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USMLE Step 1 > High-Yield Misses - UWorld > Flashcards

High-Yield Misses - UWorld Flashcards

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USMLE® Step 1 flashcards
1
Q

Abnormalities involving what structure cause Hypospadias? Epispadias?

A

Hypospadias - Uretheral/Urogenital Folds

Epispadias - Genital tubercle

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2
Q

Low levels of what electrolyte can cause hypoparathyroidism?

A

Magnesium (as in prolonged diarrhea)

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3
Q

What amino acids should be supplemented with in pyruvate dehydrogenase deficiency?

A

Lysine and Leucine as they are the only purely ketogenic amino acids.

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4
Q

Under physiologic conditions, is Cl driven in or out of the cell?

A

It is driven into the cell down its concentration gradient to try and achieve a more negative membrane potential

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5
Q

What are the lab values in Osteoporosis?

A

Serum Ca, PO4, ALP, and PTH are all NORMAL!!!

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6
Q

What is Atypical Depression?

A

Mood reactivity, leaden fatigue, rejection sensitivity, and increased sleep and appetite (reversed vegetative signs). Rx with MAOI.

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7
Q

What is another name for cANCA?

A

PR3-ANCA; Seen in Granulomatosis with Polyangiitis (Wegners)

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8
Q

What is another name for pANCA?

A

MPO-ANCA (myeloperoxidase ANCA)

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9
Q

What is a risk when starting all antidepressents?

A

Inducing MANIA in susceptible patients (particularly TCAs and venlafaxine)

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10
Q

What are the “3 D’s” of Pellagra?

A

Dermatitis (esp in sun exposed areas), diarrhea (epithelial atrophy), and dementia (neuronal degeneration). Niacin is found in the diet or synthesized from tryptophan. (non-absorbable in corn).

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11
Q

What is Hartnup Disease?

A

Decreased absorption of tryptophan leading to Pellagra from niacin deficiency.

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12
Q

How does carcinoid syndrome cause Pellagra?

A

Increased tryptophan metabolism to 5HT

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13
Q

What is a secondary method of diagnosing CF?

A

There is a negative transepithelial potential difference due to increased sodium reabsorption (results from a decreased inhibition of apical Na channels and from intracellular Cl accumulation

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14
Q

What are the Down syndrome Pre-natal findings?

A

First Trimester Screen: Serum PAPP-A DOWN, bHCG UP. Increased Nuchal transclucency
Quad ScreeN: Increased Inhibin, Increased HCG, Decreased Estriol, Decreased AFP

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15
Q

What are the Prenatal findings in Edwards Syndrome?

A

Trisomy 18.
First Trimester Screen: PAPP-A and bHCG DOWN
Quad Screen: AFP, HCG, estriol DOWN, inhibin normal or down

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16
Q

What are the prenatal findings in Patau syndrome?

A

First Trimester Screen PAPPA, bHCG DOWN, Increased Nuchal Translucency

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17
Q

What should you consider on a patient on long-term steroids (e.g. SLE patient)?

A

Iatrogenic Cushings Syndrome. Would show bilateral adrenal cortical atrophy.

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18
Q

What is a likely consequence of hydrocephalus later in life?

A

Hyperrtonicity and hyperreflexia due to upper motor neuron damage.

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19
Q

What is the name and function of the toxin produced by P. aeurginosa?

A

Exotoxin A which inhibits EF-2

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20
Q

What reaction is catalyzed by 21-hydroxylase?

A

Progersterone -> 11-Deoxycortisone

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21
Q

What gene mutation is commonly carried by melanoma?

A

BRAF B600E. Can use vemurafenib a BRAF kinase inhibitor

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22
Q

What electrolyte abnormalities is the patient at risk for in the maintenance and recovery phases of ATN?

A

Maintenance - Hyperkalemia, high anion gap metabolic acidosis, hypocalcemia
Recovery - Hypokalemia (due to brisk diuresis without full tubular function), hypocalcemia

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23
Q

What two immunodeficiencies can have lack of thymic shadow?

A

DiGeorge’s Syndrome and SCID

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24
Q

What are the three important dopaminergic systems?

A

Mesolimbic-mesocortical: regulates behavior. Schizophrenia associated
Nigrostriatal: Coordinates voluntary movement. Parkinsonism
Tuberoinfundibular: Controls prolactin secretion

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25
Q

What is the first glycolytic enzyme in beta cells?

A

Glucokinase (like the liver, not hexokinase). Inactivating mutations in glucokinase result in mild hyperglycemia that can be exacerbated in pregnancy.

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26
Q

What is the allosteric activator of Pyruvate Carboxylase?

A

Acetyl-CoA

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27
Q

What is a key difference in the Sx treated by typical and atypical neuroleptics?

A

Typical - treat positive symptoms of schizophrenia

Atypical - treat both positive and negative symptoms

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28
Q

What Abx for lung abscess in Alcoholic?

A

Clindamycin! Remember it covers anaerobes above the diaphragm and also S. pneumoniae. Need to cover anaerobes and aerobic streptoccoci in a lung abscess.

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29
Q

What is the characteristic venous blood finding in cyanide toxicity?

A

Increased SaO2 as oxygen cannot be unloaded in tissues.

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30
Q

Where is lung abscess likeley to form with aspiration while supine?

A

Likely to form in the right lung in the posterior segment of the right upper lobe or superior segment of right lower lobe

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31
Q

What is the function of IgA?

A

It acts to prevent bacterial from adhesing to and penetrating a mucosal barrier. Does not act as an opsonin.

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32
Q

What is the most common cause of death in Type 2 diabetics?

A

Coronary heart disease! (Most common cause of ESRD, but 1/2 of ESRD patients die of cardiac disease)

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33
Q

What direction does the PCL run? ACL?

A

PCL - Medial to Lateral, Anterior to Posterior (from femur to tibia)
ACL - Lateral to medial, posterior to anterior (from femur to tibia).
Remember the tibia is medial

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34
Q

What is the anatomical defect in cleft lip?

A

Failure of fusion of the maxillary and medial nasal processes (primary palate)

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35
Q

What is the anatomical defect in cleft palate?

A

Failure of fusion of the two lateral palatine processes or failure of fusion of lateral palatine processes with the nasal septum or medial palatine process (formation of secondary palate)

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36
Q

What enzyme does Etoposide inhibit?

A

DNA Topoisomerase II (2 makes transient breaks in both DNA strands etoposide inhibits ability to seal the breaks)

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37
Q

What drugs inhibit Topoisomerase I?

A

Irinotecan and Topotecan (normally it makes single strand breaks)

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38
Q

Which layer of tissue differentiates an ulcer from an erosion?

A

Ulcer - penetrate mucosal layer (i.e. goes through muscularis mucosa)
Erosions - Do not fully extend through muscularis mucosa

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39
Q

What is the most common cuase of in-hospital death after an MI?

A

Ventricular failure and Cardiogenic shock

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40
Q

What is phenotypic mixing?

A

Co-infection of a cell by two viruses; Genetic material of one virus gets encapsualted by the proteins of another so it displays the tropism of the other virus (on its next infection ONLY). Note could also be only a mix of surface components, this still allows for infection of new cell types.

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41
Q

How do you describe a HBV infected hepatocyte?

A

Cytoplasm is filled with spherules and tubules of HBsAg, cytoplasm takes on a granular “ground glass” eosinophilic appearance.

