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Qmax Flashcards

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USMLE® Step 1 flashcards
1
Q

Paroxysmal nocturnal hemoglobinuria (PNH)

A

Complement mediated RBC lysis, Impaired synthesis of GPI anchors.

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2
Q

Clinical presentation of Paroxysmal nocturnal hemoglobinuria (PNH)

A

Pts report red or pink urine in the mornings that clears out. associated with >incidence of acute leukemias

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3
Q

Dx of PNH

A

flow cytometry = - CD55/59. – Coombs test

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4
Q

AD hyper IgE, Job syndrome:

A

eficiency of Th17 cells due to a STA3 mutation decreased IL-17, there for neutrophils cant response to chemotactic stimuli.

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5
Q

Clinical presentation of Job Sx

A

frequent staph abscess (cold ), coarse facies, retained primary teeth, activation of IgE eczema

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6
Q

Labs of AD hyper IgE sx

A

> IgE, >INFg,

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7
Q

Bacterial genetics

A

Transformation, transduction, conjugation, transposition

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8
Q

Henoch-Schönlein purpura

A

small vessel vasculitis is more common in boys, self limited type 3 HSR, due to circulating IgA antigen immune complexes.

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9
Q

Triad of Henoch Schonlein purpura

A

Skin: purpura on butlocks and legs.
Arthralgias fever
GI: abd pain, hematuria

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10
Q

Dx of Henoch Schonlein purpura

A

biopsied, the glomeruli would show large deposits of IgA in the mesangium in LM.

serum complement levels are normal.

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11
Q

IgA nephropathy (also called Berger disease).

A

most common cause of primary glomerulonephritis. Nonlinear mesangial deposits of IgA
Clinically: nephritic sx
Hematuria, commonly occurs with or just after an infection (Resp ( within 2–3 days after), gastrointestinal or pharyngitis)

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12
Q

Langerhans cell histiocytosis (LCH).

A

Proliferative disorders of dendritic cells ( langerhans), cells are functionally immature and do not stimulate primary T cells

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13
Q

Langerhans cell histiocytosis (LCH). presentation

A

child with lytic bone lesions, skin rash, recurrent otitis media w/ mass involving mastoid bone

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14
Q

dx of Langerhans cell histiocytosis (LCH).

A

EM : biopsy revealing a Birbeck (“tennis racket”) granule .
biopsy shows proliferation of histiocytes - cells with grainy, eosinophilic cytoplasm, and distinct cell margins
S-100, CD1a

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15
Q

Bupivacaine mechanism of action:

A

Local anesthetic that blocks voltage-gated sodium channels and prevents depolarization
commonly used in delivery .

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16
Q

side effects bupivacaine

A

severe cardiotoxicity; Mobitz type II heart block (IV)

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17
Q

Passive immunization

A

Preformed antibodies, short time, ej: breast milk, maternal IgG placenta.

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18
Q

Passive immunization; conditions:

A

Tetanus, botulism, Hept B, Varicella, Rabies, Diphtheria toxin and Sincitial virus (palivizumab).

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19
Q

Lithium mechanism, used in?

A

related to inhibition of phosphoinositol cascade . mood stabilizer for bipolar disorder.

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20
Q

side effects of Lithium

A

tremor, goitrogen, nephrogenic diabetes insipidus, Ebstein anomaly, narrow therapeutic index

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21
Q

Menopause hormone levels

A

high FSH and LH levels and low estrogen level.

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22
Q

asthma drugs:

A
  1. Beta 2 agonist; SABA (albuterol) , LABA (Salmeterol, formoterol.) 2. Inhaled corticosteroids ( 1st line for chronic asthma, Fluticasone, Budesonide) 3. Muscarinic Antagonist: (tiotropium , Ipratropioum) 4. antileukotrienes: (montelukast..) 5. Anti IgE (allergic asthma omalizumab) 6. Methylxanthines ( theophyline, IV for status asthmaticus)
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23
Q

Gq protein class

A

H1 a1 V1 M1 , M3 ¨HAVe 1 M&M¨

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24
Q

Stimulation of Gq receptor results in :

A

Activation of Phospholipase C, resulting in hydrolysis of PIP2 (phosphatidylinositol bisphosphate) into DAG(diacylglycerol) > activates; Protein Kinase C: cellular response. and IP3 (Inositol trisphosphate) > ER > release of Ca++ > muscle contraction.

