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USMLE > Qbank 2 > Flashcards

Qbank 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Location of neurotransmitters:

  • Serotonin
  • Dopamin
  • Ach
  • GABA
  • NE
A
  • Serotonin: raphe nuclei in pons, medulla, midbrain
  • Dopamine: ventral tegmentum and substantia nigra pars compacta
  • Ach: basal nucleus of Meynert
  • GABA: nucleus accumbens
  • NE: locus ceruleus (pons)
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2
Q

derivatives of the ventral and dorsal pancreatic buds?

A
  • ventral: main pancreatic duct and uncinate process (portion of pancreas head)
  • dorsal: accessory pancreatic duct, body, tail, isthmus
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3
Q

What epithelium lines the true vocal folds?

A

-stratified squamous. Most other parts of respiratory tract are pseudo stratified columnar mucus secreting epithelium, except the pharynx (where air and food passes, is stratified squamous)

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4
Q

Treatment for narcolepsy?

A

Modafinil

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5
Q

The thymus is derived from what branchial pouch?

A
  • 3rd. With the inferior parathyroids

- ear, tonsils, bottom, to top

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6
Q

For restrictive lung disease, describe FEV1/FVC, compliance, elastic recoil, lung volumes.

A
  • there is restricted filling of lungs. Decrease compliance, and increased elastic recoil/radial traction because of fibrosis
  • FEV1/FVC is greater than 80%
  • lung volumes are decreased: decreased TLC and FVC
  • there is super normal expiratory flow rate
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7
Q

Mullerian agenesis vs androgen insensitivity syndrome

A
  • Mullerian agenesis: normal secondary sex characteristics, hypo plastic or absent uterus, no upper vagina XX
  • AIS: breast present, no uterus, pubic/axillary hair XY
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8
Q

Describe glycogen regulation involving glucagon/epinephrine.

A
  1. Glucagon
    - activates glucagon receptor->adenylate cyclase->cAMP->protein kinase A->glycogen phosphorylase kinase->glycogen phosphorylase–>breakdown of glycogen to glucose
  2. Epinephrine: activates alpha receptor->->Ca release->activates Glycogen phosphyrlase kinase->activates glycogen phosphorylase
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9
Q

Vit E deficiency presentation.

A

-presents like B12 but without the megaloblastic anemia. mUscle weakness, peripheral neuropathy, hypotonia

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10
Q

Recurrent skin infections without pus. Delayed detachment of umbilical cord. Poor wound healing. Disease and mechanism of disease?

A
  • Leucocyte adhesion deficiency

- deficiency of CD18. Inability to synthesize integrins.

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11
Q

Tredelenburg gait. What nerve is damaged?

A

Superior gluteal nerve. The damage is on the side that person is standing on that causes hip drop on the opposite leg.

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12
Q

What processes of collagen synthesis occur in the extracellular matrix?

A
  • cleavage of N and P pro peptides by peptidases to form tropocollagen
  • tropocollagen fibers assemble into fibrils and lysyl oxidase deamininates lysine and hydroxylysine residues, forming reactive aldehydes that form covalent crosslinks
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13
Q

Mechanism of spread of N. meningitidis

A
  • nasopharynx, blood, to choroid plexus, to meninges

- H. flu spread from pharynx to lymphatics to meninges

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14
Q

What are the formulas for t1/2, loading dose, and maintenance dose?

A

t1/2= (Vd x 0.7)/Cl
Loading dose= (Vd x Cp)/F
maintenance dose= (Cl x Cp x dose interval)/F

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15
Q

Define reaction formation, displacement, suppression, repression.

A
  • reaction formation: doing something opposite of your desire to cover it up. Homosexuals being homophobic and denouncing homosexuality
  • displacement: taking out anger on scapegoat -yelling at dog when angry at wife
  • suppression: consciously putting thoughts out of mind
  • repression: unconsciously putting out of mind
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16
Q

hyperthyroidism following flu like illness. What is disease? histology? findings?

A
  • tender thyroid
  • increased ESR
  • granulomatous inflammation, may see giant cells. Mixed cellular infiltrate.
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17
Q

Histology of Hashimoto thyroiditis.

