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USMLE > Qbank 4 > Flashcards

Qbank 4 Flashcards

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USMLE® Step 1 flashcards
1
Q

Proximal 1/3 of ureter receives blood supply from where?

A

Renal artery

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2
Q

Vitiligo: what causes loss of pigment?

A
  • loss of melanocytes in skin

- autoimmune association.

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3
Q

Mechanism of antibiotic that is used for S. aureus skin infections, esp. MRSA, bacteremia, endocarditis, and VRE. Side effects?

A
  • lipopeptide that disrupts cell membrane of gram positive cocci
  • side effects: myopathy and rhabdomyolysis
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4
Q

Medications that can cause seizures?

A

buproprion, clozapine, isoniazid, imipenem, fluoroquinolones

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5
Q

Gardener’s mydriasis: dry mouth, flushed, hot temperature, double vision, dilated pupils, tachycardia. Cause? Antidote?

A
  • Jimson weed poisoning, similar to atropine poisoning
  • sympathethic effects due to blockade of muscarinic receptors
  • treat with physostigmine
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6
Q

Mechanism of urinary incontinence in normal pressure hydrocephalus?

A

-hydrocephalus causes distortion of paraventricular white matter. Loss of cortical inhibition of sacral micurition center (S2-S4) leading to urge incontinence.

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7
Q

Lung hamartomas usually contain?

A

-disorganized cartilage, adipose, fibrous tissue

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8
Q

presentation of glucagonoma.

A
  • Diabetes
  • GI complaints: pain, diarrhea, anorexia
  • Necrolytic migratory erythema: red papules/plagues that grow and coalesce. Leave central clearing that is bronze and indurated with peripheral scaling an blistering
  • Anemia
  • depression
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9
Q

motile gram positive rod with narrow zone of hemolysis. Grows well at refrigeration temperatures. What bacteria? What immune response is most effective against it?

A

-Listeria
-T cell mediated immunity
-listeria is intracellular, it produces listeriolysin
O which allows it to escape phagosome into the cytosol.

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10
Q

List intracellular bacteria.

A

obligate: rickettsia, chlamydia, coxiella
facultative: salmonella, neisseria meningitidis, brucella, mycobacterium, listeria, franciscella, legionella, yersinia pestis

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11
Q

Person with Strain of tb that has decreased activity of intracellular catalase-peroxidase. Which anti-TB drug will not work?

A
  • Isoniazid

- bacterial catalase peroxidase needed to convert INH to active metabolite

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12
Q

Why is methadone drug of choice for treating heroin addiction?

A
  • long half life, good bioavailability

- able to have continuing suppression of withdrawal symptoms

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13
Q

Amino acid transamination requires what cofactor?

A

B6
-transamination occurs between amino acid and alpha-keto acid. Amino group from amino acid transferred to a-keto acid, and a-keto acid becomes an amino acid

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14
Q

Abdominal aortic aneurysm. Most common cause?

A

-atherosclerosis. Atheromas weaken underlying media.

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15
Q

Where do Viridians Streptococci bind on damaged heart valves?

A

-S. sanguinis makes dextran, which bind to fibrin platelet aggregates on damaged heart valves. Must have endothelial damage leading to fibrin platelet aggregates for binding.

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16
Q

Atelectasis, where does trachea deviate? Causes of atelectasis? X-ray findings?

A
  • Towards the side of the lesion
  • cause: bronchial obstruction, infection
  • x-ray: opacification of lung
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17
Q

Management of drug induced parkinsonism by antipsychotics.

A

Rx: benztropine (antimuscarinic) or amantadine
-dopamine agonist may worsen psychosis
Symptoms are caused by blockage of D2 receptors in the nigrastriatal pathway

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18
Q

Mechanism of action of the following antifungals:

  • nystatin
  • flucytosine
  • azoles
  • terbinafine
  • caspofungin
  • griseofulvin
A
  • nystatin: same as amphotericin. binds ergosterol and forms pores. Causes leakage of electrolytes
  • flucytosine: inhibits DNA and RNA biosynthesis by conversion to 5-FU by cytosine deaminase
  • azoles: inhibits cyp450, preventing conversion of lanosterol to ergosterol
  • terbinafine: inhibits fungal enzymes squalene epoxidase (ergosterol synthesis)
  • caspofungin: inhibits cell wall synthesis by inhibiting synthesis of beta-glucan
  • griseofulvin: interfere with microtubule function
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19
Q

Cell type that stains positive for synaptophysin

A

Neurons

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20
Q

Treatment of congenital adrenal hyperplasia

A

-low dose glucocorticoids. Suppresses ACTH secretion and decreases stimulation of adrenal cortex so that will decrease androgen production

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21
Q

Niacin can by synthesized from which amino acid?

