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MS2 - USMLE Step 1: Part 2 > Q Banks: Week of 01/30/17 > Flashcards

Q Banks: Week of 01/30/17 Flashcards

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USMLE® Step 1 flashcards
1
Q

Scar tissue is which kind of collagen?

A

Type I

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2
Q

Granulation tissue is the same type of collagen as _____________.

A

reticular collagen and lung gollagen (type III)

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3
Q

Clefts are on the __________ side of the primitive pharynx and pouches are on the __________.

A

outer; inner

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4
Q

True or false: the palatine tonsils arise from the first pharyngeal pouch.

A

False. The first pharyngeal pouch develops into the inner ear. The tonsils develop from the second pharyngeal pouch (TWOnsils).

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5
Q

Explain Shine-Dalgarno and Kozak sequences.

A

The rRNA recognizes AUG as the start sequence. However, because there can be multiple AUGs in a transcript, rRNA searches upstream for the GCCGCC Kozak sequence in eukaryotes and Shine-Dalgarno sequence in prokaryotes.

(Prokaryotes are older, so they’re like the original star that Shines.)

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6
Q

What bone is adjacent to the pisiform?

A

The triquetrum

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7
Q

Lunate dislocation can disrupt the __________ nerve.

A

median (MediaN = MooN = Lunate)

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8
Q

In addition to water, ADH also increase the resorption of _________.

A

urea, which helps build the medullary concentration gradient needed to concentrate urine

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9
Q

What is pulsus paradoxus?

A

When a person has cardiac tamponade, inspiration leads to greater filling of the pericardium. This presses down on the ventricle and decreases systolic blood pressure by 10 mmHg or more.

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10
Q

When cardiac output decreases in heart failure, what three systems get overactivated?

A

Sympathetic nervous system: increases HR and contractility
•This damages the heart by increasing afterload and stimulating deleterious remodeling.

RAAS: increases vasoconstriction and fluid retention
•Can lead to edema and pulmonary congestion

ADH system: increases fluid retention

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11
Q

What factors are needed for branched chain alpha ketoacid dehydrogenase?

A 
Thiamine
Lipoate
Coenzyme a
FAD 
NAD

(“Tender Loving Care For Nancy”)

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12
Q

Other than tear-drop cells (dacrocytosis) and anemia, how does primary myelofibrosis present?

A

With hepatosplenomegaly from extramedullary hematopoiesis and early satiety

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13
Q

Which disorders are caused by JAK stat mutations?

A

Polycythemia vera
Essential thrombasthenia
Primary myelofibrosis

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14
Q

Low estrogen causes a decreased ratio of _______________ in the bone.

A

osteoprogerin:RANK-L

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15
Q

The side effects of nitrates include _______________.

A

headaches, flushing, and hypotension

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16
Q

Nitrates should be avoided in patients with ________________.

A

hypertrophic obstructive cardiomyopathy

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17
Q

The function of glucokinase might be _____________ in a patient with insulin resistant diabetes.

A

decreased

Glucokinase is the enzyme that traps glucose in pancreatic beta cells. Thus, deficient levels of this could lead to decreased insulin secretion.

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18
Q

____________ blocks neurokinin 1 receptors in the area postrema.

A

Aprepitant

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19
Q

The two drugs that decrease aqueous humor inflow are ________________.

A

beta-2 antagonists and alpha-2 agonists; both work on the ciliary epithelium

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20
Q

How do muscarinic agonists treat closed-angle glaucoma?

A

They stimulate the pupillary sphincter to contract which loosens up the trabecular network on the periphery of the iris and promotes outflow. Also, they cause the ciliary muscle –which connects to the lens –to contract which flattens the lens and allows more room for the aqueous humor to escape.

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21
Q

________________ following the rupture of a berry aneurysm can produce focal neurologic deficits.

A

Vasospasm

Substances released into the parenchyma are believed to be the causative agent. This can be prevented with calcium channel blockers.

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22
Q

What nerve is sometimes injured in thyroidectomies?

A

The recurrent laryngeal nerve

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23
Q

By what mechanism do CCA and CCG lead to the same amino acid?

A

Wobble

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24
Q

Describe the differences between acute and chronic heart failure lung pathology.

A

Acutely, lung specimens of a patient with heart failure will display transudate (plasma in the alveoli). Chronically, hemosiderin-laden macrophages will arise.

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25
Q

Why does normal-pressure hydrocephalus lead to incontinence?

