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USMLE > Rapid Facts from Q banks 3 > Flashcards

Rapid Facts from Q banks 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

highly eosinophilic glomerulus is indicative of what?

A

Drug induced glomerulonephritis

-NSAIDS, diuretics, betalactams

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2
Q

what does post strep glomerulonephritis look like on light microscopy?

A

hypercellular

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3
Q

fetal alcohol syndrome–>cardiac defect?

A

VSD

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4
Q

Primary sclerosing cholangitis is most likely to happen in M or F? what other disease is it associated with?

A

Men, ulcerative colitis

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5
Q

Athelete with amenorrhea secondary to low body weight… What is a serious complication that can result…and why you might want to treat them with pulsatile GnRH?

A

osteoporosis

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6
Q

high fever, confusion, pneumonia, diarrhea, hyponatremia

A

legionaires disease

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7
Q

Why is Legionella hard to stain?

A

it doesn’t stain well and because it’s facultative intracellular

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8
Q

Why do you see hyponatremia with legionellaires disease?

A

It’s because it can cause SIADH and it also affects renal sodium reabsorption

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9
Q

macrophages recruit cells to form granulomas via what cytokine?

A

TNFalpha

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10
Q

describe stimulus control method of treating insomnia?

A

bed=sleep. Don’t do anything in bed if you’re not sleeping or sexing.

If you can’t sleep, get out of bed

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11
Q

What is sleep hygiene method of treating insomnia?

A

sleep hygiene=forming good patterned behavior.
no caffeine, alcohol, large meals, exercise before bed.
regular sleep schedule…etc

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12
Q

what are the positive sx of schizophrenia. How long must sx be present before dx?

A

6 months+ =schizophrenia.

positive sx: hallucinations, delusions, disorganized speech.

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13
Q

two classic symptoms of carpal tunnel?

A

thenar atrophy; loss of sensation to the median distribution

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14
Q

vaginal bleeding, lung metastases, high hCG. what is this?

A

choriocarcinoma

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15
Q

vaginal bleeding, cough/lung masses, high hCG. what is this?

A

choriocarcinoma

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16
Q

complete mole karyotype

partial mole karyotype?

A

complete=46XX or 46 XY (all from paternal)

partial=69XXX, or 69 XXY

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17
Q

ADH binds V1 and V2 receptors. what are their actions?

A

V1=vasoconstriction and prostaglandin release

V2=antiduretic

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18
Q

ADH inserts aquapoins and what else?

A

passive urea transporters

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19
Q

with massive packed RBC transfusions…what might the patient experience and why?

A

hypocalcemia due to calcium chelating citrate

hyperkalemia because of the leaked potassium from stored RBC

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20
Q

C1 inhibitor deficiency… what should you not give the pt (drug wise?)

A

ACE I..high risk of angioedema

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21
Q

Why is C1 inhibitor deficiency associated with angioedema?

A

C1 inhibitor inhibits C1 as well as Kallikrein which converts Kininogen to Bradykinin

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22
Q

chronic nose bleeds, heavy menstrual cycles…etc ddx?

A

this is a platelet aggregation defect if it’s mucocutaneous.

ddx: vWBF def, Bernard-Soulier, Glanzman

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23
Q

vWBf prolongs what?

A

VIII

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24
Q

vWBf prolongs what?

A

VIII as it is attached to it as a carrier protein

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25
Q

cardiac tamponade triad?

A

muffled/distant heart sound, hypotension, Jugular venous distension

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26
Q

If a tRNA is charged with a wrong amino acid what happens?

A

The AA-tRNA synthase is very accurate and usually fixes things very quickly. However. if this is not done…then the wrong AA will be incorporated

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27
Q

DNA glycolase…what is this?

A

base excision repair mechanism

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28
Q

Whaat is Kozac sequence?

A

GccRgcc that is right before AUG…serves as transcription initiator

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29
Q

beta thalassemia…what’s the deletion?

A

Kozac sequence that is flanking the AUG start codon of the beta chain…Thus no beta chain is synthesized

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30
Q

beta thalassemia…what’s the deletion?

A

Kozac sequence that is flanking the AUG start codon of the beta chain…Thus no beta chain is expressed

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31
Q

in hemolysis…do you think the haptoglobin will be high or low?

A

Low! because it’s all taken up and gotten rid of by the spleen

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32
Q

carbon tetrachloride. what kind of toxicty? how is it mediated?

A

hepatotoxicity. mediated by ROS–>lipid peroxidation and mitochondrial damage

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33
Q

Whipple’s disease; what do you see microscopically?

A

magenta staining on PAS

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34
Q

Psoas muscle where is it what does it do?

A

Origin is in the Lspine/ribs and it inserts on the trochanter of the hips. It’s job is to flex the leg

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35
Q

Amphotericin B mechanism?

A

binds ergosterol

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36
Q

Terbinafine mechanism?

A

binds squalene epoxide which synthesizes ergosterol

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37
Q

Caspofungin is used for what? what does it inhibit?

A

It’s used for candida and aspergillus.

It inhibits beta 1,3 D glucan

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38
Q

Certolizumab. What is this?

A

anti TNF alpha without the Fc region of the receptor.

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39
Q

What is Auspitz sign?

A

When psoriatic plaques are removed…. the underlying skin may show peticheal rashes of neutrophilic clusters…Munro microabscesses

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40
Q

Pneumonitis Jirovecii is likely in HIV pts what what CD4 count?

A
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41
Q

Phospholipase A2 receptor IgG antibodies are associated with what renal disease?

A

membraneous nephropathy

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42
Q

mixed cryoglobulinemia is associated with what hepatic disease?

A

Hep C

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43
Q

Neonate with jaundice, severe anemia, and fetal hydrops, nucleated erythrocytes, high extramedullary hematopoeisis… waht is this potentially?

A

erythrocytosis fetalis

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44
Q

Thiosulfate citrate bile salt agar (TCBS)

A

good for vibrio (very acid labile)

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45
Q

the major factor leading to hepatocarcinoma in HBV is..?

A

integration in to genome.

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46
Q

the major factor leading to hepatocarcinoma in HBV is..?

A

DNA integration in to genome.

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47
Q

47, XXX clinical features?

A

Clinically silent, may have lower IQ

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48
Q

What does PAS stain? what if you see PAS in GI?