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42
Q

What is the histologic features of HCV infection?

A

Lymphoid aggregates within the portal tracts and focal areas of microvesicular steatossis.

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43
Q

What is more dangerous, tubular or villous polyp?

A

Villious! It is a villian!

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44
Q

True or false, Larger VSDs usually have softer murmurs?

A

True! Lower pressure gradient.

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45
Q

What explains Thiopental’s short duration of action?

A

It rapidly distributes to the brain but then rapidly re-distributes to the Skeletal Muscle and Fat! The rapid brain/blood clearance leads to rapid recovery from anasthesia

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46
Q

What lipid-lowering agent causes hyperuricemia?

A

Niacin - exacerbates Gout. Other meds that cause gout: HTZ, cyclosporine, PZA.

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47
Q

How do you prevent neonatal tetanus?

A

Immunize mothers with tetanus toxoid so that they can pass the antibodies to their child.

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48
Q

What cell membrane forms the outer envelope of herpesviruses?

A

The nuclear membrane

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49
Q

What tumor is chronic lymphedema a risk factor for?

A

Angiosarcoma (Stewart-Treves Syndrome)

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50
Q

What is the difference between a strawberry and a cherry hemangioma?

A

Strawberry is in infancy, regresses spontaneously at 5-8 years old (bright red near epidermis). Cherry hemangioma is in the elderley, increasing frequency with age, does not regress

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51
Q

What nerve is commonly injured in a fibular neck fracture?

A

Common peroneal nerve! Causes foot-drop (foot is inverted and plantarflexed at rest due to loss of the superficial and deep peroneal nerves respectively). Sensation on Dorsum of Left Foot is lost

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52
Q

What cardiac defects are found in Turner’s Syndrome?

A

Bicuspid Aortic Valve and Preductal coarctation of the aorta

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53
Q

What meds mask signs of hypoglycemia?

A

Non-selective beta blockers. Selective at least allow for B2 mediated gluconeogenesis and glycogenolysis and lipolysis. Remember that sweating is cholinergic mediated

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54
Q

In the patient with metabolic alkalosis, what test is useful to determine cause?

A

A Urine CL test and determine volume status.
Urine Cl < 10 = Saline-responsive alkalosis (e.g. vomiting)
Urine Cl > normal = Contraction Alkalosis (e.g. HTZ, furosemide), chloride responsive
Urine Cl > 20 = Saline-resistant metabolic alkalsosis (e.g. Conn Syndrome)

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55
Q

At what calcium level does neuromuscular excitability become apparent?

A

<7.0 mg/dL

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56
Q

What is a charcot-bouchard pseudoaneurysm?

A

Aneurysm associated with chronic HTN usually in small vessels of the Basal Ganglia and Thalamus. Usually secondary to hyaline arteriosclerosis. Rupture leads to intracerebral hemhorrage.

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57
Q

What color are cavernous hemangiomas?

A

Blue. composed of dilated vascular spaces

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58
Q

What is the min diastolic pressure for hyperplastic arteriolosclerosis to occur?

A

> 120-130 mmHg

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59
Q

What are the important side effects of protease inhibitors?

A

Lipodystrophy (increased fat on back and abdomen - buffalo hump).
Hyperglycemia and insulin resistance
Inhibition of P-450 (don’t give with rifampin), use rifabutin)
Remember all end in “-navir”

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60
Q

Name two D2 agonists that are prefered in Parkison’s Rx?

A

Pramipexole and Ropinirole (non-ergot)

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61
Q

What does the superior laryngeal nerve innervate?

A

The cricothyroid muscle. It travels with the superior thyroid artery. The internal branch of this nerve supplies sensation to the larynx above the vocal cords.
All other laryngeal muscles are innervated via the recurrent laryngeal nerve.

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62
Q

What is a key side effect of risperidone?

A

Hyperprolactinemia (remember it is a D2 blocker preventing regulation of prolactin secretion)

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63
Q

What is the role of glucagon in beta-blocker OD?

A

It increases cAMP and increases intracellular Ca release in cardiac myocytes.

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64
Q

What phase of meiosis is the oocyte arrested in after ovulation?

A

Metaphase of meiosis II

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65
Q

What patients is invasive aspergillosis more common in?

A

Neutropenic patients (e.g. leukemia or lymphoma pt)

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66
Q

What is Charcot-Marie-Tooth disease?

A

Mutation of myelin protein that results in a “neural form” of muscular atrophy. Weakness of foot dorsiflexion due to involvement of common peroneal nerve

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67
Q

What is Bloom syndrome?

A

Generalized chromosomal instability, increased cancer susceptibility

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68
Q

What is the Haldane effect?

A

Reverse of the Bohr effect, in the lungs, O2 binding to Hb causes H+ release

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69
Q

What is the ABG results in a PE?

A

The hypoxia due to V/Q mismatch results in hyperventilation = Respiratory Alkalosis with low CO2 and low O2

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70
Q

What test has replaced the Bacitracin test?

A

The PYR test! So S. Pyogenes is PYR + (i.e. Bacitracin +) while S. Agalactiae is PYR -. Furthermore, s. Agalactiae has positive CAMP test.

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71
Q

what is the differential for Necrotizing Fasciitis?

A

S. Pyogenes, S. Aureus, C. Perfringens, S. agalactiae, Aeromonas hydrophila

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72
Q

What is the common origin of most paraneoplastic syndromes?

A

Autoimmune. E.g. paraneoplastic cerebellar degeneration due to anti-Yo (ovary, breast), anti-P/Q (lung), and anti-Hu (lung)

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73
Q

What are normal aging changes in the heart?

A

Decreased LV chamber size (length) and a “sigmoid septum” bulge. Increased connective tissue, and lipofuscin accumulation.

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74
Q

What causes an increased ESR?

A

IL-6 causes APC release from liver (fibrinogen, ferritin, CRP, etc.) and fibrinogen cause sticking of RBCs

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75
Q

What is the function of BRCA-1?

A

Tumor Suppressor, controls cll cycle and plays role in gene repair and transcription?

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76
Q

Do fatty streaks always appear where atheromas form later?

A

No! Fatty streaks often occur in vasculature not prone to atheroma development later in life

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77
Q

What nutrient does valproate inhibit the absorption of?

A

Folate!

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78
Q

What is the mechanism of cutaneous vasodilation in antimuscarinic toxicity?

A

Due to overheating from inhibition of sweat glands -> cutaneous vasodilation

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79
Q

How do you hear an S3?

A

With the bell of the stethoscope over the apex in LLD position.

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80
Q

What hypothalmic nucleus regulates circadian rhythm?

A

The suprachiasmatic nucleus

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81
Q

What is the quellung reaction?

A

Swelling of S. pneumoniae capsule as a result of specific anti-capsular antibodies

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82
Q

What is the pathognemonic finding for hepatic schistosomiasis?

A

Periportal “Pipestem” fibrosis as a result of Th2 mediated immune response against the eggs.

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83
Q

What are the diagnostic findings of neurosyphilis?

A

Positive VDRL and pleocytosis in the cerebrospinal fluid.

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84
Q

What organism causes Granuloma inguinale?

A

Klebsiella granulomatis which has rod-shaped intracytoplasmic inclusions (Donovan bodies)

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85
Q

In Fe deficient states, is transferrin increased or decreased?

A

Transferrin levels are increased

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86
Q

What is a common cause of post-influenza pneumonia in the elderley?