A

Stretched cortical fibers leads to impaired inhibition.

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26
Q

Describe the anatomy of the femoral triangle.

A

NAVy VAN!
From lateral to medial, the order is nerve, artery, and vein. Thus, the best place to access the femoral vein is just medial to the femoral artery.

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27
Q

The suffix “-cept” is reserved for molecules that ______________.

A

are soluble reCEPTors (e.g., etanercept)

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28
Q

Where is VSD heard best?

A

The 3rd and 4th left intercostal spaces

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29
Q

How does inspiration affect circulation?

A

Inspiration increases the blood flow to the right heart and actually decreases the blood flow to the left heart; the decrease is owing to the decrease in pressure of the pulmonary vessels.

Example: inspiration increases right heart sounds like tricuspid regurgitation and decreases or doesn’t affect left heart sounds.

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30
Q

What is the difference between simple and complex partial seizures?

A

In simple partial seizures, the patient does not lose consciousness or have a postictal state, whereas in complex partial seizures the patient does.

(“When it’s Simple you can Say you’ve had a seizure. When it’s COmplex you’re COnked out.”)

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31
Q

What’s the difference between a tonic-clonic and myoclonic seizure?

A

Myoclonic seizures do not involve loss of consciousness.

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32
Q

The most common mutation that causes cystic fibrosis leads to __________________.

A

misfolding and improper post-translational modification of the protein with subsequent proteolysis

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33
Q

Describe all that can happen in Patau syndrome.

A 
Think of the P's with Patau: 
•Polydactyly
• Palate defects
•holoProsencephaly
•Protrusion of the gut (omPhalocoele) 
•rocker bottom feet ("you'll need a Podiatrist")
•renal problems ("can't Pee")
•Punched-out lesions on the pate (cutis aPlasia)
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34
Q

What does nicotine use during pregnancy cause?

A

Low birth weight

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35
Q

What embryologic defect causes the phenotype seen in Patau syndrome?

A

Defective fusion of the prechordal mesoderm

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36
Q

What is the formula for absolute risk reduction?

A

ARR = (incidence of event in control group) – (incidence of event in test group)

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37
Q

Describe the overall process of ketone metabolism.

A

Fatty acids are converted to acetoacetate and beta-hydroxybutyrate in the mitochondria of hepatocytes. Those products circulate to peripheral tissues. In the mitochondria of peripheral tissues, acetoacetate and beta-hydroxybutyrate are converted to acetyl CoA.

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38
Q

Which artery supplies the AV node?

A

The posterior descending artery

Note: most people are right-dominant, meaning the PDA arises from the right coronary. In left-dominant people, however, the PDA arises from the left circumflex artery.

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39
Q

Those with PKU usually have high levels of what serum marker?

A

Prolactin

Phenylalanine hydroxylase is needed to make tyrosine. Dopamine is synthesized from tyrosine. Without dopamine the tonic inhibition in the tuberoinfundibular pathway becomes activated and prolactin levels rise.

40
Q

Remember that ___________ secretase leads to amyloid accumulation in Alzheimer’s.

A

beta

41
Q

What is key for a diagnosis of body dysmorphic disorder?

A

Engagement in deleterious, repetitive behaviors related to preoccupation with perceived body imperfections

42
Q

What is one of the best ways to ensure adherence with discharge instructions?

A

Provide a checklist for patients

43
Q

When the clavicle breaks, the medial portion is usually elevated by the ________________ and the lateral portion is brought down by the ______________.

A

SCM; pectoralis major

44
Q

What can cause restrictive cardiomyopathy?

A

Hemochromatosis
Amyloidosis
Sarcoidosis
Radiation therapy

45
Q

What does ristocetin do?

A

It activates GpIb receptors and makes them available for binding to vWF.

46
Q

How does silicosis activate TB?

A

It’s thought that silicosis causes macrophage dysfunction –specifically by inhibiting phagolysosome fusion –which causes bacteria to spill out.

47
Q

Which values are increased in COPD?

A

TLC
FRC (= RV + ERV)
RV

48
Q

Typically, those with COPD have ___________ lung elastic recoil.

A

decreased (due to increased compliance)

49
Q

Cholestyramine can cause high levels of ___________.

A

triglycerides (think of the lobster chasing the pitchfork-wielding men into the hot air balloon)

50
Q

What’s the best way to distinguish between confounding and effect modification?