A

glycogen, Whipple disease

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49
Q

What does PAS stain? what if you see PAS in GI?

A

glycogen, Whipple disease (PAS the sugar and whipped cream)

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50
Q

What is Ziehl-Neelsen stain?

A

carbofuscin stain for mycolic acid.

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51
Q

Giemsa Stains what organisms?

A

chlamydia, borrealia, rickettsiae, trypanosome, plasmodium

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52
Q

mucicarmine stain. what org?

A

cryptococcus

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53
Q

What is hepcidin. where is it produced? what does it do?

A

Produced by hepatocytes… overall decreases iron in circulation. once bound transferrin are degraded, ferritin hold on to iron, and GI absorption is decreased

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54
Q

failure of fusion of maxillary promenince will cause what? not what?

A

cleft lip. NOT cleft palate

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55
Q

TSST Staph aureus causes toxic shock syndrome… What cells does this act through?

A

It crosslinks MHCII and TCR.

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56
Q

what’s the most specific test for rheumatoid arthritis?

A

anti-cyclic citrulinated protein

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57
Q

In metabolic acidosis…How might the kidneys try to compensate?

A

It will increase reabsoption of Bicarb, it will increase secretion of H+, and it will increase reabsorption of buffers (phosphate and ammonia)

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58
Q

What are the important acid buffers of the urinary system?

A

bicarb, Phosphate, ammonia

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59
Q

In which GI segment do you find peyer’s patches?

A

Ileum

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60
Q

Where are Brunner’s glands. what’s their purpose.

A

Duodenum. secret alkaline mucus to neutrolize stomach acid

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61
Q

what nerve passes through foramen ovale?

A

V3

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62
Q

What two things are in the optic canal?

A

optic nerve, ophthalmic artery

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63
Q

What passes through foramen lacerum?

A

internal carotid artery

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64
Q

What passes through the superior orbital fissure?

A

III, IV, V1, VI, and superior opthalmic vein

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65
Q

What nerve passes through the inferior orbital fissure?

A

V2

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66
Q

What kind of hemoglobin polymerizes in sickle cell disease?

A

deoxygenated. NOT

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67
Q

recurrent thrombophlembitis. WHAT DO YOU THINK OF?!

A

Trousseau’s syndrome. CANCER>esp visceral…like pancreatic cancer

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68
Q

Donovan Bodies

A

Intracytoplasmic cysts–>Klebsiella inguinale

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69
Q

painless inguinal sore. what could it be?

A

granuloma inguinales (klebsiella inguinale), treponema, chlamydia

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70
Q

If untreated klebsiella inguinale can block lymphatic drainage and cause what?

A

elephanitis.

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71
Q

Clinical course of chlamydia?

A

painless ulcers that progress to painful lymphadenopathy and ulceration

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72
Q

name the dimorphic yeasts

A

histo, blasto, cocci, paracocci, sprothrix

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73
Q

vomiting, lethargy, failure to thrive with galactose. what is this most likely?

A

galactose 1 UDP transferase deficiency. Most common.

classic galactosemia is less severe with cataracts

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74
Q

How does NADPH help protect RBCs?

A

they reduce glutathione… thus reducing ROS from erythrocytes

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75
Q

antibodies against PRP indicates possible infection with what organism?

A

Hemophilus influenza

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76
Q

malignant pustule is associated with what kind of infectionus organism?

A

bacillus anthracis

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77
Q

osteomyelitis in healthy children. what organism?

A

staph aureus

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78
Q

increased ACTH induces enlargement of adrenal glands. is this hypertrophy or hyperplasia

A

mainly hyperplasia

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79
Q

Baclofen mechanism?

A

induces GABAb channel. thus relaxing muscles

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80
Q

Succinycholine side effects?

A

over either PNS or SNS stimulation
malignant hyperthermia
hyerkalemia (because it just opens nAchR to both Na and K)

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81
Q

fx of femoral neck is most likely to injur which artery?

A

medial femoral circumflex artery

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82
Q

which artery has a branch that supplies the proximal part of the femoral head?

A

obturator

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83
Q

hydrochlorothiazide is first lin in essential HTN in what kind of patients?

A

general population and osteoporosis

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84
Q

How does thiozolidadinones work?

A

They activate intracellular PARRY receptors…and the complex activate genes such as adiponectin…in general thus increasing peripheral sensitivity to insulin

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85
Q

What is exenatide?

A

GLP analog

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86
Q

what does GLP do?

A

it is glucagon like polypeptide. it increases satiety, increases insulin secretion, and decreases gastric emptying

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87
Q

which three drugs have the most effect on lithium metabolism?

A

Thiazides, NSAIDS, and ACEI

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88
Q

enoxaparin mechanism

A

binds ATIII and increases binding to Xa thus less IIa is created.

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89
Q

anaplasia. what does it mean?

A

lack of differentiation

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90
Q

In a situation of renal hypoperfusion. Which cells are likely to hypertrophy?

A

JG cells of the AFFERENT renal artery, because that’s where the JG cells are located

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91
Q

which two GU related bacteria lack peptidoglycan?

A

Chlamydia, ureaplasma

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92
Q

LPS is associated with which gram stain bacterias?

A

negative

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93
Q

Teichoic acid is associated with which gram stain bacteria?

A

positive

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94
Q

which gram stain bacteria have betalactamase? where is it located?

A

negative. in the periplasmic space

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95
Q

COPD pt with MI. which beta blockers are good for this pt?

A

nonselectives…A through M.

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96
Q

oligoclonal band on electrophoresis is associated with what?

A

MS

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97
Q

acetyl coA increases gluconeogenesis by allosterically activating what enzyme?

A

pyruvate carboxylase

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98
Q

dental work related endocarditis…what org?

A

viridans

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99
Q

hoarsness can be caused by dilatation of which heart chamber most often?

A

L atrium

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100
Q

which drugs can cause night blindness?

A

phenothiazines, chlorquine

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101
Q

neuro sx and elevated liver enzymes… what do you think this might be? how to confirm?

A

Wilson’s diease. LOOK FOR kayser fleisher ring

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102
Q

why is anecephaly associated with polyhydraminios?