A
  • lymphoid aggregate with germinal centers, Hurtle cells. Mononuclear infiltrate.
  • increases risk of non hodgkin lymphoma
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18
Q

Which secreted Ig forms a dimer?

A

IgA

-particular important in colostrum, first secreted milk by mom, provides infant with passive immunity.

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19
Q

antidote for beta blocker overdose

A

glucagon

-increases cAMP of cardiac myocytes, and increases intracellular calcium

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20
Q

Mechanism of Cromolyin and nedocromil. Uses?

A

-inhibits mast cell degranulation 2nd line for allergic rhinitis and bronchial asthma

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21
Q

List the overdose/poisoning for which the following antidotes are for:

  • amyl nitrate
  • dimercaprol
  • methylene blue
  • deferoximine
  • EDTA
  • penicillamine
  • trientine, oral zinc
A
  • amyl nitrate: cyanide
  • dimercaprol: arsenic or lead
  • methylene blue: methemaglobinemia
  • deferoximine: iron
  • EDTA: lead
  • penicillamine: copper
  • trientine, oral zinc: copper
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22
Q

Contents of crescent in RPGN.

A
  • abundant fibrin

- macs, monocytes, proliferated glomerular parietal cells

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23
Q

Thoracentesis, which ribs to go between?

A
  • mid clavicular: 5th and 7th (6-8 intercostal space)
  • mid axillary: 7th and 9th (8-10)
  • paravertebral: 9th and 11th (10-12)
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24
Q

Cystic tumor in cerebellum of child with Hair like glial processes. What is the tumor and what other histological features seen?

A

pilocytic astrocytoma

-spindle cells, rosenthal fibers and eosinophilic bodies

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25
Q

mechanism of enterococci resistance of aminoglycosides?

A
  • produce enzymes that transfer acetyl group (or other modifying groups) to aminoglycoside, decreasing ability for antibiotic to bind to ribosome
  • acquired by plasmids or transposons
26
Q

What is the most common benign liver tumor?

A

cavernous hemangioma

27
Q

What free radical scavenging agent is used with cisplatin to minimize nephrotoxicity?

A

-amifostine

28
Q

Most common cause of viral acute hemorrhage cystitis in children?

A

Adenovirus

29
Q

Treatment of choice for Listeria?

A

Ampicillin

-not sensitive to cephalosporins

30
Q

Mechanism and use of foscarnet?

A
  • viral DNA/RNA inhibitor and HIV reverse transcriptase inhibitor. doesn’t require activation by viral kinase
  • use for CMV retinitis when ganciclovir fails and acyclovir resistant HSV
31
Q

when can serum hCG and urine hCG be detected if fertilization occurred?

A

serum: 8 days after ovulation (implantation takes place ~ 6 days after fertilization)
urine: 14 days after ovulation

32
Q

majority of water absorption occurs where in the kidney?

A
  • proximal tubule, regardless of volume status of patient. Reabsorbs 60% of water.
  • up to 20% can be reabsorbed in the collecting ducts with ADH
33
Q

Describe steps of leucocyte trafficking and the proteins involved.

A
  1. margination
  2. Rolling:
    PMNs: siayl lewis
    endothelium: P/L- selectin
  3. tight adhesion and crawling:
    PMNS: CD 11/18 integrins (LFA-1, MAC-1)
    endothelium: I-CAM
  4. transmigration/diapedesis
    -PMNS: PECAM
    -endothelium: PECAM-1
34
Q

Where does the synthesis and assembly of ribosomal components occur?

A

-in the nucleolus

35
Q

What type of cells are juxtaglomerular cells?

A

modified smooth muscle cells of afferent arteriole that secrete renin

36
Q

Mechanism of oseltamavir.

A

-neuraminidase inhibitor: prevents viral particle release from host cell

37
Q

Abdominal discomfort, greasy stool, weight loss. Arthralgias. Intestinal biopsy shows macrophages with PAS stained granules (foamy macs).

A

Whipple disease, caused by gram positive actinomycete Tropheryma whippelli. Can also have psych and cardiac problems.

38
Q

What is a secondary effect of loop diuretics that is inhibited by NSAIDS?

A

-loop diuretics also stimulate prostaglandin release, causing vasodilation of afferent arteriole. Increases renal blood flow and increases GFR, enhancing drug delivery and diuretic response.