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25
Q

Gi protein class

A

M2 a2 D2 ¨MAD 2s¨¨

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26
Q

Stimulation of Gi receptor results in :

A

Stimulation of the Gi receptor results in inactivation of adenylyl cyclase > no events intracelular.

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27
Q

Gs protein class

A

the rest; B1 B2 B3 D1 H2 V2.

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28
Q

Stimulation of Gs receptor results in :

A

Stimulation of the Gs receptor results in activation of adenylyl cyclase > rise in cAMP > activation of protein kinase A: phosphorylation of myosin light-chain kinase : inability to bind calcium-calmodulin complex in smooth muscle cells, causing relaxation.

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29
Q

Procarbazine interactions

A

alkylating agent used in cancer; inhibits MAO ( seen in normally in the gut degrates tyramine containing foods): excess tyramine release large amounts of catecholamines.
part of Disulfiram like reaction.

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30
Q

organisms responsible for postinfluenza bacterial pneumonia

A

Streptococcus pneumoniae, Staphylococcus aureus (including MRSA), Streptococcus pyogenes, and Haemophilus influenzae.

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31
Q

Octreotide

A

somatostatin analog. By decreasing pancreatic fluid secretion, also inhibits growth hormone secretion and suppresses release of gastrin, cholecystokinin, secretin, and vasoactive intestinal peptide.

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32
Q

F foreign body aspiration:

A

the right mainstem bronchus. left main bronchus > trachea > right lower bronchus > left lower bronchus > bilateral.

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33
Q

Medulloblastomas

A

most common childhood tumors found in the cerebellar midline, appear histologically as small blue cells arranged in Homer-Wright rosettes. ( high nucleus-to-cytoplasm ratio and typically surround a neuropil.)

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34
Q

Small cell carcinoma

A

central location, very aggressive, associated with various paraneoplastic syndromes, amplification of the myc oncogene is common. MALE SMOKERS

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35
Q

SCC is associated with various paraneoplastic syndromes including:

A
  • Cushing sx: excess ACTH secretion.
  • SIADH (Lambert Eaton Myasthenic ab against presynaptic Ca++)
  • myelitis, encephalitis, or subacute cerebellar degeneration—all due to antibodies formed against neurons.
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36
Q

Delirium

A

Disorganized thinking, hallucinations illusions, cognitive dysfunctions, usually 2° to illness, infections, trauma, substance abuse. URINARY! and fecal retention!
REVERSIBLE.

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37
Q

Where is most common to see delirium

A

often seen in elderly patients with prolonged hospitalizations. “waxing and waning”.

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38
Q

tx of Delirium

A

addressing the underlying condition.
Treatment for acute delirium in patients who pose a danger to others or themselves includes a low-dose antipsychotic (ie, haloperidol) or benzodiazepines (not en elderly).

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39
Q

Digoxin mechanism and use:

A

blocks de Na/K ATPase, > indirect inhibition of Na/Ca exchanger > Rise in Ca + inotropy.
Use in HF, atrial fibrillation.

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40
Q

Digoxin side effects and antidote:

A

HYPERkalemia (poor prognosis), Cholinergic effects: diarrhea, nausea, vomiting, BLURRY YELLOWISH vision.
Antidote: normalize K, Mg Atropine, Anti digoxin fab

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41
Q

Amantadine

A

Increases dopamine availability , Use in Parkinson’s. Causes : ataxia livedo reticularis ( blotchy, reddish-blue rash). associated with anticholinergic effects.

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42
Q

Granulosa cell tumor

A

most common malignant tumor stromal, hyperestrogenism.( mostly in women over 50yo).
postmenopausal bleeding,
juvenile form <8yo sexual precocity.
histologically: Call-Exner bodies, “rosette”

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43
Q

Alport syndrome

A

x linked dominant mutation in collagen IV (basement membrane)
¨Can’t see, pee, hear¨
same type of collagen of goodpasture.