A

decreased fetal swallowing

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103
Q

name the 5 cyanotic congenital heart conditions

A 
Tetrology of Fallot
Transposition of the great vessels
Trucus arteriosus
Tricuspid atresia
Total anomalous pulmonary venous return
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104
Q

why does squattin make tetrology pts feel better?

A

increased systemic resistance allows increased pressurein aorta thus pushing more blood (via ductus arteriosus) to pulmonary circulation

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105
Q

what are the three potassium blocking antiarrhythmics?

A

Sotalol, Amiodarone, and Dofetalide

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106
Q

elastase in the lung is expressed by what cells?

A

macrophages, and neutrophils

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107
Q

middle mengingeal artery is a branch of what artery?

A

maxillary artery

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108
Q

swan cathe Pressure max=8; min=0

which compartment of the CV are you in?

A

R atrium

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109
Q

swan cath pressure max=25; min=4

which compartment of the CV are you in?

A

R ventricle

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110
Q

swan cath pressure max=25; min=8

which compartment of CV are you in

A

pulmonary artery

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111
Q

swan cath pressure max=130; min=9

which compartment of CV are you in?

A

L ventricle

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112
Q

swan cath pressure max=12; min=2 which compartment of CV are you in?

A

L atrium

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113
Q

pigmented gallstones and aplastic anemia due to Parvovirus B19 is commonly seen in patients with what heme disorder?

A

spherocytosis

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114
Q

what is the postptrandial alkaline tide?

A

It is the surge of plasma HCO3- post a meal and rise in Cl- due to increased acid secretion

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115
Q

high amount of what secreted components will decrease the likelihood of cholesterol crystal precipitation?

A

bile salts and phosphotidylcholine

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116
Q

cholesterol conversion to bile acids… then to bile salts by conjugation to what substances?

A

glycine and taurine

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117
Q

why is HbF left shifted?

A

It doesn’t bind as well to 2,3 DPG…because it has a serine instead of histadine in the 2,3DPG binding spot.

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118
Q

deamination of bases is carried out by which mechanism of repair? what are the steps

A 
base excision. 
Glycosylase removes base
endonuclease/lyase cuts
polymerase fills it in
ligase seals
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119
Q

name two substances that can kill spores. How do they kill?

A

hydrogen peroxide and iodine. ROS and halogenation

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120
Q

How does alcohol based disinfectants kill?

A

disruption of membranes

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121
Q

What is chlorhexidine? how does it work?

A

Disinfectant–> works by dirupting membranes and coagulation ofcytoplasm

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122
Q

Treatment for Strongyloides?

A

Ivermectin

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123
Q

Which form of Strongyloides is infective?

Which form is in the stool?

A

filariform is infective
rhabdoform is in the stool
parasite adults and eggs are seen generally seen only in biopsy

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124
Q

What is pinworm’s actual name?

A

enterobius vermicularis

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125
Q

Why might a patient experience fat/skin necrosis about 1 day after warfarin therapy?

A

protein C rapidly reduces (also factor VII)… thus there may be transient hypercoagulability

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126
Q

what is serum sickness/ what causes it?.. what are the symptoms?

A

type III hypersensitivity due to either using nonhuman serum or monoclonal antibody therapy (inflixamab)… sx include vasculitis, skin rash, fever, arthralgia post therapy. ALSO LOW SERUM complements!

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127
Q

What is unique about plasmodium vivax and ovale that is different from plasmodium falciprium? How do you treat those?

A

vivax and ovale have ability to establish chronic hepatic infection. Thus, you need more than just the regular treatment. first line=chloroquine, but for vivax/ovale you must add primaquine.

Primaquine does NOT work in intraerythrocyte forms.

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128
Q

fever every 48 hours… what is this?

A

plasmodium vivax/ovale

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129
Q

atropine overdose… what do you treat with? why?

A

physostigmine because it crosses BBB

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130
Q

Essential tremor first line treatment (2)

A

primidone and propranolol

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131
Q

What is primidone used for? what is one of it’s metabolites?

A

essential tremor; phenobarbital

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132
Q

what are the symptoms of Atypical depression? what kind of antidepressant that is not often used is used as adjunct therapy?

A

mood reactivity, hypersensitivity to criticism, increased sleep/appetite, very heavy arms/legs (laden fatigue)

-MAOI are sometiems used as adjunct

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133
Q

Warfarin use; esp in pt of advanced age, DM, alcoholism,HTN …falling due to buckling knees…what is the dx?

A

retroperitoneal hematoma; which would press on the posas major… and thus the femoral nerve.

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134
Q

The branches of what nerve comes out between iliacus and poas?

A

Femoral n

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135
Q

poly arteritis nodosa occurs in what sized. histo? vessels?

A

small to medium sized.

transmural inflammation/fibrinoid necrosis

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136
Q

polyarteritis nodosa sx?

A

fever, abd pain, peripheral neuropathy, fatigue, weightloss

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137
Q

What infection is associated polyarteritis nodosa?

A

Hep B

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138
Q

salt and pepper skull upon x-ray…what do you think of?

A

primary hyperparathyroidism

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139
Q

high calcium; low phosphate…what do you think of?

A

primary hyperparathyroidism

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140
Q

duodenal ulcer. what two things do you think of?

A

H. pylori; NSAID

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141
Q

TdT is a marker for what?

A

TdT is a marker for lymphoid origin cells

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142
Q

mature B cell leukemia (SLL/CLL) markers?

A

CD19 and CD5

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143
Q

lecithinase of C. perferingens…what is lecithinase also called?

A

phospholipase C OR alpha toxin

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144
Q

what happens to salts in nephrotic syndromes?

A

retention due to RAS system

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145
Q

nephrotic syndrome can lead to increased cholesterol/triglycerides, LDL/VLDL…etc why?

A

this is due to increased lipoprotein synthesis (due to protein loss) by liver, and LPL decrease.

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146
Q

what’s different between primary infection and reactivation of HSV1

A

gingivostomatitis is primary infection. it tends to be in young children and mostly in the mucosal membranes

Reactivation is mostly on the lips and face

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147
Q

what was the umbilical vein?

A

ligamentum teres

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148
Q

umbilical arteries originate from where?

A

internal iliac arteries

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149
Q

p value is the same thing as what?

A

alpha error

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150
Q

Is the Salk vaccine for poliomyelitis live attenuated? or is it killed?

