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MS2 - USMLE Step 1: Part 2 > Q Banks: Week of 01/23/17 > Flashcards

Q Banks: Week of 01/23/17 Flashcards

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USMLE® Step 1 flashcards
1
Q

What three drugs prevent platelet binding to GpIIb/IIIa?

A

Abciximab
Eptifibitide
Tirofiban

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2
Q

Abciximab binds to a receptor that is defective in what genetic bleeding disorder?

A

Glanzmann thrombasthenia (GpIIb/IIIa)

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3
Q

Von Willebrand factor binds to what platelet receptor?

A

GpIb

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4
Q

What is key for a diagnosis of schizoaffective disorder?

A

A two-week psychotic episode without mood symptoms

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5
Q

When a stem gives you the description of a research project, be sure to look for the ________ value.

A

P

I missed a question because the stem described a study with a P-value of 0.45, meaning it was not significant. They asked what accounted for the difference between the two groups, and the answer was “latent period” –essentially saying that the minor difference was due to arbitrarily extended latency period in one group.

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6
Q

The glans penis drains directly to the ____________ lymph nodes.

A

deep

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7
Q

Describe the lymph drainage of the lower extremity.

A

The medial leg drains straight to the superficial inguinal lymph nodes, while the lateral leg drains to the popliteal nodes then deep inguinal nodes.

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8
Q

Describe the pathogenesis of chronic allograft rejection.

A

Occurring more than 3 months after transplant, chronic rejection is characterized by sparse (i.e., not dense) mononuclear infiltrate with thickening of the tunica intima and interstitial fibrosis.

Note: a classic clinical finding is gross atrophy of the organ in question (such as a shrunken kidney).

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9
Q

Beta-endorphin is derived from ____________.

A

pro-opio melanocortin

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10
Q

Which strand of DNA is typically methylated, the daughter or parent?

A

The parent strand!

Recall that methylation is used to distinguish the older (and likely original) strand of DNA. Thus, when an error-correcting mechanism encounters a mismatch, it uses the methylated strand to guide what should be there.

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11
Q

Mutations in what kind of enzyme can lead to xeroderma pigmentosum?

A

Nucleotide excision repair

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12
Q

What should be regularly monitored in a patient with ankylosing spondylitis?

A

Degree of chest expansion

Ankylosing spondylitis can progress to stiffen the vertebral and costovertebral joints, thereby limiting the ability to expand the chest in respiration.

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13
Q

True or false: ankylosing spondylitis can present with elevated rheumatoid factor.

A

False. RF is not associated with ankylosing spondylitis.

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14
Q

Describe the position of the leg vein that is often used for bypass surgeries.

A

The great saphenous vein is predominantly on the anterior-medial aspect of the leg (from top to bottom). It inserts into the femoral triangle and can be surgically accessed just inferior and lateral to the pubic tubercle.

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15
Q

Where in the cell does heme synthesis occur?

A

It starts with ALA synthase in the mitochondrial matrix. ALA itself gets pumped into the cytosol. Once the substrate has been metabolized to coproporphobilinogen, it gets pumped back into the mitochondria where ferrochetalase completes the process.

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16
Q

PRPP synthase is the first step in the production of _____________.

A

purines

Thus, mutations that activate this enzyme can lead to gout.

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17
Q

Describe how right- and left-sided lesions to the frontal lobe present.

A

Left-sided: apathy and depression
Right-sided: disinhibition

(Think of the left arm hanging low and the right going crazy and flopping around!)

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18
Q

Dominant parietal lesions often present with _______________.

A

Gerstmann syndrome –difficulties writing, doing math, or distinguishing between left and right

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19
Q

Describe the use of probenecid in treating gout.

A

It is a second-line agent (allopurinol being the first-line treatment) that is contraindicated in those with a history of kidney stones or “renal colic.”

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20
Q

Where should needles be inserted for thoracentesis?

A

Just superior to the rib at the following sites:
• Midclavicular: 6th to 8th
• Midaxillary: 8th to 10th
•Paravertebral: 10th to 12th

Going higher than these sites risks lung puncture while going lower risks abdominal organ puncture.

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21
Q

What is thought to be the initiating event in the development of Zenker diverticulum?

A

Dysfunction of the cricopharyngeal muscles (specifically failed relaxation of the posterior pharyngeal wall)

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22
Q

What receptors does cyproheptadine target?

