvate –> OA)
acetyl-CoA carboxylase (acetyl-CoA –> malonyl CoA)
propionyl-CoA carboxylase (propionyl CoA –> methylmalonyl CoA)

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51
Q

B12 cofactor for enzymes:

A 
homocysteine methyltransferase (homocysteine --> methionine); indirectly affects SAM (bc needs methionine)
methylmalonyl-CoA mutase (methylmalonyl-CoA --> succinyl CoA)
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52
Q

4 functions of vit C

A

1) antioxidant
2) keeps Fe in reduced state (so increases absorption)
3) hydroxylation of proline and lysine for collagen
4) in dopamine beta-hydroxylase –> convert dopamine to NE

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53
Q

ethanol metab shunts which 2 processes

A

pyruvate –> lactate
OAA –> malate

to regen NAD+!

inhibs gluconeogenesis + stim FA synth

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54
Q

mitochondria is site of

A

FA oxidation (beta-oxidation)
acetyl-CoA prod
TCA cycle
oxidative phosphorylation

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55
Q

cytoplasm is site of

A 
glycolysis
FA synthesis
HMP shunt
protein synth (RER)
steroid synth (SER)
cholesterol synth
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56
Q

mitochondria AND cytoplasm are sites for

A

Heme synth
Urea cycle
Gluconeogenesis

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57
Q

phosphorylase

A

adds inorganic phosphate W/O using ATP!!

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58
Q

shuttle producing 32 ATP

A

malate-aspartate (in heart/liver)

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59
Q

shuttle producing 30 ATP

A

glycerol-3-phosphate (muscle)

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60
Q

hexokinase properties

A

LOW Km and Vmax

UNINDUCED by insulin

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61
Q

glucokinase properties

A

HIGH Km and Vmax

INDUCED by insulin

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62
Q

fasting state changes seen in glycolysis/gluconeogenesis

A

increased FBPase-2, cAMP
decreased PFK-1, PFK-2, fructose-2,6-bisphosphate
glucagon!!

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63
Q

increased fructose-2,6-bisphosphate is sign of what state

A

fed

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64
Q

fed state changes seen in glycolysis/gluconeogenesis

A

decreased FBPase-2, cAMP
increased PFK-1, PFK-2, fructose-2,6-bisphosphate
insulin!!

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65
Q

carboxylase function

A

adds CO2 group w/ help of biotin!

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66
Q

when you see F-2,6-Bisphosphate think:

A

there’s enough glucose, we need more energy!

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67
Q

arsenic poisoning key feature

A

garlic breath

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68
Q

similar to pyruvate DH complex

A

alpha-ketoglutarate DH complex

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69
Q

pyruvate DH complex deficiency features

A

buildup of pyruvate and alanine –> lactic acidosis
X-linked gene mut of E1-alpha subunit
neuro deficits in infancy!

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70
Q

pyruvate DH complex deficiency tx

A

increase ketogenic nutrients:
high fat content
increase LEUCINE or LYSINE intake

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71
Q

Cori disease vs. von Gierke disease

A

Cori - NORMAL blood lactate levels

von Gierke - elevated lactate + hepatic steatosis

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72
Q

Niemann-Pick vs. Tay-Sachs

A

Tay-Sachs has NO hepatosplenomegaly

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73
Q

Hurler’s synd vs. Hunter’s synd

A

Hunter’s synd:
NO corneal clouding!
aggressive behavior
X-linked!

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74
Q

4 fates of pyruvate

A

alanine
OAA
acetyl-CoA
lactate

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75
Q

pyruvate –> alanine

A

alanine aminotransferase (w/ B6) - amino group from liver to muscle (from glutamate)

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76
Q

pyruvate –> OAA

A

pyruvate carboxylase (w/ biotin) - OAA can replenish TCA cycle or go to GNG

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77
Q

pyruvate –> acetyl-CoA

A

pyruvate DH complex (B1, B2, B3, B5, lipoic acid) - glycolysis to TCA cycle

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78
Q

pyruvate –> lactate

A

LDH (w/ B3) - anaerobic glycolysis (RBCs, kidney medulla, lens, testes, cornea)

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79
Q

citrate synthase rxn

A

acetyl-CoA –> citrate

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80
Q

isocitrate DH rxn

A

isocitrate –> alpha-ketoglutarate

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81
Q

alpha-ketoglutarate DH rxn

A

alpha-KG –> succinyl-CoA

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82
Q

succinate DH is part of?