A

Pneumoccocus is the most common cause followed by S. Aureus and H. Flu

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87
Q

What type of cells are the atypical lyphocytes seen in EBV infectioN?

A

CD8+ T Cells

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88
Q

What vaccines use a diptheria toxoid in them?

A

H. Flu and Pneumoccocal polysacharide vaccines use diptheria toxoid conjugates

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89
Q

What is the mechanism of hyperoxaluria in Chrons?

A

Loss of bile acid causes fat malabsorption which saponifies with Ca in the lumen leading to Ca wasting and therefore decreased oxalate excretion as a calcium complex.

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90
Q

What is Perinaud Syndrome?

A

Paralysis of upward gaze due to tectal compression in the midbrain. Usually from a tumor of the pineal region (often a Germinoma).

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91
Q

What is the prodromal period of HBV infection characterized by?

A

It is a Serum-Sickness like picture (in contrast HCV is usually asymptomatic)

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92
Q

What is the typical cause of Non-bacterial Thrombotic Endocarditis?

A

Hypercoagulability e.g. in Cancer

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93
Q

What can precipitate Wernicke’s Encephalopathy in a Thiamine defficient patient?

A

GLUCOSE INFUSION!!! Must always give glucose + thiamine in a thiamine deficient patient.

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94
Q

At what point is pulmonary vascular resistance lowest?

A

At the FRC

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95
Q

What is the origin of a complete vs. partial mole?

A

Complete mole is purley paternal in origin (46 XX or XY), partial has both maternal and paternal

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96
Q

Which ligament of the uterus contains the uterine artery?

A

Transverse cervical ligament

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97
Q

What lateral eye motion is spared in intra-nuclear opthalmoplegia?

A

Convergence (bilateral adduction) is spared

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98
Q

What is the chronological progression of EtOH withdrawal?

A

4-5 hours after last drink: tremors
12-48 hrs: ANS dysfunction and GI symptoms
48+ hrs: Tonic Clonic seizures or Delerium Tremens (Flucuating arousal levels, SNS activity, hallucinations)
Subsides by day 4-5

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99
Q

What characterizes a positive skew distribution?

A

Mean > Median, the tail runs off to the right

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100
Q

What is caused by a deficiency of C1, 3, 4?

A

A lupus-like syndrome

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101
Q

What is the most commonly injured structure in the rotator cuff?

A

The supraspinatus tendon, will have a positive Empty-Can test

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102
Q

What is the mechanism of HbF’s increased O2 affinity?

A

It lacks + histamine residues to it can’t bind the - 2,3-DPG thereby causing a left shift

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103
Q

What are the anti-pseudomonal florquinolones?

A

Ciprofloxacin and Levofloxacin are good for this

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104
Q

What is an example of a “respiratory quinolone”?

A

Moxifloxacin

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105
Q

What aminoglycosides have good anti-pseudomonal activity?

A

Amikacin, Gentamycin, Tobramycin

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106
Q

What population is particularly at risk for death with HEV infection?

A

Pregnant Women

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107
Q

What is the order of receptor activation as you increase dopamine dose?

A

D1 - Increased GFR
B1 - Increased systolic BP
alpha1 - Increased diastolic BP

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108
Q

What is Bosentan used to treat?

A

It is used to treat primary pulmonary HTN (endothelin antagnoist)

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109
Q

What are two compounds that build up in MCAD deficiency?

A

1) Dicarboxylic acidemia/uria

2) C8-C10 acyl carnities

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110
Q

What is the mechanism of gallstone formation in pregnant women?

A

Estrogen - increased cholesterol synthesis

Progesterone - decreased bile acid secretion and slowed GB emptying

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111
Q

What are the different types of secretory glands?

A

Aprocine - secrete into hair follicle (give sent) via merocrine secretion
Holocrine - entire cell is shed (e.g. sebacious glands)
Ecrine sweat glands - merocrine secretion

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112
Q

What type of vaccine is the MMR?

A

Live-attenuated

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113
Q

What diseases does BK virus cause?

A

It results in post-transplant nephropathy or hemhorragic cystitis in immunocoromposied

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114
Q

What are two side effects of linezolid?

A

Optic neuritis and serotonin syndrome

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115
Q

What is the characteristics of Acne?

A

1) Epidermal hyperplasia
2) Increased sebum
3) Inflammation
4) P. Acnes
“Comedonal and inflammatory nodular erruption”

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116
Q

What amino acid becomes essential in people with a positive nitrogen balance?

A

Arginine (needed to make histones)

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117
Q

What histologic changes are seen in hepatitis?

A

Hepatocyte Injury - Ballooning degeneration
Hepatocyte Death - bridging necrosis and fibrosis
mononuclear inflammation in sinusoids and portal tracts

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118
Q

What is ruxolitinib?

A

A JAK2 inhibitor

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119
Q

What agar is Nisseria species cultured on?

A

VCN agar (Vancomycin-Colistin-Nystatin)/Thyer-Martin Agar

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120
Q

What part of the urethra is most vulnerable in a pelvic fracture?

A

Membranous segment. In a stradle injury however, the bulbar urethra is more vulnerable

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121
Q

What enzyme converts cholesterol to bile acids?

A

7-alpha hydroxylase

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122
Q

What is Dupuytren’s contracture?

A

Fibroproliverative disease of palmar fascia leading to decreased finger flexibility

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123
Q

What is seen in multicystic kidney dysplasia?

A

There is no pelvocaliceal system

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124
Q

What effect does inspiration have on left heart murmurs?

A

It decreases them

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125
Q

What effect does inspiration have on right heart murmurs?

A

It increases them

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126
Q

Why does interstitial lung fluid cause dyspnea?

A

It decreases the compliance of the lungs

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127
Q

What is the major virulence factor for S. pyogenes?

A

Protein M

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128
Q

What is seen on barium esophogram with diffuse esophageal spasms?

A

A corkscrew esophagus

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129
Q

What type of effect does Jimson Weed have on the body?

A

It is an anticholinergic - “Gardner’s Mydriasis”

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130
Q

Why does acute Aortic Regurgitation cause pulmonary edema?

A

B/c the left atrium isn’t dilated as it is in chronic

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131
Q

What tachyrthmia is EtOH known to precipitate?

A

Atrial Fibrilation

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132
Q

What is Acanthosis?

A

Increased stratum spinosum thickness

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133
Q

What two metabolites are depleted by EtOH that inhibits gluconeogenesis?

A

Pyruvate and Oxaloacetate

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134
Q

What is the rate of maternal-fetal infection with HepB if HBeAg is high?

A

95% else 20%

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135
Q

What is the difference between Entocapone and Tolcapone?

A

Entocapone - Peripheral COMT inhibitor

Tolcapone - Peripheral and Central COMT inhibitor

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136
Q

What is Danazol used to treat?

A

Endometriosis and hereditary angioedema

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137
Q

How do you differentiate aplastic anemia from myelofibrosis?

A

Myelofibrosis has splenomegally

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138
Q

What is the pathophysiology of C1 esterase deficiency?

A

Causes increased bradykinin (kallikrien not inactivated), C3a, C5a - Increased permeability

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139
Q

What is a Marjolins ulcer?

A

SCC that develops > 10 years after trauma

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140
Q

What is the DDx of pulsus paradoxus?

A

Tamponade, Constrictive Pericarditis, Restrictive Cardiomyopathy, Severe COPD

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141
Q

What determines the ventricular contraction rate in Afib?

