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USMLE > Rapid Facts from Q banks > Flashcards

Rapid Facts from Q banks Flashcards

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USMLE® Step 1 flashcards
0
Q

What is the formal name for eczema? What’s poison ivy like skin conditions? What’s different?

A

Atopic dermatitis is eczema. It’s severe in infants and lichenification and less severe in elder kids and adults.

Contact dermatitis–usually acute, where as atopic is more chronic onset

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1
Q

What is the most sensitive indicator of recent alcohol use?

A

Serum gamma glutamyl transferase (GGT) (also called gamma glutamyl transpeptidase) is the most sensitive indicator of recent alcohol use. It is elevated in 80% of alcohol-related disorders and is usually the first index to react; therefore, it can be used for the above purposes. Other drugs (e.g., barbiturates, phenytoin) can also increase serum GGT levels. It should also be noted that in DSM-5, patients are diagnosed with alcohol use disorder, alcohol intoxication, or alcohol withdrawal.

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2
Q

Pneumonia in chronic alcoholic?

Tx?

A

Klebsiella. Also in DM and CoPD.

Tx with 3rd gen cephalosporin-

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3
Q

Salmon Colored rash with silvery scale; pt also has JOINT disease

A

Psoriasis

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4
Q

Metalloproteinases are involved in what way in cancer

A

invasion

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5
Q

Loss of Ecadherin; gain of Laminin

A

Tumor invasion initial events

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6
Q

Antiplatelet therapy when ASA cannot be used

A

Clopidogrel

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7
Q

Two primary cell types for heme synthesis; what are they used for?

A

hepatocytes–>p450; erythrocytes–>hemoglobin

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8
Q

What prevents mature erythrocytes from heme synthesis

A

loss of mitochondria

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9
Q

Major regulating step of glycolysis?

A

PFK1

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10
Q

Lipid A on LPS in Gram negative

A

ex: e coli; septic shock by activating neutrophils/granulocytes

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11
Q

whats the goal of urea cycle

A

make ammonia to urea

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12
Q

Thiazides act on what channel? It causes elevation in? contraindications

A

Na/Cl channel and causes elevation of glucose, calcium, uric acid…don’t use in gout, hypercalcemia pt, and diabetic pts

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13
Q

Hb A2 subunits?

A

Alpha2 delta2

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14
Q

Vasculitis in graft vessels

A

acute rejection

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15
Q

fibrosis and thickening of graft vessels

A

chronic rejection

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16
Q

Three key associations of Conn’s

A

HTN, hypokalemia, metabolic alkalosis (alkalosis may lead to paresthesia/weakness)

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17
Q

How does Hep B help Hep D?

A

Hep D needs to be coated with Hep B surface antigen in order to infect hepatocytes

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18
Q

nl GFR

A

125

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19
Q

Filtration Fraction

A

GFR/RPF

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20
Q

on-off phenomenon

A

parkinson’s disease; cycles of relief with Levodopa. Relief is not consistent and therapeutic periods decrease as time progresses due to Nigrastriatal degeneration

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21
Q

Caudate degeneration

A

Hungtington’s; CAG loss of GABA

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22
Q

Locus ceruleus?
Raphe nucleus?
Red Nucleus?
Nucleus basalis of Meynert?

A

NE, 5HT, upper extremity motor coordination; Ach

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23
Q

2 tissues that cannot use ketone bodies for enegery. why?

A
  1. RBC–>no mitochondria for ketone oxidation
  2. hepatocytes–> don’t have succinyl CoA-acetoacetate CoA transferase (thiophorase) to convert acetoacetate to acetoacetyl coA
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24
Q

What are the two ketone bodies?

A

acetoacetate and beta hydroxybutyrate made from FA; then converted to Acetyl CoA in periphery

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25
Q

Familial Chylomicronemia syndrome. mutation? accumulation? symptom?

A

LPL and ApoCII mutation; accumulates chylomicrons; ; acute pancreatitis risk/xanthomas/retinalis/hepatosplenomegaly; CHILDREN!

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26
Q

milky plasma; low LPL

A

familial chylomicronemia

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27
Q

Familial hypercholesterolemia. Mutation? accumulation? symptoms/risk?

A

LDLR or ApoB mutation; accumulation of LDL; at risk for premature CAD/xanthomas

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28
Q

Familial Dysbetaproteinemia. Mutation? accumulation? risk?

A

ApoE mutation; accumulation of chylomicrons and VLDL remnants;

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29
Q

Familial Hypertriglyceridemia. mutation? accumulation? risk?

A

ApoA-V mutation; accumulation of VLDL; increased pancreatitis/and DM

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30
Q

Asthmatic using steroid inhaler; proximal bronchiectasis; high IgE and eosinophilia

A

Allergic bronchopulmonary aspergillosis

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31
Q

Berkson’s bias

A

selection bias by selecting hospitalized patients as control group

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32
Q

Power; definition; how to increase power?

A

ability of a study to ID difference when the difference truly exists; increase sample size

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33
Q

Entecapone; use; mechanism

A

used for adjunct therapy in Parkinson’s; COMT inhibitior–>increases amount of Dopamine entering brain.

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34
Q

fulminant hepatitis in pregnant woman

A

HepE

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35
Q

Why can you not use betalactams against chlamydia trachomatis

A

It doesn’t have a cell wall. Tx: doxycycline/macrolides

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36
Q

pneumonia, finger clubbing, steatorrhea

A

cystic fibrosis (F508) (steatorrhea–>DEAK deficiency)

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37
Q

baby lack of meconium passage

A

cystic fibrosis (F508)

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38
Q 
Down syndrome associations:
neurology 
cardio
GI (2)
endocrine (2)
Cancer 
joint
A
  • early onset alzheimer
  • cards: ASD/VSD
  • GI: hirshprung/duodenal atresia
  • Endo: T1DM; hypothyroid
  • acute leukemia
  • atlantoaxial instability
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39
Q

anemia/reticulocytosis; jaundice; dark urine post dapsone

A

G6PD

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40
Q

G6PD oxidative stresses that are NOT drugs

A
  1. Fava beans
  2. Infection
  3. DKA
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41
Q

G6PD oxidative stress drugs

A
  1. antimalarials
  2. Dapsone
  3. sulfamethoxazole-trimetheprim
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42
Q

Vitamin D toxicity

A

hypercalcemia/calcium deposition; kidney STONES!

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43
Q

2 classic signs of long thoracic nerve/ Serratus anterior injury

A

winged scapula
inability to abduct arm above horizon (from ground to horizon is via supraspinatus and deltoid)
MASTECTOMY

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44
Q

granulomas in carotid/temporal arteries’ media?

A

temporal/giant cell arteritis

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45
Q

granulomas in arotic arch media?

A

takayasu arteritis–>asian woman pulseless disease.

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46
Q

lung cancer with necrosis/cavitation and hypercalcemia

A

squamous cell carcinoma

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47
Q

Lung cancer with clubbing and hypertrophic osteoarthropathy?

A

Adenocarcinoma (women non smoker, peripheral)

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48
Q

Lung cancer with gynecomastia/galactorrhea?

A

Large cell carcinoma ( peripheral)

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49
Q

VACTERL

A

vertebral, anal atresia, tracheoesophageal fistrula, renal limbs

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50
Q

imperforate anus most likely to see what other anomalies?

A

urinary tract abnormalities including renal

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51
Q

First order kinetics–>how long will drug reach steady state?

A

4-5 half lives

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52
Q

squamous cell metaplasia in CF patient

A

vitamin A deficiency due to steatorrhea

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53
Q

Ig heavy chain is on what chromosome?

A

14

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54
Q

Nasal polyp in child

A

CF

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55
Q

Cri du chat mutation

A

Ch 5 short arm deletion

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56
Q

Paradoxical split causes (2)

A

aortic stenosis or left bundle branch block

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57
Q

Black liver

A

Dubin Johnson; Direct bilirubinemia (conjugated; can’t get out)

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58
Q

If you’re given PaCO2; how do you figure out PAO2?

A

PAO2=150 (PaCO2/0.8)

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59
Q

What are three common lung parameters that increase in smokers

A

compliance and residual volume in emphysema; PAO2-PaO2 gradient

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60
Q

painful oral ulcers in IV drug user who is HIV positive

A

Kaposi Sarcoma

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61
Q

Kaposi Sarcoma disease process;

A

HHV8 in HIV

  1. painful oral ulcers
  2. blue-brown skin rashes on extremities
  3. GI/lung lesions in later stage
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62
Q

Kaposi Sarcoma Histology

A

spindle cell proliferation, endothelial cell proliferation, extravasation of RBCs, inflammation

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63
Q

Fructose metabolism 2 enzymes

A

Fructose–(Fructokinase)–>Fructose 1 phosphate–(aldolase)–>Glyceraldehyde–>enter into glycolysis

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64
Q

HBV vaccinated individual serotype?

