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Qbank4 Flashcards

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USMLE® Step 1 flashcards
1
Q

what vaccines are conjugated? why?

A

vaccines of the encapsulated organisms… AKA hemophilus, neisseria, strep pneumo. Their virulence is via capsule, which is best counter acted by antibodies…thus a protein toxin is conjugated to activate T cells/B cell interaction for Ab isotype switch

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2
Q

what kind of vaccine is varicella?

A

live attenuated

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3
Q

what kind of vaccine is BCG?

A

live attenuated

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4
Q

what is homeodomain genes?

A

hox genes.

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5
Q

early diastolic snap with rumbling at heart apex

A

mitral valve stenosis

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6
Q

fixed split

A

ASD

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7
Q

Pt with mitral valve stenosis. what’s the probable cause?

A

rheumatic heart disease (chronic)

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8
Q

which sun screen protects against UVB?

A

PABA; zinc

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9
Q

which sun screen protects against UVA?

A

avobenzone, zinc

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10
Q

unconjugated bilirubin is insoluble…what is it attached to?

A

albumin

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11
Q

virulence factors of Pseudomonas

A

A (exotoxin A-EF ribosylation), Collagenase/Phospholipase C, DNase, Elastase, Fibrinolysin

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12
Q

urinary incontinence in diabetic? sx and associations

A

can’t feel urge to urinate
overflow incontinence due to loss of efferent and afferent nerves
increased urination at night due to relaxation of pelvic muscles

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13
Q

burning feet and GI distress. what vitamin is missing?

A

vitamin B5; CoA

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14
Q

what structures are supplied by the PCA?

A

visual cortex, corpus callosum/splenium, thalamus, cranial nerves III and IV

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15
Q

when do you use ADP receptor blockers?

A

PCI, unstable angina/nonSTEMI

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16
Q

when do you use Heparin?

A

in pt prevention of DVT/PE

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17
Q

name the top 3 possibilities of pituitary secretive tumor

A

prolactin, ACTH, GH

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18
Q

harsh systolic crescendo, decrescendo murmur

A

HCM (or it could be aortic stenosis)

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19
Q

Pt with calcium stones…which diuretic is good for them?

A

thiazides, because it increases passive calcium reabsoprtion… thus less calcium is dumped into the kidneys…thus less stones

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20
Q

what is the mechanism by which thiazides lead to less calciuria

A
  1. It inhibits Na/Cl transporter… thus less Na is in the tubular cell… Na then flows into the cell more readily in exchange for Ca pumped out to the blood… thus more calcium reabsorption.
  2. hypovolemia created by the thiazides induces PT to reuptake more Na and thus Calcium follows
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21
Q

pelvic fracture is likely to injur which part of the urethra in men?

A

membranous portion

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22
Q

straddle injury is likely to injure which aprt of the urethra?

A

the proximal portion of the penile urethra

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23
Q

what are some signs of tumor lysis syndrome? how do you treat it?

A

Tumor lysis syndrome you will have 1. Increased intracellular electrolyte leakage… like K and P. 2. You will have increased uric acid.

Thus complications include arrythmias, renal failure, gout.

Treat with Allopurinol/Pegloticase

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24
Q

what does carbidopa do. what symptoms are lessened when used with levodopa; what symptoms will not better/worsen?

A

carbidopa inhibits Levodopa activity in the periphery and thus concentrates it in the brain.

This lessens N/V symptoms; but worsens agitation/anxiety

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25
Q

low potency antipsychs are which? what are their SE?

A

Chlorpromazine and Thioridazine;

SE include: anti cholinergic, antihistamine, antialpha andrenergic

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26
Q

what shoud you not give in digoxin tox?

A

calcium gluconate

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27
Q

HFE on intestine epithelium detects what and what does it do?

A

it interacts with transferrin…if low iron then will increase iron absorption by increasinf divalent metal transporter… n decreasing hepcidin…

mut leads to inability to detect transferrin…leading to hemachromatosis

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28
Q

hemophilus travels to brain to cause meningitis via what route?

A

lymphatics

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29
Q

myxomatous changes in blood vessel

A

medial degeneration; marfan

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30
Q

what is cacipotriene?

A

vit D analog

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31
Q

what vitamin can you use to treat psoriasis?

A

vit D analogs

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32
Q

CD34 is what marker?

A

endothelial

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33
Q

what might a pt with abetaliproproteinemia have symptom wise? waht about histologically in the jejunal lumen?

A

sx: ataxia, malabsorption of fat soluble vitamins, steatorrhea.

Histo: large foamy intestinal epithelium because no betalipoprotein =no chylomicron/VLDL/LDL thus the absoprbed fats cann’t enter bloodstream and remains in the cells

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34
Q

what’s the difference between plasmin over activation and DIC?

