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USMLE 1 > Review Questions > Flashcards

Review Questions Flashcards

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USMLE® Step 1 flashcards
1
Q

What adult structures are derived from the 3rd aortic arch?

A

Common carotid and proximal part of internal carotid

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2
Q

What adult structures are derived from the 2nd aortic arch?

A

Stapedial artery, hyoid artery

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3
Q

What adult structures are derived from the 4th aortic arch?

A

L: aortic arch
R: proximal part of subclavian artery

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4
Q

What adult structures are derived from the 6th aortic arch?

A 
Proximal part of pulmonary arteries (L and R)
Ductus arteriosus (L)
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5
Q

How does a branchial cleft cyst arise?

A

Failure of cervical sinus to obliterate; branchial cleft origin (ectoderm); located in lateral neck and does NOT move when PT swallows

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6
Q

Outline the heart tube formation

A

Heart tube elongates, folds into S-shape with atrial chamber posterior and ventricular anterior, anterior grows to incorporate SVC and pulmonary vein, septum primum forms, septum secundum forms

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7
Q

3 causes of ASD

A
  • Ostium secundum overlaps foramen ovale
  • Absence of septum secundum
  • Neither septum primum or septum secundum forms
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8
Q

What does the truncus arteriosus give rise to?

A

Ascending aorta and pulmonary trunk

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9
Q

What does the L. horn of the sinus venosus give rise to?

A

Coronary sinus

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10
Q

What do the R. common cardinal vein and R. anterior cardinal vein give rise to?

A

SVC

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11
Q

What does the bulbus cordis give rise to?

A

Smooth parts of the L & R ventricles

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12
Q

What does the R. horn of the sinus venosus give rise to?

A

Smooth part of the R. atrium

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13
Q

What gives rise to the trabeculated L & R atria?

A

Primitive atria

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14
Q

What gives rise to the trabeculated L & R ventricles?

A

Primitive ventricles

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15
Q

Which fetal vessel has the highest oxygen content?

A

Umbilical vein > Ductus venosus > IVC > R. atrium

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16
Q

What is Eisenmenger syndrome?

A

L –> R shunt leads to incr. pressure in the pulmonary circuit which leads to Pulmonary HTN –> reversal of shunt R–>L

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17
Q

What is the most common congenital cardiac anomaly?

A

VSD: failure of endocardial cushions to fuse

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18
Q

What is the most common congenital cause of early cyanosis?

A

Tetralogy of Fallot

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19
Q

How can MVO2 be decreased in ischemic situations?

A

Decr. afterload, Decr. contractility, Decr. HR

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20
Q

What changes will increase SV at a given preload?

A

Sympathetic stimulation, ionotropic drugs, incr. intracellular Ca, decr. extracellular Na

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21
Q

What factors affect stroke volume?

A

Contractility, Preload, Afterload

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22
Q

What effect does squatting have on SV?

A

Decr. SV by incr. afterload

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23
Q

What infection does C. trachomatosis (A-C) cause?

A

Eye infection; occurs in Africa

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24
Q

What infection does C. trachomatosis (D-K) cause?

A

STD, PID, Urethritis, Neonatal conjuctivitis

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25
Q

What infection does C. trachomatosis (L1-L3) cause?

A

Lymphogranuloma venerum

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26
Q

What is Cor Pulmonale?

A

RHF d/t pulmonary disease

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27
Q

What are the signs of RHF?

A
  • Peripheral edema
  • JVD
  • Hepatosplenomegaly
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28
Q

What are the signs of LHF?

A
  • Cardiac dilation
  • Dyspnea on exertion
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Pulmonary congestion sx i.e. Rales
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29
Q

What medications are used to tx Acute HF?

A

LMNOP

-Loop diuretics, Morphine, Nitrates, Oxygen, Positioning/Pressors

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30
Q

How is Coxiella burnetti different from the other Rickettsial spp?

A

(-) Weil-Felix rxn, No vector, aerosol transmission of spore, No rash, interstitial pneumonia

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31
Q

What serum lab marker helps assess oxygenation of tissues?

A

Lactic acid

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32
Q

Where does the QRS complex fall in relation to valvular dynamics?

A

MV closure

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33
Q

What is the most common protozoal infection in the U.S.?

A

Toxoplasma gondii

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34
Q

What is teh most common helminthic infection in the U.S.?

A

Enterobius vermicularis

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35
Q

What murmurs are heard best in the L. Lateral decubitus position?

A

MV Stenosis, MV Regurgitation, L. sided S3, Late S4

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36
Q

Rumbling late diastolic murmur with an opening snap

A

Mitral stenosis

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37
Q

Pansystolic murmur that is best heard at L. Lower sternal border and radiates to the R. Lower sternal borner

A

Tricuspid regurg or VSD

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38
Q

Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Left ICS

A

Pulmonic stenosis

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39
Q

Late systolic murmur preceded by a mid-systoic click

A

MV Prolapse

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40
Q

Crescendo-decrescendo systolic murmur that is best heard in the 2nd-3rd Right ICS

A

Aortic stenosis

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41
Q

Early diastolic decrescendo murmur heard best along L. side of sternum

A

Pulmonic Regurg

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42
Q

Late diastolic decrescendo murmur heard best along L. side of sternum

A

Tricuspid stenosis

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43
Q

What drugs cause a disulfiram-like rxn?