A

anti-HBsAg antibodies; nothing else

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65
Q

Window period of HBV infection… Definition? Marker?

A

the period when surface ag is no longer detectable, but Anti-HBsAg antibodies are not measurable. The marker is Anti-HBcAg antibodies HBcAg is in the envelop and not detected)

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66
Q

What’s the significance of HBVeAg and anti-HBVeAg

A

indicates presence of HBV DNA
Antibodies indicate low replication and infectivity; if antigen is present for more than 3 months it means establishment of chronicity

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67
Q

Strong humeral response is linked to which kind of T cell? cytokines?

A

Th2; IL5 (IgA); IL4 (IgE)

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68
Q

Which type of T cells are seen in sarcoidosis? which cytokines are prevalent?

A

Th1 repsonse; IL2, IFNY (macrophages!)

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69
Q

1 gram of fat is how many calories?

A

9 cal

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70
Q

1 gram protein is how many calories?

A

4 cal

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71
Q

I gram of carbohydrate is how many calories?

A

4 cal

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72
Q

1 gram of ethanol is how many calories?

A

7 cal

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73
Q

4 physician payment strategies? what do they mean?

A

capitation: fixed amount per enrollee–>encourages preventative treatments
Fee for Service: entices physicians to do more tests/procedures
Discounted Fee for service: the discount is for the patients for expensive procedures, thus physicians are less likely to order excessive expensive tests
Salary: no financial risk for the physician based on practice. physician is unlikely to increase/decrease testing or increase/decrease enrollees

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74
Q

LMN lesion signs in upper extremities; UMN lesion signs in lower extremities; scoliosis

A

Syringomeylia

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75
Q

Spinal cord section with lateral horns

A

T1- L2

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76
Q

Spinal cord section with large ventral horn

A

Lumbar and Sacral

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77
Q

Spinal cord section that’s ovoid with a lot of white matter

A

cervical

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78
Q

Spinal cord section that has prominent ventral and dorsal roots

A

lumbar

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79
Q

How to avoid tolerance to nitrates

A

give small doses throughout day with “nitrate free periods”

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80
Q

How is bipolar with psychotic features different from schizoaffective disorder

A

Bipolar with psychotic features/major depression with psychotic features only have psychosis when mood abnormalities are occuring

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81
Q

What is schizoaffective disorder; what is it? DSM5 criteria?

A

mood disorder plus signs of schizophrenia; can have psychotic episodes without mood disorder
DSM5:
-episodes of major depression or mania
-> or equal to 2 weeks of psychosis without mood disturbance
-mood disturbance is present for majority of illness
-no induced by drugs

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82
Q

Immune mediators of septic shock

A

IL1, IL6, TNFa

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83
Q

Cresenteric/rapidly progressive glomerulonephritis three types

A

Type I anti GBM good pasture with IgG and C3 deposits
Type II immune mediated IgA (Henoch Scholein)/SLE/post strep (lumpy bumpy)
Type III ANCA

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84
Q

PDA heart sound

A

continuous murmur loudest during S2

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85
Q

Reassortment

A

when segmented viruses infect a cell and the segments mix to produce a new combo (influenza A)

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86
Q

Foscarnet mechanism; Side Effects

A

pyrophosphate analog that chelates calcium; hypocalcemia/hypomagnesia

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87
Q

Acyclovir side effects

A

neurotoxicity, nephrotoxicity, tremors/delirium

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88
Q

Lamivudine mechanism; Side effects

A

reverse transcriptase inhibitor; peripheral neuropathy and lactic acidosis

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89
Q

HIV patient with visual problems; cause?

A

CMV retinitis; treat with Gancyclovir, Foscarnet, and Cidoforvir

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90
Q

What is confidence interval; what is null value?

A

CI of 95 is if a study is done 100x, 95 times would be within the range; null value value of 0 indicates no statistical significance

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91
Q

patients with low acetylating drug inactivators are affected by what kind of drugs?

A

Isoniazid, Dapsone, procainamide, hydralazine

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92
Q

Sarcoidosis/Hodgekins lymphoma with hypercalcemia. why?

A

increased T cell activity–>activated macrophages and alpha 1 hydroxylase–>increased vitamin D levels

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93
Q

Pin worm treatment? if pregnant?

A

Albendazole; Pyrantel pamoate

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94
Q

EML4-ALK fusion gene

A

non-small cell lung cancers resulting in constitutive Tyrosine kinase activity

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95
Q

Recurrent lobar strokes in elderly that are not severe

A

cerebral amyloid angiopathy

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96
Q

Honey Comb lungs

A

idiopathic pulmonary fibrosis

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97
Q

Breast Biopsy with myxoid stroma and squished epithelia lined ducts

A

Fibroadenoma

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98
Q

When is betahCG detectable in maternal serum?

A

after day 6 (8-11 days); implanatation must occur prior

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99
Q

Heparin mechanism?

A

increases Antithrombin III activity

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100
Q

Attributable Risk?

A

Exposed with dz/all exposed-not exposed with dz/all not exposed

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101
Q

Increase in portal system pressure will cause increased drainage in which veins to produce the following?

  1. esophageal varices
  2. caput medusa
  3. Hemorrhoids?
A
  1. L gastric Vein –>esophageal veins
  2. Paraumbilical vein–>super/inferior epigastric vein
  3. Superior rectal vein –>inferior/middle rectal vein
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102
Q

Oseltamivir

Mechanism

A

It’s a neuraminidase inhibitor and thus prevent the newly synthesized virion from budding off the host cell

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103
Q

Enfevirtide

mechanism; what is it used for?

A

prevents Influenza A/B from penetrating host cell

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104
Q

At FRC what is the intrapleural pressure? what is the intrapulmonary pressure?

A

Intrapleural is negative (about -5); intrapulmonary is 0–>thus no airflow

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105
Q

Osmotic fragility test is used to diagnose what? how does this test work?

A

dx for spherocytosis (hereditary spherocytosis due to ankryin/spectrin abnl); cell will lyse when put in hypotonic solution

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106
Q

femoral head necrosis, episodic thrombosis, spleen infarcts are indicative of what disease?

A

Sickle Cell Anemia

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107
Q

Frothy Urine

A

Protein or bile acids

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108
Q

Lipid and glycogen filled cells upon renal biopsy

A

Clear cell carcinoma of the kidneys; arises from renal tubular cells

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109
Q

What are two side effects of Fibrates such as Gemfibrozil

A
  1. increased chance of myopathy/hepatotoxicity when used in conjunction with statins
  2. increased risk for gall stones due to increased excretion of cholesterole in bile
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110
Q

Which statin is the worst for myopathic SE?

A

Simvastatin

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111
Q

Theophylline mechanism?

A

decrease phosphodiesterase activity thereby increasing cAMP–>bronchodilation

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112
Q

Epinephrine’s effect what receptors? on HR, SBP, and DBP?

A

Epi acts on alpha 1, alpha 2, beta 1, and beta 2.

increases HR via Beta 1
increases SBP via beta 1 and alpha 1
decrease DBP at low doses via beta 2
increases DBP at high doses via alpha 1

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113
Q

Isoproterenol

mehcanism?

A

beta 1 and beta 2 nonselective AGONIST!!! NOT NOT NOT ANTAGONIST

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114
Q

Phenylephrine

mechanism?

A

selective alpha AGONIST–>thus increasing BP

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115
Q

malaria treatment? first line?

A

chloroquine is first line… however mefloquine or some other quine if resistant

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116
Q

Normal filtration fraction

A

20%

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117
Q

RFP equation

A

use clearance of PAH

UV/P

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118
Q

Two ways of calculating GFR

A 
UV/P for either creat or inulin
or Kf (difference in hydrostatic pressure- difference of oncotic pressure)
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119
Q

What happens to GFR and FF if ureter is obstructed?

A

both decreases

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120
Q

ApoA-1 function

A

LCAT activation to esterify cholesterol

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121
Q

ApoB48 function

A

chylomicron assembly; on chylomicrons

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122
Q

ApoB100 function

A

on LDL particles for uptake into extrahepatic cells

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123
Q

ApoCII function? deficiency?