A

complex II in ETC and uses FADH2

converts succinate –> fumarate

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83
Q

blocks complex I of ETC

A

amytal
rotenone
MPP

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84
Q

blocks complex III of ETC

A

antimycin A

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85
Q

blocks complex IV of ETC

A

H2S
CO
sodium azide (N3-)
CN-

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86
Q

blocks ATPase of ETC

A

oligomycin A

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87
Q

uncoupling agents do what in ETC

A

produce heat by allowing H+ to leak down their concentration gradient

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88
Q

examples of uncoupling agents

A

2,4-DNP
thermogenin (in brown fat)
aspirin

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89
Q

sites for HMP shunt (pentose phosphate pathway)

A

lactating mammary glands
liver
adrenal cortex
RBCs

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90
Q

AA required during periods of growth

A

Arg

His

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91
Q

what donates NH4 group to citrulline to make argininosuccinate

A

aspartate

catalyzed by arginosuccinate synthetase

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92
Q

ornithine transcarbamoylase rxn

A

ornithine –> citrulline

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93
Q

in urea cycle, argininosuccinate to arginine step creates what?

A

fumarate

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94
Q

which step creates urea

A

arginine to ornithine via arginase

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95
Q

what 2 AA can be used in urea cycle to remove NH4

A

alanine

glutamate (w/ NH4 –> becomes glutamine which is directly transported to liver from muscles)

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96
Q

tx for hyperammonia

A

reduce protein intake
benzoate, phenylbutyrate (bind AA –> facilitate excretion)
lactulose - acidify GI tract + trap NH4

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97
Q

homocystinuria vs. Marfan

A

lens subluxation in:

  • Marfan = upward
  • homocystinuria = downward and inward
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98
Q

accum of what AA in maple syrup urine dz

A

Ile
Val
Leu (especially this)

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99
Q

FA synth begins w/

A

citrate (in mitochondria) –> transport to cytoplasm + become acetyl-CoA by ATP citrate lyase

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100
Q

FA degrad inhib by

A

malonyl-CoA

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101
Q

urine tests detect which ketone

A

acetoacetate only

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102
Q

function of pancreatic lipase

A

degrad of TG in SI

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103
Q

function of LPL

A

degrad of TG in chylomicrons and VLDLs

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104
Q

function of hepatic lipase

A

degrad of TG in IDLs

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105
Q

function of hormone-sensitive lipase

A

degrad of TG in adipocytes

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106
Q

function of LCAT (lecithin-cholesterol acyltransferase)

A

esterification of cholesterol

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107
Q

function of CETP (cholesterol ester transfer protein)

A

transfer of cholesterol esters to other lipoprotein particles

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108
Q

chylomicron function

A 
TG --> peripheral tissues
chylomicron remnants (depleted of TG): cholesterol --> liver
secreted by intestinal epith cells
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109
Q

VLDL function

A

hepatic TG –> periph tissues

secreted by liver

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110
Q

IDL function

A

TG + cholesterol –> liver

formed in degrad of VLDL

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111
Q

LDL function

A

hepatic cholesterol –> periph tissues
taken up via recept-med endocytosis
formed by hepatic lipase modif of IDL in periph tissue

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112
Q

HDL function

A

cholesterol from periphery –> liver
repository of apoC and apoE
secreted from liver and intestine

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113
Q

hyperchylomicronemia vs. familial hypercholesterolemia

A

no increased risk of atherosclerosis in hyperchylomicronemia (but pancreatitis!)

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114
Q

thalamus a relay for everything except?

A

olfaction!

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115
Q

increase preload by

A

increased BV (overhydration, transfusion, preg)
exercise (slight)
increased sympathetic activity

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116
Q

wide splitting seen in conditions that

A

delay RV emptying like pulm stenosis, RBBB

exaggeration of normal inspiration split, but ALSO split in expiration (but by less)

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117
Q

fixed splitting seen in

A

ASD; pulmonic closure delayed regardless of breath by SAME amount

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118
Q

paradoxical splitting seen in

A

delayed LV emptying (like aortic stenosis, LBBB)

P2 occurs BEFORE A2, and paradoxically, on inspiration gets closer to A2 thereby eliminating the split

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119
Q

only virus w/ 2 identical ssRNA molecules

A

retrovirus

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120
Q

only DNA virus that replicates in cytoplasm

A

poxvirus

others replic in nucleus

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121
Q

only 2 RNA viruses that replicate in nucleus

A

influenza, retrovirus

others replic in cytoplasm

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122
Q

virus that acquires its envelope from nuclear membrane

A

herpesvirus family

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123
Q

ONLY ssDNA virus

A

parvovirus

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124
Q

all DNA viruses are linear except:

A

papilloma, polyoma (circular, supercoiled)

hepadna (circular, incomplete)

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125
Q

all DNA viruses are icosahedral except:

A

poxvirus (complex)

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126
Q

3 poxviruses:

A

variola (smallpox)
vaccinia (cowpox - provides immunity to smallpox)
Molluscum contagiosum

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127
Q

EBV latent in

A

B-cells

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128
Q

CMV latent in

A

mononuclear cells (lymphocytes, monocytes)

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129
Q

Roseola features:

A

high fevers that can cause seizures, followed by macular rash

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130
Q

Tzank test to check for

A

HSV-1, 2

VZV

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131
Q

Deformed cell seen in EBV infection

A

atypical lymphocytes (CD8+ reactive T-cells) aka Downey cells (w/ foamy appearing basophilic cytoplasm)

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132
Q

drug that forms a maculopapular rash that covers trunk + extremities when given to EBV mono pt

A

amoxicillin

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133
Q

all picornaviruses are _________ except __________

A

enteroviruses (fecal-oral spread)

rhinovirus is not

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134
Q

rhinovirus is unique from other picornaviruses in that

A

it is destroyed by stomach acid and therefore does not cause GI dz

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135
Q

1 cause of fatal diarrhea in children + its MOA

A

rotavirus - decrease reabsorp of Na and loss of K (due to villous destruction)

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136
Q

paramyxoviruses contain what protein

A

F (fusion) protein –> resp eptih cells to fuse + form multinucleated cells

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137
Q

tx for RSV pneumonia in pre-mature infants

A

palivizumab (Mab against F protein)

also, ribavirin

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138
Q

measles vs. rubella rash

A

both are descending maculopapular rashes, BUT:
measles - involves hands/feet
rubella - truncal

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139
Q

complications of measles

A

SSPE (subacute sclerosing panencephalitis)
encephalitis
giant cell pneumo (rare)

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140
Q

rabies infection found in what part of brain

A

Purkinje cells of cerebellum (Negri bodies seen in neurons)

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141
Q

vaccines available for which hepatitis viruses

A

HAV, HBV (and HDV by extension)

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142
Q

env gene in HIV forms

A

envelope proteins gp120 and gp41 (from cleavage of gp160)

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143
Q

gp120 function in HIV

A

attachment to host CD4+ T-cell

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144
Q

gp41 function in HIV

A

fusion and entry

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145
Q

gag gene in HIV is also known as? and forms what?

A

p24

capsid protein

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146
Q

pol gene in HIV forms

A

reverse transcriptase
aspartate protease
integrase

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147
Q

nef gene in HIV does what?

A

decreases expression MHC class I proteins on surface of infected cells

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148
Q

false negative ELISA/Western blot seen in which HIV population

A

those w/ acute infection (bc low Ab)

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149
Q

false positive ELISA/Western blot seen in which HIV population

A

babies born to infected mothers bc gp120 crosses placenta

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150
Q

latent HIV phase, virus replicates in where in body

A

LN

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151
Q

oral candidiasis in HIV pts when CD4 < ?

A

400

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152
Q

esophageal candidiasis in HIV pts when CD4 < ?

A

100

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153
Q

histo difference in B.henselae vs Kaposi sarcoma in HIV

A 
B.hens = NEUTROPHILIC infiltrate
Kaposi = LYMPHOCYTIC infiltrate
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154
Q

opportunistic infections seen with CD4 < 400

A

oral candidiasis

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155
Q

opportunistic infections seen with CD4 < 200

A

cryptosporidium - diarrhea
JC virus (reactivation) - PML
PCP

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156
Q

opportunistic infections seen with CD4 < 100

A

esophageal candida
Histoplasmosis dissem dz (HSM, fever, cough, etc)
Toxoplasmosis (MANY ring-enhancing lesions)

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157
Q

opportunistic infections seen with CD4 < 50

A

C.neoformans
CMV retinitis (cotton-wool spots)
MAC

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158
Q

T.gondii vs. primary CNS lymphoma in HIV pts (histo)

A

T.gondii - MANY ring-enhancing lesions

CNS lymphoma - usually FOCAL lesion

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159
Q

bugs mimicking appendicitis

A

Y.pestis (mesenteric adenitis)
Salmonella
C.jejuni

160
Q

tx for atypical pneumo

161
Q

tx for neonatal pneumo

A

ampicillin + gentamicin

162
Q

empiric tx for meningitis

A

ceftriaxone + vancomycin
add ampicillin if Listeria suspected!
also maybe give dexamethasone

163
Q

Neisseria meningitidis presents first w/

A

purpura on skin before meningitis

164
Q

+ leukocyte esterase test seen in

A

BACTERIAL UTI

165
Q

+ nitrate test seen in

A

GRAM NEG bacterial UTI (presence of Enterobactericeae)

166
Q

measles vs. rubella

A

postauricular LAD in rubella!

