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QBank Randos Flashcards

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USMLE® Step 1 flashcards
1
Q

PCA damage leads to (vision wise)

A

Contralateral homonymous hemionopsia w/ macular sparing. Macua has PCA and MCA supply?

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2
Q

Describe S3. Frequency? When position is it easiest to hear? How can you accentuate it?

A

In left lateral decubitus - almost always pathological in older patients. Use BELL – can pick up low frequencies well. If the pt exhales you can hear sounds the best because it decrease lungs volume and places heart closes to the chest wall.

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3
Q

What effect does Valsalva maneuver have on hearing heart murmurs?

A

Valsalva – DEC blood return. DEC flow out of heart and thus DEC BP. So mitral prolapse and hypertrophic CM are easier to hear. Aortic stenosis is HARDER to hear since there is less flow through the left ventricle.

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4
Q

What is isolated diastolic dysfunction?

A

Ventricle has compliance problem (amyloidosis, LV hypertrophy etc). So pumping is fine, but it cannot fill as well. LV end diastolic PRESSURE is elevated, as LV end diastolic VOLUME is DEC (in order to maintain CO). EF is NORMAL.

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5
Q

Where is there a serine instead of histidine in hb B subunit resulting in poor ioninc interact w/ 2,3 bph?

A

HbF

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6
Q

High altitudes – what is the pH, PaO2, PaCO2, plasma HCO3?

A

Basically know that PaO2 and PaCO2 are significantly lower. pH ~7.48, PaO2 – 60, PaCO2-20, Plasma HCO3-15

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7
Q

How does heparin work on AT3?

A

Unfractionated binds to AT3 via pentasaccharide in heparin chain. Causes conformational change in AT3, which in turn INC AT binding and neutralization of thrombin

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8
Q

Most common cause of death in Sudden Cardiac Death –

A

Vfib in prehospital phase. Majority of all SCD are CAD related.

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9
Q

Preterm babies are at risk for what non-surfactant problem?

A

Hemorrhagic disease – cutanoues, GI, intracranial bleeding. Supplement w/ Vit K

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10
Q

First generation antihistamines? Second generation anthistamines? Difference?

A

First generation – Hydroxyzine, promethazine, chlorpheniramine and diphenhydramine. Second generation – Fexofenadine, Loratadine, Cetrizine

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11
Q

Another name for pancoast tumor?

A

Superior sulcus tumor.

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12
Q

What is crescentic glomerulonephritis?

A

AKA rapidly progressive glomerulonephritis – can include Wegeners etc.

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13
Q

What is the most common cause of cardiac abnormality predisposing to Naïve Valve bacterial endocarditis among 15-60 year old AMERICANs?

A

Mitral valv. Prolapse. Hemodynamic factors promote it.

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14
Q

JAK2 is a?

A

Myelopriliferative disease – Non-receptor!!!! Tyrosine Kinase assoc w/ EPO. Falls into the same grouping as CML. Receptor Tyrosine Kinase include receptors for insulin, ILGF, epidermal growth factor. Can cause solid tumors.

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15
Q

Loss of Viral infectivity by ether means?

A

It was a Enveloped virus. From otuer lipid bilayer. Nonenveloped viruses are resistant to action of ether.

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16
Q

How do you treat plummer vinson?

A

Iron preparation.

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17
Q

Ventilation perfusion mismatch leads to what in A-a gradient?

A

INC A-a gradient

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18
Q

Left atrial dilation leading to left recurrent laryngeal nerve impingmenet known as?

A

Orter syndrome?

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19
Q

Seizure disorder plus gingival hyperplasia – think

A

Phenytoin (occurs in 50% of of pt after3-4 months. Due to INC platelet derived growth factor PDGF. When gingival M! exposed to PDGF, stimulate prolif of gingival cells and alveolar bone. May regress after discontinuation

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20
Q

Why are you careful with giving a depressed patient an antidepressant w/ a family history of bipolar disease?

A

Antidepressants may induce mania in susceptible patients w/ bipolar disorder. Must monitor for mood elevations.

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21
Q

Other than ASD, what I associated w/ heart in Downs?