A

tryptophan

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22
Q

what cranial nerve can be injured in a transtentorial/uncal herniation? What artery?

A

CN III

PCA

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23
Q

What artery can be compressed in subfalcine herniation?

A

ACA

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24
Q

Define the following: Berkson bias, Hawthorne effect, Pygmalion effect.

A
  • Berkson bias: study population selected from hospital is less healthy than general population
  • Hawthorne effect: change in behavior in subjects as results of being aware they are being studied
  • Pygmalion effect: Researcher’s belief in efficacy of treatment changes outcome of that treatment. E.g. More likely to document positive results if expect positive results.
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25
Q

Urine smells like burnt sugar. What enzyme is deficient? What enzymes can’t be degraded? Supplement with what vitamin would lead to improvements?

A

a-ketoacid dehydrogenase
isoleucine, leucine, valine: branched amino acids
-thiamine, is a cofactor for the enzyme.

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26
Q

Which vein has the most different oxygen content compared to aorta?

A

Carotid Sinus

  • because there is high myocardial oxygen demand
  • heart extracts oxygen more efficiently than any other tissue
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27
Q

Hyperacute transplant rejection is what type of hypersensitivity?

A

Type II -due to preformed antibodies in the host. Anti ABO or anti HLA (IgG antibodies)

  • see gross mottling and cyanosis
  • arterial fibrinoid necrosis and capillary thrombosis
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28
Q

Parasympathetics to lacrimal, submandibular, sublingual glands originate from which nerve?

A

Facial

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29
Q

At what steps do the following diseases of collagen synthesis occur?

  • Osteogenesis imperfecta
  • Ehler-Danlos syndrome
  • Scurvy
A
  • Osteogenesis imperfecta: inside fibroblasts cytosol, inability of form triple helix after glycosylation at RER
  • Ehlers-Danlos: usually problem in cross linking collagen fibers after it has been excreted into extracellular matrix
  • Scurvy: problems with hydroxylation of specific proline and lysine residues at RER
30
Q

Dark skin patches with ulcerated appearance and occasional necrotic center in chemotherapy patient. What bacteria?

A

Pseudomonas Aeruginosa

-Ecthyma gangrenosum

31
Q

Ab pain, nausea, vomiting, lacrimation, yawning. Muscle aches, dilated pupils, hyperactive bowel sounds, piloerection. What is patient withdrawing from?

A

Heroin/opioids.

  • does not result in seizures like alcohol or benzo withdrawal.
  • yawning and lacrimation are fairly specific to opioid withdrawal
32
Q

Dysthymic disorder

A

chronic low intensity mood disorder that responds well to antidepressants
-symptoms less severe than major depressive disorder but must be present for at least 2 years

33
Q

Sweat glands in axilla and pubic area are what type? Rest of body?

A
  • apocrine glands in axilla and pubic area. Secrete membrane bound vesicles into hair follicles
  • eccrine/merocrine glands are through rest of body, secrete directly to skin surface
34
Q

Periorbital and temporal pain, with lacrimation, nasal congestion and ptosis. Lasts about 30 mins and classically occurs a few hours after going to sleep. What type of headache?

A

Cluster

-affects males more than females. Usually have 1 year interval of being headache free

35
Q

Adverse effects of protease inhibitors?

A
  • lipodystrophy
  • hyperglycemia
  • inhibition of cyp450
36
Q

What is the best indicator of the severity of mitral regurg?

A

S3 sound, indicating left ventricular overload

37
Q

besides influenza, what other virus has segmented genome?

A

rotavirus

38
Q

Why does squatting improve tetralogy of Fallot?

A

Increases systemic vascular resistance and decreases right to left shunt, improving cyanosis.

39
Q

What determines ventricular contraction rate in Afib?

A

AV node refractory period

40
Q

What causes hypocalcemia in patient who receives multiple packed red blood cells?

A

Citrate added to blood chelates calcium

41
Q

What provides the fastest reversal of warfarin’s effects?

A

fresh frozen plasma

-Vit K takes more time

42
Q

In Hirschprung disease, where would you sample for biopsy, the narrow or dilated portion? How deep would you biopsy?

A
  • Narrow portion, up to submucosa where the Meissner’s plexus is. It is the most superficial layer can see missing ganglion cells
  • Auerback’s plexus is in muscular layer
43
Q

Fidaxomicin

A

antibiotic for C dif with minimal systemic absorption

44
Q

What contributes to gallstones formation in Crohns disease?