A

activate Lipoprotein LIpase (LPL); deficiency is Chylomicronemia

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124
Q

ApoE3 and ApoE4 function? deficiency disease?

A

uptake of chylomicrons and VLDL remnants; deficiency=dysbetalipidemia

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125
Q

elevated alkine phosphatase differential organs

A

liver, bone, placenta, (intestines, kidney, leukocytes)

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126
Q

Blood/Gas partition coefficient; what does it mean if it’s high? what does it mean if it’s low?

A

If high it means gas likes the blood thus more soluble;
If it’s low it means it easily separates out of blood… thus low solubility;
In inhaled anesthetics; low blood/gas partition=concententrates to brain more quickly

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127
Q

What is a inhaled anesthetic with low blood/gas partition coefficient? How soluble is it? fastness of onset?

A

NO, it’s very non soluble thus fast onset

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128
Q

What is an inhaled anesthetic with high blood/gas partition coefficient? how soluble is it? fastness of onset?

A

Halothane; it’s very soluble therefore slow onset

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129
Q

Anti inflammatory cytokines

A

TGFbeta; IL10

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130
Q

If patient cannot consent, has no proxy, and no family members. If a friend claims to know the pt’s wishes…what do you do if pt needs emergent care?

A

Give emergent care

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131
Q

Pathogenic process of Giardia? How does immune response act against it?

A

Giardia attaches to microvilli and thus causes atrophy/damage to duodenum/jejunum.
IgA prevents adherence

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132
Q

Standard Error-What is it? How to calculate?

A

variability due to sampling rather than study of the entire population…which would then be Standard deviation; calculate by SD/sqrt(n)
meaning if sample size increases SE decreases

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133
Q

Standard Deviation and Standard Error… what’s the difference?

A

Standard deviation is the variability of a entire population. Standard Error is SD taking in to account of sampling error–>thus SE=SD/sqrt(n)

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134
Q

What is the Z score for calculating Confidence interval? for 95%? 99%?

A

95%=1.96

99%=2.58

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135
Q

How to calculate Confidence interval?

A

CI=mean+/-Z(SE)
OR
Cl=mean+/-Z(SD)

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136
Q

Which enzymes of heme synthesis are inhibited by lead?

A

ALAD; ferrochetalase

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137
Q

Acute Intermittent Porphyria can be caused by which drugs and what kind of lifestyle things?

A 
phenobarbital
phenytoin
griseofulvin
alcohol
low caloric diet
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138
Q

Why can Acute Intermittent porphyria improve with heme administration

A

Heme feeds back to inhibit ALAS thus decreasing the accumulation of Aminolevulinic acid and porphobilinogen

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139
Q

superior laryngeal nerve courses with what? innervates what m?

A

superior laryngeal artery and innervates cricothyroid m

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140
Q

5 hydroxyindolacetic acid elevation?

A

excess serotonin break down product…maybe carcinoid syndrome

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141
Q

mast cell content

A

histamine, tryptase

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142
Q

Carotid baroreceptors are innervated by what nerve?

Aortic baroreceptors are innervated by what nerve?

A

Carotid=herring’s nerve (Glossopharyngeal)

Aortic=vagus nerve

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143
Q

neck stimulation–>syncope; why?

A

stimulation of nerve of herring Glossopharyngeal nerve thus baroreceptor activation–>vasodilation and syncope

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144
Q

coin lesions with popcorn calcifications in lung

A

hamartoma

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145
Q

pulmonary chondroma

A

lung hamartoma; characterized by cartilage

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146
Q

Statins SE

A

myopathy; hepatotoxicity

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147
Q

Meyer’s loop. What is it; connects what structures?

A

genu of the optic radiation; connects lateral geniculi to visual centers in occipital lobe

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148
Q

pruitic red papules/vesicles on flexor surfaces

A

BUZZ WORDS: WEBBING OF FINERS/LINEAR BURROW

scabies!

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149
Q

flagellated skin discoloration and pulmonary fibrosis in cancer patient

A

Bleomycin

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150
Q

uncomfortable sensation in BLE when falling asleep; better with stretching. Diagnosis? Common causes? Treatment?

A

dx: restless leg syndrome
causes: iron deficiency, uremia, DM
treatment: dopamin agonists

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151
Q

liver failure post general anesthesia?

A

Halothane (or sevoflurane and isoflurane) causing massive hepatic necrosis

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152
Q

microvesicular hepatic fatty change

A

Reye syndrome

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153
Q

Treatment for enuresis

A

Avp
Imipramine
Indomethacin

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154
Q

Treatment for enuresis

A

Avp
Imipramine
Indomethacin

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155
Q

What drugs can worsen ischemic region perfusion during an MI

A

drugs that selectively dilate coronary arteries; Dipyridamole and adenosine

This allows healthy vessels to dilate and thus “steal” the limited blood going to ischemic regions via collaterals

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156
Q

What is phenotypic mixing

A

protein of other virus is packaged into progeny, but no genetic material exchanged…thus the next generation of progeny will NOT have trait

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157
Q

7 year old post recent infection/vaccination/hypersensitivity has nephropathy; what is it most likely? How do you dx? what do you see?

A

minimal change; do EM–> you see podocyte foot effacement

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158
Q

CNIII courses between which two arteries?

A

PCA; SCA at level of midbrain

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159
Q

irregular EKG with no p-waves and narrow QRS complex

A

Afib (along with low amplitude fibrillary waves)

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160
Q

What is the ventricular rate in Afib?

A

about 70-190 BPM; atria is firing rapidly due to reentry, and impulses travel to ventricles via AV node at irregular rates and timing is dictated by repolarization rate of AV node

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161
Q

Most common ectopic site of conduction in afib?

A

pulmonary artery

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162
Q

Length constant of impulse propagation; what does it mean

A

how long impulse goes before decreasing to 37% of its original amplitude; better insulation increases length constant

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163
Q

Time Constant of impulse propagation. what does it mean

A

how long it takes to change the membrane potential; increase means slower propagation

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164
Q

allergic asthma histo findings

A

eosinophilia and charcot leyden crystals

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165
Q

In liver failure; which clotting factor deficiency is apparent first? WHy?

A

Factor VII; due to shortest T1/2

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166
Q

pt with jaundice, elevated PTT and AST, N/V fever very severe; History of surgery 1 week PTA
What’s the dx? Histo?

A

hepatic necrosis due to Halothane

Necrosis AND inflammation with atrophy

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167
Q

Tryptophan makes what

A

Niacin/NAD, Serotonin, Melatonin

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168
Q

Hartnup disease

A

defective renal absorption of tryptophan–>Pellagra;
(Proline/Arginine levels are nl)

Tx: high protein diet/NAD replacement

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169
Q

Lac operon components and function

What leads to activation of lac operon?

A

I=regulatory; synthesizes inhibitory protein that binds O
P=promoter
O=operator; allows binding of inhibitory protein
Z=beta galactosidase
Y=permease
A= …

activates when glucose is NOT present THUS increased cAMP; and when lactose is present

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170
Q

Three types of benign Colon polyps?

2 types of malignant?

A

hamartoma, lymphoid (children), hyperplastic

tubular adenoma, villous adenoma

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171
Q

allopurinol; mech

A

inhibits xanthine oxidase

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172
Q

mania treatment 4

A

lithium, valproate, cabamazepine, olanzepine

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173
Q

What are NNRTIs? whats special about them? name 3

A

nonnucleoside reverse transcriptor inhibitor without need for phosphorylation;

nevirapine, efavirenz, delaviradine

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174
Q

pulmonary hypertension

Demographic; mutation; symptoms

A

women 20-40; BMPR2 mutation; dyspnea and exercise intolerance

PLEXIFORM LESIONS

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175
Q

How do you treat pulmonary hypertension

A

lung transplant for definitive cure;

Bosetan-= endothelin receptor antagonist–>prevents vasoconstriction

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176
Q

Child with nephropathy that recently had an infection;

ddx: how to distinguish IgA nephropathy and post strep GN

A

IgA is days after, IgA present; mesangial dense chunks on EM
Post strep is weeks after, C3 is low, lumpy bumpy on light microscopy; subepithelial lumps on EM

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177
Q

Henoch Scholein–>systems involved

A

renal, skin, GI

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178
Q

histone core; what’s in it?

what’s out side of it?