A

Cleft in anterior leaflet of miral valve or septa leaflet in tricuspid valve. VALVE.

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22
Q

Ethambutol – side effects and mech?

A

Vision changes - optic neuritis – color blindness. Mech – inhibit arabinosyl transferaes – which POLYMERIZES ARABINOSE (Carbohydrate) in mycobacterial CELL WALL.

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23
Q

What types of heme things should be though of in neprhotic syndrome?

A

Hypercoag – loss of Protein C, S, AT3. May leadt o renal vein thrombosis -> left sided vericocele.

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24
Q

What are janeway lesions due to?

A

Septic microemboli to cutaneous blood vessels – usu solels of feet and palms in pt w/ baceiral endocarditis

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25
Q

If you suspect Goodpasture, or other things. But they aren’t there What category do you select?

A

Crescent formation

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26
Q

Emprical tx for meningitis? If listeria suspected?

A

Cetriaxone. Cetriaxone +Ampicillin

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27
Q

Origin of RCC? How to remember?

A

Proximal tubule – a lot of ATp random processing going on. Epithelial proximal.

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28
Q

Restlessness and sudden jerking movements after sore hroat 3 months ago?

A

Sydenhams chorea? CNS autoimmune rx to group A b hemolytic strep sore throat. ESP from Acute Rheumtic Fever

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29
Q

Wiskott Aldrich Syndrome Triad. Tx?

A

Eczema, thrombocytopenia, combined B and T lymph def. Repeat infections after 6-12 months. Esp unable to mount humoral immune response against polysacch capsules (Neisseria meningitides, H flu, Stpre pneumo etc). T cell – PCP, herpesviridae. Tx w/ HLA bone marrow tx. Due to X linked

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30
Q

Most likely cause of new onset cardiac murmur in young adult? Complication?

A

BaCaterial endocarditis. Complication – acute diffuse proliferative glomerulonephritis secondary to circulating immune complexes.

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31
Q

What would a drug that relaxes smooth muscles of arterioles lead to? Minimal Venous effect. What drug could this be? Mech?

A

Arteriolar vasodilation -> baroreceptor mediated activation of sympathetic system. Reflex INC Heart rate, contractility INC renin -> sodium and fluid retention. This could be Hydralazine. INC cGMP – smooth muscle relaxation. First like for HTN in pregnancy, with methydopa. Frequently co-administered w/ B blocker to prevent reflex tachy. Can cause lupus like syndrome w/ Hyralazine, Procainamide, INH

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32
Q

What does Pol gene of HIV do? When do you have lots of mutations in Pol? Env gene?Gag gene?

A

Pol (encodes reverse transcriptase, aspartate protease, integrase) responsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV protease inhibitors . Usu due to selective pressure of antiretroviral drugs/chemotherapy. Env (gp12- ,gp 41) gene enables escape from host neutralizing Ab. Gag gene for capsid protein.

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33
Q

How does tumor lysis syndrome present?

A

Often can follow chemotx. Rapid cell turnover -> HYPER P, K, uricemia, HYPOCalcemia. Prevent w/ hydration and hypouricemic agents (allopurinol or rasburicase)

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34
Q

Contraction of efferent arteriole (glomerulus) leads to?

A

INC GFR, DEC RPF and INC FF.

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35
Q

Candida – normal inhabitant of

A

GI tract, Oral cavity. Common contaminant in sputum cultures. Candida in sputum does not indicate disease.

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36
Q

How presentation of HMP shunt defects differs from glycolysis defects?

A

HMP shunt (glutathione, G6PD) – episodic hemolytic anemia. Glycolysis (Pyruvate Kinase) – chronic hemolytic anemia.

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37
Q

What should be used cautiously w/ Benzos in elderly?

A

Any type of sedative. Esp 1st generation anti-histmaines. Prone to falls. Chlorpheniramine, Diphenhydramine (Benadryl), Promethazine, hydroxyzine)

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38
Q

If you see interstitial collection of mononuclear inflame cells and scattered multinucleated giant cells surrounded by fibrosis of interstitium in heart?