A

The AV node (it gates impulses)

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142
Q

What can a “soft breathy voice” indicate?

A

Vocal cord paralysis

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143
Q

What animal is associated with leprosy in the SW US?

A

Armadillos

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144
Q

What is the typical source of bleeding in neonatal IVH?

A

The germinal matrix (highly vascular)

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145
Q

What is a typical presentation of neonatal IVH?

A

Premature (<32 wks), 5th day of life, bulging fontanelle, deerebrate posturing

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146
Q

What are the viral dependent nucleosides?

A

Acyclovir, Valacyclovir, Famiciclovir, Ganciclovir

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147
Q

What are the anti-viral nucleotides?

A

Cidofovir, Tenofovir

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148
Q

What are the symptoms of systemic mastocytosis related to?

A

Increased histamine secretion (e.g. increased gastric acid secretion)

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149
Q

What protein is involved in neutrophil translocation?

A

PECAM-1

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150
Q

What is Zellweger Syndrome?

A

Peroxisomal disease - unable to form myelin = hypotonia and seizures

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151
Q

What is Refsum disease?

A

Lack of alpha-oxidation.

Avoid Chlorophyl in diet

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152
Q

What species are associated with oysters?

A

V. Vulnificus (sepsis, 50% mortality)

V. Parahemolyticus (diarrhea)

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153
Q

What should S. Aureus in the urine make you think?

A

Metastatic Infection

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154
Q

What is cladribine used for?

A

Hairy Cell Leukemia. It is resistant to ADA and penetrates BBB

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155
Q

What is fludrabine used for?

A

It is a purine analog used for CLL

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156
Q

What is Dacarbazine?

A

Methylating agent

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157
Q

What two tumors are GFAP positive?

A

GBM and Ependymomas

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158
Q

What are the stages of lobar pneumonia?

A

Day 1: Congestion (red, heavy, boggy)
Day 2-3: Red hepatization (red, firm)
Day 4-6: Gray heptaization (gray-brown, firm) Neutrophils
Resolution

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159
Q

Why are 90% of Anal Fisures at the posterior midline or anal verge?

A

Less perfusion to these parts

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160
Q

Where do the deep inguinal nodes receive lymph from?

A

Posterior calf and glans penis

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161
Q

What is CNS finding in narcolepsy?

A

Decreased hypocretin-1 in CSF

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162
Q

What does 14-3-3 protein in CSF indicate?

A

CJD

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163
Q

Why does restrictive lung disease have increased flow rates?

A

Increased radial traction on airways

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164
Q

What prevents hypernatremia in mineralocorticoid excess?

A

Aldosterone Escape

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165
Q

What artery supplies the diaphragmatic surface of the heart?

A

Posterior Descending Artery

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166
Q

What is Ondine’s Curse?

A

Brainstem respiratory center damage

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167
Q

What are dipyramidole and cilostazole (PDE inhibitors) used for?

A

Intermittent Claudication

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168
Q

What differnetiates Meineirs disease from Labrynthitis?

A

Meineirs disease is recurrent

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169
Q

What is chromatolysis?

A

Changes following axonal injury: cellular swelling, displacement of nucleus, dispersion of Nissel substance

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170
Q

Why is it hard to make anti-HCV antibodies?

A

Hypervariable regions of envelope glycoproteins and RNA Pol lacks 3’-5’ exonuclease activity

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171
Q

What is a toxicity of phentermine, fenfluramine, dexfenfluramine?

A

Secondary pulmonary HTN -> cor pulmonale -> arhythmias

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172
Q

True or false, MRSA is resistant to carbapenems?

A

TRUE

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173
Q

Are golgi tendon organs sensitive to stretch or contraction?

A

Contraction

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174
Q

Are Muscle Spindles sensitive to stretch or contraction?

A

Stretch

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175
Q

What molecule do almost all transaminases use as their acceptor?

A

alpha-ketoglutarate -> Glutamate (some give to OXO to make aspartate for urea cycle)

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176
Q

What is caudal regression syndrome and what is the main risk factor?

A

Agenesis of sacrum and occasionally lumbar spine.

Risk Factor = Poorly controlled maternal diabetes

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177
Q

What culture conditions are required for L. Pneumophilia?

A

L-Cysteine + Buffered Charcol Yeast Extract

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178
Q

What is the DDx of pancytopenia without splenomegally?

A

Severe B12/folate deficiency
Aleukemic leukemia
Myelodysplastic Syndrome
Aplastic Anemia

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179
Q

What is a common cause of meningitis in neurosurgery patients?

A

S. Aureus

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180
Q

What do depolarizing blockers show in Train-of-4 testing?

A

Phase 1 - equal depolarization to all 4 twitches

Phase 2 - fading response (like non-depolarizing)

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181
Q

What does carbofusin stain?

A

It is an aniline dye that stains mycolic acid in mycobacterium and nocardia

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182
Q

What is imperforate anus most commonly associated with?

A

Other Gu malformations (e.g. renal agenesis, hypospadias, epispadias, exostrophy)

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183
Q

Is the mamillary body anterior or posterior on the brain stem?

A

Anterior

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184
Q

What is a microscopy finding of hydatid cysts?

A

Eggshell calcification

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185
Q

Is orotic acid involved in pyrimidine or purine synthesis?

A

PYRIMIDINE Synthesis

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186
Q

What is sampling bias?

A

Type of selection bias, causes non-random sampling of a target population -> compromised generalizability

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187
Q

What is atrition bias a form of?

A

It is a form of selection bias

188
Q

How do you differentiate the types of esophagitis in HIV+ patients?

A

Candida - Pseudomembranes
HSV-1 - Small vesicles and punched out ulcers (Cowdry A)
CMV - Linear ulcerations, nuclear and cyto inclusions

189
Q

What bacterium can supply factor X and V for H. flu to grow?

A

S. Aureus

190
Q

What does PZA work well against intracellular bacteria?

A

Works best at an acidic pH - in phagolysosomes

191
Q

What is the name of the enzyme deficient in Pompe’s disease?

A

Acid Maltase = Acid alpha glucosidase

192
Q

How does Foscarnet induce hypocalcemia?

A

1) Chelation

2) Renal Mg wasting - decreases PTH

193
Q

What physical exam finding is seen with breast CA invasion of cooper’s ligaments?

A

Skin Retraction

194
Q

True or False, Amiodarone prolongs QT?

A

True, but much lower risk of Torsades than other Class III

195
Q

What does the V617F JAK 2 mutation cause?

A

Increased sensitivity to growth factors

196
Q

What two strains cause tertian malaria?

A

Vivax and Ovale - symptoms every 48 hours

197
Q

What vitamin deficiency can mimic Friedrich’s Ataxia?

A

Vitamin E

198
Q

What molecule is inhibited by Amatoxin?

A

RNA Pol II

199
Q

Why does exhalation increase the S3 heart sound?

A

Brings it closer to the chest wall

200
Q

Why can ketamine block morphine tolerance?

A

Ketamine is NMDA antagonist, NMDA plays a role in morphine tolerance

201
Q

What divides the anterior 2/3 of tongue from posterior 1/3?

A

The terminal sulcus/foramen cecum

202
Q

What is used to treat Grave’s Opthalmopathy?

A

Glucocorticoids

203
Q

Why do you give atropine with an inferior MI?