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44
Q

Phenylalaline, Arginine. Histidine, Glycine and Tryptophan are precursors of:

A 
Pheny : Tyrosine
Arginine: Creatine BUN ang growth.
Histidine: histamine
Glycine: porphyrin heme synthesis. 
Tryptophan: melatonin, serotonin.
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45
Q

chancroid.

A

painful penile ulcer and inguinal lymphadenopathy with purulent discharge.
Chancroid is a sexually transmitted disease caused by Haemophilus ducreyi, which is a gram-negative coccobacillus
tx. zithromycin, ceftriaxone, and ciprofloxacin.

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46
Q

Peroxisomes

A

contain enzymes involved in very-long-chain fatty acid metabolism. Refsum disease is a peroxisomal disorder that affects myelin sheath formation, leading to various neurologic deficits and thick, scaly skin.

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47
Q

Normal pressure hydrocephalus (NPH) presentation?

A

classic triad of urinary incontinence, gait difficulty, and mental decline (“wet, wobbly, and wacky”)

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48
Q

ECG finding in diabetic ketoacidosis (DKA)

A

Initially hyperkalemia ( peaked T-waves and long QRS complex). Once Insulin is administered ECGs show (low voltage T waves and prominent U waves > hypokalemia, glucose is driven inside the cell, > rise in Na/K/ATPase activity> K moves inside the cell.

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49
Q

Oxygen hemoglobin curve shift to the right:

A

low affinity of Hb for O2 (easy to give out tissues): Excercise,
increased: Temp, adult hemoglobin , CO2, 2,3bisphosphoglycerate, decreased: pH.

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50
Q

Meningitis in 6 months- 6 years old

A

S. pneumo
N. meningitidis
H, influenzae type B
Enteroviruses

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51
Q

Cowdry A inclusion bodies

A

herpes zoster skin rashes( eosinophilic inclusions surrounded by clear halo.

52
Q

hypoventilation

A

respiratory acidosis, f low pH, high PaCO2, and high bicarbonate

Other causes of respiratory acidosis include airway obstruction, lung disease, and opioids.

53
Q

X-rays findings in RA

A

shows erosions and narrowing of the joint spaces, as well as ulnar deviation of the fingers at the metacarpophalangeal joints

54
Q

Celecoxib

A

Reversibly and selectively inhibits COX2,

RA, Osteoarthritis, Helps maintain gastric mucosa ( not corrosive effects like other NSAIDS)

55
Q

cytoskeletal element involved in primary infection with HSV 1

A

virus utilizes dynein-dependent retrograde transport to travel from the axon to the cell body and integrate into the host DNA. Thus, the virus can remain latent

56
Q

cytoskeletal element involved in reactivation of infection with HSV 1

A

mediated by kinesin-dependent anterograde transport.

57
Q

Avascular necrosis

A

most common site is the femoral head (circumflex femoral art) due to: Corticosteroids, alcoholism, sickle cells. trauma, gaucher disease

58
Q

Corticosteroids mechanism, side effects

A

inhibits NF-kB, suppress both B and T Cell functions ( decreased transcription of many cytokines.
avascular necrosis, abdominal striae and increased girth, suppression of the hypothalamic-pituitary-adrenal axis, hyperglycemia, osteoporosis, moon facies, buffalo hump, immunosuppression, and impaired wound healing.

59
Q

spinal muscular atrophy (SMA)

A

an autosomal recessive mutation in the SMN1 gene, destruction of the anterior horn cells of the spinal cord, LMN ONLY : ¨floppy baby¨, symmetric weakness.