167
Q

Fitz-Hugh-Curtis synd features

A

from PID
infects liver capsule
see “violin-string” adhesions of parietal peritoneum to liver

168
Q

avoid what when taking tetracyclines

A

anything w/ divalent cations bc inhibs absorption

169
Q

aminoglycoside resistance is by

A

transferase enzymes that acetylate, phosphorylate or adenylate drug to inactivate it

170
Q

macrolide resistance is by

A

methylation of 23S rRNA

171
Q

anaerobic infection tx

A

clindamycin (above diaphragm)

metronidazole (below diaphragm)

172
Q

SE of sulfonamides

A 
HST
hemolysis in G6PD def pts
nephrotox (tubulointerstitial nephritis)
photosensitivity
kernicterus in infants
displace other drugs from albumin (like warfarin)
173
Q

prophylaxis for meningococcal infection

A

ciprofloxacin

rifampin (for children)

174
Q

prophylaxis for H.flu meningitis

175
Q

prophylaxis for recurrent UTIs

176
Q

prophylaxis for endocarditis w/ surgical or dental procedures

A

penicillins

177
Q

prophylaxis for preg women w/ GBS

A

ampicillin DURING labor

178
Q

prophylaxis of strep pharyngitis in child w/ prior rheumatic fever

A

oral penicillin

179
Q

prophylaxis for prevention of post surgical infection due to S.aureus

180
Q

prophylaxis for prevention of gonoccocal or chlamydial conjunctivitis in newborn

A

erythromycin ointment

181
Q

prophylaxis for MAC if CD4 <50

A

azithromycin

182
Q

toxoplasmosis, antimalarial tx

A

pyrimethamine

183
Q

T.cruzi tx

A

nifurtimox

184
Q

leshmaniasis tx

A

Na stibogluconate

185
Q

ribavirin MOA/SE

A

competitively inhib IMP dehydrogenase + inhib synth of guanine nucleotides
SE = hemolytic anemia, teratogen

186
Q

foscarnet binds to

A

pyrophosphate-binding site of enzyme

187
Q

enfuvirtide binds to

188
Q

tenofovir unique in that it is a

A

nucleoTIDE analog (does not have to be phosphorylated to be active)

189
Q

HIV prophylaxis during preg

A

zidovudine

190
Q

tx for chronic granulomatous disease

191
Q

maraviroc MOA

A

CCR5 anatagonist; inhib gp120 conformational change

192
Q

murmur ass. w/ coarctation of aorta

A

aortic regurg

193
Q

heart disorder ass w/ 22q11 synd

A

ToF

truncus arteriosus

194
Q

heart disorder ass w/ congenital rubella

A

PDA

pulmonary artery stenosis

195
Q

heart disorder ass w/ Turner’s synd

A

Coarctation of aorta (preductal)

bicuspid aortic valves

196
Q

heart disorder ass w/ infant of diabetic mother

A

transposition of great vessels

197
Q

monckeberg lesion seen in what part of artery

198
Q

atherosclerosis deposits seen in what part of artery

199
Q

AAA ass w/?

A

Atherosclerosis

200
Q

thoracic aortic aneurysm ass w/ + can cause what?

A

HTN

also, can cause AR

201
Q

ST depression

A

stable/unstable angina

202
Q

ST elevation

A

prinzmetal’s angina

203
Q

tx for prinzmetal’s angina

A

dihydropyridine CCB

204
Q

MI ECG changes seen

A

ST depression –> ST elevation

205
Q

most useful marker in detecting MI reinfarction

206
Q

MI changes seen in 0-4 hrs

A

NO gross/microscopic changes

risk of arrhythmia, shock

207
Q

MI changes seen in 4-12 hrs

A 
dark mottling (pale w/ tetrazolium stain)
early coag necrosis, edema

risk of arrhythmia

208
Q

MI changes seen in 12-24 hrs

A

still dark mottling
contraction bands from reperfusion injury (via fibrinolytic therapy)
release of necrotic cell content into blood

risk of arrhythmia

209
Q

MI changes seen in 1-3 days

A

hyperemic tissue
extensive coag necrosis; acute inflamm; NEUTROPHILS!

risk of fibrinous pericarditis (in transmural infarcts esp)

210
Q

MI changes seen in 3-14 days

A

yellow-brown central softening!
MACROPHAGES, granulation tissue @ margins

risk of: free wall rupture (can cause cardiac tamponade), papillary muscle rupture (can cause MR), IV septum rupture (can cause VSD), ventricular aneurysm [all from macrophage weakening]

211
Q

MI changes seen in 2 wks to several months

A

gray-white tissue!
scar seen

risk of Dressler’s synd

212
Q

MI changes reversible w/in

A

20-40 mins

213
Q

causes a systolic dysfunction

A

dilated cardiomyopathy

214
Q

causes a diastolic dysfunction

A

hypertrophic cardiomyopathy

restrictive cardiomyopathy

215
Q

marker used to dx CHF

216
Q

common cause of cor pulmonale

A

pulm HTN (from obliteration of pulm vasculature by COPD)

217
Q

bacterial endocarditis signs

A 
Fever
Roth spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhages (splinter hemorrhages)
Emboli
218
Q

