usmle 2: block 1 Flashcards
note: some are block 2
1
Q
pulling sensation in groin with..
ascites, hydrothorax, &..
A
ovarian fibroma: meig’s syndrome
2
Q
hCG & LDL are elevated in what ovarian neoplasm
A
dysgerminoma
3
Q
AFP is elevated in what ovarian neoplasm
A
yolk sac tumor, endodermal sinus
4
Q
presentation of yolk sac tumor
A
in ovaries/testes or saccrococcegeal region
has schiller-duval bodies
5
Q
drug eluting stents elute..
A
clopidogrel
6
Q
paclitaxel
A
taxol
stabilizes MT, preventing mitosis
7
Q
schiller-duval bodies
A
endodermal sinus, yolk sac tumor
8
Q
call-exner body
A
granulosa cell tumor (malignant ovarian neoplasm)
resembles primitive follicle
9
Q
CA-125
A
monitor progression of all ovarian neoplasms, but not good for screening
10
Q
most common malignant ovarian neoplasm
A
serous cystadenocarcinoma
11
Q
most common benign ovarian
A
serous cystadenoma
12
Q
what is the cornea composed of
A
- endothelial layer: cellular, mitochondrial rich, translucent
- descement’s membrane (location of Cu2+ deposition
basement membrane
13
Q
probenicid on uric acid? on penicillin?
A
LOWERS uric acid (inhibits reabsorption) INCREASES penicillin (inhibits secretion)
14
Q
input to cerebellum?
A
cortex -> MCP (contralateral) via ipsilateral pontine nuclei spinal cord (proprioception) -> ICP (ipsilateral)
via climbing and mossy fibers
15
Q
output from cerebellum
A
purkinje fiber -> deep cerebellar nuclei (DEGF) -> contralateral cortex superior cerebellum peduncle
16
Q
lateral lesions to cerebellum
A
voluntary movements of extremities; tendency to fall ipsilaterally
17
Q
medial lesions to cerebellum?
A
midline structures;
truncal ataxia, nystagmus, head tilting.
wide-based (cerebellar) gait & defective truncal coordination
usu bilateral
ALCOHOLICS (thiamine-deficiency linked)
18
Q
alcoholic wide based gait based on..
A
midline cerebellar defects; thiamine deficiency linked!
19
Q
xanthomas are most characteristic of..
tendinous more specific for..
A
increased cholesterol (tendinous more specific)
severely increased triglycerides
20
Q
urease breath test?
A
drink radiolabeled urease
H. ployri converts to CO2 + NH3
will breath out radiolabeled CO2
the NH3 raises the pH around bacteria & protects it
21
Q
low-pitched, rumbling, mid-diastolic murmur in apex LLD
A
mitral stenosis
22
Q
most common cause of mitral stenosis
A
rheumatic heart disease
23
Q
cardiac manifestation of TB?
A
tuberculosis pericarditis
24
Q
peutz-jeghers syndrome
A
autosomal dominant.
STK11 (serine/threonine kinase chr. 19) mutation
- pigmented mucocutaneous macules
- lips, buccal muscosa (pathognomonic) hands & feet - numerous hamaratomatous polyps in GI tract
usu benign
can: abdominal pain, GI bleed (intussuception, obstruction, malignant transformation)
develop during first few years of life
25
blue nails & dyspigmentation of lower legs
consider Wilson's disease (hepatolentincular degeneration)
26
enzyme deficiency in gilbert's syndrome
reduced activity of UDP-gluconornyl transferase
27
atrophic glossitis, megaloblastic anemia, shuffling gait in elderly women of Northern European descent
pernicious anemia presentation
gait: due to degeneration of dorsal column proprioception to cerebellum
28
liposarcoma vs. lipoma
liposarcoma: LIPOBLAST: nonmembrane bound cytoplasmic lipid characterestically causing nuclear indentations & scalloping of nuclear membrane
lipoma: mature fat cells, without pleomorphism
both present as slow growing, painless masses in deep connective tissue
29
most common malignant soft tissue tumor in adults? children?