60
Q

“Monday disease”

A

Industrial exposure of Nitrates: headaches, dizziness, and palpitations, specifically every Monday: development of tolerance for the vasodilating action of nitrates during the work week and loss of tolerance over the weekend.
nonatherosclerotic-related cardiac ischemia. biggest risk

61
Q

Down sx GI problems

A
  • duodenal atresia
  • hirschsprung disease
  • annular pancreas
  • celiac disease
62
Q

Peutz Jeghers sx

A

ADs, Numerous hamartomas throughout the GI tract + hyperpigmented lips, hands and genitalia.

high risk of colorectal ca, small intestine, stomach ca, pancreatic ca, breast ca , ovarian .. 50% of patients will develop a ca ~50yo

63
Q

Chromosomal instability pathway of Colorectal CA

A
  1. Loss of APC gene (80% of sporadic cases)
  2. KRAS mutation (overgrowth) ADENOMA
  3. Loss of tumor suppressors p53, DCC
    CARCINOMA
64
Q

Microsatellite instability pathway

A

HNPCC (Lynch sx), CA of the proximal colon

mutations or methylation mismatch repair genes

65
Q

Dubin johnson

A

AR, cannot excrete conjugated bilirubin into bile. liver turns black, elevated direct bilirubin

66
Q

Allantois>Urachus postnatal derivative:

A

Urachus ( duct between fetal bladder and the umbilicus)

Median umbilical ligament

67
Q

Total / partial failure of the urachus to obliterate:

A

Patent Urachu:s pee from umbilicus. Urachal cyst: risk for adenoca of the bladder

68
Q

Sulfonylureas mechanism and se?

A

1st: chlorpropamide, tolbutamide 2nd: glipizide, glyburide.
insulin secretagogues by blocking k+ channels in beta cells.

(1st) disulfiram-reaction, (1,2) weight gain, (2st) hypoglycemia.

69
Q

Aortic arches

1st, 2nd, 3rd, 4th, 6th.

A

1st: maxillary
2nd: stapedial, hyoid
3rd: common carotid, proximal carotid art
4th: left aortic arch, right: subclavian
6th: pulmonary art, ductus arteriosus.

70
Q

Bruton X linked agammaglobulinemia

A

Xlinked recessive, Defect BTK a tyrosine kinase gene > no B Cell maturation.
Recurrent bact. and enteroviral infection ~6months, absent/scanty tonsils or lymph nodes
NO LIVE VACCINES

Dx; low IgG, IgM IgA

71
Q

Scleroderma (systemic sclerosis)

A

connective tissue disorder common in African-American women.
Collagen deposition with fibrosis. Renal and Pulmonary (most common cause of the death).

72
Q

Types of scleroderma

A

Diffuse Scleroderma: widespread, rapid progression, early visceral involvement (anti-Scl 70 antbd, antiDNA topoisomerase 1 antbd.)
Limited Scleroderma: limited skin involvement (fingers and face) part of CREST
Calcinosis, anti Centromere, Raynaud P., LES dysmotility, Sclerodactyly, Telangiectasia.

73
Q

Essential Tremor

A

high frequency postural tremor, bilaterally symmetric upper extremities LE, head, and voice, FAMILIAL,

improved/relieved with ALCOHOL.
worsened with movement, anxious.

74
Q

Cerebellar tremor

A

Intention tremor, ipsilateral to cerebellar lesion, abnormal finger to nose or heel shin test

75
Q

Parkinsonian Tremor

A

Resting Tremor Asymmetric, decreases with movement, postural instability

76
Q

Psychogenic tremor

A

abrupt onset, spontaneous remission usually due to stressful event mental disease.

77
Q

Pleiotropy

A

mutation of a single gene produces multiple phenotypic effects due to affecting multiple organ systems. Therefore, a patient will present with multiple traits associated with one disorder.

78
Q

anticholinergic toxicity

A

Flushing, dilated pupils, altered mental status, fever, decreased saliva and tear, constipation, urinary retention

tx physostigmine

79
Q

Neutrophils fail to respond to chemotactic stumuli

A 
Job sx (hyper igE)
Leukocyte adhesion deficiency sx
80
Q

Adenosine Deaminase deficiency

A

SCID (severe combined immunodeficiency)

81
Q

failure of endodermal development

A

DiGeorge sx

82
Q

Defective tyrosine kinase gene

A

Bruton agammaglobulinemia

83
Q

Zileuton mechanism and use

A

a 5-lipoxygenase pathway inhibitor that blocks; arachidonic acid > to leukotrienes.
use in : chronic asthma >12yo . hepatotoxic.