Rheumatic fever signs

A 
Fever
Erythema marginatum
Valvular lesions (fibrosis and vegetations)
ESR elevated
Red-hot joints (migratory polyarthritis)
Subcut. nodules
Syndenham's chorea
219
Q

2 things seen on histo w/ rheumatic fever

A 
Aschoff bodies (granuloma w/ giant cells)
Anitschkow's cells (activated histiocytes that look like "caterpillar cells" bc of condensed chromatin, abund cytoplasm)
220
Q

ECG changes in pericarditis

A

widespread ST elevations and/or PR depression

221
Q

pericardial knock heard when

A 
early diastole (shortly after S2)
brief, high-freq sound
222
Q

cause of Raynaud’s phenom

A

arteriolar vasospasm

223
Q

tx for Raynaud’s

A 
dihydropyridine CCB (vasodil)
aspirin (to prevent clots)
224
Q

vasculitis w/ increased p-ANCA + differences b/w them

A

microscopic polyangiitis - no granulomas; segmental fibrinoid necrosis
churg-strauss synd - granulomatous, necrotizing vasculitis w/ eosinophilia

225
Q

vasculitis w/ increased c-ANCA

A

Wegener’s granulomatosis

226
Q

strawberry hemangioma

A

infancy

grows rapidly, regresses spontaneously (around 5-8y.o)

227
Q

cherry hemangioma

A

elderly
no regression; freq increases w/ age
thin-walled BV

228
Q

pyogenic granuloma

A

raised capillary hemangioma

ass w/ trauma + pregnancy

229
Q

cystic hygroma

A

cavernous lymphangioma often on posterior neck/lateral chest wall
ass w/ Turner synd

230
Q

glomus tumor

A

painful! (but benign)
red-blue tumor UNDER FINGERNAILS
glomus cell (mod SM cells) tumor - controls thermoregulation

231
Q

bacillary angiomatosis

A

B.hensalae
in AIDS pts
necrotizing granulomatous adenitis (inflamm of LN) w/ stellate microabscesses

232
Q

angiosarcoma

A

BV malignancy
head, neck, breast areas
ass w/ pts receiving radiation therapy (esp breast cancer, Hodgkin’s lymphoma)
metastasis to brain/bone

233
Q

lymphangiosarcoma

A

persistant lymphedema

ass. w/ post-radical mastectomy

234
Q

spider angiomas

A

red central papule w/ outwardly radiating vessels that BLANCH on pressure
estrogen dependent!
ass w/ preg, liver dz, pts taking OCPs and estrogen

235
Q

cavernous hemangioma

A

dilated vascular spaces w/ thin-walled endoth cells

soft blue compressible masses

236
Q

Sturge-Weber disease

A

congenital - affects capillary-sized vessels
findings:
port-wine stain on face (nevus flammeus)
ipsilateral leptomeningeal angiomatosis (intracerebral AVM)
seizures
early-onset glaucoma
skull opacities (“tram-track” calcifications)

237
Q

drug class protective against diabetic nephropathy

238
Q

arteriolar vasodilator

A

hydralazine

239
Q

vasodilation OR venodilation (but not both together) can ALWAYS lead to a (SE)

A

compensatory tachycardia

240
Q

malig HTN 1st line drug

A

nitroprusside (balanced arterial/venous vasodil)

241
Q

fenoldapam MOA

A

dopamine D1 recept agonist

242
Q

malig HTN w/ renal failure: use what drug?

A

fenoldopam

243
Q

fenoldopam causes what effects

A

coronary, periph, renal, splanchnic vasodil

decreases BP and increases natriuresis

244
Q

beta-blockers CI w/ what other drug

A

non-dihydropyridine CCBs

245
Q

beta-blockers CI in angina

A

pindolol
acebutolol

bc partial Beta agonists

246
Q

precapillary sphincters respond to

A

histamine, decreased O2, increased pCO2, decreased pH - causes dilation of capillaries

247
Q

HMG-CoA reductase inhibitors inhib conversion of HMG-CoA to?

A

mevalonate

248
Q

3 SE of niacin

A

hyperuricemia (–> gout)
hyperglycemia (–> acanthosis nigracans)
red flushing of face

249
Q

SE of fibrates

A

myositis
hepatotox
chol gallstones

CI w/ statins

250
Q

MOA of fibrates

A

upregulate LPL –> increased TG clearance

activates PPAR-alpha

251
Q

fibrates increases conc of what lipoprotein

252
Q

digoxin indicated for

A 
chronic CHF (bc increases contractility)
Afib (bc decreases AV node conduction and depresses SA node)
253
Q

poor prognostic indicator of digoxin tox

A

hyperkalemia

254
Q

factors predisp to digoxin tox

A

hypokalemia
quinidine, verapamil (displaces digoxin binding from tissue binding sites –> decreased excretion)
renal failure (decreases excretion)

255
Q

increased markers in NTD

A

AFP

AChE (confirmatory)

256
Q

ass w/ Chiari I malformation

A

syringomyelia

257
Q

ass w/ Chiari II malformation

A

hydrocephalus
aqueductal stenosis
thoracolumbar myelomeningocele common
herniation!!