39
Q

Treatment for treating acute heroin/opioid withdrawal in neonates.

A

Tincture (extract) of opium

-should not give naloxone (antagonist) to patient in withdrawal.

40
Q

Which step in the TCA cycle generates GTP?

A

succinyl-coA to succinate, catalyzed by succinyl-CoA synthetase

41
Q

Which steps of the TCA cycle generate NADH? FADH2?

A
  1. isocitrate to a-ketoglutarate by isocitrate dehydrogenase
  2. a-ketoglutarate to succinyl-coA by a-ketoglutarate dehydrogenase
  3. Malate to oxaloacetate by malate dehydrogenase
    FADH2
    -succinate to fumarate by succinate dehydrogenase
42
Q

Child with abdominal dissension and firm irregular mass. Also with opsoclonus-myoclonus “dancing eyes dancing feet”.

A

Neuroblastoma of the adrenal, originating from neural crest cells.
-there are increased secretions of catecholamines in urine: VMA, HVA

43
Q

What can be given to help prevent kidney stone formation? pH that different stones precipitate at?

A
  • hydration
  • citrate: binds free calcium
  • calcium oxalate, uric acid, and cysteine stones precipitates at low pH, so alkalization of urine can help. Except calcium phosphate and struvite stones precipitates at high pH.
44
Q

Chemotactic factors for neutrophils?

A

Il-8, C5a, LTB4

45
Q

How to calculate renal plasma flow, renal blood flow, and Filtration fraction?

A
  • RPF=U(pah)xV/P(pah)
  • RBP=RPF/(1-Hct)
  • FF=GFR/RPF
46
Q

Describe reactions in polyol pathway.

A
  1. glucose to sorbitol by aldose reductase
    - NADPH->NADP+
  2. Sorbitol to fructose by sorbitol dehydrogenase
    - NAD+ to NADH
    - retina, renal papilla, and Schwann cells have less sorbitol dehydrogenase activity and are more susceptible to damage by sorbitol in diabetes
    - lens can be overwhelmed in hyperglycemia–>cataracts
47
Q

What cytokine activates Eosinophils?

A

Il-5

secreted by Th2 helper cells

48
Q

How is Cryptococcal neoformans acquired?

A

-found in soil and pigeon droppings. Is inhaled with hematogenous dissemination to meninges

49
Q

Which features of Wierneke-Korsakoff syndrome are permanent?

A
  • memory loss, learning abnormalities, confabulation are permanent
  • Wiernicke: oculomotor abnormalities, ataxia, and confusion. Are reversible.
50
Q

Microscopic findings in Reye’s syndrome?

A
  • LM: microvesicular steatosis. No inflammation or necrosis.

- mechanism: aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes

51
Q

Mechanism of canagliflozin? Side effects?

A
  • SGLT-2 inhibitors. Blocks reabsorption of glucose in PCT.

- adverse effects: glucosuria, UTIs, vaginal yeast infections

52
Q

NO is synthesized from what amino acid?

A

arginine

53
Q

What kind of virus is rubella?

A

Togavirus

54
Q

Which viruses have an envelop that resembles nuclear membrane?

A

-Herpesvirus

55
Q

In attacks of acute intermittent porphyria, what is there a buildup of?

A

-delta-aminolevulinic acid and porphobilinogen

56
Q

Treatment of cryptococcal meningitis?

A

induction with flucytosine, then amphotericin B.

-maintenance by fluconazole.

57
Q

Effects of isoproterenol ?

A

b1 and b2 agonist.

-increases cardiac contractility, decreases TPR (bp)

58
Q

Side effects of phenytoin

A
  • CNS: nystagmus, ataxia
  • gingival hyperplasia due to activation of PDGF
  • fetal phenytoin syndrome
  • interferes with folate metabolism, leading to megaloblastic anemia
  • induction of cypp450
59
Q

What markers are elevated in neural tube defects that can be detected in amniotic fluid?

A
  • AFP

- acetylcholinesterase because of leakage of fetal CSF fluid into amniotic fluid

60
Q

Precision vs. reliability vs. accuracy?

A
  • precision =reliability

- accuracy=degree measurement matches gold standard measurement

USMLE (4 decks)

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