adults: liposarcoma
children: rhabdomyoscarcoma
30
FAP
osteoma in skull
fibroma (desmoid tumor)
congenital hypertrophy of retinal pigmented epithelium
gardener syndrome (autosomal dominant)
31
FAP + malignant CNS tumor
turcot syndrome
32
dermoepidermal junction autoantibodies (against type VII collagen)
epidermolysis bullosa acquisita
33
basement membrane IgG auto-antibodies in skin
bullous pemphigoid
34
lung surfactant maturation screen
L/S
lecithin/sphingomyelin 2:1
note: lecithin = DPPC = dipalmitoyl phosphatidyl choline
35
purpose of surfactant
decrease surface tension of alveoli
reduce pressure needed to keep alveoli inflated
(increased compliance)
36
sympathetic innervation to eye
3 neuron system
1. hypothalamus -> descend to lateral horn spinal cord
2. enters sympathetic trunk & ascends to superior cervical trunk
3. superior cervical trunk, along internal carotid, joins branches of opthalmic division of CN V
go to pupil dilators & superior tarsal
37
bulbar vs. pseudobulbar
bulbar:
- LOWER motor neuron
- cranial nuclei from medulla (CN IX, X, XI, XII) & nerves
pseudobulbar:
- UPPER motor neuron
- corticobulbar tracts in mid pons
- for these lesions to be apparent, must be bilateral, as these nuclei receive bilateral input
38
bromocriptine
dopamine receptor agonist
| rx: prolactinoma
39
clomiphene
SERM
- blocks estrogen receptors in hypothalamus (blocks negative feedback)
- increase release of pituitary gonadotropins
40
what can be used to trigger ovulatory cascade when follicles are mature? (i.e. in an oocyte donor)
hCG therapy, triggers ovulation
41
can a person w/ turner have a baby?
w/ IVF
| ovaries don't work, but uterus is fine
42
lithium side effects
LMNOP
motor (tremors)
nephrogenic diabetes insipidus
hypothyroidism
pregnancy: teratogen: ebstein anomaly
43
mood disorder history
THINK LITHIUM
44
3 problems in hypertrophic cardiomyopathy
1. diastolic dysfunction: rigid, less volume
2. LVOT: increased afterload
3. increased cardiac work: MI
45
2 causes of renal artery stenosis
1. atherosclerosis
| 2. fibromuscular dysplasia (females)
46
when giving blood to patient w/ IgA deficiency..
must be blood from someone else w/ IgA deficiency!
if IgA is in blood, they will have anaphylaxis (they'll make anti-IgA)
could be in: RBC, platelet, FFP, IVIG
47
DNA Pol III? DNA Pol I?
DNA Pol III: continues from RNA primer
| DNA Pol I: removes primer (5'-3' exonuclease), & places new DNA
48
receiver operating characteric ROC curve? measure of accurary?
sensitivity vs. 1-specificity
want rectangular test
area under curve: accuracy!
true positive rate vs. false positive rate
49
accuracy formula
TP + TN / all observations
50
false positive rate
1-specificity
specificity: without disease, test negative
false positive rate: without disease, test negative
51
true positive rate
sensitivity
with disease, test positive
52
false negative rate
1-sensitivity
with disease, test negative
53
CA-125
high specificity,
low sensitivity
(low false + rate, low PPV)
54
17-hydroxyprogresterone elevation
CAH due to 21-hydroxylase deficiency
55
PTHrP
squamous cell carcinoma of lung
| hypercalcemia
56
CA-19-9
pancreatic adenocarinoma
57
cyclosporine
calcineurin inhibitor (binds CYCLOphilin)
prevents IL-2 transcription
-- can't convert NFAT-P to NFAT
[NFAT is TF for IL-2 gene]
use:
transplant rejection prophylaxis
psoriasis
rheumatoid arthritis
58
tacrolimus
calcineurin inhibitor (binds FKBP)
prevents IL-2 transcription
--can't convert NFAT-P to NFAT
[NFAT = TF for IL-2 gene)
59
oprelvekin
IL-11
good for thrombocytopenia
60
filgrastim
G-CSF (recover bone marrow)
61
sargramostin
GM-CSF (recover bone marrow)
62
aldesleukin
IL-2
63
IFN-a
```
rx:
chronic hep B
chronic hep C
hairy cell leukemia
condyloma acuminatum
renal cell carcinoma
malignant melanoma
```
64
IFN-b
multiple sclerosis
65
IFN-c
chronic granulomatous disease
66
IL-2 transcription
calcineurin
NFAT-P -> NFAT
NFAT -> transcription factor for IL-2 gene
67
cyclosporine toxicity
```
NEPHROTOXIC
HTN
hyperlipidemia
hyperglycemia
tremor
hirsuitism
gingival hyperplasia
```
68
-limus drugs (tacrolimus & sirolimus)
binds FKBP
69
calcineurin inhibitors (cyclosporine & tacrolimus) are both..