258
Q

ass w/ Dandy Walker malformation

A

hydrocephalus
spina bifida
agenesis!!

259
Q

causes of glossitis

A 
B12 def
riboflavin (B2) def
Fe def
niacin def (B3)
260
Q

NE changes/synth in

A

increased in anxiety
decreased in depression

Locus ceruleus

261
Q

dopamine changes/synth in

A

increased in schizophrenia
decreased in depression, Parkinson’s

ventral tegmentum and SNc (midbrain)

262
Q

serotonin (5-HT) changes/synth in

A

decreased in anxiety, depression

Raphe nucleus (pons)

263
Q

ACh changes/synth in

A

decreased in Alzheimer’s, Huntington’s
increased in REM sleep, Parksinson’s

Basal nucleus of Meynert

264
Q

GABA changes/synth in

A

decreased in anxiety, Huntington’s

Nucleus accumbens

265
Q

BBB composed of

A

astrocyte foot process
tight junctions
BM

266
Q

areas of brain w/o BBB

A

area postrema
neurohypophysis
OVLT (senses changes in osmolarity)

267
Q

melatonin can inhibit the prod of

A

LH and FSH from ant pituitary

268
Q

globus pallidus internus does what to movement

269
Q

globus pallidus externus does what to movement

A

facilitates

270
Q

subthalamic nucleus does what to movement

271
Q

substantia nigra pars compacta does what to movement

A

facilitates

272
Q

SNr does what to movement

273
Q

how does MPP cause Parkinson’s

A

destroys dopaminergic cells in substantia nigra by inhib ETC @ complex 1

274
Q

how does MPTP become MPP

A

MAO metabolism

275
Q

cause of neuronal death in Huntington’s

A

NMDA-recept binding and glutamate toxicity

276
Q

drug that is metab to active phenobarbitol-like metabolite

277
Q

intention tremor = dysfun in what area

A

cerebellar damage

278
Q

hemiballismus = lesion where

A

contralateral STN

279
Q

myoclonus = lesion where and is common in what conditions

A

nucleus ambiguus of medulla

w/ metabolic abnorm (like liver or renal failure)

280
Q

lesion of hippocampus =

A

inability to make NEW memories (anterograde amnesia)

281
Q

lesion of superior colliculus –>

A

parinaud’s synd (paralysis of upward gaze)

282
Q

conduction aphasia = damage to

A

arcuate fasciculus

283
Q

ass w/ CN III palsy

A

PComm artery aneurysm

284
Q

common causes of intraparenchymal hemorrhage

A

systemic HTN!
amyloid angiopathy
vasculitis
neoplasm

285
Q

genetic cause of ALS

A

defect in superoxide dismutase 1

286
Q

tx for ALS/it’s MOA

A

riluzole - decreases presynaptic glutamate release (can moderately increase survival)

287
Q

nonbenzo hypnotics?

A

zolpidem
zaleplon
eszopiclone

288
Q

CN III and vascular damage –>

A

motor dysfunct –> ptosis, down and out pupil

289
Q

CN III compressive damage —>

A

parasymp dysfunct –> blown pupil (absent pupillary light reflex)

290
Q

pie in the sky lesion

A 
temporal lesion (MCA)
aka Meyer's loop
291
Q

pie on the floor lesion

A 
parietal lesion (MCA)
aka dorsal optic radiation
292
Q

right homonymous hemianopia

A

left optic TRACT lesion

**switch for left

293
Q

left anopia

A

right optic NERVE lesion

**switch for right

294
Q

butorphanol MOA/uses

A

MOA - mu-partial agonist; kappa full agonist

uses - severe pain

295
Q

tramadol MOA/uses

A

weak opioid agonist; inhib serotonin + 5-HT reuptake

use - chronic pain

296
Q

tolerance does not develop to which opioid SE

A

constipation

miosis

297
Q

1st line prophylaxis of status epilepticus

298
Q

1st line for simple, complex, tonic-clonic seizures

A

carbamazepine

299
Q

1st line for trigeminal neuralgia

A

carbamazepine

300
Q

DOC for partial seizures

A

lamotrigine

301
Q

1st line for seizures in children

A

phenobarbitol

302
Q

valproic acid MOA

A

blocks NMDA receptors

increases GABA conc by inhib breakdown + increasing synth

303
Q

1st line for acute status epilepticus + eclampsia seizures

A

diazepam, lorazepam

304
Q

1st line for eclampsia seizures

305
Q

phenytoin blood SE

A

megaloblastic anemia by decreasing folate absorption (bc of inhib of intestinal conjugase)

306
Q

CI for barbiturate use

A

acute intermittant porphyria

307
Q

osteoclasts stain positive for what + req what 2 signals

A

TRAP positive

M-CSF + RANK-L signals

308
Q

substance that can cause morphine tolerance + what can block it?