A

Killed. Sabin is live

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151
Q

What are 4 big causes of metabolic alkalosis?

A

Vomiting
Diuretic use
antacid use
Hyperaldosteronism

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152
Q

assessing pt with metabolic alkalosis…what do you want to assess first?

A

fluid status and urine Cl for differential

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153
Q

generalized anxiety disorder has to be symptomatic for how long?

A

6 months

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154
Q

when does delirium tremens onset?

A

48-72 hours post last drink

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155
Q

What is the first sx of alcohol withdrawal?

A

Tremors

156
Q

What is tachyphylaxis? what are two drugs with prominent tachyphylaxis? How do you sustain the drug’s effectiveness?

A

rapid tolerance of the drug, thus deeming it ineffective

alpha agonist nasal congestants
nitroglycerine

you should take drug free periods to maintain drug effectiveness

157
Q

Rebound Rhinorrhea…what is this?

A

tachyphylactic reaction to prolonged alpha agonist use for nasal decongestion. NE is depleted, thus vessels redilate and pt could e (but not necessarily) experiences rhinorrhea

158
Q

what is the etiology of pt with Trendelenberg sign?

A

medial gluteal nerve injury. Lesion is on the opposite side as the hip drop

159
Q

resting cell membrane potential is mainly due to K permeability. What is the ion that contributes the most next?

A

Na

160
Q

Loop diuretics inhibit NaKCl symporter. What else does it do?

A

It stimulates prostaglandin release thus causing vasodilation and increasing renal blood flow…

161
Q

why is brown fat brown?

A

it has a lot of mitochondria

162
Q

How does ASD lead to Eisenmanger syndrome?

A

Pulmonary vessels will be under increased pressure…thus will hypertrophy and eventually shunt will reverse to R to L leading to late onset cyanosis

163
Q

Wide fixed S2 that doesn’t change with breathing is what?

A

ASD

164
Q

When is the physician able to share info about the patient without explicit consent?

A

If the patient is present and doesn’t object when physician has given them a chance to say “don’t preceed”

If the patient is not present and via judgement of doc that its in pt’s best interest to share… such as MI pt who’s wife is on scene without ID

165
Q

what three conditions most contribute to elevated BUN

A

renal failure, heart failure, dehydration

166
Q

hepatic encephalopathy is due to increased what in the blood? how does it pertain to encephalopathy?

A

Increased ammonia in the blood… It affects brain by increasing inhibitory neurotransmission and decreasing excitatory

167
Q

in hepatic encephalopathy…what can precipitate/exacerbate it?

A

increased GI intake of ammonia; or increased cell breakdown products such as in GI bleeding

168
Q

WHat kinds of things signal through the Jak Stat pathway?

A

growth hormones, cytokines, erythropoietin

169
Q

Glucagon, PTH, and TSH acts through what receptor?

A

G protein Gs

170
Q

where is bar body found?

A

periphery of nucleus

171
Q

where is the most prominent effect of Hansen’s disease seen?

A

leprosy likes colder temperatures.. thus it often most affect eyes, digits, testes, peripheral nerves

172
Q

diphtheria is what shape and what gram stain?

A

rod; gram +

173
Q

diphtheria strains can gain virulence via what mechanism?

A

phage lysogenic specialized transduction

174
Q

what is minimal alveolar concentration of a inhaled anesthetic? How does it relate to potency?

A

MAC is the percentage of the anesthetic is in the mixture to induce effect in 50% of the population (ED50%)… the lower the MAC the more potent the drug is

175
Q

which two things can activate classical complement pathway?

A

IgG and IgM

176
Q

is IgG or IgM better at activating complement

A

IgM

177
Q

C1 binds Ig to activate classic complement pathway… where does it bind?

A

C1 binds the Fc region of Ig NEAR THE HINGE not the END

178
Q

lump in breast that changes with menstrual cycle… what is this

A

fibrocystic changes

179
Q

What is the mutation in Facto V Leiden?

A

Glu to Arg mutation of Protein C…thus cannot cleave factor V and increased thrombosis risk

180
Q

What are the three major complications of Factor V Leiden?

A

DVT, cerebral vein thrombosis, spontaneous abortions

181
Q

polyethylene glycol has what kind of GI effect

A

osmotic laxative

182
Q

second hand smoke increases what risk?

A

asthma

183
Q

asthma pts may have imbalance of T cells… which is predominant

A

Th2

184
Q

What is inherited pancreatitis…what is defective here?

A

Inherited defect either in Trypsinogen (less to being inactivated) or decreased SPINK (which prevents trypsinogen premature activation)….
Therefore Typsin is prematurely activated and is resistant to being inactivated…causing pancreatitis

185
Q

Name three betalactamase inhibitors

A

clavulanic acid
tazobactam
sulfabactam

186
Q

Dilated coronary sinus indicates what?

A

R heart pressure is increased. Potentially pulmonary hypertension or L to R shunt or pulmonic valve stenosis

187
Q

Pinealoma…what are three common manifestations?

A

Parinaud’s syndrome
hydrocephalus due to blockage of the cerebral aqueduct
Precocious puberty–> pinealoma often secret gonadotropins

188
Q

pt with angiomyolipoma and subependymoma… what is this

A

tuberous sclerosis

189
Q

are long acting or short acting benzos more addictive

A

short acting

190
Q

are long acting or short acting benzos more associated with day time drowsiness?

A

long acting

191
Q

Name three short acting Benzos

A

Oxazepam
Alprazolam
Triazolam

192
Q

Name three medium acting benzos

A

Lorazepam
Estazolam
Temazepam

193
Q

Name 4 long acting benzos

A

chlordiazepoxide
chlorazepate
diazepam
flurazepam

194
Q

name the 4 types of thyroid carcinomas?

A

Papillary
Follicular
Anaplastic
Medullary

195
Q

How to distinguish follicular adenoma and follicular carcinoma of the thyroid?

A

Must do biopsy…fine needle aspiration is NOT ok… because the only difference is capsullar invasion

196
Q

if fetus is Rh+ and mother is Rh-…when is most likely for mother to be exposed to fetal blood and mount a response in subsquent pregnancies?

A

in late gestation, especially during delivery

Rh Allloimmunization

197
Q

How do you prevent mother developing Rh antibodies during first pregnancy with Rh positive baby?