A

b/c SA and AV node are compromised and need to prevent bradycardia

204
Q

True or false, acalculus cholecystitis can occur following ischemia?

A

True

205
Q

What condition should you suspect in someone with papilledema on Vitamin A or doxycycline?

A

Pseudotumor cerebri

206
Q

In Dubin-Johnson syndrome, what is the pigment composed of?

A

Epinephrine metabolites

207
Q

Is Marfan Syndrome associated with Berry Aneurysm?

A

NO

208
Q

True or false, LEMS often has autnomic symptoms?

A

True

209
Q

How do beta blockers affect thyroid hormone signaling?

A

Decrease the conversion of T4 to T3

210
Q

Are the RV changes in pulmonary HTN reversible or not?

A

Reversible

211
Q

What is a urinary marker of osteoclast activity?

A

Urinary Deoxypyrindinoline

212
Q

What does pasturella cause?

A

GNR, causes acute localized soft tissue infection following a bite

213
Q

Can reactive lymphocytes be seen with viruses other than EBV?

A

YES! e.g. CMV, HBV

214
Q

Why are halothane and sevoflurane prefered in asthmatics?

A

They have bronchodilator properties

215
Q

What enzyme do fibrates inhibit?

A

7-alpha hydroxylase - increased gallstone risk

216
Q

What causes pigment stone formation?

A

Damaged hepatocytes release beta-glucoronidase. Deconjugates bilirubin

217
Q

How do you tell a hypertrophic scar from a keloid?

A

Hypertrophic scar - organized collagen

Keloid - disorganized collagen

218
Q

What is osoclonus (non-rhythmic conjugate eye movements)-myclonus syndrome associated with in children?

A

Neuroblastoma

219
Q

What is letrozole?

A

An aromatase inhibitor

220
Q

What is the nucleotide sequences that proceed start codon?

A

CAAT -> TATA -> Start

221
Q

What are classic features of legionella infection?

A

High Fever + CXR Findings + GI Symptoms
Minimally productive cough
Smoker
Sputum stain negative!

222
Q

What can you treat legionella with?

A

Resp quinolones: Lefo

Azithromycin

223
Q

Why do optic tract lesions cause a marcus gunn pupil?

A

Nasal retinal fibers contribute input to the pretectal nucleus and split prior to entering the LGN

224
Q

What is the capsule of H. Flu composed of?

A

Polyribosyl-ribitol-Phosphate (PRP)

225
Q

What signals can activate phosphorylase kinase?

A

cAMP (glucagon/Epi)
Calcium (muscle)
NE binding of alpha1 (Liver)
ADP binding (muscle)

226
Q

What antibodies are indicated in membranous nephropathy?

A

PLA2R

227
Q

What blood finding can be caused by HCV?

A

Mixed Cryoglobulinemia

228
Q

What is a “Phlegmasia Alba Dolens’?

A

Milk leg due to iliofemoral venous thrombosis in a peripartum woman

229
Q

What do you see on EM of a carcinoid?

A

Dense core granules

230
Q

What is the most common appendiceal tumor?

A

Carcinoid

231
Q

In general, what states are associated with carpal tunnel syndrome?

A

Fluid retention

232
Q

What is a papillary fibroelastoma?

A

It is a heart mass that involves a valve

233
Q

What is tiotropium?

A

Long acting anticholinergic bronchodilator

234
Q

What tick transmits Ehlercia and Anaplasma?

A

Ehrlichia - Lone Star Tick (Amblyomma americanum) (S/SW US)

Anaplasma - Ixodes ticks (NE and pacific)

235
Q

What animal is Ehrliciosis associated with?

A

Deer and Dogs

236
Q

What cells to Ehrlichia infect and What do Anaplasma infect?

A

Ehrlichia - Monocytes

Anaplasma - Granulocytes

237
Q

What can you use to treat Ehrlichia and Anaplasma?

A

Doxycycline, Minocycline, Rifampin

238
Q

Why can late Ehrlichiosis be a shock-like picutre?

A

can cause a 30x increase in TNF

239
Q

What does low I-123 uptake suggest?

A

Thyroiditis while increased suggests graves

240
Q

What is the typical pattern of language development?

A 
12 mo - first word
1-2 yrs - 2 word questions
2-3 yrs - lots of words
3-4 yrs - 4+ word sentences, other people understand them
4-5 yrs - clear fluent speach
241
Q

What component of TPN is suspected to cause fatty liver?

A

Linoleic (w-6) acid

242
Q

When do you hear egophony?

A

In consolidated lungs (e.g. pneumonia)

243
Q

What murmurs are common in pregnancy?

A

S3, Split S2 (more pronounced with insp.)

Systolic flow murmurs (e.g. mid-systolic ejection murmur, high output state)

244
Q

What is a good marker of chronic pancreatitis?

A

Fecal elastase < 200 mcg/g stool

245
Q

What is silver nitrate ointment used to prevent?

A

Gonnorhea, not good for chlamydia

246
Q

What is a common finding of all Type III HS reactions?

A

Decreased C3 due to immune complex fixation

247
Q

What is convergent strabismus?

A

deviation towards the midline

248
Q

What are GABA B receptors linked to?

A

They are GPCRs that are linked to K channels

249
Q

What area of the brain has increased dopamine in nicotine addiction?

A

Nucleus Acumbens

250
Q

True or false, atelectasis has a more localized change in breath sounds?

A

True

251
Q

What are the findings in bronchitis?

A

Rales/crackles or rhonci, and increased fremitus

252
Q

Which parasite is associated with cutaneous larva migrans?

A

Ancyclostoma species

253
Q

What is the codon of a splice site?

A

5’ - AG GU - 3’

254
Q

What is used to treat combined absence and tonic-clonic seizures?

A

Valproate

255
Q

What differentiated conus medularis and cauda equina syndrome?

A

Conus medularis is damage to sacral cord w/o lumbar nerve root involvement (so limb symptoms involving lumbar reflexes e.g. knee jerk, are absent)

256
Q

What is the typical cause of cauda equina?

A

Central lumbar disk herniation

257
Q

What happens to reflexes in cauda equina?

A

They disappear b/c this is an injury of a LMN not an UMN

258
Q

How does glucose inhibit the lac operon?

A

decreases cAMP. cAMP normally binds CAP which acts as positive regulator of lac operon

259
Q

What is indapamide?

A

a thiazide diuretic

260
Q

What side dose a STN injury cause hemibalismus on?

A

Contralateral

261
Q

How do you differentiate vWD from Glanzman’s?

A

Glanzmans - Normal Ristocetin, poor ADP response

vWD - poor aggregation to ristocetin

262
Q

What molecules do myxomas produce?

A

VEGF and IL-6

263
Q

What disease has a sandpaper-like rash with circumoral palor?

A

Scarlet fever

264
Q

What is the histology of PBC?

A

florid duct lesions - granulomatous destruction of interlobular ducts with M0, lymphs, plasma cells, eos

265
Q

What drug is piphenoxylate mixed with to prevent abuse?

A

Atropine

266
Q

What is synthetic BNP called?

A

Nesiritide

267
Q

What is the Hawthorne effect?

A

Tendancy of a study pop to affect the outcome due to the knowledge they are being studied

268
Q

What cofactors are needed for homocysteine to methionine?

A

B12/Folate

269
Q

What antimicrobials are sporicidal?

A

H2O2 and Iodine

270
Q

What procedures is chlorhexidine contraindicated in?