A

Metronidazole, Cephalosporins, 1st gen. Sulfonylureas

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44
Q

What are the 5 Hereditary Thrombosis syndromes

A
  • Factor V Leiden
  • Prothrombin 20210
  • Protein C deficiency
  • Protein S deficiency
  • Antithrombin deficiency
45
Q

Preferred pharmacologic treatment of Aortic dissection

A

B-blockers

46
Q

What are the Non-Dihydropyridine CCBs?

A

Verapamil, Diltiazem

-block Ca-channels at pacemaker cells to decr. contractility

47
Q

What are the Dihydropyridine CCBs?

A

Nifedipine, Amlodipine, Felodipine, Nicardipine, Nisoldipine

-cause vasodilation by acting on VSM

48
Q

What antihypertensives are safe to use in pregnancy?

A
  • Hydralazine
  • Methyldopa
  • Labetalol
  • Nifedipine
49
Q

What drug causes First dose orthostatic hypotension

A

a1-blockers (-zosin)

50
Q

What drug is Ototoxic esp. with aminoglycosides

A

Loop diuretics

51
Q

What drug causes Hypertrichosis

A

Minoxidil

52
Q

What drug causes Cyanide toxicity

A

Nitroprusside

53
Q

What drug causes Dry mouth, sedation, severe rebound HTN

A

Clonidine (a2 agonist)

54
Q

What drug causes Bradycardia, impotence, asthma exacerbation

A

B-blockers

55
Q

What drug causes Reflex tachycardia

A

Nitrates, Hydralazine, Diphenhydramine

56
Q

Avoid this drug in PTs with sulfa allergy

A

Loop and Thiazide diuretics

57
Q

What are the risk factors for Coronary Artery Dz

A

Smoking, HTN, low HDL, age >45, family hx Congestive Heart Dz

58
Q

How do free radicals damage cells?

A

Lipid peroxidation, Protein modification, DNA breakage

59
Q

Which vitamins have anti-oxidant properties?

A

A, C, E

60
Q

Which enzymes participate in elimination of free radicals?

A
  • Catalase
  • Superoxide dismutase
  • Glutathione peroxidase
61
Q

What is the role of TGF-B

A

Angiogenesis, Fibrosis, Cell Cycle arrest

62
Q

What are the Granulomatous diseases?

A
  • B. henselae (cat scratch), F. tularensis, L. monocytogenes, M. leprae, M. tuberculosis, T. pallidum, Schistosomiasis, Fungal infections (histoplasmosis, blastomycosis)
  • Berylliosis
  • Churg-Strauss
  • Crohn’s
  • Granulomatosis with polyangiitis (Wegener’s)
  • Sarcoidosis
  • Chronic Granulomatous dz
  • Foreign bodies
63
Q

What is the role of TNF-a

A
  • Inflammatory cytokine

- Induces and maintains granuloma formation

64
Q

What cytokine activates macrophages

A

IFN-y; produced by Th1 cells

65
Q

Disease states with incr. ESR

A
  • Most anemias
  • Infections; esp. Osteomyelitis
  • Inflammation; i.e. Temporal Arteritis
  • Cancer
  • Pregnancy
  • Autoimmune DO
  • Polymyalgia Rheumatica
66
Q

Disease states with decr. ESR

A
  • Sickle Cell anemia
  • Polycythemia
  • CHF
67
Q

How does Iron cause toxicity?

A

Peroxidation of membrane lipids –> cell death

-Chronic poisoning can lead to metabolic acidosis (within 6-72hrs)

68
Q

What are the acute phase reactive proteins?

A

Fibrinogen, CRP, Ferritin, ESR

69
Q

What organs does Primary Amyloidosis affect?

A
  • Renal –> Nephrotic syndrome
  • Cardiac –> Restrictive cardiomyopathy, arrhythmias
  • Hematologic –> Easy bruising
  • GI –> Hepatomegaly
  • Neurologic –> Neuropathy

*IgLight chains

70
Q

What conditions are associated with Secondary Amyloidosis?

A
  • Rheumatoid arthritis
  • IBD
  • Spondyloarthropathy
  • Protracted infection

*serum amyloid A

71
Q

Dialysis-related Amyloidosis

A

B2-microglobulin

-may present as carpal tunnel syndrome

72
Q

What type of amyloid is present in Heritable Amyloidosis?

A 
Mutated Transthyretin (TTR)
-ATTR neurologic/ cardiac amyloidosis
73
Q

What type of amyloid is present in Senile Amyloidosis?

A

Normal TTR

74
Q

Amyloid deposition in Alzheimer’s disease

A

Amyloid-B protein from APP

75
Q

Amyloid deposition in DM II

A

Amylin deposition in pancreatic islets

76
Q

Amyloid deposition in Medyllary thyroid carcinoma

A

Calcitonin –> A-Cal

77
Q

What is multi-drug resistance protein I?