A

both will have increased bleeding and factor deficiency…

However, only DIC will have ddimer

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35
Q

PTT does not rise when Heparin is given…dx?

A

ATIII deficiency

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36
Q

leukemias by age

A

ALL 60

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37
Q

what are the three causes of megalocytic anemia?

A

Folate/B12 deficiency

Orotic aciduria

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38
Q

what are causes of macrocytic-nonmegalocytic anemia?

A

liver disease
alcoholism
reticulocytosis

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39
Q

why are reticulocytes blue hued?

A

because they have RNA

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40
Q

number 1 cause of death in sickle cell adults?

A

acute chest syndrome; usually occurs post pneumonia

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41
Q

what are lysed in PNH? what are complications of PNH

A

RBC, WBC, and platelets are destroyed in PNH due to complement activation;

Thus this leads to anemia/iron deficiency, AML deveopment potentially/infections, and THROMBOSIS due to bursting of platelet contents.

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42
Q

Pt with PNH dies, what is the likely cause?

A

thrombosis

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43
Q

how do you treat autoimmune hemolysis?

A

Steroids, IVIG to make the macrophages eat the IG instead of the IG on the RBC

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44
Q

what are CD34 cells

A

hematopoeitic stem cells

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45
Q

Eosinophilia is seen in waht malignancy

A

Hodgkins

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46
Q

lymphocytosis is seen in what bacteria infection

A

bordetella

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47
Q

alkylating chemotherapy is associated with what blood cancer?

A

myelodysplastic syndrome; AML

48
Q

carribean patient with rash and lytic bone lesions

A

adult T cell lymphoma

49
Q

suprachiasmatic nuclei

A

circadian rhythm

50
Q

anterior nucleus of hypothalamus lesion

A

hyperthermia

51
Q

Spongiosis of epidermis is seen in what?

A

eczema

52
Q

what do you seen for skin biopsy for urticaria

A

dermal edema. no epidermal changes

53
Q

urge incontinence in MS. where is the lesion?

A

frontal lobe thus decreasing in CNS inhibition of micturition center.

54
Q

Where does micturitiion urge come from?

A

S2-S4. spinal micturition center

55
Q

Fatigue, proximal weakness, myoedema with percussion to muscle, elevated CK

A

Hypothyroidism

56
Q

why does an infection of the biliary system lead to brown stones?

A

bacteria injure hepatocytes…releasing beta glucuronidase…thus hydrolyzing conjugated bilirubin and precipitating stones

57
Q

nasal ulcer, oliguria

A

Wengener CANCA

58
Q

ether can destroy what kind of viruses?

A

enveloped

59
Q

N acetylmuranic acid and N acetylglucosylamine are components of what?

A

peptidoglycan precursor

60
Q

D-ala-D-ala is a structural component of waht

A

pepetidoglycan precursors that is bound by transpeptidases… Penicillins are analogs of these

61
Q

why does Hep C have such large antigenic variation to its envelope?

A

Because it doesn’t have 3’-5’ exonuclease proof reading to the Viral coded RNA pol

62
Q

Why do you see cataracts in galactokinase deficiency?

A

galactokinase deficiency prevents galactose conversion to galactose 1 phosphate… thus it will be acted upon by aldoase reductase and transformed to galacitol and build up in the lens

63
Q

what kind of receptors are GABAa, b, and c?

A

A and C are chloride channels

GabaB is a Gi protein

64
Q

What is GABA synthesized from?

A

Glutamate

65
Q

What vitamin is needed in synthesis and catabolism of GABA?

A

B6

66
Q

What is the cause of stress incontinence?

A

weakened sphincter or pelvic floor

67
Q

how is resistance against penicillins achieved

A

mutation of PBP or penicillinase

68
Q

How is resistance against Aminoglycosides achieved?

A

acetylation or other modification of the abx

69
Q

How is resistance against tetracyclnes achieved?

A

changing the ribosomal structure or efflux pump

70
Q

How is resistance against floroquinolones achieved

A

changing gyrase structure

71
Q

decreased FEV1/FVC

A

obstructive

72
Q

increased FEV1/FVC

A

restrictive

73
Q

the time period between starting to take vitamin E to seeing the clinical benefits of vitamin E is called?

A

latency period.

This can also apply to pathogens

74
Q

What is the rare disease assumption?

A

when i disease is rare… OR approximates RR

75
Q

schiling test with elevated urine cobalamine indicates what’s the issue?

A

decreased dietary intake of cobalamine… since clearly Intrinsic factor is there and the ileum is intact to intake it

76
Q

bradycardia post MI in leads II, III, AVF. what vessel is occluded?