A

(2A, 2B, 3,4) x2 are inside

H1 is OUTSIDE

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179
Q

tRNA-binding site for proteins

A

3’ CCA

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180
Q

tRNA structure and unique features

A

Structure:

  • 3’ end is acceptor site with CCA recognition –>binds proteins
  • L arm is D loop
  • R arm is TpsyC loop; with small variable loop above
  • codon recognition is the top loop
  • It has modified bases such as dihydrouracil
  • it’s about 80 bp
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181
Q

HIV env processing

A

env is glycosylated to 160 and then chopped into gp41 and gp120

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182
Q

Bilat shoulder and pelvic muscle stiffness, fever, weight loss, elevated ESR. What is this? what is this associated with?

A

Polymyalgia rheumatica; associated with temporal arteritis

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183
Q

CD8 infiltration and destruction of myocytes due to increased MHCI on myocytes

A

Polymyositis

184
Q

Internal Capsule stroke sx

A 
contralateral loss of motor function arm, leg, face. 
contralateral hyperspasticity (clasp knife spasticity-->resistance then weakness upon further resistant application)
185
Q

MI with bradycardia

Treatment?

A

infarct of R coronary artery –>infarction of SA node.

Atropine-Block vagal stimulation to increase HR

186
Q

What does mydriasis do to the angle of the anterior chamber?

A

decreases the angle…thus can block canal of schlem and cause glaucoma

187
Q

PAH
what does it measure?
How is it processed in the kidney?

A

It measures RPF
It is freely filtered at the glomerulus and then actively secreted by carrier enzymes in tubules… carrier enzymes can be saturated

188
Q

PT is prolonged by what drug
PTT is prolonged by what drug
What prolongs both?

A

Warfarin (PT)
Heparin (PTT)
any Xa inhibitors (Rivaroxaban, Apixaban, Fondaparinux)

189
Q

Breast fed infants need supplementation of what vitamins?

A

Vitamin D and K

190
Q

What are simple/complex seizures

A

simple=no LOC +postictal

complex LOC +postictal

191
Q

no B cells, T cells are present; what’s the disease?

A

Bruton’s agammaglobulinemia

192
Q

Calmodulin and Myosin light chain kinase are only in what kind of muscle?

A

smooth

193
Q

pure alpha 1 agonist’s affect on SBP/DBP and HR?

A

SBP and DBP will rise–>increase vagal tone–>HR will fall

194
Q

Which anti arrythmic drug is associated with prolongation of QT wave but very little risk of Torsades?

A

Amiodarone

195
Q

Which class is Amiodarone? how does it work?

A

It’s class III thus it inhibits outward K flow… allowing prolongation of repolarization

196
Q

First dose hypertension is associated with what drug? what are predisoposing factors?

A

ACE I;

hyponatremia, hypovolemia, high renal aldosterone level, heart failure, renal disease

197
Q

hyperammonia is associated in depletion of what?

A

glutamate in CNS–>taken up/build up of Glutamine in astrocytes and causes astrocyte swelling
alpha-ketoglutarate depletion inhibits glutamine to be converted back to glutamate

198
Q

Infant with head to oneside, cries when positioned to opposite side. Large lump on lateral neck

A

congenital torticollis due to malpositioning

199
Q

common organisms that will contaminate culture… but does not necessarily indicate disease?

A

Candida albicans; Staph Epidermidis

200
Q

Bacterial pharyngitis=what organism?

A

Strep A

201
Q

Syphilis specific test

A

FTA-ABS

202
Q

Childhood Paramyxovirus infection can predispose one to what disease in adulthood?

A

Paget’s disease

203
Q

Gluconeogenesis upregulation via intracellular receptor binding..?

A

cortisol;

Glucagon and NE bind G proteins

204
Q

Schistoma hemotobium?
Schistoma masoni/Japoni?

What is the carrier animal

A

larva incubate in freshwater snails –>penetrate skin–>mature in liver–>migrate to intestines

Schistoma hematobium–> lays eggs in bladder causing pain and bleeding/scaring
Schistoma masoni/japoni–> lays eggs in liver/intestines–>shed in stool

205
Q

What is the effect of rapid heart rate on coronary blood flow?

A

decreases coronary blood flow, because of the REDUCED time in diastole

206
Q

xray findings of englarged heart, increased vascular shadowing of the lungs, Kerley B lines, and pleural effusion at the bases…dx?

A

L ventricular failure

207
Q

Steady incidence of a disease over time, but increased prevalence means what?

A

Improved quality of care thus prolonging the course of a disease

208
Q

Ballooning degeneration indicates what?

A

hepatocyte injury ex…hepatitis A

Bridging necrosis=hepatocyte death

209
Q

5 hydroxyindolacetic acid is breakdown product of what? increased in serum indicates what?

A

5HT/serotonin…thus increased 5hydroxyindolacetic acid in serum may indicate carcinoid

210
Q

Simulating factors for Osteoclasts (2)

A

RANKL and M-CSF

211
Q

Hep C has a lot of diversity in its envelope glycoprotein…why?

A

lacks 3’-5’ exonuclease

212
Q

Trigeminal Neuralgia–>treatment?

A

Carbamazepine (FIRSTLINE)

213
Q

Sudden onset of tingling in one arm that subsides. What is this?!

A

TIA! ASA prophylaxis duh!

214
Q

Theophylline mechanism? side effects?

A

phosphodiesterase inhibitor. Side effects like strong caffeine tachyarrhythmia, diarrhea, abd pain, seizures

215
Q

CD4<50 HIV pt is susceptible to what?

A

MAC

216
Q

HIV pt with hepatosplenomegaly, anemia, elevated alkaline phosphatase, elevated lactate dehydrogenase. What organism? what CD4 count? what treatment

A

MAC, Azithromycin, CD4 50

217
Q

which lipid lowering drugs increase risk of stones?

A

Fibrates and Cholestyramine; because they increase bile cholesterol content

218
Q

TB treatment?

A

Rifampin
Isoniazid
Pyrazinamide
Ethambutol

(RIPE)

219
Q

Aminoglycoside mechanism?

A

micins

-inhibits 30S

220
Q

Clomiphene–>mechanism

use?

A

use: fertility issues/PCOS

inhibits estrogen feedback at the thalamus…thus increasing GnRH pulsing and thus increasing fertility

221
Q

What’s the difference between CML and AML?

A

CML=many bands and immature cells, but blasts20%

222
Q

Li Fraumeni tumor types

A

leukemia, sarcoma, brain, breast, adrenal

223
Q

Type II pneumocytes functions

A

surfactant secretion; regeneration of alveolar lining

224
Q

“atypical lymphocytes” on histology associated with what? lymphocytes are peusdopoding to the surrounding RBCs

A

mononucleosis

225
Q

How can you tell ALL vs AML on histo?

A

Auer rods

226
Q

What are important components of surfactant? what does the ratio to sphinogmyelin indicate

A

lecithin (Dipalmitoyl phosphatidylcholine) and phosphatidylglycerol

Lecithin/Spingomyelin >2 indicates lung maturity

227
Q

What is hypoxemia? what are 4 major causes of it?

A

low PO2 in the arterial system;

causes: hypoventilation, diffusion defect, VQ mismatch, R to L shunting

228
Q

dry cough with hypercalcemia and elevated ACE?

A

sarcoidosis

229
Q

custard/mayo food poisoning

A

staph aureus

230
Q

undercooked beef food poisoning

A

HUS/ecoli

231
Q

HUS three hallmark sx

A

hemolytic anemia, thrombocytopenia, and renal insufficiency

232
Q

result of enteropeptidase deficiency?

A

Trypsinogen cannot be converted to trypsin. thus chymotrypsinogen, carboxypeptidase, elastase are also not activated

233
Q

Nitroprusside effects vasculature how?

A

decreases afterload AND preload via vasodilation

234
Q

HPV histology

A

Koilocytes

235
Q

Chronic prednisone user undergoes surgery is at risk for what?

A

Adrenal insufficiency; thus prophylaxis should be given with a large dose of corticosteroids

236
Q

cirrhosis induced increased estrogen levels. sx?

A

spider angiomas, palmar erythema, gynecomastia, hairloss, and testicular atrophy

237
Q

endothelial/intima injury in atherosclerosis leads to vascular thickening…what mediates this?

A

SMC migration/collagen synthesis

238
Q

Diphenhydramine inhibits what receptor?

A

H1

239
Q

What drugs have antimuscarinic side effects?

A 
atrophine
H1 receptor blockers, 
traditional antipsych meds
TCA
antiparkinsonians
240
Q

What’s the most common spread modality of childhood osteomyelitis?
Where does it attack?