A

Aschoff bodies found in Acute rheumatic carditits. Plump mM! w/ abundant cytoplasm, and central nuclei w/ slender chromatin ribbons (Anitschkow cells – caterpillar cells). Larger M! can become multinucleated -> Aschoff giant cells.

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39
Q

Dystrophic Calcification. What is this a hallmark of?

A

Cell injury and death. Most commite sites being aged and damage cardiac valves and atheromatous plaques.

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40
Q

Chronic Bronchitis – most common grouping of causes?

A

ENVIRONMENTAL (includes smoking). Allergy can also cause chronic bronchitis, but more usually causes asthma. AKA, Smoking is classified under envt, NOT allergy.

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41
Q

What does Blood/gas partition coefficient mean? What does it translate to in practice?

A

Solubility of anesthetic in blood. Anesthetic w/ highe rlbood/gas partition are absorbed greater by blood and have a slower onset of action.

42
Q

HIV pt w/ IV drug use history w/ ab distention and anorexia. Ascities and large mass surrounding small intestine. Medium sided tumors w/ basophilic toplasm w/ proliferation fraction (Ki-76 fraction of >99%) – What is assoc w/ this?

A

EBV. Medium sized lymphocytes w/ high prolific index and high Ki-67 fraction approaching 100%. Starry sky. EBV identified in approx. 50% of systemic B cell lymphomas and almost ALL Primary CNS lymphomas in HIV infection. High mitotic index is typical of Burkitts. Burkitts usu in Jaw in Endemic African. Pelvis and abdomen in sporadic form.

43
Q

Describe chest pain in acute pericardidtis?

A

Sharp and pleuritic. DEC when pt sits and leans forward (DEC pressure on parietal pericardium). Friction rub most striking. Often caused by MI, RF, Uremia, Viral infectiou -> fibrinous exudate. DO NOT SEE KUSSMAULS (chronic constrictive) in ACUTE pericarditis, unless there is tamponade. Would NOT Hear S3 in acute pericarditis, unless tamponade. Would NOT see pulsus paradoxus except in cor pulmonale, constrictive (chronic) pericarditis, and cardiac tamponade. Would NOT hear pericardial knock – right after S2 – heard in CONSTRICTIVE (chronic pericarditis)

44
Q

If you see pancytopenia w/ bone marrow biopsy that is “Dry” – aka mainly fat, fibrou,scattered lymphocytes and plasma cells think?

A

Aplastic anemia. Not myelodysplastic – which still have cells, just disordered/dysplastic. Also not MYelopthisic, which you get pancytopenia but often see fibrosis , granulomas or other space occupying lesions. Often metastatic Ca. So fi you see MAINLY FAT – APLASTIC ANEMIA.

45
Q

Hyperresonate lungs w/ acute onset pain and dyspnea in tall thin pt. Lacks audible breath sounds.

A

Apical subpleural blebs. I guess these (spontaneous )are hepyerresonate too! Not just tension. Pneumothorax presentation is both hyperressonate, DEC tactile fremitus, diminished breath sounds, unilateral chest pain dyspnea and expansion.

46
Q

How is Severe Combined Immunodeficiency different than common variable immunodeficiency? Does Absence of thymic shadow = DiGeorge?

A

SCID = T and B lymphocyte problem. Severe manifestation in 7 month old. Common Variable ImmunoDEF is usually just B problem( DEC plasma cells, DEC AB). Can be acquired in 20s to 30s. You can have absence of thymic shadow in SCID.

47
Q

What are subungual splinter hemorrhages caused by?

A

Same reason you get Janeway Lesions – microemboli from infectious endocarditis usually. Listen for MR.

48
Q

What is myocardial hibernation? Myocardial stunning?

A

Hibernation – repetitive low flow state – can be reversed by reperfusion. REVERSIBL. In damaged tissue, myocardial energy metabolism is DEC but there is sufficient ATP to prevent contracture. Can be reversed w/ CABG surgery or balloon angioplasty. Stunning – less severe form of ischemia induced reversible (hibernation) loss of contractile function. Repetitive stunning can lead to hibernation.

49
Q

Difference between nonnuceloside RTI and Nucleoside RTIs?