A

Histamine and serotonin receptors (hence its use in serotonin syndrome)

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23
Q

What is the pathophysiology of neonatal hypoglycemia in the babies of mothers with poorly controlled diabetes in gestation?

A

Beta-cell hyperplasia in the developing fetus occurs due to high glucose. Following delivery, the glucose is withdrawn (because the mother’s liver was producing it), but the insulin release remains high.

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24
Q

There are two ways that DIC can develop in pregnant women. Describe both.

A
  • Placental hematoma can lead to release of tissue factor into the circulation that leads to hypertensive DIC.
  • Amniotic fluid can enter the bloodstream and lead to hypotensive DIC.
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25
Q

Granulomas are found in which kind of IBD?

A

Only Crohn’s!!!!

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26
Q

True or false: hyperaldosteronism often presents with hypernatremia.

A

False. Aldosterone escape generally allows patients with Conn syndrome to avoid pedal edema and excess sodium.

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27
Q

Infusions of packed RBCs can lower what electrolyte?

A

Calcium, because RBCs are often packaged with calcium citrate to avoid coagulation. Citrate can chelate calcium.

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28
Q

Trace the timeline of alcohol withdrawal.

A

6-12 hours: anxiety and tremulousness
12-48 hours: seizures
12-48 hours: hallucinations
48-96 hours: delirium, agitation, hypertension, diaphoresis

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29
Q

What are the two most common sites for aspiration pneumonia to develop?

A

In an upright patient: right basilar lobe

In a supine patient: right middle lobe

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30
Q

Describe the structure of the tetanus toxin.

A

The heavy chain binds gangliosides on inhibitory neurons and the light chain cleaves the release of toxin.

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31
Q

What blood pressure pattern is most commonly seen with aortic stenosis?

A

Isolated systolic hypertension, because the left ventricle must overcome the stiff valve to get into the systemic circulation

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32
Q

Explain coronary steal.

A

In a patient with a coronary occlusion, the arterioles distal to the occlusion will be maximally dilated to try to induce more flow. They get some of this flow from anastomoses distal to the occlusion. If you give a drug that selectively dilates coronary arteries –like adenosine or dipyridamole –then the arterioles in the healthy arteries will dilate more but the arterioles in the occluded vessel will not. Thus, blood will be shunted away from the unhealthy area.

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33
Q

What kind of drugs are cilostazol and dipyridamole?

A

Platelet phosphodiesterase inhibitors

Platelets cannot function when cAMP is too high, thus they prevent platelet activation.

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34
Q

What pathology will be present in the lungs of a patient with chronic transplant rejection?

A

Fibrotic obstruction of the terminal bronchioles

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35
Q

You already know that the liver and pancreas express GLUT2 receptors, but what other tissues also have insaturable glucose channels?

A

Brain, kidney, RBCs, and intestine

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36
Q

Which amino acid is most prevalent in collagen?

A

Glycine

The formula for glycine is gly-x-y, where x is often proline or lysine.

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37
Q

What anti-epileptics treat bipolar disorder?

A

Lamotrigine, valproate, and carbamazapine

Remember the winter festiVAL with the snow sculpture of the CAR and the little kid wearing the lLAMa hat.

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38
Q

Which second-generation antipsychotic is often used to treat bipolar disorder?

A

Quetiapine

39
Q

As flow rate increases in pancreatic secretions, ___________ concentration decreases.

A

chloride

40
Q

Describe the positioning of the piriformis muscle.

A

It originates on the anterior surface of the sacrum, extends through the greater sciatic foramen –which is superior to the lesser sciatic foramen –and then attaches to the greater trochanter.

It facilitates external rotation when the thigh is extended and abducts the leg when the thigh is flexed.

41
Q

Weakness of the ______________ contributes to the formation of direct inguinal hernias.

A

transversalis fascia

42
Q

Direct inguinal hernias are covered only by the _______________ fascia.

A

external spermatic

43
Q

Where in the tubule does mannitol act?

A

In the descending loop of Henle

44
Q

What is the difference between Tourette’s and chronic tic syndrome?

A

Tourette’s involves both motor and vocal tics while chronic tic syndrome involves one or the other.

Note: vocal tics includes grunts, snorts, and throat clearing.

45
Q

What non-cranial bones are often broken in shaken baby syndrome?

A

Ribs (because people grab the child and hold with pressure on the ribs)

46
Q

Retinal hemorrhages in an infant are highly suggestive of _______________.

A

abusive head trauma

47
Q

Carcinoembryonic antigen is often secreted by _____________.