84
Q

others antileukotrienes

A

Montelukast and Zafirlukast ( block leukotrienes receptor CysLTI)

85
Q

Carcinoid Sx

A

Chronic diarrhea, intermittent facial flushing, asthmatic wheezing, and right sided valvular heart disease ( tricuspid regur/pulmonic ste). due to a carcinoid tumor.
increased 5-hydroxyindoleacetic acid (5-HIAA)

86
Q

Carcinoid tumor

A

most common malignancy of the small intestine ( ileocecal junction) secrete serotonin (5-HT) which is metabolized by the liver (first pass) and does not cause symptoms. however if metastasize to the liver it become symptomatic ( no longer metabolize)

87
Q

contractions of the gastrointestinal tract.

A

Is determined by the frequency of slow waves. they are rhythmic depolarization and repolarization of the smooth muscles cells within the muscularis propria. PARA UP SYMP DOWN

88
Q

Meckel Diverticulum

A

true diverticulum derived from the vitelline duct, most common congenital anomaly of the GI tract (first 2 years of life), 2 epithelia (gastric/pancreatic) can cause hematochezia/melena RLQ pain.
dx: technetium-99m pertechnetate scan detects ectopic gastric tissue.

89
Q

Criteria for dx of RA

A 
88% (+):
rheumatoid factor (immunoglobulin M antibody against the Fc portion of immunoglobulin G), levels of anti-cyclic citrullinated peptide.

Number and size of involved joints (preferably small joints)

Elevated erythrocyte sedimentation rate or C-reactive peptide

Duration of symptoms for 6 weeks or longer

90
Q

Exemestane

A

steroidal aromatase inhibitor (AI) for postmenopausal women with hormone-receptor-positive breast cancer. ( ER-positive, PR-positive and HER2-negative ). prevents conversion of testosterone to estradiol and androstenedione to estrone.

91
Q

Fibrates mechanism

A 
Gemfibrozil, bezafibrate, fenofibrate  
Upregulate LPL (lipoprotein lipase ) by activation of the PPAR-alfa-protein >> HDL synthesis and TG clearance.
92
Q

Side effects of fibrates

A

myopathy (+ statins more risk) cholesterol gallstones

93
Q

autoimmune gastritis

A

associated with other autoimmune disorders, such as Hashimoto thyroiditis, can lead to pernicious anemia, due to antibodies that interfere with parietal cell secretion of intrinsic factor..

94
Q

Differential diagnosis of a genital ulcer

A

primary syphilis, genital herpes, lymphogranuloma venereum, and chancroid.

95
Q

Genital Herpes

A

characterized by small, vesicular lesions on the external genitalia. may start with itching/burning and followed by moderate pain but are not typically associated with fever.

96
Q

Syphilis and lymphogranuloma venereum

A

both present with ulcers, but they are usually painless.

97
Q

chancroid.

A

painful ulcer, fever and bilateral swollen lymph nodes. IM ceftriaxone

98
Q

most likely causative organism of viral encephalitis in a patient with AIDS

A

HSV, It typically affects the temporal lobe, causes bloody CSF on lumbar puncture, and is treated with acyclovir.

99
Q

Pathogenesis of atherosclerosis

A

Endothelial cell dysfunction > LDL oxidation and macrophages accumulation > foam cell formation > Factor release ( activation of platelets, cytokines, inflammatory mediators ) > smooth muscle cell proliferation PDGF/ FGF( elastin and collagen)> extracellular matrix deposition > fibrous plaque ATHEROMA

100
Q

Coronary artery occlusion most commonly occur

A

1.left anterior descending (arterial intraventricular branch) > anterior wall MI, 2. right coronary artery 3. circumflex.

101
Q

5 deadly causes of chest pain

A 
aortic dissection
unstable angina
MI
PE
Tension pneumothorax
102
Q

Central diabetes insipidus (DI).

A

Low ADH and responsive to vasopressin; problem with production of ADH at level of neurohypophysis

103
Q

Nephrogenic diabetes insipidus (DI).