A

hematogenous;

metaphysis

241
Q

Number needed to harm equation

A

NNH=1/Attributable Risk

242
Q

Attributable risk? what is it? how to calculate

A

difference in the chance of disease with exposure versus disease without exposure;

disease in all exposed-disease in all unexposed

243
Q

Urea cycle produces urea and ornithine from what?

A

ammonia and arginine

244
Q

Only a few organisms needed for infection.

A

Campylobacter, Shigella, Enteromoeba histolytica, Giardia

245
Q

What kind of fetal morphology defect process is holoprosencephaly?

A

malformation; defect is in the tissue

others include–> anencephal, congenital heart disease, polydactyly

246
Q

Potter’s syndrome is an example of what kind of fetal morph defect?

A

deformation- the fact that the baby is squished

Sequence-the fact that the renal agenesis led to malformation of lungs/oligohydramnios

247
Q

amniotic band syndrome is an example of what kind of fetal morph defect?

A

disruption

248
Q

Mucormycosis treatment

A

amphotericin B

249
Q

Amphotericin B side effects

A

nephrotoxicity–>monitor hypokalemia/hypomagnesia

250
Q

Diabetic drugs ending in Flozin…what’s the mechanism

A

Ex: canagliflozin;

inhibits sodium-glucose cotransporters 2 in kidneys to decrease reabsorption

251
Q

Acute Tubular Necrosis (ATN) stages

A

initial->ischemic injury occurs
maintenance–> cast forms oligouria occurs, electrolyte abnl due to retention
recovery –>vigorous diuresis–>loss of electrolytes/dehydration

252
Q

muddy brown cast

A

acute tubular necrosis

253
Q

Kussmal sign (NOT the breathing) is a sign of what?

A

constrictive pericarditis

254
Q

pericardial knock

A

constrictive pericarditis

255
Q

how is tetanus diagnosed?

A

hx and presentation. ONLY

256
Q

Thiazide side effects.

A

hyperurecemia, hyperglycemia, hyperlipidemia, hypercalcemia,
hypotension, hypokalemia

257
Q

Halothane side effects

A

hepatic necrosis; malignant hyperthermia

258
Q 
malignant hyperthermia; 
causal agent?
what's the defect? 
lab abnormalities?
treatment?
A
  • cause: inhaled general anesthetics (halothane; succinylcholine)
  • defect: ryanidine receptors
  • labs: K increase, CK increase, myoglobin increase
    treatment: dantrolene
259
Q 
Post brain ischemic damage...
when do you see red neurons?
when do you see necrosis/neutrophils
when do you see macrophages
when do you have macroscopic liquifactive changes?
whend do you see glial scars?
A 
Red neurons- 12-24 hous
necrosis/neutrophils 24-72 hours
macrophages appear...about 3-5 days
macroscopic changes can be seen 1-2 weeks
gilal scars can be seen 2 weeks on
260
Q

suprachiasmatic nuclei function

A

circadian rythm

261
Q

supraoptic nuclei funciton

A

ADH and oxytocin

262
Q

anterior nucleus of hypothalamus function?

posterior nucleus of hypothalamus function?

A

dissapates heat–>lesion=hyperthermia

conserve heat–>lesion=hypothermia

263
Q

ventromedial nucleus of hypothalamus?

lateral nucleus of hypothalamus

A

ventromedial–>lesion leads hyperphagia and weight gain

lateral –>lesion leads to weight loss

264
Q

Cystic degeneration of the Putamen is which neurodegenerative disease?

A

Wilson’s disease

265
Q

Increased COX2 in patient with history of adenomatous polyp is at risk for what?

A

Recurrence of adenoma/adenocarcinoma; thus ASA is protective

266
Q

adenoma carcinoma sequence for colon cancer

A
  1. APC inactivation
  2. COX2 over expression/hypermethylation
  3. kras activation; DCC inactivation; p53 inactivation
  4. other abnl build up
267
Q

bitemporal heminopsia makes you think of what??

A

prolactinoma

268
Q

prolactinoma’s effect on LH/FSH, testosterone/estrogen, and GnRH

A

all are suppressed

(remember GnRH is also supporessed since prolactin usually suppresses ovulation via GnRH supp during pregnancy

269
Q

aspiration while supine affects which portions of lung

A

posterior segment of the upper R lobe/superior segment of R lower lobe

270
Q

patient with myopia improves in far sighted vision in mid40s. what is this due to?

A

Development of presbyopia (inability for lens to focus on near obj)…thus in away balances out myopia….

This is due to decreased collagen in the lens

271
Q

Injury of what nerve leads to hyperacusis

A

Stapedius nerve of the facial nerve

272
Q

How do you calculate RPF?

A

Renal plasma flow=(1-Hct)(Renal blood flow)

273
Q

spongiform gray matter changes

A

Creuzfeld Jakob’s

274
Q

Colchicine SE?

A

N/V abd pain, diarrhea

275
Q

Insomnia tx that causes priapism?

A

Trazadone

276
Q

pt with malabsorption and papulovescicular rash in linear pattern?

A

dermatitis herpetiformis

277
Q

which IL helps class switch to produce IgE?

A

IL4

278
Q

Maintenance dose equation?

A

(Cplasma at steady statex CL)/bioavailability fraction

be careful of the time unit though

279
Q

How to calculate halflife?

A

(0.7 x Vd)/CL

280
Q

How to calculate loading dose?

A

(Vd x Cplasma at steady state)/bioavailability fraction

281
Q

how does renal/hepatic disease affect loading dose and maintenance dose?

A

loading is the same

maintenance is decreased

282
Q

oral candidiasis tx?

A

nystatin

283
Q

motion sickness is treated with what classes of drugs?

A

antimuscarinic or antihistamines (with antimuscarinic action)

284
Q

Mousy/musty odor in infant dx?

A

PKU

285
Q

sumatryptan mechanism?

A

5HT1B/1D agonist on postsynaptic R

286
Q

Nitroprusside + AMS +lactic acidosis

A

Cyanide poisoning as Nitroprusside is metabolized to cyanide and NO…

287
Q

Cyanide poisoning/Nitroprusside poisoning

A

sodium thiosulfate

288
Q

Fructose can enter glycolysis via which two pathways?

A
  1. Fructokinase; aldolase; triokinase

2. Hexokinase

289
Q

Clinical signs of Sarcoidosis?

A 
Schaumann calcifications
Astroid bodies/ACE increase
Respiratory/renal disease
Calcium increase
Ocular lesions
Immune granulomas
D increase/Diabetes insipidus
Osteopathy
Skin erythema nodosum
Intrastitial pulmonary fibrosis
Seventh nerve palsy
290
Q

liver abscesses in developing countries are likely what?

developed countries?

A

entamoeba/echinococcal–developing

bacteria such as staph

291
Q

Fetal Adrenal gland structure and what does it secret?

A

inner fetal zone only secrets androgens (due to lack of 3 beta hydroxysteroid converting of pregnenolone to progesterone)

Adult zone in the periphery will secret cortisol, but in small amounts. fetal cortisol secretion is increased by CRH

maternal and fetal cortisol contributes to lecithin secretion

292
Q

Lecithin increase in late pregnancy is stimulated by what primarily? other things?

A

cortisol primarily

other things: prolactin, insulin, sex hormones, thyroid hormone, and catecholamines

293
Q

esophageal cancer associated with dysphagia is more likely squamous? or adenocarcinoma?

A

squamous…adenocarcinoma would be too far down for dysphagia sensations.

294
Q

firstline treatment for acute gout? what if they’re contraindications? what are some contraindications?

A

NSAIDs… give colchicine if contraindicated via renal disease or peptic ulcer

295
Q

Fibrates mechanism? SE?

A

Fibrates inhibit 7alpha hydroxylase thus decreasing cholesterol conversion to bile acid.

thus increase of cholesterol..leads to gallstones

296
Q

mRNA synthesis is accomplished by which polymerase?

A

RNA pol II

297
Q

Where is TATA box in relation to the coding sequence?

A

about 25 bp before

298
Q

How does IL2 act to counter cancer?

A

It stimulates primarily T cells and NK cells to kill cancer cells.

It also stimulates B cells and monocytes

299
Q

How are osteoblasts connected to each other? why are they connected so?

A

gap junctions; to exchange info on metabolic components… thus monitoring calcium levels…etc

300
Q

direct hernia… what is at fault for its occurrence?

A

weak/breakdown of transversalis fascia

301
Q

stab wound to L 5th intercosytal space at sternal border? mid clavicular?