A

Neuro, ENT, Optho

271
Q

Does the solubility of an anesthetic affect MAC?

A

No, just onset time

272
Q

What is responsible for the green color of pus and sputum?

A

Neutrophil MPO which contains heme

273
Q

What causes levido reticularis?

A

Venule swelling from capillary obstruction

274
Q

What is the histologic features of papillary thyorid CA?

A

GG nucleus with intranuclear grooving

275
Q

What vaccines use heat-killed bacteria?

A

Y. Pestis and B. Pertussis

276
Q

What is a sign of atheroembolic disease of renal arteries?

A

Renal failure and lower limb ischemia following invasive vascular procedure

277
Q

What is the name of the stain used for C. Neoformans?

A

Mucicarmine

278
Q

What drug is always added to empiric meningitis rx in an infant?

A

Ampicillin

279
Q

How do TNF, catecholamines, steroids, glucagon, and FFA induce insulin resistance?

A

Via serine phosphorylation of insulin response elements which inhibits tyrosine phosphorylation by insulin receptor

280
Q

When do myoclonic seizures often occur?

A

In the morning. Rx valproate

281
Q

What are basic first line seizure drug choices?

A

Parital: Carbamazepine
Tonic-clonic: Phenytoin, Carbamazepine, valproate
Myoclonic: Valproate
Absence: Ethosuximide, Valproate

282
Q

What is a culture feature of enterohemhorragic E. Coli?

A

Does not ferment sorbitol and does not produce glucuronidase

283
Q

What is used to treat neonatal opiate withdrawal?

A

Paregoric/tincture of opium

284
Q

Which organisms favor transformation?

A

SHiN = S. Pneumoniae, H. flu, Neisseria

285
Q

Which toxins are produced by transduction?

A

Shiga, Botulinum, Cholera, Diptheria, Erythrogenic toxin of S. pyogenes

286
Q

What diseases can you diagnose with serum electropheresis?

A

Alpha1-antitrypsin
Brutons Agammaglobulinemia
Multiple Myeloma

287
Q

What type of acid base abnormality is present in Barter syndrome?

A

Hypokalemic metabolic allkalosis

288
Q

Which amyloid protein is present in familial and senile amyloidosis?

A

AF amyloid

289
Q

What do you see on histology with OCPs?

A

Decidualized stroma with inactive glands

290
Q

What type of malaria shows Schuffner dots?

A

Vivax and Ovale

291
Q

What happens to TPR and CO when an organ is removed?

A

Increased TPR (loss of a parallel resistor) and decreased CO, BP is same

292
Q

Intoxication with what drug can mimic EtOH withdrawal?

A

cocaine

293
Q

What skin tumor has pallisading nuclei?

A

Basal Cell Carcinoma

294
Q

What nerves exit the greater sciatic foramen above and below the piriformis?

A

Above - Sup. Gluteal

Below - Inf. Gluteal, Sciatic, Pudendal

295
Q

What defines an exudative effusion?

A

Fluid/Serum Protein > 0.5
Fluid/Serum LDH > 0.6
LDH > 2/3 normal serum value

296
Q

What CBC is characteristic of hairy cell leukemia?

A

Pancytopenia

297
Q

Does SSPE affect white and gray matter?

A

Yes vs. PML which is only white

298
Q

What is the oriT -> Tra associated with?

A

HfR. Differs from conjugated plasmid in that entire plasmid isn’t transfered every time and that it is an episome that must be re-integrated via homologous recomb for stability

299
Q

What amino acid does F. Tularensis require to grow?

A

Cysteine

300
Q

What states are tularemia associated with?

A

Arkansas, MO

301
Q

When does the moro reflex dissapear?

A

5 months

302
Q

When does necrotizing enterocollitis usually occur?

A

When infant is started on oral foods

303
Q

What mass is associated with excessive fibroblasts?

A

Desmoids

304
Q

What is the order of importance of gastric CA risk factors?

A

H. Pylori > Smoking > pernicious anemia > EtOH > Nitrates

305
Q

What cell types are associated with Erythema Multiforme (target lesions) and SJS?

A

CD8+ are primary involved with some CD4+ help

306
Q

What is the active tension on a muscle equal to?

A

Active Tension = Total Tension (increased with length) - Passive Tension (decreased with length)

307
Q

What does an ulcer found in the distal duodenum suggest?

A

Zollinger Ellison Syndrome

308
Q

What is CD31?

A

PECAM, an endothelial marker

309
Q

Why does nervous system input have little effect on coronary blood flow?

A

Because NE doesn’t act on B2 receptors

310
Q

What is unique about the capsule of H. Flu type B?

A

It contains PRP and is only capsule serotype with pentose monosacharides. Absorbs factor H which destroys C3b opsonins

311
Q

What stain illuminates Auer Rods?

A

Peroxidase

312
Q

What is a marker of immature lymphocytes that can be stained for?

A

Tdt

313
Q

What are the products of the HIV genes?

A

env -> gp 120/41
gag -> nucleocapsid proteins p24 and p7
pol -> reverse transcriptase, integrase, polymerase
tat/rev -> regulatory required genes

314
Q

What type of vasculitis is associated with antibiotic use?

A

Microscopic polyangiitis/hypersensitivity angiitis (Type III HS)

315
Q

What does the sodium-cyanide nitroprusside test detect?

A

SH groups (e.g. cystine in the urine), turns purple

316
Q

Which molecule inhibits the PI3k/Akt/mTOR pathway?

A

PTEN (removes phosphates from PIP3)

317
Q

Which heart sound is associated with prolonged HTN?

A

S4

318
Q

What are two symptoms of vitamin D toxicity?

A

Polydipsia and Anorexia

319
Q

What compound stimulates PMNT to convert NE to Epi?

A

Cortisol

320
Q

What type of HTN is Esmolol useful for?

A

Post-operative HTN

321
Q

What is Diazoxide?

A

It is an arteriole dilator like hydralazine, but it doesn’t improve perfusion and can cause reflex SNS activation (like hydralazine)

322
Q

What is the most common benign liver tumor?

A

Cavernous Hemangioma

323
Q

What is a common cause of death in adult type coarctation of the aorta?

A

LV Failure, Ruptured AA, ICH

324
Q

Which is more aggresive, Burkit’s or Follicular lymphoma?

A

Burkits is very aggressive and chemo sensitive

Follicular is indolent and has painless LAD

325
Q

What is the most commonly invovled part of colon for CA?

A

Recto-sigmoid > Ascending > Descending

326
Q

What does the “crescent sign” on a hip film indicate?

A

Subchondral collapse following avascular necrosis of the head of the femur

327
Q

What is a globus hystericus?

A

A lump in the throat

328
Q

What is DNA laddering and when is it seen?

A

It is fragments of DNA in 180 bases and it seen in Apoptosis

329
Q

What are dicyleliomine and hyoscyamine?

A

Anti-spasmods with anticholinergic SFX

330
Q

Which supplements can help in hypertrygliceridemia?

A

Fish oil

331
Q

What nerve is injured with penetrating trauma to popliteal fossa?

A

Tibial nerve

332
Q

Which bacterium is commonly found in endometritis?

A

B. frag

333
Q

What is nummular eczema?

A

Pruritic coin shaped erythematous patches, exacerbated by irritants

334
Q

Is flexor or extensors involved in psoriasis? Atopic dermatitis?