A

Give mother IgG anti-Rh. This will bind the fetal RBCs that cross into maternal circulation. However, not a significant amount will cross to the fetus!

198
Q

What is Carcinoembryonic Antigen used for (CEA)

A

monitoring colorectal cancer

199
Q

What is CA125 used for?

A

monitoring ovarian cancer

200
Q

What is the drug of choice for patient with both absence seizures AND Tonic clonic seizures?

A

Valproic acid

201
Q

what type of seizure is carbamazepine preferable?

A

preferred in partial complex. can also be used for generalized tonic clonic

202
Q

What type of seizure is phenytoin prefered?

A

tonic clonic and status epilepticus

203
Q

What is a serious side effect of carbamazepine?

A

agranulocytosis

204
Q

In consensus pupillary reaction… which nucleus receives sensory information?

A

Pretectal nucleus

205
Q

In consensus pupillary reaction…which nucleus sends out motor information? to where?

A

Edinger Westfal nucleus –>ciliary ganglion –>ciliary muscle

206
Q

pt with mitral valve endocarditis experiences stroke. What are the two likely causes? what’s more likely?

A

Mitral valve prolapse, rheumatic heart disease

mitral valve prolapse is more common leading to Native Valve Bacterial Endocarditis

207
Q

intrahepatic hydatid cyst is associated with what?

A

ecchinococcus

208
Q

confusion in elderly male with bacteremia. What is likely the source of infection

A

UTI.

209
Q

What exactly causes overweight individuals to be resistant to Insulin?

A

High Free FA and triglycerides

could be due to increased serine phosphorlyation similar to TNFa, glucagon, and glucocorticoids

210
Q

What do you use to treat increased intracranial pressure?

A

Mannitol

211
Q

Name a serious side effect of Mannitol?

A

Pulmonary edema… occurs due to increased volume in vessels… thus increasing hydrostatic pressure

212
Q

How does sulfonylurea work?

A

It binds KATP channel in beta pancreatic cells… closing the channel–>depolarization and insulin release.

213
Q

Insulin is released from depolarization of beta cells… what comes before this starting with glucose entry?

A

Glucose enters cell –>glyclysis–>ATP –>bind to KATP channel–>closure of K channels

214
Q

stimulation of transcription factor PARRy… leads to what?

A

Increased adiponectin
Increased GLUT4
Increased fatty acid transport proteins
Increased insulin receptor substrates

215
Q

what are the DM drugs that do not cause hypoglycemia?

A

Metformin–>regulates gluconeogenesis and glucose related factors
Thiozolidodindiones–>increased peripheral sensitivity to insulin via upregulating PARRy related factors

216
Q

posterior 1/3 of tongue. what nerve is responsible for taste? what nerve is responsible for sensation? what nerve is responsible for motor?

A

Taste: IX, X
Sensation: IX, X
motor: XII (X is pharynx)

217
Q

Anterior 2/3 of tongue. What nerve is repsonsible for taste? what nerve is responsible for sensation? what nerve is reponsible for motor?

A

taste: VII
sensation V3
motor: XII

218
Q

histo: packed follicles with normal lymph node architecture, centrocytes “cleaved” small cells,

A

Follicular lymphoma BCL2; t14;18

219
Q

Pt with recurrent otitis media dies after blood transfusion…why?

A

Pt has deficiency in IgA…and often these patients will have IgG against IgA…thus transfusion lead to anaphylaxis.

220
Q

If parent of child wants to leave AMA when the child has a condition that could kill him/her…what should you do?!

A

First explain to the parents why they need to stay.
If it doesn’t work you need to bring this to court.

DO NOT DC PT!!!

221
Q

acute movement side effect of atypical anti psychotics?

A

acute dystonia (hrs to days)

222
Q

Longterm movement side effect of atypical antipsychotics?

A

Tardive dyskinesia

223
Q

Akathesia. what is this/what caues it?

A

restlessness, can occur anytime

224
Q

When does parkinsonian sx develop in the timeline of antipsych use?

A

Parkinsonian sx weeks to months

acute dystonia (hrs to days)
Tardive dyskinesia (long term)
225
Q

What does Leptin do?

A

It decreases appetite by decreasing neuropeptide Y and increasing alphaMSH

226
Q

amphotericin B SE?

A

nephrotoxicity–>hypokalemia/hypomagnesia–>cardiac abnl

227
Q

4 year old M with signs of puberty. elevated 17hydroxlyprogesterone and testosterone. Everything else normal. What is the dx?

A

nonsalt wasting type of 21 hydroxylase deficiency

228
Q

why exactly does adrenal hyperplasia occur in 21 hydroxylase deficiency?

A

no cortisol production leads to increased ACTH stimulation… thus increasing adrenal mass…

The point of treating with cortisol replacement is in part to down regulate ACTH

229
Q

schistocytes are seen when?

A

microangiopathic hemolytic anemia (DIC, TTP, HUS, malignant HTN, metastatic carcinoma
OR mechanical destruction: prostetic heart valve, calcified valves

230
Q

schistocytes in elder adult with neurologic symptoms…ddx?

A

Thrombotic thrombocytopenic purpura (TTP)

231
Q

schistocytes in child

A

HUS

232
Q

rapid correction of hyponatremia could result in what?

A

central pontine myelinolysis

233
Q

Rapid correction of hypernaturemia could result in what?

A

cerebral edema

234
Q

dietary lipid is digested where/how? where is it absorbed?

A

It’s digested in the duodenum with help of bile acids… then it’s absorbed in the Jejunum.

235
Q

Where is DEAK vitamins absorbed?

A

Jejunum

236
Q

How are hydroceles formed (Testes)

A

open processus vaginales… leading to fluid accumulation

237
Q

What occurs in adaptation to high altitude?

A

increased 2,3BPG and R shifts the curve

238
Q

When does S3 occur?

A

-low pitched right after S2
when pressure of filling blood exceeds the capacity of the ventricle.

  • rapid filling in elevated compliance
  • dilated cardiomyopathy–>rapid filling into over filled ventricle
239
Q

Temporal arteritis has similar morphology to what other vasculitis?

A

Takayasu. Both have giant cells (temporal or aorta/pulm arch)

240
Q

WIlson’s disease is associated with atrophy of what CNS part?