A

colorectal cancer

48
Q

What cell receptor does GPI anchor?

A

CD55 and CD59

Both of these receptors are involved in protection against complement lysis.

49
Q

In order to stimulate an MHC I response, the vaccine has to be ___________.

A

live; as such, inactivated vaccines predominately generate antibody which prevents future infections from occurring

50
Q

Trace the timeline of pathologic changes in brain injury.

A 
0 - 12 hours: often no changes
12 - 24 hours: eosinophilic apoptotic cells
24 - 72 hours: neutrophilic infiltration
3 - 7 days: macrophage infiltration 
1 - 2 weeks: scar/gliosis formation
Greater than 2 weeks: fibrotic scar
51
Q

Explain Ladd’s fibrous bands.

A

If the midgut does not rotate the whole 270º, then the fibrous bands that normally anchor the cecum to the retroperitoneum will be in the RUQ. The fibrous bands run over the duodenum and lead to non-bilious vomiting in a newborn.

52
Q

What happens when the dorsal and ventral pancreatic buds fail to fuse?

A

Pancreatic divisum is usually asymptomatic

53
Q

_____________ can produce relative erythrocytosis.

A

Dehydration (excessive diuresis)

54
Q

Mutations in ____________ can lead to hypertrophic cardiomyopathy.

A

beta-myosin heavy chain

55
Q

True or false: ventricular muscle conducts faster than atrial muscle.

A

False.

“Atrial gets an A in the speed TRIAL!”

56
Q

Carbon monoxide raises the level of _____________.

A

carboxyhemoglobin

Note: CO does not cause methemoglobinemia.

57
Q

What is the functional utility of reverse transcriptase PCR?

A

It can detect mRNA.

58
Q

Explain ß and 1 – ß.

A

ß is the probability of making a type II error–failing to reject the null hypothesis when it is actually false (meaning that there is an effect but it was not detected).

Thus making ßsmaller improves your statistical power, represented by 1 – ß.

59
Q

Tetrahydrofolate inhibits the reaction that converts ________ to ________.

A

dUMP; dTMP

Note: this reaction is catalyzed by thymidylate synthase.

60
Q

What disorder selectively targets the anterior horn LMNs?

A

Poliomyelitis

61
Q

What topical cream used for psoriasis targets a nuclear receptor?

A

Vitamin D analogs: calcitriol, calcipotriene

62
Q

Other than calcification, what gross features do craniopharyngiomas often present with?

A

Dark fluid

63
Q

How does ionizing radiation affect cancer cells?

A

It causes dsDNA breaks.

64
Q

What is stimulus control?

A

A form of treating insomnia that tries to get people to only associate the bedroom with sleep

Specific examples of stimulus control would be telling person to stop reading or watching movies in bed; to leave the bedroom if they don’t feel sleepy; or to go to bed only when sleepy.

65
Q

True or false: itchiness often goes away with continued opioid use.

A

True!

66
Q

Describe the path of the radius nerve distal to the elbow.

A

The radial nerve breaks into the superficial division (which covers the sensory innervation of the posterior hand) and the deep interosseous (which passes through the supinator canal and controls the extensors of the hand and fingers).

67
Q

Repetitive supination and pronation of the wrist may lead to _____________.

A

injuries of the posterior interosseous nerve

68
Q

What are guidelines for managing somatic symptom disorder?

A

Overall, you want to have patients who are distressed due to pain but have no detectable illness see the same PCP regularly. The idea behind this is that patients with SSD are likely to seek out costly testing and will do so more if they see specialists. As such, regular visits with a PCP can help prevent redundant or unnecessary testing.

Also, reassure them that you do not think they are faking and that you recognize their distress.

69
Q

What pancreas pathology is seen in those with T2DM?

A

Amyloid deposition

This occurs because amylin is secreted with insulin. With the excess insulin secretion characteristic of T2DM, amyloid deposits accumulate.

70
Q

Give the Hardy-Weinburg equilibrium formula.

A

p^2 + 2pq + q^2 = 1

q^2 = homozygous allele frequency
p^2 = homozygous wild-type frequency
2pq = carrier frequency

Also, p + q = 1

71
Q

The most serious complication of acute rheumatic fever is ______________.

A

pancarditis with mitral regurgitation; this can lead to mental status changes in the short term and mitral stenosis in the long term

72
Q

What histologic findings are pathognomonic for acute rheumatic findings?