A

High ADH and no response to vasopressin; problem with receptors within kidney responding to circulating ADH

104
Q

Nitroprusside MA and toxicity

A 
increases cGMP > release of NO. 
Cyanide toxicity (confusion, seizures, vomiting, arrhythmias, cherry-red–colored lips and mucous membranes, and later the development of cyanosis. ) by inhibition mitochondrial cytochrome C oxidase in the electron transport chain
105
Q

antidote for Cyanide toxicity

A

sodium thiosulfate or hydroxocobalamin

106
Q

Vitamin B12 deficiency

A

megaloblastic anemia, angular cheilitis, glossitis, and both motor and sensory symptoms such as paresthesias.

Pernicious anemia is the most common cause

107
Q

Oligodendrogliomas

A

tumor of oligodendrocytes, usually frontal lobe. slow growing and often calcified. fried egg appearance.

108
Q

side effects of PPI

A

decreased on somatostatin levels > gastrin levels to rise:atrophic gastritis , , B12 deficiency, weakened bones ( Mg, Ca low absorption), and increased risk of C. difficile infection and pneumonia.

109
Q

Levodopa side effects

A

hallucinations nausea postural hypotension,on and off phenomenon, rarely autoimmune hemolytic anemia.

110
Q

positive acute-phase proteins

A

IL 6, IL-1, IL-8, and TNF-α.

111
Q

Organisms that are urease positive

A

(S, saprophyticus, Proteus or Klebsiella) increase urinary pH and promote the formation of ammonium magnesium phosphate stones. STRUVITE

112
Q

Celiac Sprue

A

autoimmune disorder with intolerance to gluten.
foul smelling diarrhea, weight loss, abd pain, associated with dermatitis herpetiformis.
HLA DQ2 HLA DQ8
findings: IgA, anti- transglutaminase, endomysial, gliadin peptide antibobies

113
Q

Sarcoidosis

A

immune-mediated, widespread non caseating granulomas. elevated ACE, CD4/CD8 ratio in bronchoalveolar lavage. most common in AfricanA.

114
Q

Sarcoidosis x ray findings and tx

A

typically demonstrates bilateral hilar lymphadenopathy and interstitial infiltrates.
steroids if symptomatic

115
Q

5α-Reductase

A

converts testosterone to DHT, male sexual development.
Congenital 5α-reductase deficiency results in male internal genitalia (including testes) but ambiguous or female-appearing external genitalia.

116
Q

von Willebrand disease

A

AD most common inherited bleeding disorder. is a platelet adhesion defects ( lack of vWF Acts as a ligand in platelet adhesion).

117
Q

clinically vWD

A

Patients typically present with easy bruisability and prolonged mucosal bleeding; bleeding time is elevated and the PTT may be normal or increased.

118
Q

thiazides mechanism

A

inhibiting sodium chloride reabsorption in the distal convoluted tubule of the nephron.
result is mild volume depletion, increased proximal sodium reabsorption, and increased reabsorption of calcium.

119
Q

1st line pharm tx for Tourettes:

A

are typical and atypical antipsychotic agents such as haloperidol and risperidone, respectively.

120
Q

Vitamins A, D, E, and K are absorbed in the small intestine by

A

micelles formed with bile salts.

121
Q

herpes zoster, otherwise known as shingles

A

infects sensory nerves and can remain latent for years in the dorsal root ganglion or trigeminal ganglia.

122
Q

chemotherapy regimen for Hodgkin lymphoma

A

MOPP regimen: Mechlorethamine, Oncovin (vincristine), Procarbazine, and Prednisone. This regimen proved capable of curing more than 70% of patients

123
Q

first-line combination chemotherapy regimen for Hodgkin lymphoma in the United States

A

ABVD regimen: Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. MOPP is still used, however, for patients who relapse or have allergies that prevent them from taking the ABVD regimen.

124
Q

WAGR syndrome

A

combination of Wilms tumor, aniridia, genitourinary anomalies, and mental retardation (intellectual disability).

125
Q

niacin.

A

is associated with flushing and significantly elevated HDL levels.

reduced hepatic triglyceride and VLDL synthesis

USMLE Rx (1 decks)

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