A

RCA

77
Q

which is worse. arnold chiari I or II

A

II… this one both vermis and medulla are in the foramen magnum and there will be meningomyelocele

78
Q

What’s the vitamin most likely needing parenteral replacement?

A

B12, since people who are deficient are usually deficient due to atrophic gastritis… (unless they’re strict vegetarians)

79
Q

what makes green sputum?

A

neutrophil Myeloperoxide (contains heme)

80
Q

eye lesion in HIV pt. What’s the CD4 count?

A

less than 50. this is CMV

81
Q

Squamous cell carcinoma of the bladder…what’s the cause?

A

Schistomiasis hematobium

82
Q

what’s ethambutol’s mechanism? side effect?

A

Mechanism: inhibition of D arabinose crosslinking thus inhibiting the cell wall. Side effect: Green/red color blindness

83
Q

why is warfarin used for prophylaxis post mechanical valves and not heparin?

A

because heparin is ONLY IV

84
Q

which cytokine is responsible for cachexia seen in cancer?

A

TNFa

85
Q

glycogen phosphorylase is activated by what?

A

epinephrine and glucagon… leading to increased Calcium and PKA…thus phosphorylating glycogen phosphorylase kinase

86
Q

what do you use to treat WPW?

A

procainamide, amiodarone

87
Q

how many seconds are in a small box of ECG

A

0.04s

88
Q

how many seconds are in a large box on ECG

A

0.2s

89
Q

Afib treatments. How to rhythm control; how to rate control? what to do if the arrythemia is more than 48 hours?

A

if less than 48 hours: rate control with digoxin, beta blocker, calcium channel blocker
rhythm control with sotalol and amiodarone

If it’s more than 48 hours you must start on heparin and warfarin

90
Q

what is first degree AV block?

A

PR interval will be more than .2s

91
Q

what heart abnl can lyme disease cause?

A

first and third degree heartblock

92
Q

what is second degree AV block

A

mobitz I=wenckebach: longer longer drop

mobitz II=random drop

93
Q

what is third degree AV block?

A

no correlation between atrial and ventricular beats

94
Q

which way is R axis deviation toward? and which side is L axis deviation towards?

A

L is toward AVL

R is toward III

95
Q

how to calclulate HR?

A

1500/small boxes

estimate by 300-150-100-75-60-50

96
Q

what are the key features of afib on EKG?

A

no p waves; irregularly irregular QRS

97
Q

torsade with deafness?dx

A

Jervall and lange neisen

98
Q

breast lesion with abundant lymphocytic infiltrate

A

medullary carcinoma (invasive)

99
Q

what is comedonecarcinoma?

A

subset of DCIS characterized by central necrosis and no invasion

100
Q

most common cause of death due to MI?

A

V fib within hours of the initial event

101
Q

distended macrophage in lamina propria of small bowel would indicate what disease?

A

whipple

102
Q

secreting tumor of the appendix…what should you think of?

A

carcinoid syndrome or another neuroendocrine tumor.

103
Q

uniform rosette like glandular cells in the appendix with eosinophilic cytoplasm

A

neuroendocrine cells/carcinoid tumor

104
Q

slightly larger RBC with blue hue.. what is it and why is it blue?

A

reticulocyte; mRNA remnant.

105
Q

strawberry hemangioma; what’s the growth pattern

A

at first grows with the child… then will regress within a couple of years

106
Q

patient with bleeding demonstrates prolonged bleeding time and PTT. what is the dx?

A

vonwillebrand; autosomal dominant

107
Q

prolonged TT, PT, PTT. bleeding time is normal

A

dysfibrinogenemia

108
Q

delayed bleeding; normal PT and PTT

A

factor XIII deficiency… factors in cascade are not missing but can’t crosslink fibrin

109
Q

what’ the effect of polycythemia vera on EPO?

A

EPO is decreased by feedback

110
Q

what are key sx of churg strauss?

A

asthma, wrist/footdrop, heart, GI, kidney problems

111
Q

what do you see on histo with churg strauss?

A

necrotizing granulomas; eosinophilia. high IgE

112
Q

Name the small vessel vasculities?

A

Wengener’s, micrscopic polyangiitis, churg strauss, henoch scholein

113
Q

palpable purpura …what do you think of?

A

vasculitis

114
Q

which of the small vessel vasculities have granulomatous necrosis?

A

Wengener; churgstrauss

115
Q

treatment for small vessel vasculities?

A

cyclophosphomide/corticosteroids

116
Q

polyarteritis nodosa is associated with what infection seromarker?

A

hepB positive in 30%

117
Q

what organs does polyarteritis nodosa effect and what organ does it not effect?

A

it affects skin, kidneys, brain, GI, heart

SPARES LUNGS

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