A

Basal ganglia due to oxidative damage

241
Q

EGFR1 mutation?

A

lung adenocrcinoma

242
Q

WT1 is it a tumor suppressor or protooncogene?

A

tumor suppressor

243
Q

VHL is it a tumor suppressor or protooncogene?

A

tumor suppressor

244
Q

What is BRCA1/2’s functional role

A

DNA repair of double stranded breaks

245
Q

What is the pulmonary wedge pressure in ARDS? why?

A

normal. because wedge pressure measures L atrial pressure. If this is increased, it would suggest cardiogenic pulmonary edema rather than ARDS

246
Q

Dx delusion disorder. how long does sx have to be?

A

1 month

247
Q

What is a method to terminate SVT without meds or cardioconversion

A

val salva

248
Q

If alveolar and tracheal PO2 is about the same. what do you think is the problem?

A

perfusion mismatch

249
Q

Which conditions will make the lungs diffusion dependent rather than perfusion dependent?

A

Ephysema, pulmonary fibrosis, high intensity workout

250
Q

acute stress disorder becomes PTSD after what amount of time?

A

1 month!!!

251
Q

SE of isoniazid?

A

neuronal toxicity; hepatotoxicity

252
Q

isoniazid mechanism?

A

inhibits mycolic acid synthesis;

must be activated by catalase in the bacteria (KatG encodes)

253
Q

what is kernicterus?

A

unconjugated bilirubin deposits in the brain causing encephalopathy…such as in Crigler Najjar

254
Q

what is the mutation in Dubin Johnson’s?

A

MRP2; transporter for conjugated bilirubin

255
Q

What can lead to deconjugation of bilirubin? what is the clinical result of this?

A

high numbers of anaerobes or Staph aureus. This causes lipid malabsorption. NO LIVER PROBLEMS or BILIRUBIN PROBLEMS!

256
Q

patient with hyperthyroidism being treated with … develops oral ulcers and infections with fever… what do you need to think about?

A

agranulocytosis.

257
Q

why is nafcillin preferred than penicillin in treating staph aureus?

A

nafcillin is penicillinase stable… and most staph aureus species have penicillinase

258
Q

What kind of vaccine is MMR?

A

live attenuated

259
Q

opioid related miosis is mediated through which receptor stimulation?

A

kappa

260
Q

opioid related antidepression effect is through which receptor stimulation?

A

delta

261
Q

opioid related constipation is achieved through which receptor?

A

mu

262
Q

name the betalactamase stable penicillins

A

Nafcillin, Oxacillin, Dicloxacillin, methacillin (not used in people. only in the lab)

263
Q

proprionyl coA is converted to Methylmalonyl coA via what? what happens to the methylmaloyl coa?

A

proprionyl CoA carboxylase.

then the methylmalonyl coA isomerizes to succinyl coA and enters TCA

264
Q

long term PPI use can predispose you to what

A

osteoporosis

265
Q

Why do you inject nonlabeled B12 in to the blood with the oral radiolabeled B12 in Schillings test?

A

to make sure that the ingested labeled B12 will be excreted by creating B12 excress

266
Q

at what spinal levels does IVC split into iliac?

A

L4-L5

267
Q

What do you use bisphosphonates to treat?

A

Osteoporosis, Paget’s, and hypercalcemia associated with malignancy

268
Q

follicular thyroid cancer. mutation?

A

Ras

269
Q

anaplastic thyroid cancer. mutation?

A

p53

270
Q

uncal herniation could cause what visual defect?

A

It could compress on PCA thus creating contralateral honoynmous hemianopsia with macular sparing

271
Q

Pt with aortic stenosis presents with pulmonary edema with afib onset. why is this happening?

A

a fib means the L atrium is not pumping and thus decreasing L ventricular preload. Since it’s not squeezing as much the blood backs up in the lung because the ventricle is very poor at contracting due to severe hypertrophy

272
Q

Ureter passes behind what and over what?

A

beneath gonadal arteries and over interal iliacs

273
Q

VIPoma symptoms? what cells are they?

A

pancreatic islet cells.

Watery Diarrhea Hypokalemia Achlorhydria

274
Q

CCK action? what cells produce cck?

A

duodenal I cells produce cck in response to fats; gall bladder contraction, increase pancreatic enzymes, and decrease stomach emptying

275
Q

most common causes of otitis media?

A

strep pneumo,
Hemophilus,
Moraxella

276
Q

cholestyramine should not be used in patients with what?

A

hypertriglyceridmia

277
Q

What is the superficial cervical fascia

A

superficial fat and platysma

278
Q

High dose of folate in a pt with seizure history who is medically treated? what happened?

A

high folate displace phenytoin thus causing seizure

279
Q

ventral pancreatic bud becomes what?

A

the uncinate process and the main pancreatic duct

280
Q

what gene is mutated in Paroxysmal Nocturnal Hemaglobinuria?

A

PIGA

281
Q

What is the molecular defect in paroxysmal nocturnal hemaglobinuria?

A

GPI linker is missing so that CD55 and CD59 are not on cells to prevent complement attack

282
Q

What are some complications of Paroxysmal nocturnal hemoglobinuria?

A

thrombotic complications (ex: bud chiari) due to hemolysis and factor release; aplastic anemia/pancytopenia

283
Q

what lab abnormalities are seen in vWF D?

A

prolonged bleeding time;
abnormal ristocetin
and increased PTT due to factor VIII deficiency

284
Q

what is ristocetin?

A

It activates platelet GP1b on platelets so that VWBF can bind

285
Q

How is preprocollagen, procollagen, and tropocollagen different from eachother?

A

Preprocollagen is freshly synthesized single strands within the cell.

Procollagen is without the ER targeting seuence, and it is glycosylated/hydroxylated in the cell. then exported

Procollagen is cleaved to form tropocollagen inthe extracellular space. it is insoluble. These are linked together via lysyl oxidase

286
Q

what type of diarrhea does VIP cause?

A

secretory

287
Q

sandpaper like rash in a young child

A

scarlet fever

288
Q

what is the rash called in parvovirus B19?

A

erythema infectiosum

289
Q

what is the difference between COX 1 and COX 2?

A

COX 1 is constitutive and COX2 is only expressed in situations of inflammation

290
Q

what are three treatments for Alzheimer’s disease?