A

Effect modification can be subject to stratification analysis, meaning you can isolate the variable and still have a valid project.

Confounding occurs when a variable cannot be teased out. For instance, you might look at shoe size and IQ in elementary school students. Age would obviously be a confounding factor, but it could not be isolated.

51
Q

The channel that thiazides inhibit pumps ____________.

A

sodium and chloride (calcium is brought in through another channel via the gradient that is produced)

52
Q

Diphenoxylate is often combined with __________.

A

atropine; this is done because diphenoxylate can cause euphoria if taken in high doses. Adding atropine, however, will make it toxic

53
Q

What two signs suggest a specific cause of hyperthyroidism?

A

Pretibial myxedema and exophthalmos

Hyperthyroidism might be caused by a hot nodule or exogenous intake. Graves disease, however, will present with pretibial myxedema because that is a direct result of antibodies directed again the TSH receptor.

54
Q

_____________ are invaginations of the extracellular space into the outer membrane of myocytes.

A

T-tubules

55
Q

T-tubules ensure that _______________.

A

myofibrils receive the depolarization signal at the same time

56
Q

In addition to forming a diverticulum, the omphalomesenteric duct can also form a ____________.

A

cyst

57
Q

True or false: single-strand binding proteins only interact with the lagging strand.

A

False. SSBs interact with both strands as soon as DNA helicase unzips the DNA.

58
Q

Describe the functions and position of H1.

A

It is the only histone protein outside the core nucleosome. H1 binds the linker regions of DNA (the part that wraps around and overlaps with the preceding segment.

59
Q

How can antibody-mediated blood transfusion reactions be differentiated from IgE-mediated reactions?

A

IgE-mediated reactions present with anaphylaxis while IgG mediated reactions present with hemoglobinuria and fever.

60
Q

By what mechanism does Huntington’s disease lead to neuronal death?

A

It is a gain-of-function mutation that leads to histone deacetylation. This silences the transcription of many genes needed for neuron survival.

(Think of Woody Guthrie unable to Hunt because he lost his acetylation gun.)

61
Q

What is a scotoma?

A

A visual defect with normal vision around the edges

62
Q

Which antiviral can cause hypocalcemia?

A

Foscarnet (because it chelates calcium)

63
Q

Why are FICNBs not administered directly into the femoral ring?

A

The femoral nerve is lateral to the femoral sheath in the inguinal crease, so it is best accessed lateral to the femoral ring.

64
Q

How should a physician who morally opposes abortion respond to a patient who seeks an abortion?

A

Doctors are not required to perform procedures that are against their moral codes, so physicians in this case should refer patients to doctors who will provide abortions without imposing moral guidelines on the patient.

65
Q

What two things inhibit ALA synthase?

A

Heme and glucose

66
Q

In an H&E stain of the adrenal gland, the ____________ layer will appear as the most basophilic.

A

adrenal medulla

67
Q

In an infusion of norepinephrine, the area around the catheter can become cold and hard due to extravasation. How can this be treated?

A

Alpha-agonists like phentolamine

68
Q

Somatostatin binds to a ___________ receptor.

A

Gi

69
Q

What does glycosylase do?

A

In base-excision repair, glycosylase removes the errant nucleoside. Endonuclease and then lyase follow glycosylase by removing the sugar-phosphate backbone from the chain. Polymerase can then fill in the correct base and ligase complete BER.

70
Q

Which of the lipid drugs can cause gallstones?

A

Fibrates (stones behind jellyfish) and bile-acid sequestrants (gull flying gold down to rock pile)

71
Q

Give the correct order of airway resistance among the trachea, bronchi, bronchioles, and terminal bronchioles.

A

Bronchi
Trachea
Bronchioles
Terminal bronchioles

The bronchi have the most resistance because that is where airway comes together and is most turbulent.

72
Q

Amatoxins from mushrooms and ricin from castor beans both inhibit protein synthesis. How does each do so?

A

Ricin inhibits the 60S subunit and prevents translation

Amatoxin inhibits RNA polymerase II.

(aMatoxin inhibits mRNA. Ricin inhibits rRNA.)

73
Q

Differentiate erosions and ulcers.

A
  • Erosions: more superficial; less bleeding; extends through the mucosa and into the muscularis mucosa
  • Ulcers: deeper; more bleeding; extends into the submucosa (where the arteries are)

(“Ulcers are Under the SUBmucosa like SUBmarines are Under the sea.”)