A

Psoriasis - Extensors

Atopic dermatitis - flexors

335
Q

Does GFR completely recover with heminephrectomy?

A

No, can get back to around 80%

336
Q

What are some acquired causes of porphyria cutanea tarda?

A

aromatic hydrocarbons, HCV, estrogen supplements

337
Q

Which RBC disorders show decreased osmotic fragility?

A

Sickle cell and Thalasemias

338
Q

What causes abd pain in DKA?

A

Ileus from carb depletion

339
Q

How does DKA cause hyponatremia?

A

For each 100 mg/dL increase in glucose, Na drops by 1.6 meq/L due to osmotic dilution

340
Q

What is another word for spina bifida cystica?

A

Myelomeningocele

341
Q

How does NO affect the heart?

A

Increased HR and decreased ESV
Decreases ejection time and stroke work
TPR unchanged

342
Q

What is Albright Hereditary Osteodrystrophy?

A

Skeletal development defects due to end organ resistance to PTH, TSH, LH, FSH

343
Q

What is Allelic Heterogeneity?

A

Different mutations in the same locus cause similar phenotype

344
Q

What is genetic heterogeneity?

A

Mutations in different genes cause the same phenotype

345
Q

What is phenotypic heterogeneity?

A

mutations in the same gene cause different phenotype

346
Q

What is variable expresivity?

A

Same mutation, different phenotypic severity

347
Q

What is Apert syndrome?

A

FGFR2 mutation, misense, cr10, syndactyly

348
Q

What chromosome is associated with maturity onset diabetes of the young type 1?

A

20

349
Q

How do sertoli cells increase the androgen concentration in luminal fluid?

A

They secrete androgen binding protein

350
Q

Which ganglion is targeted to treat excessive axillary sweat?

A

T2

351
Q

What does red safrenin O stain?

A

cartilage, mucin, mast cell granules

352
Q

What is the rate limiting step of dopamine synthesis?

A

Tyrosine to DOPA

353
Q

What cofactor is needed for dopamine beta hydroxylase?

A

Cu2+

354
Q

What RNA in humans is transcribed as one piece and then cleaved?

A

Ribosomal RNA from RNA Pol I. Note that RNA Pol III makes the 5S rRNA

355
Q

Why do meglitinides have a lower risk of hypoglycemia?

A

They don’t stimulate insulin release when glucose is low, unlike sulfonylureas

356
Q

What is the difference between lamellar and woven bone?

A

Lamellar - regular alignment, mechanically strong

Woven - immature or pathologic

357
Q

How does follicular thyroid carcinoma present?

A

As a nodule, see small follicles w and w/o colloid

358
Q

What is Shared Psychotic Disorder?

A

When it is due to a relationship with someone else and there is no better explanation

359
Q

What are transporters associated with antigen processing?

A

They bring viral components to the ER to assemble with MHCI

360
Q

What does CD1 do?

A

Presents lipid containing antigens

361
Q

What does the invariant chain do?

A

It is removed from MHC II in endocytic compartments (it blocks the binding site till then)

362
Q

What is Lichen Sclerosis?

A

White patches of thinned skin + pruritis. It is autoimmune against ECMI. Female perineal region. Plaques can coalesce.
Rx: High potency steroids as can lead to SCC

363
Q

What is puromycin?

A

tRNA analog leads to premature chain termination

364
Q

What should be used for anticoag in valve replacement?

A

Warfarin + Aspirin

365
Q

What induces COX-2 expression?

A

Inflammation

366
Q

Which fungus can have a broom like appearance?

A

Aspergillus as it has septate hyphae with conidophores with a terminal vesicle

367
Q

What glomerular disease is HIV, heroin, and Hbs associated with?

A

FSGS

HIV - Collapsing glomerulopathy (form of FSGS). Epithelial cell enlargement and vacuolization

368
Q

What gene is mutated in hand-foot-genital syndrome?

A

HoxA-13

369
Q

What gene is mutated in wardenburg syndrome (deafness + pigmentation anomalies)?

A

Pax-3

370
Q

What must be done to diagnose circardian rhythm sleep disorder?

A

Rule out caffeine use or underlying psych illness

371
Q

When is muscle velocity maxiumum?

A

No afterload, if passive tension is increased, velocity is decreased

372
Q

A strain of what muscle can avulse the lesser trochanter of the femur?

A

Psoas

373
Q

What macrolide is least likely to interact with P-450?

A

Azithromycin

374
Q

What are RS cells derived from?

A

Post-germinal center B cells (show somatic hypermutation)

375
Q

Which fossa does the foramen spinosum lie in?

A

Middle cranial fossa

376
Q

What characterizes primary biliary cirrhosis?

A

Granulomatous inflammation and anti-mitochondrial antibodies

377
Q

What meds are used in HTN in pregnancy?

A

Methyldopa, labetalol, nifedipine, hydralazine

378
Q

What id dicyclomine?

A

Antispasmodic, used in IBS. muscharinic blockade and inhibitor of bardykinin induced GI spasms

379
Q

What ion inserts itself into protoporphyrin when there is problems with ferocheletase?

A

Zn

380
Q

What is the germ tube test for candida?

A

Formation of pseudohyphae in animal serum

381
Q

What is cincalcet?

A

It is a calcimimetic agent that increases CaSR sensitivity. Used in secondary hyperparathyroidism

382
Q

Which organism is more destructive, pneumoccocus or Klebsiella?

A

Klebsiella (currant jelly sputum)

383
Q

How do you calculate the 95% CI?

A

sample mean +/- Z(SD/sqrt(n))

384
Q

Are the gastric acid secretagogues synergistic?

A

Yes

385
Q

What disease causes beaded bile ducts?

A

PSC

386
Q

Does the RER Make proteins for lysosomes? Peroxisomes?

A

Lysosomes - yes

Peroxisomes - no

387
Q

Which drugs are beta 1 selective?

A

A-M

388
Q

What is the ELEK test?

A

Tests for a toxin-producing strain of C. Diptheria

389
Q

What type of HS is late lyme disease?

A

Type III

390
Q

Can the cellular changes of necrosis occur after death?

A

NO

391
Q

Where do the lymphatics of lateral leg drain?

A

Popliteal nodes

392
Q

What is the Cushing Reflex?

A

With increased ICP we see increased BP and decreased HR (from barroreceptors and vagal response) to maintain cerebral perfusion pressure (MAP-ICP)

393
Q

What happens to HR with a brain stem injury?

A

Increases to 100 bpm which is the basal state without PNS tone

394
Q

Differentiate inflammatory breast CA from Pagets

A

Pagets - Epidermal invasion

Inflammatory - dermal lymphatic invasion - Peu D’orange

395
Q

What cells have a CD 14 endotoxin receptor?

A

Macrophages

396
Q

What type of pericarditis is Dresslers?

A

Fibrinous

397
Q

What vitamin deficiency is seen with broad-spectrum ABX?

A

Vitamin K

398
Q

What drugs are used for acne?

A

Doxycycline and Clindamycin

399
Q

What cell exerts master control over Fe absorption?

A

Hepatic parenchymal cells via hepcidin

400
Q

What is Rasburicase?

A

It is a recombinant Urate Oxidase that degrades uric acid to allantoin

401
Q

Where does the deep peroneal nerve provide sensation?

A

Between the great and 2nd toe

402
Q

What does an increased slope of the CV and Venous Return curves indicate?