A

Nonnucleoside – do NOT require activation via intracellular phosphorylation. Are structurally unrelated to nucleosides. Eg. Nevirapine, Efavirenz, delavirdine.

50
Q

Small cell vs Squamous Lung Cancer? Which is chromogranin +?

A

Small cell – Ach, ACTH chromogranin+. Squamous – keratin pearls. PTH

51
Q

Drug for A fib. Leads to constipation and second degree block. Think?

A

Verapamil

52
Q

Levels of Shillings test

A

First give IM cobalamin and oral cobalamin. Normal Urine excretion means that it is taken up by gut and excreted – dietary def. If Lower than normal excretion, it was not taken up. So next step is to diff between intestinal absorption or IF problem. So next, give oral + IF. If okay, then it’s pernicious anemia. If not okay, it’s intestinal abs. problem.

53
Q

Where do ACE inhibiors work on nephron, Where do B blockers work on nephron?

A

ACE – block AT2 from constricting efferent arteriole. Therefore DEC GFR (+ hyperkalemia cough, mild Cr elevation), Rare lifethreatening angioedema. B blockers work by inhibiting B1 receptors of juxtaglomerular cells to reduce renin secretion. Does not have a sig effect on GFR.

54
Q

TB drug that must be activated by intracellular catalase peroxidase?

A

Isoniazid

55
Q

Hysterectomy put what neighboring anatomical partners at risk?

A

Ureters. They are just posterior to uterine arteries, which are ligated in procedure. Ligated ureters -> hydronephrosis and backup. Flank pain and palpable deep mass.

56
Q

What kidney disease is assoc w/ Phospholipase A2 receptors (PLA2R) and IgG4?

A

PLA2R indicate glomerulonephritis. Major pathogen for idiopathic membranous nephropathy. Mainly IgG4 ab.

57
Q

In newborns, how do the kidneys of ADPKD look on ultrasound?

A

Normal – too small cysts to see.

58
Q

Acute angle glaucoma. Drug would affect the kidney where?

A

Given acetazolamide. Affects Proximal tube reabs of HCO3. Also INC water excretion. Also present in the eye – prevents aqueous humor formation. Rare side effects include metabolic acidosis, dehydration, hypokalemia, hyponatremia.

59
Q

Appearance of spleen in pt w/ SS? Why?

A

Fibrosis, brownish discoloration. Due to repetitive splenic infracts by microvessel occlusions. Evently autosplenectomy. Brownish due to hemosiderosis.

60
Q

Brain disease. Where do you see “large inracytoplasmic vacuoles”, “ Lewy bodies” “multiple lacunar infarcts”

A

Large intracytoplasmic vacuoles aka spongiform – CJD. Lewy body = Parkinson and Lewy body dementia. Multiple lacunar infarcts in vascular dementia.

61
Q

What would you see INC PT time and thrombocytopenia in an alcoholic, even after vit K admin?

A

INC PT time due to F7 def because liver is cirrhotic and F7 has shortest half life. Thrombocytopenia because chronic liver disease can lead to hypersplenism.

62
Q

During contraction of cardiac myosite, Ca INC. Right before relaxation, where does the Ca go?

A

Na/Ca active pump, pumps Ca back into SR. aka Calcium efflux.

63
Q

Columnar mucin secreting cells that fill alveolar spaces w/o invading stroma/vessels. What is this?

A

Bronchioalveolar CA (subtype of lung adenoCA). Can occur in nonsmokers from alveolar epi. Peirpehral and often multifocal.

64
Q

Sickle cell trait – what is retic count and MCHC values

A

Both are usually normal. Even w/ 40$ HbS.

65
Q

Pure Re Cell Aplasia presentation?

A

(normal platelets, WBC count) – Rare form of marrow failure. Assoc w/ thymoma, lymphocytic leukemias, Parvovirus B19.

66
Q

Uremic platelet dysfunction (lets say not going to dialysis as frequently) – PT, PTT, Platelet count, BT?

A

PT, PTT, Platelet count – all normal. Bleeding time is INC tho.

67
Q

Other than pneumothorax cases, when do trachea deviate towards/away from center?