A

sternal border–>R ventricle

mid clavicular–>L ventricle; but MORE LIKELY the L lung OVERLAYING the heart

302
Q

pattern of ventilation versus perfusion from lung apex to base?

A

both incrase as gets closer to base, but perfusion increases much more than ventilation

303
Q

3 zones of lung perfusion

A

Zone 1: no perfusion under nl circumstance because alveolar pressure is greater than blood
Zone 2: arterial pressure can over come alveolar pressure in systole –>periodic perfusion
Zone 3: constant perfusion bc arterial pressure is always larger than alveolar

304
Q

What are PTH and calcium like in primary osteoporosis?

A

NORMAL!!!!!!!!!

305
Q

What does S4 sound like?

A

a presystolic sound occuring right before S1

306
Q

Where/when is S4 best appreciated?

A

apex during expiration while pt is decubitus

307
Q

if pt lacks PDH… what kind of diet should they follow?

A

ketogenic diet

308
Q

Which are the soley ketogenic amino acids?

A

Leucine and lysine

309
Q

Which amino acids are both glucogenic and ketogenic?

A

phenylalanine, isoleucine, tryptophan

310
Q

What is the difference between glucogenic/ketogenic amino acids?

A

glucogenic amino acids feed into glycolysis or TCA cycle; ketogenic are precursors of acetoacetate

311
Q

What test is able to distinguish between the two types of leprosy? why can this work?

A

Lepromin test is to test for Th1 response against M leprosy
Tuberculoid type will develop induration due to strong Th1 response
Lepromatous leprosy will not react to Lepromin test because it has weak Th1 response and some Th2 response.

312
Q 
Orotic aciduria
What is accumulating?
What is the defect?
sx? 
tx?
A

orotic acid accumulation due to mutation of OMP decarboxylase and orotate phosphoribosyl transferase thus cannot convert orotic acid to UMP;
sx include: neuro sx, hypochronic megaloplastic anemia, and growth retardation

313
Q

What is Gardner’s mydriasis? tx?

A

antimuscarinic effects from Jimson weed poisoning… it’s the same sx as atropine over dose….
Treat with Physostigmine

314
Q

sx of lead poisoning?

blood smear findings

A

COLICKY abd pain, constipation, HA, decreased memory
Bruton’s line
peripheral neuropathy causing Wrist/foot drop

hypocrhomic anemia with basophlic stippling

315
Q

Acute effect on CBC with corticosteroid administration

A

Increased neutrophil due to demarginalization;

Decreased everything else; lymphocytes, monocytes, eosinophils, basophils

316
Q

which adrenergic receptor increase insulin secretion; which decreases it?

A

alpha2 decreases insulin

beta 2 increases insulin

317
Q

sharp chest pain that gets slightly better when pt leans forward?

A

pericarditis

318
Q

What is the most common cardiac manifestation of SLE?

A

pericarditis

319
Q

bacteroides treatment?

A

piperacillin tazobactam

320
Q

what is an add on to therapy that prolongs pt’s life in Stage 3 and 4 Heart failure?

A

spironolactone/eplerenone

–>inhibition of aldosterone (which has cardiac remodeling properties)

321
Q

WBC cast?

A

pyelonephritis

322
Q 
Cardiac associations
1Down syndrome
2DiGeorge
3Friedreich's ataxia
4Marfan
5Tuberous sclerosis
6Turner's
A

1: ASD ostium primium; AV regurgitation
2. Tetralogy of Fallot; aortic arch abnormalities
3. Hypertrophic cardiomyopathy
4. cystic medial necrosis of the aorta
5. rhabdomyoma–>valve obstruction
6. aortic coarctation

323
Q

gamma hemolytic, grows on saline and bile salt agar. pyrrolidonyl arylamidase positive.
What organism is this? where does it reside?

A

enterococcus; resides in nl flora of GU and GI system

324
Q

allergic asthmatic with frequent excerbations and poor lung functioning. Uses steroid inhaler and short acting beta agonist already. Have tried long acting beta agonist as well… What is the best next add on?

A

Omalizumab. IgE antibody

325
Q

lower trunk of brachial plexus carries nerves from which spinal levels?

A

C8-T1

ALL innervate intrinsic muscles of the hand

326
Q

10 years after radical mastectomy…what cancer is the patient at risk of?

A

lymphangiosarcoma __>endothelia of lymphatics

327
Q

Insulin acts at tyrosine Kinase R… What are its down stream actions?

A

activation of glycogen synthase

and protein phosphatase (which inactivates glycogen phosphatase)

328
Q

how to assess severity of mitral stenosis with auscultation?

A

interval between A2 and snap opening… shorter is worse meaning more pressure

329
Q

Major functions of HMG shunt

A

produce Ribose-5-phosphate and NADPH for reduction power

330
Q

does DDAVP cuse significant vasoconstriction?

A

no because it does not strongly activate V1

331
Q

How does DDAVP relieve minor bleeding in vWB disease patients?

A

it induces endothelial cells to release vWBF

332
Q

Von Willebrand factor interacts with what clotting factor?

A

non covalently stabilizes factor VIII

333
Q

What is cord factor?

A

TB virulence factor that inactivates neutrophils, damages mitochondria and increases TNF

334
Q

myoclonic seizures with exercise

A

Myoclonic epilepsy with ragged red fibers (MERRF) mitochondrial disease

335
Q

Leber hereditary optic neuropathy. mode of transmission?

A

mitochondrial

336
Q

beta lactams are irreversibily binding to what?

A

they bind penicillin binding proteins such as Transpeptidase that crosslinks the peptidoglycan…NOT the cell wall itself.

337
Q

which diuretic causes the most amount of water loss? thiazides versus loop?

A

loop

338
Q

Pituitary apoplexy? how to differentiate from berry aneurysm?

A

apoplexy occurs ususaly in a background of exisitng adenoma… Thus pt is more likely to have both chronic (including bilat temporal hemianopsia, decreased libido, and cardiovascular collpase due to adrenal insuff) and acute symptoms

berry aneurysm rupture is mostly just acute symptoms

339
Q

satellite phenomenon?

A

when haemophilus only grows near beta hemolytic staph aureus because it supplies NAD (factor V) to haemophilus

340
Q

how many liters is the plasma compartment?

A

3-5 L

341
Q

Why does cholera produce “rice water stool”?

A

It is milky in color because of the mucin and sloughed off epithelial cells

342
Q

acute viral hepatitis.. histology findings

A

balloon degeneration, counsilman bodies, mononuclear infiltrates

343
Q

gag proteins? (HIV)

A

p24 and p7

344
Q

env proteins?

A

p41, p120

345
Q

pol protein?

A

reverse transcriptase

346
Q

which genes are required for viral gene synthesis in HIV?

A

rev, tat, reverse trascriptase

347
Q

which cytokines are secreted by Th2 in differentiation of IgE

A

IL4 an IL13

348
Q

What does Rinne test for? What does it mean when the sound is louder on the mastoid than air?

A

test for whether there’s a neurosensory or conduction error. Nl should have louder in air…
If louder on mastoid –>conduction defect
If not heard on mastoid–>neurosensory defect

349
Q

What does weber test test for?

A

Determines which side hearing defect is on.

  • If conduction defect is present abnormal side will be louder because that’s the only thing they’ll be hearing
  • if it’s neurosensory then the abnormal side will be quieter.
350
Q

what diarrheal agent can be transmitted both from uncooked foods and domestic animals?

A

campylobacter

351
Q

which enteritis agent causes pain that mimics appendicitis?

A

Campylobacter

352
Q

what is the difference between an ulcer and erosion?

A

erosion does NOT penetrate muscularis mucosa…ulcers do.

muscularis mucosa is apart of the mucosa. underneath is submucosa

353
Q

What is winter’s formula? what does it predict

A

PaCO2=1.5bicarb+8+/-2

it predicts respiratory compensation in the event of metabolic acidosis. If PCO2 is much different than prediction… it is likely that there’s respiratory contribution to metabolic derrangement too…

–>ex: DKA metabolic acidosis, may lead to pulmonary edema causing compounded respiratory acidosis

354
Q

Naloxone what is it’s mechanism? what is it used for?

A

opioid receptor blocker (all three receptors). used for opiod drug OVER DOSE (Heroin is an opioid)

355
Q

What is Flumazenil? What is it used for?

A

Benzodiazepine receptor blocker. Used for Benzo overdose

356
Q

diarrhea, rhinorrhea, sneezing, pupillary dilation, nasal stuffiness, N/V denotes withdrawal from what substances?