A

MDR1 is expressed by some cancer cells to pump out toxins- including chemotherapeutic agents; mechanism of decr. responsiveness to chemotherapy

78
Q

What cellular change is characterized by proliferation, loss of cellular orientation, shape and size?

A

Dysplasia

-often pre-neoplastic but is reversible

79
Q

What is desmoplasia?

A

Fibrous tissue formation in response to neoplasm i.e. Linitis plastica (diffuse stomach cancer)

80
Q

What has more prognostic value- Tumor Stage or Grade?

A

Stage

-degree of localization/ spread based on site and size of primary lesion, spread to regional LN, presence of metastases

81
Q

Carcinoma

A
  • Epithelial origin

- Lymphatic spread

82
Q

Sarcoma

A
  • Mesenchymal origin; mesenchymal tumors rarely TRANSFORM into malignant
  • Hematogenous spread
83
Q

Which carcinomas spread hematogenously?

A
  • Renal cell carcinoma
  • Hepatocellular carcinoma
  • Follicular carcinoma of thyroid
  • Choriocarcinoma
84
Q

What are the mediators of Cachexia?

A

TNF-a, TFN-y, IL-6

-Cachexia occurs in chronic disease states i.e. cancer, AIDS, heart failure, TB

85
Q

How do oncogene mutations increase cancer risk?

A

Gain of function mutation in 1 allele

86
Q

How do tumor suppressor mutations increase cancer risk?

A

Loss of function mutation in both alleles

87
Q

What area of lymph nodes increases in extreme cellular immune responses

A

Paracortex (T-cell region)

88
Q

What are the components of lymph?

A
  • Interstitial fluid with high protein content
  • Chylomicrons with high TG content
  • Antibodies
89
Q

Where does T-cell selection occur?

A

Corticomedullary junction in the Thymus

90
Q

Components of the innate immune system

A

Cell-mediated; germline encoded; non-specific; primary defense against intracellular pathogens

  • Neutrophils
  • Macrophages
  • Monocytes
  • Dendritic cells
  • NK cells (lymphocyte)
  • Complement

TLRs recognized PAMPs (LPS, flagellin, ssRNA, etc.)

91
Q

Components of the adaptive immune system

A

Humoral; variation via VDJ recombination; primary defense against extracellular pathogens

  • T-cells
  • B-cells
  • Circulating antibodies
92
Q

MHC I

A

HLA-A, B, C

  • Bind TCR and CD8; present endogenously synthesized antigens to CD8+ cytotoxic T-cells
  • Expressed on all nucleated cells
93
Q

MHC II

A

HLA-DR, DP, DQ

  • Bind TCR and CD4; present exogenously synthesized proteins to CD4+ T-helper cells
  • Only expressed on APCs
94
Q

What cytokines enhance NK cell activity?

A

-IL-2, IL-12, IFN-B, IFN-a

95
Q

B-cell functions

A
  • Recognize antigen –> somatic hypermutation
  • Produce antibody
  • Maintain immunologic memory
96
Q

T-cell functions

A
  • help B-cells make antibody and produce cytokines to activate cells of immune system
  • kill virus-infected cells directly
  • delayed (Type IV) hypersensitivity
97
Q

IL-12

A

Stimulates Helper T-cell –> Th1 cell

Th1 cell secretes IFN-y, IL-2

98
Q

IL-4

A

Stimulates Helper T-cell –> Th2 cell

Th2 cells secretes IL-4,5,6,10,13

99
Q

Antigen presenting cells

A

Macrophages, B-cells, Dendritic cells in skin

100
Q

Regulatory T-cell surface markers

A

CD3, CD4, CD25, FOXP3

  • fxn is to suppress CD4 and CD8 T-cell fxns
  • produce IL-10 and TGF-B
101
Q

What part of Ab recognizes Ag?

A

Variable part of L and H chains

102
Q

What part of Ab fixes complement?

A

Fc portion of IgM and IgG

  • Heavy chain contributes to Fc portion (carboxy terminal)
  • Fc portion determines Ab isotype
103
Q

Which Ig crosses the placenta to provide passive immunity?

A

IgG

104
Q

Which cytokines induce production of Acute Phase reactants?

A

-IL-1, IL-6, IFN-y, TNF-a

105
Q

Primary opsonins in bacterial defense?

A

C3b, IgG

106
Q

Fxn of DAF and C1 esterase inhibitor

A

Prevent complement activation on self-cells

-DAF deficiency –> complement mediated RBC lysis and PNH

107
Q

Which vaccines are live attenuated?

A

-MMR, Polio (oral- Sabin), Influenza (intranasal), Varicella, Yellow Fever, Smallpox

108
Q

Which vaccines are inactivated?

A

-Cholera, Hepatitis A, Polio (Salk), Influenza, Rabies

109
Q

Which vaccines are egg-based?

A

-Yellow Fever, Influenza, MMR (to a small extent)

USMLE 1 (13 decks)

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