A

Decreased TPR

403
Q

Does an acute AV fistula have an increase in MAP?

A

No, need to wait for renal compensation

404
Q

What is Raltegravir?

A

Integrase inhibitor

405
Q

What kind of metabolic alkalosis are saline responsive?

A

H+ loss

Contraction

406
Q

What benign tumor is pure red cell aplasia associated with?

A

Thymoma

407
Q

Which artery runs with the radial nerve in the spiral groove?

A

The deep brachial artery

408
Q

Which rash moves faster, rubella or measels?

A

Rubella runs faster

409
Q

How does TNF cause insulin resistance?

A

Causes serine phophorylation of IRS-1

410
Q

What is pantazocine?

A

Partial agonist and weak antagonist at mu receptors.

411
Q

What causes apple peal atresia?

A

Spiral like appearance around SMA due to vascular occlusion in utero

412
Q

What is found in maternal serum/amniotic fluid with gastroschesis/omphalocele?

A

Increased AFP

413
Q

What parasite is associated with larva currens?

A

Strongyloides Stercoralis

414
Q

What indicates the severity of mitral stenosis?

A

The A2 to OS interval is inversley proportional to severity

415
Q

What two vasodilators can cause coronary steal syndrome?

A

Adenosine and dipyridamole

416
Q

What is the finding with ABPA?

A

proximal bronchietasis

417
Q

What is the microscopic finding in Granuloma Inguinale?

A

Donovan Bodies in cytoplasm

418
Q

What are chlorpheniramine, and promethazine and hydroxyzine?

A

First gen H1 blockers

419
Q

What are the symptoms of verapamil toxicity?

A

AV nodal block + constipation

420
Q

What happens to length and time constants in demyelination?

A

Length constant decreases

Probably decreases the time constant due to lower capacitance (impairs temporal summation as things dissipate faster)

421
Q

What are the LVEDP and LVEDV findings in diastolic and systolic HF?

A

Diastolic: LVEDV normal, LVEDP up, EF normal
Systolic: LVEDV increased, LVEDP increased, EF decreased

422
Q

Which drugs increase the hyperkalemia risk of ACEI?

A

Non-selective beta blockers

423
Q

What is myc?

A

A transcription factor

424
Q

What is primidone?

A

Anti-epileptic, metabolized to phenobarb and PEMA

425
Q

What is a sign of amyloid angiopathy?

A

Recurrent lobar hemhorrages

426
Q

What is the inheritance pattern of G6PD deficiency, PDH deficiency, PK deficiency?

A

G6PD - XLR
PDHD - X Dominant
PKD - AR

427
Q

What are the two forms of PDH deficiency?

A

Metabolic (lactic acidosis) vs. Neurologic (gray matter degn, brainstem necrosis)

428
Q

Which signlaing molecules use a JAK/STAT pathway?

A

GH, Prolactin, IL-2, Cytokines

429
Q

What are the side effeccts of CCB?

A

Flushing, Ankle edema

430
Q

What are the subtypes of eczematous dermatitis and what is a common histologic finding

A

Allergic Contact + Atopic + Drug Related + Photo + Irritant

Spongiosis

431
Q

When is cheyne-stokes respiration observed?

A

Cardiac or Neurologic disease

432
Q

What effect can Niacin have on BP, uric acid, insulin?

A

Increases insulin resistance
Decreases BP (think flushing)
Increases uric acid production

433
Q

What are the side effects of protease inhibitors?

A

Lipodystrophy, Hyperglycemia, P-450 inhibition

434
Q

What are the findings in glucagonoma?

A

Necrolytic migratory erythema in groin, hyperglycemia, stomatitis, cheliosis

435
Q

What is required to diagnose atopic dermatitis?

A

Intense pruritis

436
Q

What is another name for lactose?

A

Galactosyl-B1,4 glucose

437
Q

What growth factors drive angiogenesis?

A

FGF and VEGF

438
Q

What growth factor promotes SMC migration into atheromatous plaques?

A

PDGF and TGF-beta

439
Q

What is tolcapone?

A

A central + peripheral COMT inhibitor

440
Q

Which rifamycin should be used in patients on HAART?

A

Rifabutin as it does not induce P-450

441
Q

What is the AML M7 type?

A

Megarkyoblasts, t(1;22), down syndrome associated

442
Q

What is the pacemaker for the ventricles in 3rd degree heart block?

A

AV node (45-55 bpm)

443
Q

How does Niacin work?

A

decreases hepatic TG and VLDL synthesis and suppresses fatty acid release in peripheral tissues

444
Q

What cholesterol med can increase TG?

A

Bile acid binding resins

445
Q

What must you consider in a patient on steroids?

A

IATROGENIC CUSHINGS

446
Q

What is the test for gestational diabetes?

A

OGTT

447
Q

What is a test of concentration? Comprehension?

A

Concentration - months of year backwards

Comprehension - following multistep commands

448
Q

Is pseudomonas motile? Oxidase +/-?

A

Motile, Oxidase +

449
Q

What do you see in Amphotericin renal tox?

A

Decreased K and Mg due to DCT membrane permeability

450
Q

How do mu receptors work?

A

Increase K efflux (GPCR) and hyperpolarize

451
Q

What enzyme converts DOPA to Dopamine?

A

DOPA decarboxylase needs B6

452
Q

What enzyme converts Dopamine to Epi?

A

Dopamine Beta Hydroxylase needs Vitamin C and Cu

453
Q

What is Aromatic L-amino acid decarboxylase?

A

DOPA decarboxylase (also converts 5-HTP to 5-HT)

454
Q

Where does HBV get its envelope?

A

The ER

455
Q

If SNc, Locus Ceruleus, and Vagal Nucleaus Doraslis are all pale, what should you think?

A

PKU

456
Q

What is myotonia?

A

Abnormally slow relaxation (e.g. handshake, doorknob grip)

457
Q

What are the signs of myotonic dystrophy?

A

Myotonia with cataracts, frontal balding, gonadal atrophy. AD disorder

458
Q

What is TIBC proportional to?

A

Transferrin levels, not % saturation

459
Q

What three chronic myeloproliferative disorders are associated with JAK2 mutations?

A

Polycythemia Vera
Essential thrombocytosis
Primary myelofibrosis (massive splenomegally)

460
Q

What drub can be used for JAK2 V617F mutations?

A

Ruxolitinib

461
Q

What is cladribine used for?

A

Hairy Cell Leukemia (adenosine analog)

462
Q

What can hepatic artery thrombosis lead to in a transplanted liver?

A

Biliary tree infarction due to severing of collateral blood supply

463
Q

What is the most likely cause of differential cyanosis in an older child?

A

PDA as a coarctation sever enough to produce this would have been fatal if not corrected in childhood

464
Q

What are the types of non-neoplastic colonic polyps?

A

Hyperplastic, Hamartomatous, Inflammatory, Lymphoid

465
Q

What can be a cause of paraneoplastic cerebellar degeneration?

A

Autoimmune in lung, breast, ovary, uterus, lymphoma

466
Q

What liver function abnormalities are seen with actuve liver injury?

A

Prolonged PT/INR
Increased AlT
Normal: albumin, spleen size, no ascites

467
Q

What molecules are metabolized to propionyl-CoA?

A

Valine, Isoleucine, Threonine, Methionine, Cholesterol, Odd Chain Fatty Acids

USMLE Step 1 (4 decks)

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