74
Q

Describe the pathogenesis of tachyphylaxis.

A

Tachyphylaxis is the process by which excessive use of nasal decongestants leads to relative vasodilation. This occurs because nerve terminals down-regulate norepinephrine in response to excess alpha-adrenergic agonist release. With decreased levels of norepinephrine in the nasal mucosa, the blood vessels dilate.

Note: this can also happen with nitroglycerine for angina.

75
Q

What is linkage disequilibrium?

A

Normally, separate alleles should be inherited at random. In some cases, however, alleles are more likely to stick together in gametogenesis; this process is called linkage disequilibrium.

Example: x is found in 10% of the gametes and y is found in 10% of the gametes but xy is found in 6% of the gametes (when you’d expect only 1%).

76
Q

What is heteroplasmy?

A

Finding different genes in the nucleus and the mitochondria

77
Q

Describe the areas that the left gastric, right gastric, and the gastroepiploic arteries feed.

A

The left and right gastric arteries supply the lesser curvature and the gastroepiploic arteries (from the splenic artery and the gastroduodenal artery) supply the greater curvature.

78
Q

Most ulcers arise in the area where the ___________ (superiorly) meets the ______________ (inferiorly).

A

gastric acid producing epithelium; gastrin-producing epithelium (of the antrum)

79
Q

What is the most sensitive test for malabsorption?

A

Fats are typically the first nutrient affected in malabsorption, so a Sudan fat stain is the most sensitive test –even more so than intestinal biopsy.

80
Q

What’s the difference between DNA polymerase I and III?

A
  • III just goes 5’ to 3’ (for leading strand replication)

* I can go 5’ to 3’ and also has 5’ to 3’ exonuclease activity to remove the pr1mer (get it?)

81
Q

True or false: primase removes primers.

A

False. It synthesizes primers.

82
Q

In general, you cannot share patient information with friends or family without permission from the patient. What is an exception to this rule?

A

If the patient is incapacitated (e.g., in surgery, unconscious) and the other individual is wondering if the patient is alive.

Example: a woman tells you she is Bob’s wife. Bob has been in a bad accident and is in surgery. You can inform her that Bob is alive but that she’ll have to verify that she is his wife before you can share specifics.

83
Q

The right renal artery passes _____________ to the IVC.

A

posterior

84
Q

The primary defect in tetralogy of Fallot is _____________.

A

anterior/superior deviation of the infundibular septum

“anterior displacement of the inFUNdibular septum makes your pulmonary artery as narrow as a FUNnel.”

85
Q

Say you’ve got an adolescent who has signs of long-term cyanosis. In the clinical history, how might you be able to distinguish between TOF and VSD?

A

TOF will present with cyanotic episodes that started at birth, while VSD will usually be asymptomatic until the left-to-right shunt becomes a right-to-left shunt.

86
Q

Which are typically deeper into the gastric mucosa, the parietal cells or the chief cells?

A

Chief cells

“The Parietal cells are suPerficial. The CHief cells are as deep as the CHallenger.”

87
Q

What does glucagon do that helps correct beta-blocker overdose?

A

It raises intracellular calcium.

88
Q

Remember that filtration fraction (FF) is a dependent variable, so if you decrease renal blood flow (with, say, angiotensin II) then ______________.

A

FF will increase (as will GFR)

89
Q

Which anticoagulant is indicated in the treatment of TIA?

A

COX inhibitors

90
Q

Looking at a graph of pressures of the heart and great vessels, what is the classic sign of aortic stenosis?

A

A large pressure gradient between the left ventricle and the aorta

Normally, the pressure should be very close between the LV and the aorta.

91
Q

What kind of anemia might present with constipation?

A

Lead poisoning

92
Q

True or false: the anemia found in liver disease is most often microcytic.

A

False. It is usually normocytic.

93
Q

What clinical sign distinguishes PDA from the other congenital cardiac defects that may cause cyanosis?

A

PDAs are distal to the left subclavian artery, so highly oxygenated blood is delivered to the upper extremities. As such, Eisenmenger’s syndrome from a PDA will usually have worse clubbing on the lower extremities.

94
Q

Which of the sulfonylureas is shortest acting?

A

Glipizide (it’s the ZIg-zagging baby swan that moves so fast!)

95
Q

Aortic regurgitation can lead to _______-centric hypertrophy.

A

ec (expanding diameter –get it? –DCM)

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

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