A

Opioids

357
Q

Pt with dyspnea and elevated liver enzymes; Acid schiff stain pink granules

A

alpha 1 antitrypsin disease

358
Q

How to treat opiod withdrawl in infant?

How to treat opioid withdrawal in adult?

A
  • Infant Tincture of opium

- adult: methadone/ buprenorphine and PENTAZOCINE (partial agonist)/ Suboxone (buprenorphine+naloxone

359
Q

Status epilepticus. What is this? how to treat?

A

tonic clonic seizure lasting more than 30 minutes or continuous seizure episodes without regaining consciousness.

Treatment: 1. lorazepam + phenytoin

  1. add phenobarbital
  2. intubate and put on general anesthesia
360
Q

Pol gene mutation accomplishes what for the virus?

env gene mutation accomplishes what for the virus?

A

pol mutation results in drug resistance

env gene results in hiding from immune system

361
Q

what are 4 major ways of cellular signalling receptors?

A

-steroid R, channel R, G protein, enzyme linked

362
Q

what’s different about MAPK pathway and JAK/STAT?

what things are signalled through which receptor?

A

MAPK is receptor tyrosine kinase (with intrinsic enzyme activity)
-All the growth factors!

JAK/STAT is receptors linked to other things with tyrosine kinase activity

  • IL2
  • prolactin
  • Growth hormone
  • Cytokines
363
Q

accumulation of proprionic acid indicates missing what enzyme? which amino acids will worsen the disease?

A

missing proprionyl coA carboxylase which converts proprionyl coa to malonylcoa.

Ile, Met, Val, Thr will make proprionyl coa levels even higher thus worsening the disease

364
Q

premature baby, intracranial hemorrhage?

A

germinal matrix bleeding in to ventricle

365
Q

cardinal vein becomes what

A

SVC

366
Q

Vitellin vein becomes what?

A

portal vein system

367
Q

tetrahydrobiopterin is a cofactor for synthesis starting with which amino acids?

A

tryptophan and phenylalanine

368
Q

anti centromere and anti topoisomerase I

A

systemic scleroderma; Calcinosis, Raynaud, Esophageal dysmobility, Sclerodactyly, Telangiectasia (CREST)

369
Q

anti dsDNA

A

SLE primary

370
Q

anti histone

A

drug induced SLE; Procainamide, hydralazine, isoniazid, phenicillinamine

371
Q

anti phospholipid associated with what?

A

hypercoagulability and miscarriages

372
Q

is Rheumatic fever associated with impetigo or pharyngitis or both?
what about post-strep glomerulonephritis?

A

rheumatic fever only occurs with pharyngitis;
post strep glomerulonephritis can occur with either impetigo OR pharyngitis (think kidney has to finely filter all blood, versus heart is only affected by what’s hear in large quantities)

373
Q

What is alveolar ventilation? what’s the forumla?

A

alveolar ventilation is amount of air breathed (minute ventilation) without the deadspace in 1 minute.

alveolar ventilation=(tidal vol-deadspace) x breaths/minute
versus minute ventilation=tidal vol x breaths/min

374
Q

what is anatomic deadspace?

what is physiologic deadspace?

A

anatomic dead space is the airway–>the part that doesn’t take part in gas exchange
physiologic dead space=anatomic dead space +parts of lung that’s not well perfused for gas exchange.
=tidal vol x (PaCO-PECO)/PaCO

375
Q

shock, hypoglycemia, hyponatremia, hyperkalemia…what do you think of?

A

adrenal crisis

376
Q

Misoprostol mechanism? use?

A

prevention of NSAID induced ulcers… it’s an Prostaglandin E1 analog

377
Q

epigastric pain that is alleviated with food

A

ulcer, treat with abx

378
Q

H pylori treatment

A

Tetracycline, clarithromycin, amoxicillin, metronidazole

379
Q

Pioglitazone acts on what receptor? what does it increase?

A

PARR-y; increase of adiponectin

380
Q

What is the drug of choice for Hairy Cell leukemia? what is it’s mechanism? what’s special about it?

A

Cladribine–> a purine analog that causes chain termination

It cannot be broken down by adenosine deaminase thus can reach high levels in plasma. Renal excretion in original form.

381
Q

deQuervain’s subacute granulomatous thyroiditis sx/findings?

A

post viral infection, pain/”discomfort”, decreased iodine uptake, incrased ESR

382
Q

What hormones have intracellular receptors? which are nuclear and which are cytoplasmic that migrate to the nucleus?

A

T3 and T4 have intranuclear receptors

Glucocorticoids, mineralocorticoids, sex hormones will bind intracytoplasmically and migrate to nucleus

383
Q

Eclampsia treatment?

A

Magnesium sulfate

384
Q

which step in glycolysis needs NAD?
Where is NAD needed in TCA?
How is NADH recycled back to NAD?

A

glyceraldehyde 3 phos conversion to 1,3 bisglyceraldehyde. via glyceraldehyde phosphate dehydrogenase.

TCA req it both going from Isocitrate to alpha ketoglutarate an continuing to succinyl coa

rcycled in electron chain transport OR anaerobic respiration

385
Q

B27 HLA type diseases are associated with what musculoskeletal findings? respirtory? cardiac?

A

enthesopathy (tendonitis), restricted breathing due to costovertebral/costosternal joint immobility, aortic insufficiency due to aortitis.

386
Q

will you see RF in B27 diseases?

A

no

387
Q

what are c-Jun and c-Fos?

A

transcription factors that bind leucine zipper

388
Q

gap between first and second toe

A

Down syndrome

389
Q

polar granules in gram positive bacteria in clusters resembling V/Y shape

A

Diphtheria

390
Q

which kidney stones are radiolucent?

A

Uric acid ONLY

391
Q

Which vitamins in excess can cause renal stones?

A

D, C

392
Q

What substances/conditions can precipitate calcium stones?

Treatment?

A

ethylene glycol, vitamin C, and crohn’s disease

Treat with thiazide and citrate

393
Q

which kidney stones precipitate at low pH?

A

uric acid and cysteine

394
Q

CCK is made by what cells? where?

A

I cells in the duodenum/jejunum, secreted upon sensing fats

395
Q

What is “reverse T3”

A

It’s an inactive metabolite of T4

396
Q

What is Nesiritide? what cellular effect does it have? what is it used for?

A

It’s an analog of ANP/BNP, it promotes both veno and arterial dilation. It increases cGMP.
Used for L ventricular dysfunction induced cardiac failure

397
Q

ESRD… what happens to phosphate? calcium? PTH?

A

increased phosphate and decreased vitamin D–>decreased calcium–>increased PTH…can cause bone abnormalities

398
Q

Steven Johnsons is associated with what neuro drugs?

A

Phenytoin, phenobarbital, carbamazepine, and lamotrigine

399
Q

Where is ANP produced? Where is BNP produced? in what condition is BNP produced?

A

ANP is from atria; BNP is produced by ventricle in response to stress and volume overload (pathogenic hypertrophy)

400
Q

Which viruses bud off using host cell membranes?

A

Herpes family viruses

401
Q

Digoxin is eliminated how? what are toxicity side effects?

A

renal elimination; SE: visual/color changes, N/V, abd pain, diarrhea, fatigue, dizziness, delirium, confusion, junctional escape beats/vtach/fib

402
Q

What is Varenicline?

A

partial agonist of the nicotinic ach receptor. Thus relieving cravings and yet will bring down the effect if pt smokes

403
Q

What is Quellung reaction?

A

Its using antibodies to detect capsules of organisms causing pneumonia

404
Q

Spironolactone what are all the things it does?

A

It inhibits aldosterone R inhibitor, also decreases cardiac fibrosis.
Also inhibits testosterone

405
Q

which antivirals depend on viral thymidine kinase for phosphorylation?

A

Famcyclovir
Acyclovir
Gancyclovir

—>AKA ALL THE VIRS

406
Q

Afib treatment first line?

Second line?

A

firstline is calcium blockers and betablockers

second line is digoxin

407
Q

Digoxin toxicity treatment?

A
  • GI activated charcol
  • Insulin, hemodialysis
  • Digoxin fragment antibodies
408
Q

How is K affected in usage of Digoxin?

A

Digoxin binds to the K receptor of Na/K ATPase…thus
toxicity…you often see hyperkalemia
however, hypokalemia may potentiate a patient in having side effects

409
Q

IL12 what does it do? What if it’s deficient what infections do you get? how do you fix it?