A
  1. anticholinesterases (Donepezil, Rivstigmine, galantine)
  2. NMDA antagonists (Memantine)
  3. antioxidants (Vit E/Tocopherol)
291
Q

insertion of central venous catheters. what are the safety guidelines?

A
  1. washhands/ sanitizers
  2. use full barriers during insertion
  3. disinfect skin with chlorhexidine
  4. avoid femoral sites
  5. remove when not needed.
292
Q

what do patients with atopic dermatitis often have?

A

allergic rhinitis
asthma

This is the “allergy triad”

293
Q

What is the mechanism of Ticlodipine?

A

ADP receptor blocker on platelets thereby inhibiting GPIIb/IIIa. Like Clopidogrel

294
Q

abciximab targets what?

A

GPIIbIIIa

295
Q

what does cilostazol do? what’s another drug in this category?

A

phosphdiesterase inhibitor that increase cAMP level. thus not allowing platelet to be activated and also acts as a vasodilator.

Dipyridamole

296
Q

How does cAMP level correlate with platelet activation?

A

decreased cAMP leads to platelet activation

297
Q

what are the sideeffects of loop diuretics?

A 
Ototoxicity
Hypokalemia
Dehydration
Allergy (Sulfa)
Nephrotoxicity
Gout
298
Q

what drugs cause ototoxicty/nephrotoxicity??

A

Aminoglycosides
Cisplatin
Loop diuretics
vancomycin

299
Q

Side effects of Thiazides?

A

hypokalemia, hyponatremia, hypomagnesia

Hyperglycemia, hyperlipidemia, hyperuricemia, hypercalcemia (hyperGLUC)

300
Q

cholestyramine binds what?

A

it binds bile acids

301
Q

bilobed neutrophils post chemotherapy. what is this?

A

pseudo pelger huet anomaly

302
Q

what is myelophthisic anemia?

A

anemia due to space occupying lesion

303
Q

tongue claudications and scalp tenderness with hair brushing. morning stiffness. what is this?

A

temporal arteritis

304
Q

Side effect of dimercaperol?

A

nephrotoxicity; hypertension

305
Q

phlegmasia alba dolens. what is this?

A

white leg due to thrombosis of the iliofemoral veins in pregnancy when the gravid uterus presses down PLUS hypercoagulability

306
Q

Varicose veins predispose pt to what complication?

A

skin ulceration/infections/superficial thromboses

307
Q

summer month; child with pharyngitis and conjunctivitis

A

adenovirus

308
Q

meningitis post exposure to mouse urine. what is this disease? what kind of virus is it?

A

lymphocytic choriomeningitis virus (LCV);

arena virus

309
Q

what is the presentation of pericaditis?

A

sharp pleuritic pain radiating to the neck worse with swallowing. better with leaning forward.

310
Q

Pericarditis post MI?

A

localized will self resolve; onset 2-4 days after MI

autoimmune 1 week post MI onset is dressler’s

311
Q

what structures are drained to the paraaortic lymph nodes?

A

testes/ovaries, kidneys, urterus

312
Q

What structures are drained to the internal iliac nodes?

A

bladder, prostate, lower rectum above the pectinate line, vagina

313
Q

Henoch-Scholein sx? What is it caused by?

A

palpable purpura on BLE, nephritis, arthralgias, and GI discomfort.

This is mediated by IgA deposition in the vessels.

314
Q

if you see lower extremity cyanosis without BUE cyanosis…what is this?

A

patent PDA… with Eisenmenger.

This is NOT coarctation as coarctation does not lead to cyanosis, just weak pulses.

315
Q

immingrant child/teen with new cyanosis due to heart problems

A

this is Eisenmanger’s due to L to R shunt that has reversed to R to L shunt.

316
Q

cardiac tamponade due to wall rupture ususally occurs on which day post MI?

A

This usually occurs4-7 days after MI when the tissue is completely dead and degraded by neutrophilic infiltrate. rupture can cause tamponade and lead to systemic hypotention thus death

317
Q

pain in long bone in young boy. what are two can’t misses?

A

Osteomyelitis-staph via hematogenous spread

osteosarcoma

318
Q

which diabetic drugs do not increase insulin secretion?

A

metformin, glitazones, acarbose, dietary modifications

319
Q

what kind of tremor do parkinson pts have

A

resting tremor

320
Q

What kind of tremor do essential tremor pts have?

A

postural tremor

321
Q

typical antipsychs block what receptors

A

d2

322
Q

atypical antipsychs block what?

A

d2, H1, alpha1, and Serotonin2

323
Q

tremor with holding positions. family history. tremor decreases with EtOH. what is this? waht’s the treatment?

A

Essential Tremor. Use nonselective Beta blockers, primidone

324
Q

isolated cardiac amyloidosis

A

ANP

325
Q

Isolated pancreatic amyloidosis

A

amylin

326
Q

Isolated thyroid amyloidosis

A

calcitonin

327
Q

isolated pituitary amyloidosis

A

prolactin

328
Q

why do men have higher hct count?

A

androgens! thus steroid abuse can elevate hct

329
Q

how does childhood HAV most likely present?

A

anicteric. no jaundice

330
Q

aversion to smoking with acute illness. waht is this?

A

Hep A in adults

331
Q

tyrosinease deficiency

A

albinism

332
Q

what is the reason why you don’t want to use asprin in gout?

A

Because it’s antiuricosuric, and only slightly uricosuric at high doses

333
Q

why is the SNS overly activated in DKA?

A

despite glucagon induced hyperglycemia/lipolysis in DKA, the body is in a hypoglycemic state due to inability to take in glucose. thus… SNS is activated due to NE, cortisol, GH, and glucagon upregulation… which all worsens the hyperglycemia

334
Q

ornithine and citrate of the urea cycle, which is in the cytoplasm which is in mito?

A

Ornithine in mito; citruline in cyto

335
Q

what is the hCG level at the end of pregnancy?

A

low. It falls after about 10 weeks

336
Q

4 year old with arm extended and pronated. refuse to move it. no bruising. dx?

A

nursemaid’s elbow. subluxation of ulna out of annular ligament

337
Q

what’s the difference between Topo I and topo II?