A

Away – large pleural effusions. Twoards – atelectasis (volume loss). Can be caused by mechanical blocking of ventilation (CA in smoker), leading to alveolar collapse.

68
Q

Silica presentatio vs Beryllium?

A

Silica – eggshell calcification of hilar nodes and birefringent silica particles on polarized light surrounded by fibrous tissueBerylium – lnoncaseating epithelioid granulomas indistinguishable from sarcoidosis. Without obvious associated particles.

69
Q

Child holds head to one side and may have lump in neck? What is this, what is it due to?

A

Congenital torticollis - due to birthing trauma or malposition of head in utero - SCM injury and fibrosis. May have other musckuloskeletal anomalies. Head points away from contracture. Most cases resolve w/ conservative therapy and stretching exercises.

70
Q

Pare Retina, Cherry red macula - monocular vision loss…

A

Central Retinal Aartery occlusion - often permanent. Pale retina and cherry red macula (Macula still has blood - has separate blood supply from choroid artery) - retina only has central retinal artery (off opthalmic artery)

71
Q

5 year old w/ LNA, oral ulcers, and + Tzanck. When was this acquried?

A

Primary infection of HSV1 - not from mom.HSV1 often gotten in children ages 1-3 - results in oral lesions - smear of oral ulcer scrapigns shows multinucleated giant cells and inclusion bodies. This is not an reactivation, as reactivation often affets less than a 10% of the original topography, and is confined to one side. Reactivation may give cold sores.Not gingivostomatitis.

72
Q

Action of interferon a, b. Who secretes this? Interferon Gamma?

A

DESTROBYS BOTH VIRAL AND HOST RNADEC PROTEIN SYNTH OF INFECTED CELLS.Secreted from many euk cells. INF-g mainly from NK and T cells. Promotes TH1 differentiates - induces Class 2 MHC and M!

73
Q

Which any Herpes Simplex Virus drug does not require activation?HIV?

A

Foscarnet - does nto requrie activation by viral kinase(for HIV, Tenofovir, does not require phosphorylation to be active)

74
Q

Retina image w/ infl;ammatory vascular sheathing and associaetd hemorrhages in HIV + . Concern for? Complication?

A

CMV retinitis. Common complication is retinal detachment due to tearing of thin atrohic scar tissue. Tx w/ ganciclovir

75
Q

Birthing association w/ cleft palate, polydactyly, rocker bottom feet?

A

All have trisomy 13 Patau (and Trisomy 18- Edwards also has Rocker bottom feet)

76
Q

Anatomy of Cricothyrotomy?

A

There is the THYROID cartilage There is the CRICOID cartilage.In between them is the CRICOTHYROID membrane.Puncture this.

77
Q

What is encoded by env, gag, pol?

A

env (envelope = gp120, 41)gag - capsid (p24)pol (reverse transcriptase, protease, integrase)

78
Q

Damage to pterion (whwere frontal, parietal, tmepora, and sphenoid meet) is a risk for what artery severing?

A

Middle meningeal artery via foramen spinosuym (epidural) - which is a branch of the MAXILLARY, WHICH IS A BRANCH OF THE EXTERNAL CAROTID

79
Q

Septae hyphae. Nonseptate hyphae.

A

septate - aspergillusNonseptate - mucor/rhizopus.

80
Q

Strawberry tongue - think?

A

Kawasaki, Scarlet fever! (GAS) Kawasaki -rash on hands, no sore throat - acutoimmune. Scarlet fever - rash on chest, sore throat (tonsillar exudates) + circumoral pallor (pale around mouth) – via pyrogenic exotoxin

81
Q

Post-DKA - black necrotic eschar.How do confirm diagnosis?

A

Mucosal biopsy. Would show nonseptate hyphae w/ right angel branching.(blood cultures usu NEG in mucor. Seen in disseminated mycoses) Surgical debridement and amphotericin B.

82
Q

Other than the usual Turner finnids - what else is characteristic on birth?

A

Lymphedema

83
Q

How id reassortment different han recombination?