A

without IL12 T cells cannot become Th1 cells thus no IFNY will be present to activate macrophages…
Thus, these patients are prone to mycobacterial infections…. because you can’t keep them in the granulomas

410
Q

pt with hx of hyperlipidemia and CAD, extreme pain 30-40 min post meal. weight loss hx. mucosal and villi atrophy on endoscopy

A

celiac/SMA/IMA atherosclerotic plaques can block off blood flow. worst 30 minutes post meal due to increased cardiac demand

411
Q

night blindness

A

zinc or vitamin A def

412
Q

painful papulovesicular rash with central clearing and center is bronze colored and indurated. Located on extremities, face, and groins. Pt also has glossitis/chelitis

What is this called? what are some ddx?

A

this is called necrolytic migratory erythema. Due to hyperglycemia… Thus could be seen in uncontrolled DM or glucagonoma

413
Q

Aflotoxin. Which strain is the worst? what does it cause genetically and molecularly?

A

B1 is the worst. causes G-T transversion in the p53 gene.

414
Q

psuedomonas first line treatment?

second line?

A

first line is Ticarcillin and piperacilin

second line is ceftazidime and cefapime

415
Q

Shigatoxin in shigella and EHEC action?

A

inhibits 60S subunit in human cells leading to cell death

416
Q

Which e.coli does not ferment lactose?

A

EHEC

417
Q

investigator’s decision is influenced by prior knowledge of exposure. What kind of bias is this?

A

Observer’s bias

418
Q

young patient presenting with tetany. History show recurrent infections. Labs show hypocalcemia. Pt also has cardiac abnormalities… what is this?

A

DiGeorge

419
Q

ataxia, loss of fine sensation/proprioception, and big heart? what is the genetic defect

A

Friedrich’s ataxia. chromosome 9 GAA triplet repeat. progresive disease

420
Q

Galactose metabolism

A

Galactose –(galactokinase)–> Galactose-1-phosphate–(uridyltransfrerase)—>glucose-1-phosphate

421
Q

classic galactosemia is missing what enzyme

A

uridyl transferase.

422
Q

blancheable nests of capillaries on skin, ataxia, and frequent pneumonias. What is this? what is the defect?

A

Atxia Telangiectasia
ATM gene mutation–> failure to mend double stranded breaks
Triad: Ataxia, IgA deficiency, Angioma

  • increased AFP
  • decreased IgA, IgG, IgE, lymphopenia
423
Q

What are two common mutations that causes SCID?

A

IL2R gamma chain; adenosine deaminase

424
Q

String sign

A

Crohn’s narrowing of lumen

425
Q

culture negative endocarditis

A

HACEK organisms- Haemophilus, actinobacillus, Cardiobacterium, eikinella, Kingella

Others include bartonella, Coxiella, histo, mycoplasma, chlamydia

426
Q

what are the sources of ATP for myocytes? what is the main source? which one is more energy efficient and why?

A

myocytes get energy from glycolysis, glucose oxidation, and FA oxidation.

Main source is FA oxidation but it is least efficient since it needs more O2 for every ATP generated. Therefore when O2 is comprmised it may be mroe efficient to induce heart to use more glucose derived resources

427
Q

CD14

A

monocytes

428
Q

mononucleiosis

What organism, what cells are infected, what cells are abnl?

A

EBV infect B cells, CD8 T cells are abnormal

429
Q

What is cardiac stunning?

A

short term ischemic event that leads to transient loss of contractility that quickly recovers

430
Q

What is cardiac preconditioning

A

heart gaining resistance to ischemia from recurrent exposures to ischemia

431
Q

What is cardiac hibernation

A

long term exposure to ischemia inducing heart to decrease in contractility by down regulating contractile elements (calcium channels/beta adrenergic R) and increase relaxation elements (NOS, TNFalpha). However, if blood supply is reestablished, contraction will be regained

432
Q 
What is the renal handling of (in PT)...
PAH
Creatinine?
Inulin?
urea
Na/Cl
bicarb
glucose/proteins?
A

PAH is freely filtered and secreted (approximates renal plasma flow)
creatinine is freely filtered and sliiiiightly secreted
inulin is freely filtered and not secreted or reabs
urea is freely filtered and poorly slightly reabsorbed…but to a lesser extent where it still accumulates in the tubules
Na/Cl moves largely with water in the proximal tubule
bicarbis actively reabsorbed due to CA
protein and glucose are almost all reabsorbed

433
Q

Pulsus parvus et tardus

A

slow rise of carotid pulse in systole… indicative of aortic stenosis

434
Q

RPGN…what cells/proteins do you expect to find?

A

macrophages, glomerular parietal cells, and fibrin!

FIBRIN is the crest

435
Q

name 3 betalactamase inhibitors

A

clavulanic acid, sulbactam, tazobactam

436
Q

increased PRPP activity is putting pt at risk for what?

A

Gout

437
Q

Gower hemoglobin.

When is it produced? what are subunits? where is it produced?

A

embryonic Hb zeta2epsilon2–>yolk sac

438
Q

Signs of Kwasaki disease?

A 
Children of asian decent; vasculitis of medium sized vessels
fever for >5 days plus...4 of these
conjunctivitis
mucositis -strawberry tongue
cervical lymphadenopathy
edema, erythema, desquamation of BUE/BLE
rashes diffusely
439
Q

What are kids with Kwasaki disease at risk for?

A

coronary aneurysm

440
Q

1 year old oral thrush and progressive lymphopenia born to IV drug user mother… what does the baby have? how could this have been prevented?

A

HIV, vertical transmission could be reduced by prenatal zidovudine

441
Q

what is alpha interferon used to treat?

A

Hep B/C, condyloma accuminatum

hairy cell leukemia, and kaposi sarcoma

442
Q

All of the cranial nerves are covered by oligodendrocytes except for which one? what is it covered by?

A

II –>schwan cells

443
Q

verocay bodies

A

Schwanoma findings –> non nucleated areas (eosinophilic) dispersed in antoni A pattern cells

444
Q

pancreatic exocrine enzymes are involved in digestion of what?

A

proteins, fats, and carbohydrates

445
Q

Describe sweat gland adrenergic stimulation

A

preganglionic neuron release Ach to stimulate postganglionic. post ganglionic ALSO release Ach to stimulate the sweat glands

THIS IS ADRENERGIC NOT PARA

446
Q

high QRS voltage

A

cardiomyocyte hypertrophy

447
Q

action of bradykinin?

A

vasodilator, increase permeability, mediates pain

448
Q

ACE I SE?

A

cough, angioedema
renal insufficiency, hyperkalemia,
hypotension
teratogen

449
Q

what is different about phenoxybenzamine vs phentolamine?

A

phenoxybenzamine is irreversible
phentolamine is reversible

both are nonselective alpha inhibitors

450
Q

polyuria/polydypsia in bipolar pt?

A

nephrogenic diabetes insipidus.

Lithium
Movement (tremor)
Nephrogenic DInsipidus
HypOthyroidism
Pregnancy (Ebstein)
451
Q

Genetic torsades diseases; how to differentiate?

A

Jervall and Lange-Nielson: deafness with torsades
Romano-Ward: no deafness

both are defective Ik channel

452
Q

mutations in beta chain of myosin?

A

hereditary hypertrophic myopathy

453
Q

Torsades de pointe causal drugs

A

Party at Soto with Queen, clean queen, Risky Mac, Teasing with Thighs

Sotalol, Quinidine, chloroquine, Rispiradone, Macrolides, Protease inhibitors, thiazides

454
Q

ectopic pregnancy treatment of choice <6weks

A

Methotrexate

455
Q

Sulfonamide mechanism?

A

Folate precursor, PABA, analog…thus inhibiting prokaryokte folic acid synthesis

456
Q 
What colored granules are...
Lipofuscin
hemosiderin
melanin
glycogen
hyaline
A

lipofuscin-yellow brown (lipid oxidation)
hemosiderin-brown (or red on prussian blue)
melanin-dark brown/black
glycogen-clear (like clear cell renal carcinoma)
hyaline-glassy solid pink

457
Q

why do babies of DM mothers experience postpartum transient hypoglycemia?

A

hyperglycemia bit maternal insulin DOES NOT cross placenta. Thus baby secrets a lot of insulin. Once the high glucose source is withdrawn… baby becomes hypoglycemic

458
Q

which two bones articulate with radius?
Which bone articulates with the thumb
which bone articulates with middle finger?

A

scaphoid and lunate
thumb–>tripezium
middle finger–>capitate

USMLE (9 decks)

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