A

Topo I –>single stranded cleavage to release negative coils

TopoII–>ds cleavage to release both positive and negative coils

338
Q

Podophyllin and Etoposide. mech? use?

A

both are Topo II inhibitors of the lyase activity. thus cannot heal DNA breaks.

Podophyllin -for genital warts
etoposide- for cancer (lung, testicular)

339
Q

mechanism of Irinotecan

A

topo I inhibitor

340
Q

What is the sequence TTAGGG

A

telomere!

341
Q

What are the two subunits of telomerase? what kind of enzyme is telomerase

A

it has TERT-transcriptase and TERC- built in RNA sequence.

It’s a RNA dependent DNA pol

342
Q

egg shell calcifications in the liver–>rupture leads to anaphylaxis. what is this?

A

Ecchinococcus

343
Q

monitor what with Clozapine?

A

CBC

344
Q

which antipsych drugs are mostly associated seizure SE?

A

TCA and buproprion

345
Q

corneal reflex is mediated by what nerves?

A

afferent V1; efferent VII

346
Q

cranial nerve III palsy sx?

A

eye lid droop
loss of pupillary reaction
down and out eyes

347
Q

Why might a sickle cell pt have macrocytic anemia?

A

high cell turnover leading to folate deficiency

348
Q

alcoholic with macrocytic anemia…what is likely the missing supplement?

A

folate. cobalamine deficiency is not as common in alcoholics as folate

349
Q

daptomycin mechanism? what class is it used against?

A

It depolarizes cell membrane. Gram positives

350
Q

What are the three treatments for MRSA?

A

Vancomycin, Daptomycin, Linezolid

351
Q

which antibiotic is associated with pulmonary distress and elevated CK levels?

A

daptomycin

352
Q

which antibiotic is associated with optic neuritits and thrombocytopenia?

A

Linezolid; also associated with serotonin syndrome

353
Q

what are two ways to calculate Cardiac output?

A

CO=HRxSV

CO=O2 consumption/A-V gradient O2

354
Q

diabetic who is well adhering to treatment develops hypoglycemia…what do you think preceipitated this?

A

exercise…leads to a drop in glucose levels… usually insulin would stop secreting to prevent further drop, but diabetics have exogenous insulin

355
Q

what may precipitate hyperglycemia in diabetics?

A

stresses…such as infections, pain, sleep deprivation. stress up regulates catecholamines/corticosteroids…increased gluconeogenesis leads to too much sugar for how much insulin is administered

356
Q

schizophrenic patient develops amenorrhea post treatment. why?

A

treatment with antipsychs –>iinhibition of D2 receptors… thus releasing prolactin from inhibition. Excess prolactin will cause inhibition of FSH and LH

357
Q

what is different about hepatitis C and hepatitis B on histology?

A

C will have central macrovesicular steatosis with aggregating lymphocytes.
B will have cells with granules of surface antigen/ have ground glass appearance

358
Q

what is in the Thyar Martin agar?

A

Vancomycin, Colistin, and Nystatin

359
Q

which rRNA is not made in the nucleolus?

A

5S rRNA

360
Q

Fabry’s disaese…what is missing?

A

alpha galactosidase A

361
Q

without surfactant do you expect smaller or larger alveoli to collapse first?

A

smaller ones will due to la place’s law…2T/r… smaller R means larger pressure and thus will divert air to larger alveoli

362
Q

what can trigger cataplexy?

A

joking/positive emotinos

363
Q

low hypocretin. ddx? where is the hypocretin secreted from?

A

narcolepsy; secreted from lateral hypothalamus

364
Q

which prostacyclins are antagonistic of TXA

A

prostacyclin I2 abd H2

365
Q

which prostacyclins inhibit gastric acid secretion

A

PGE2

366
Q

polyvinyl chloride, arsenic leads to which kind of cancer? what’s the tumor marker?

A

liver angiosarcoma; CD31 PECAM

367
Q

XIIa. what are the two functions?

A

XIIa activates XIa; it also activates Kallikrein,..which intern activates Plasminogen to plasmin

368
Q

kallikrein action?3

A

actionvates plasmin and bradykinin; neutrophil chemotaxis

369
Q

bradykinin function?

A

vasodilation/increase permeability; mediates pain

370
Q

What does protein C do?

A

It inactivates factors 5 and 8

371
Q

Heparin can cause what side effects?

A

HIT; bleeding; OSTEOPOROSIS

372
Q

in HIT what do you do?

A

stop heparin; give warfarin and direct thrombin inhibitors

373
Q

what is the difference between heparin and LMWH

A

LMWH inactivates Xa versus Heparin inactivates Thrombin and Xa via potentiating antithrombin

374
Q

How do you calculate compliance?

A

Vol/Pressure=compliance

375
Q

what are three ways CO2 is transported in the blood?

A

dissolved, bound to Hb, mostly as HCO3

376
Q

CO2 produced by the tissue is converted to HCO3 how? and how is HCO3 converted back to CO2 at the lungs?

A

RBCs convert CO2 to HCO3 at the level of the tissue via carbonic anhydrase. and is extruded from the RBC in exchange for chloride

same thing happens at the lungs.

377
Q

In exercise, what happens to the venous vessels, arterioles, skeletal arteries?

A

everything vasoconstricts, except for muscle arteries relax due to local modulation

378
Q

what locations do steps of the collagen synthesis process occur?

A

hydroxylation and glycosylation and tiplet formation are in RER. then golgi does nothing but secrete it. in the EXTRACELLULAR SPCE is where the cleavage and lysyl oxidation occurs

379
Q

what molecules are glycosylated to collagen?

A

glu and galactose

380
Q

necrotizing fasciitis ddx?

A

strep pyogenes, staph aureus, strep perferingens

381
Q

oval fat bodies/maltese cross in urine

A

nephrotic syndrome

382
Q

why nephrtic pt is more prone to…

infections?
thrombosis?

A

loss of immunoglob and antithrombin

383
Q

clostridum dificil treatment

A
  1. Metronidazole
  2. vanco if severe
  3. fidaxomicin if recurrent
384
Q

What are advantages of Fidaxomicin in severe C. Diff tx?

A

it has minimal systemic absorption;

It is very narrow spectrum

385
Q

meningiomas are from what structure?

A

arachinoid villi

USMLE (9 decks)

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