A

glutamate (NMDA activation)

ketamine can block

309
Q

complex regional pain syndrome type I vs. II

A

type I - NO evidence of nerve damage; severe, burning pain, muscle spasm, joint stiffness, restricted mobility, vasospasm, increased hair growth
type II - evidence of nerve damage

310
Q

early detection of diabetic nephropathy =

A

check for microalbuminemia

311
Q

oral ulcers can be seen in what dz?

A

pemphigus vulgaris
paraneoplastic pemphigus
Behcet dz
Crohn’s dz

312
Q

examples of flat bones

A

skull
sternum
bones of pelvis

313
Q

most common location of hematogenous osteomyelitis in adults

A

vertebral body

**also same location for Pott’s dz

314
Q

classic findings in multiple myeloma

A
  • easy fatiguability (from anemia)
  • constipation (from hypercalcemia)
  • bone pain in back and ribs usually (from production of osteoclast activating factor by myeloma cells and subseq bone lysis)
  • renal failure
315
Q

dz found in metaphysis of long bone

A

osteochondroma
osteosarcoma
osteomyelitis in children

316
Q

dz found in epiphysis of long bone

A

giant cell tumor (osteoclastoma)

317
Q

dz found in diaphysis of long bone

A

Ewing sarcoma

chondrosarcoma (w/in medullary cavity)

318
Q

DI dx w/ urine specific gravity <

319
Q

systolic dysfunction

320
Q

diastolic dysfunction

A

HCM (due to LV rigidity)

RCM

321
Q

GI drug CI in pts w/ Parkinson or SI obstruction

A

metoclopramide

322
Q

estrogen deficiency can lead to:

A
  • atrophied vagina
  • infertility
  • breast atrophy
  • osteopenia
323
Q

types of substances that CAN’T cross placenta

A

water-solube (like conjugated bilirubin, heparin)

324
Q

types of substances that can cross placenta

A

lipophilic substances (like unconj bilirubin, warfarin)

325
Q

smoking cessation ass w/ what effects?

A
  • prolong life expectancy
  • decreases risk of MI, cerebrovascular injury, lung cancer
  • slows rate of pulm function loss
326
Q

EDS = problem w/ what enzyme

A

lysyl oxidase (contains Copper)

327
Q

macrolide resistance

A

methylation of 23S rRNA binding site

328
Q

aminoglycoside resistance

A

transferase enzymes that inactivate drug by acetylation, phosphorylation, or adenylation

329
Q

chloramphenicol resistance

A

plasmid-encoded acetyltransferase that inactivates drug

330
Q

step in urea cycle that forms urea

A

hydrolyzation of L-arginine by arginase to ornithine and urea; ornithine transported back to mitochondria to restart

331
Q

Bloom synd defect?

A

mut in DNA helicase

332
Q

hyperestrogenemia causes?

A 
spider angiomas (telangiectasias)
palmar erythema
gynecomastia
testicular atrophy
decreased body hair
Dupuytren's contractures
333
Q

Kayser-Fleisher rings located in what part of eye?

334
Q

Lisch nodules of NF1 located in what part of eye?

335
Q

retinal lesions caused by what diseases?

A

DM
HTN
pseudoxanthoma elasticum
Tay-Sachs disease

336
Q

osteogenesis imperfecta involves what part of eye?

337
Q

different retinoid meds

A 
isotretinoin
acetretin
tretinoin
adapalene
tazarotene
338
Q

“sputum eosinophils” think:

339
Q

most common cause of death w/ HCM

340
Q

most common cause of death w/ RCM

341
Q

AA w/ 3 titratable protons

A 
His
Arg
Lys
Asp
Glu
Cys
Tyr
342
Q

tx for hemorrhagic cystitis (if already occurring)

A

N-acetylcysteine

343
Q

magenta-colored tongue =

A

vit B2 deficiency

344
Q

burnt almonds smell?

A

cyanide poisoning

345
Q

dimorphic fungi

A 
Sporothrix schenkii
Blastomyces
Paracoccidioides
Coccidioides
Histoplasma

molds @ 25-30C
yeast @ 35-37C

346
Q

DOC for toxoplasmosis

A

pyrimethamine and sulfadiazine

347
Q

Reactive arthritis seen after infection w/ what 6 bugs?