A

Aschoff bodies with Anitschkow cells

73
Q

If you are shown an MRI with a gray area along the falx cerebri, what might it be?

A

Meningioma

74
Q

Why don’t sensitivity or specificity change with changes in prevalence?

A

Because they reflect intrinsic strength of the test itself

Take sensitivity, for instance: TP/(TP + FN) reflects what percent of people WITH THE DISEASE will test positive. Thus, increasing the amount of people who have the disease will not affect this value.

75
Q

PD-L1 is analogous to what other receptor?

A

CTLA-4

PD stands for programmed death. It is a receptor that deactivates T cells. Inhibiting PD or CTLA thus prevents the deactivation of T cells and allows T cells to fight cancer.

76
Q

The molecule ______________ destroys helminths and is also capable of damaging bronchiole tissue in asthmatics.

A

major basic protein

77
Q

How does neprilysin work?

A

It inhibits metalloproteases that degrade endogenous peptides such as BNP, ANP, glucagon, and oxytocin.

Note: this increases natriuresis.

78
Q

Myasthenia gravis reduces the ______________.

A

post-synaptic potential

79
Q

Prolonged use of glucocorticoids –say, for SLE –can cause ______________ of the adrenal glands.

A

bilateral atrophy

80
Q

What’s the difference between normal sadness and adjustment disorder with depression?

A

Adjustment disorder presents marked distress and impairment of life function. If a person reports being sad but states that they can manage their life appropriately, then it is likely normal sadness (particularly if it’s only been for a short duration).

81
Q

What are three cardinal symptoms of hydrocephalus?

A

Macrocephaly, poor feeding, and hyperreflexia/spasticity

82
Q

What is the mechanism behind fibrates causing gallstones?

A

The rate-limiting enzyme in bile synthesis is cholesterol 7-alpha hydroxylase. Reducing the amount of bile makes the bile secretion more viscus, because more of it is cholesterol. As such, gallstones develop.

83
Q

Which artery supplies most of the blood to the femoral neck?

A

Medial circumflex artery

Think of a giant falling femur by the Museum of Contemporary Art.

84
Q

What two classes of medication are often used to treat pulmonary hypertension?

A

Prostacyclin analogs (remember Sketchy’s Pro-Slugger ball shooter that targeted the red rackets) and endothelin inhibitors like bosentan (remember BOSs maN sTAN and his END O’ THE LINe note to the kid messing with the Pro-Slugger machine)

85
Q

In evaluating birth defects, differentiate association, deformation, and field defects.

A
  • Association: defects that are known to correlate but without a clear etiology or structural connection (for instance, duodenal atresia and CNS defects are known to correlate
  • Deformation: when an external force damages the fetus, such as the pressure of the uterus in a woman with oligohydramnios
  • Field defect: when one defect sets off a cascade of nearby defects, such as failure of the forebrain to divide leading to defects in the eyes
86
Q

Where are the lesser and greater omenta?

A

They parallel the lesser and greater curvatures of the stomach! So the lesser omentum connects the lesser curvature to the liver and the greater omentum hangs off the greater curvature.

87
Q

Gouty arthritis and PUD are symptoms of which myeloproliferative disorder?

A

Polycythemia vera

The increased RBC turnover leads to excess purine metabolism and the increased blood viscosity leads to ischemic damage of the mucosa.

88
Q

Polycythemia vera results from a mutation in what kind of protein?

A

A cytoplasmic kinase

The erythropoietin receptor has no intrinsic kinase activity. It must interact with janus kinase, which is a free cytosolic kinase, to phosphorylate STAT and induce transcription of myeloproliferative genes. Mutations in JAK lead to it being constituitively active.

89
Q

Beta-blocker associated hyperkalemia happens with _____________.

A

nonselective beta-blockers

90
Q

What is indapamide?

A

A thiazide diuretic

Indapamide = IN-DIAPER-P

91
Q

What are the potassium sparing diuretics?

A

ACE inhibitors
Triamterene/amiloride (both ENaC blockers)
Spironolactone/eplerenone (aldosterone antagonists)

92
Q

What are the thiazide diuretics?

A

Hydrochlorothiazide, indapamide, and chlorthalidone

“HICks have high glucose, lipids, uric acid, and calcium.”

93
Q

True or false: the brain senses hypoxia and releases factors that induce the release of EPO from the kidneys.

A

False. The peritubular cells of the kidneys sense hypoxia on their own and release EPO.

MS2 - USMLE Step 1: Part 2 (142 decks)

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