nephrotosix
70
tacrolimus toxicity
like cyclosporine: MAIN: NEPHROTOXIC
MORE risk of diabetes & neurotoxicity
LESS risk of hirsuitism & gingival hyperplasia
nephrotoxic
hyperlipidemia
tremor
71
sirolimus (rapamycin)
binds FKBP
mTOR inhibitor
(TF for proliferation genes)
blocks T cell activation & B cell differentiation
prevents IL-2 signal transduction
NON-NEPHROTOXIC
72
basiliximab
monoclonal Ab to IL-2
| like sirolimus / rapamycin, blocks IL-2 reception
73
immunosuppressant effects of glucocorticoids
inhibits NF-kB
| inhibits cytokine transcription
74
NFAT & NFkB
both transcription factor for IL-2 (cytokine)
75
azathiopurine blocks
blocks rapidly dividing T & B cells
like 6-MP
```
PRPP amidotransferase
(rate limiting step for purine synthesis)
```
converts PRPP -> 5-phosphoribosylamine
(then add base + carbon)
cleared by xanthine oxidase
(increase w/ allopurinol rx)
76
mycophenolate mofetil
like azathiopurine, blocks rapidly dividing T & B cells
blocks IMP dehydrogenase (can't make de novo GMP)
77
muromonab
Ab against CD3 on T cells
| immunosupressants
78
gingival hyperplasia (4)
verapamil
phenytoin
cyclosporine
nifidipine
79
drug induced parkinson's (3)
anti psychotics
reserpine
metoclopromaide
cog-wheel ARM
80
metoclopromide
rx: nausea & gastroparesis
D2 receptor antagonist
increase resting tone, contractility, LES tone, motility.
does not influence colonic transport time.
contraindicated in parkinsons
81
alkaptonuria (ochronosis)
autosomal recessive, bengin.
deficiency of homogentisate oxidase
can't break down tyrosine -> fumarate
major problem: debilitating arthralgia
(homogentisic acid = toxic to cartilage)
urine black on standing
dark blue/grey on sclerae & ear
(no mental retardation)
82
major long-term consequence of alkaptonuria?
debilitating arthralgia (3-4th decade)
knee, hip, shoulder, intervertebral joints
83
parkinsons symptoms mnemonic
TRAPS
```
resting Tremor
Rigiditiy (cogwheel)
Akinesia (or brady)
Postural instability
Shuffling (festinating) gait
```
degradation of neurons in substantia nigra pars compacta
84
location of substantia nigra pars compacta
ventral midbrain
near cerebral peduncles (corticobulbar tracts)
'mickey mouse' ears
85
lesion to occipital lobe? lesion to PCA
if occipital lobe: homonymous hemianopsia
if PCA: homonymous hemianopia w/ MACULAR SPARING
can be quadrants if only lingual / cuneate lobe of cortex involved
86
where are juxtaglomerular cells located
modified smooth muscle cells in afferent arteriole, near glomerulus
in close contact w/ macula densa of DCT
87
3 stimuli for renin release
1. decrease tubular NaCl in macula densa
2. B1 receptor sympathetics
3. decreased pressure in afferent arteriole
88
Tamm-Horsfall glycoprotein
exclusively secreted by renal tubular epithelial cells of TAL
if low urine flow, can form hyaline casts
89
normal albumin excretion in urine
< 30mg/day
90
amniotic fluid acetylcholinesterase AChE
open neural tube defect
| bc its present in blood cells, muscle, and nerve tissue
91
neural tube defect, elevated..