A 
Campylobacter
Shigella
Salmonella
Yersinia
Chlamydia
Bartonella
348
Q

tx for acute mania

A

mood stabilizer (lithium, carbamazepine, valproate) + atypical antipsych (olanzapine usually)

349
Q

findings highly ass w/ ankylosing spondylitis

A
  • enthesopathies (inflamm @ site of insertion of tendons into bone)
  • pain can limit chest wall expansion –> causes hypoventilation (monitor chest wall!!)
  • ascending aortitis –> dilation of aortic ring and aortic insuff
  • anterior uveitis in 20-30%
350
Q

source of N in urea cycle?

351
Q

function of prokaryotic 16S rRNA

A

contains seq complimentary to Shine Dalgarno seq on mRNA –> necessary for initiation of protein synth

352
Q

3’–>5’ DNA exonuclease activity

A

proofreading + removal of mismatched nucleotides

353
Q

K-ATP channel regulatory substance in pancreatic beta-cells

354
Q

mRNA translation regulation/degradation depends on?

A

cytoplasmic P bodies

355
Q

essential activator of CPS1 + substrates formed from?

A

N-acetylglutamate

precursors = acetyl-CoA + glutamate

356
Q

babies exclusively breast-fed req supplementation of what vit?

A

vit K and D

357
Q

BH4 = cofactor in?

A

dopamine
serotonin
tyrosine
NO

358
Q

SSPE caused by measles virus due to lack of Ab to what?

A

M-component of virus

359
Q

common cause of death in PCP toxicity?

360
Q

most common non-nuclear DNA found in eukaryotic cells?

361
Q

common cause of death in diphtheria infection?

A

cardiomyopathy

362
Q

1st thing to do in acute diphtheria infection?

A

admin passive immunization (diphtheria antitoxin)

363
Q

1st line tx for acute gout

A

NSAIDS

2nd line = colchicine; then GC

364
Q

increased # of trinucleotide repeats in Fragile X synd leads to?

A

hypermethylation of FMR1 gene –> inactivation

365
Q

inhaled anesthetic solubility correlates to?

A

blood/gas partition coefficient

366
Q

inhaled anesthetic potency correlates to?

367
Q

clearance of inhaled anesthetic usually by

A

exhalation through lungs

368
Q

parvovirus B19 replicates in?

A

bone marrow

369
Q

MOA of pentazocine

A

opioid narcotic w/ partial agonist activity and weak antag activity @ mu receptors

370
Q

pentazocine SE

A

withdrawal symptoms in pts dependent on or tolerant to opioids

371
Q

gastric ulcers form because of?

A

lack/destruction of mucosal layer

372
Q

duodenal ulcers form bc of?

A

increased acid production

373
Q

UMN lesion sites =

A
  • CS tract
  • medulla, pons, midbrain
  • internal capsule
  • precentral gyrus (primary motor cortex)
374
Q

alpha-receptors _______ insulin secretion?

375
Q

beta-receptors _______ insulin secretion?

A

stimulates

376
Q

NADPH used in?

A
  • anabolic processes (steroid + FA synth)
  • resp burst
  • P-450
  • glutathione reductase
377
Q

what inhibits glucokinase activity

378
Q

what inhibits hexokinase activity

379
Q

stim/inhib of pyruvate kinase?

A

stim by: F-1,6-BP

inhib by: ATP, alanine

380
Q

LDH pathway impt in?

A 
RBC
leukocytes
kidney medulla
lens
testes
cornea
381
Q

Chlamydia cell wall lacks _________? It also uses an EXTERNAL __________ bc ________?

A

lacks peptidoglycan;

uses external ATP source bc they’re obligate intracellular organisms

382
Q

OTC deficiency unique in that it’s inheritance is?

A

X-linked recessive (vs. most other urea cycle enzyme defects which are AR)

383
Q

OTC stimulated by what vitamin?

384
Q

tyrosine can form what 2 substances?

A

Dopa

thyroxine

385
Q

tyrosinase activity on Dopa produces?

386
Q

Tay-Sachs histo?

A

lysosomes w/ onion skin

387
Q

Niemann-Pick histo?

A

foam cells

388
Q

Gaucher disease histo + unique feature?

A

Gaucher’s cells (macrophages w/ cytoplasmic fibrils) - look like crumpled tissue paper
unique - bone crises

389
Q

Krabbe disease histo + unique feature?

A

globoid cells

unique - optic atrophy

390
Q

FA synth starting substrate?

391
Q

FA synth req what vitamin?

A

biotin (for acetyl-CoA –> malonyl-CoA)

392
Q

what inhibits acyl-CoA translocation from cytoplasm to mitochondrial matrix?

A

malonyl-CoA

393
Q

injections in superomedial part of buttock injure what?

A

gluteal nerves

394
Q

injections in inferomedial part of buttock injure what?

A

sciatic nerve

395
Q

serotonin-releasing neurons

A

raphe nucleus (in brainstem)

396
Q

NE-secreting neurons

A

nucleus ceruleus (in dorsal pons)

USMLE Step 1 Random Facts (35 decks)

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