A

Reassortment occurs in virus w/ segmented DNA (influenza) - can be swapped between speciesRecombination refers to crossing over of 2 double stranded DNA (parvo etc)

84
Q

Most common bacterial causes of otitis media, sinusitis, conjuncitivits?

A

Strep pneumo, Nontypable H flu, 3 Moraxella catarrhalis. Hib only affects typable H flu B, which affectsMENINGITIS, PNEUMONIA, SPESIS, EPIGLOTTITIS.

85
Q

Most common cause of Otitis externa? What pt populations?

A

Psueodmonas - most common cause of Malignant Otitis externaSeen in elderly diabetic pt.Exquisite ear pain and drainage -granulation tissue often seen within ear canal.

86
Q

What is immunity to Influenza based off of?

A

Circulating ab to Hemagglutinin (igG and IgA in nasopharynx)

87
Q

What enzyme removes RNA primers?

A

DNA pol 1. 5’3 exonucleas. Removes Primer and also replaces w/ DNA. PS. DNA pol3 is STILl 5’3 synthesis, it just is 3’5 EXONUCLEAS

88
Q

What can cause cushingoid fat redistrubtion to belly other than cortisol?

A

Cortisol OR highly active ANTI-RETROVIRAL THERAPY (HAART)esp HIV1 proteas inhibitors.

89
Q

CMV in immunocompetent?

A

Mononucelosis. Immunocompromised - retinitis, penumonia, esophagitis, colitis, hepatitis

90
Q

Influenza - what are neuraminidase inhibitors?

A

Oseltamivir, Zanamivir

91
Q

Cleft lip/palate, microcephaly, micropthalmos. What is this plus what are other asosciated effects?

A

Patau chr 13 - nondisjunction during material meiosis 1. Cleft lip and palate, polydactyly, rocekr bottom feet, holoprosencephaly.

92
Q

What makes you think edwards? Microcephaly etc. but

A

Fingers overlap !!! both edwards and patau have rocker bottom feet.

93
Q

Toxin of C. diptheria is most similar to?

A

Pseudomonas.Both inactivate EF2 via ribosylation - inbhiit protein synthesis.

94
Q

When ligating inferior thyroid artery, what is at risk?

A

recurrent laryngeal nerve. travels in close proxmimity to inferior thyroid artery.

95
Q

Congenital rubella?When would you give vaccine and waht type of vaccine?

A

Cataracts, deafness, PDA/pulmonic stenosis.Live attenuated vaccien - 12-15 months and again at 4-6 y.o. Also for nonpregnant woemn of childbearing age who lack serum ab against rubella.

96
Q

How can nonpathogenic corynebacterium gain ability to caus epseudomembranous pharyngitis?

A

Acquiring Tox gene via lysogenization by temperate BACTERIOPHage. aKA transudctino

97
Q

Where are high freq sounds picked up in inner ear? Low freq?

A

By oval window (entry - attaches to stapes) and round window.Low frequencies - helicotrema (opposite end.

98
Q

Flushed skin and mydriasis due to?

A

Muscarininc receptor block.

99
Q

Bulimia nervosa signs?

A

parotid enlargement, enamel erosion. irregulat menstruation (in normal body weight range, or slightly over/under)Amenorrhea occurs in anorexia nervosa.

100
Q

3 most common causes of Downsyndrome?

A

Meiotic nondisjunction - usu maternalUnbalanced Robertsonia translocations (46 chromosomes but an extra arm of 21 is attacehd to atnoerh chrmoosome - translcoation)MOSAICISM - 2 cell lines - one w/ normal genotype, one w/ trisomy 21

101
Q

What is used to grow neisseria? What is in that medium?

A

Thayer martin - vanc (inhbiits GP) colistin (polymyxin inhibits GN), nystatin (blocks yeast), Trimethoprim (inhibits proteus)

102
Q

Prolonged exposure to loud sound causes hearing loss due to dmg to ? What frequencies are lost first?

A

Stereociliated hair cells of organ of Corti.Can be from fracture of stereocilia due to shearing forces agaisnt tectorial membrane. - HIGH frquency lost first REGARDLESS of frquency of sound

USMLE (16 decks)

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