A

bile acid wasting because not absorbed in ileum. Result is there is less bile acid in gallbladder and increased cholesterol to bile acid ratio.

45
Q

Preferred med for absence seizures with clonic-tonic seizures.

A

valproate acid

46
Q

What is the single most important risk factor for aortic dissection?

A

Hypertension

47
Q

Best way to prevent neonatal tetanus?

A

Vaccination of mother with tetanus toxoid during pregnancy. Immunized mother would transfer IgG antibodies to fetus

48
Q

How to prevent toxicity by acyclovir?

A

Hydration

-if not hydrated, can cause obstructive crystalline nephropathy and acute renal failure

49
Q

What can be used to test coronary vasospasm for Prinzmetal Angina?

A

Ergonovine stimulates alpha adrenergic and serotonergic receptors. Low doses causes vasospasm in patients with Prinzmetal’s angina.

50
Q

Which acethylcholinesterase inhibitor can cross the BBB?

A

physostigmine

51
Q

What serum marker is elevated with temporal arteritis?

A

ESR

52
Q

Defective transport of cysteine ornithine lysine arginine across intestinal and renal tubular epithelium. Manifestation?

A

cysteinuria. Only clinical manifestation is recurrent kidney stones.

53
Q

What drug can be given to control symptoms of carcinoid tumor?

A

Ocreotide.

54
Q

22 year old woman with severe weakness of her left leg, beginning 2 days after fiancee broke of engagement. No PE findings. What disorder?

A

Conversion disorder. Unconscious manifestations of neurological symptoms, especially after life stress.

55
Q

Uremic platelet dysfunction.

A

Uremic toxins in renal failure patients cause qualitative platelet disorder. Impaired aggregation and adhesion. Normal labs except for prolonged bleeding time.

56
Q

biologic agent suffix meanings

A
  • nib: kinase inhibitor
  • mab: monoclonal antibody
  • cept: receptor molecule
57
Q

Hematogenous osteomyelitis commonly affects children. What part of the bone does it usually affect?

A

Metaphysis of long bones

58
Q

Sudden right sided weakness. Uncontrolled HTN. No abnormalities on CT. 4 weeks later, imaging shows small cavitary lesion in left internal capsule. Condition caused by?

A

Lacunar infarcts. In acute setting small infarct size may not show up on CT scan. Most often due to hypertensive arteriolosclerosis

59
Q

Common presentation of right sided colon cancers?

A

Iron deficiency anemia due to ongoing blood loss and systemic symptoms

60
Q

Mechanism of Cilostazol

A

Platelet phophodiesterase inhibitor. Increases cAMP and prevents platelet aggregation. Also causes vasodilation. Used to treat peripheral arterial disease/claudification.

61
Q

Aspiration of hydatid cysts due to echinococcus can cause what?

A

-often affects the liver

spilling over of cysts content into peritoneum can cause anaphylactic shock

62
Q

What neuro pathways are affected by B12 deficiency?

A
  • dorsal columns
  • descending lateral corticospinal tracts: upper neuron signs
  • peripheral nerves
63
Q

In AV block, what becomes response for pacing the ventricles?

A

AV node, when conduction between SA and AV node is impaired. Heartbeat at 45-55 beats/min
-if anything below the AV node and bundle of His took over pacemaking function, would have beats ~20beats/min

64
Q

The ductus arteriosus is derived from which aortic arch?

A

6th

65
Q

Which site on tRNA is for binding amino acid? Which site for anticodon?

A
  • 3’ CCA site for binding amino acid

- opposite arm has anticodon

66
Q

Akathisia

A

subjective restlessness with an inability to sit still.

-side effect of antipsychotics

67
Q

Ressortment vs recombination

A

Ressortment refers to mixing of genome segments in segmented viruses.
-recombination involves crossing over of two double stranded DNA molecules

68
Q

Bilateral lower lobe infiltrates after cruise. Hyponatremia. High fever, confusion, watery diarrhea. Sputum gram stain shows many neutrophils, but few or no organisms. What organism?

A

Legionella.

69
Q

Over a year, a nontender cervical lymph node that fluctuates in size. What lymphoma?

A

follicular cell lymphoma.Indolent clinical course with remissions and recurrences.

70
Q

Elevated alkaline phosphatase of unclear origin can be followed up with what lab test?

A

y-glutamyl transpeptidase. GGTP. Will help elucidate whether ALP elevation was of liver or bone origin.

71
Q

What are levels of testosterone and LH in Klinefelter’s syndrome?

A

Low testosterone and elevated LH. Usually the leydig cells are also dysfunctional

USMLE (4 decks)

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