AFP and AchE
92
thyroxine deficiency on bone
usu NOT fracture
instead: pain, ache, stiff
93
presentation of cystathione-beta-synthase deficiency (3)
homocysteinuria from methionine breakdown.
cysteine becomes essential amino acid.
1. ectopia lentis (downward lens displacement)
2. osteoperosis
3. mental retardation
3. thin, fair hair & skin: marfanoid
4. propensity for arterial & venous thromboelmbolism
94
presentation of phenylketonuria? (4)
1. fair pigmentation
2. mousy odor
3. seizures
4. mental retardation
mutation in phenylalanine hydroxaylase, can't make tyrosine
95
presentation of maple syrup urine disease
mutation in branched-chain alpha-keto acid dehydrogenase
can't decarboxylate the alpha-keto acid derivatives of leucine, isoleucine, valine.
96
proline synthesized from..
glutamate
97
level of pancreas
L2
98
what types of drugs cross placenta? what types of drugs do not?
CROSS: lipid soluble
DO NOT CROSS: water soluble
99
why can heparin be given during pregnancy but not warfarin
heparin sulfate: charge: water soluble, will not cross placenta
warfarin: lipophilic: will cross palcenta
100
what type of bilirubin can cross placenta
unconjugated can cross: lipid soluble
conjugated = water soluble = won't cross
101
differentiating gonorrhea vs. chlamydia infection
often, treat for both
gonorrhea:
- purulent discharge
- microscopy: multiple WBC w/ intracellular gram - cocci
chlamydia
-microscopy: neutrophils w/ NO pathogens
(bc chlamydia lacks muramic acid, won't gram stain)
- also causes epididmyitis!
102
common cause of epididymitis?
chlamydia
103
unique feature of neisseria (gonococcal & meningococcal LPS
lack repeating O antigen in LPS!
104
which neisseria ferments maltose & has capsule
meningococcus
gonococcus: NO capsule, NO maltose, NO vaccine
105
difference between..
acyclovir, famciclovir & ganciclovir
vs.
zidovudine, cytarabine, vidarabine
acyclovir, famciclovir & ganciclovir
activated by viral kinase first (then host)
zidovudine, cytarabine, vidarabine
activated by host cell kinase
106
CMS retinitis T cell count
<50
107
PCP pneumonia T cell count
<200
108
chloroquine mechanism
blocks detoxification of heme into hemozin
heme accumulates & is toxic to plasmodia
note: most falciparium -> resistant
109
rx for p. falciparium
artemether/lumefantrine
or
atovaquone/proguanil
life threatening, use quinidine or atesunate
110
what enzyme does ribavarin block
IMP dehydrogenase, can't make GMP
111
cidofovir & foscarnet
do not need viral kinase activation
112
tenovovir
only NRTI that does not need to be phosphorylated by host kinases
is a nucleoTIDe
113
smoking cessation on lung functoin
will stop further damage, but does not IMPROVE.
WILL decrease risk of lung cancer
is associated w/ weight gain (food to replace smoking)
114
recidivism
resumption of harmful activity after abstinence / rehab
115
what allows chicken virus to infect humans
often: genetic reassortment
116
genetic reassortment
responsible for sudden shifts
2 distinct influenza strains (ie that infect diff animals) infect same cell, HA from 1 and NA from other packaged together --> new virion
novel strain of virus to which we have NO susceptibility
HA and NA are surface proteins, also targets of immune system
117
antigenic drift
point mutations in HA and NA
slightly alters product proteins
can slightly increase infectivity, etc
gradual drift
118
phenotypic mixing
2 viruses infect same cell
| progeny have coat or envelope proteins not coded for by genetic material packaged within them
119
hypoglycemia in McArdle?
NO
mutation in muscle glyocgen phosphorylase.
muscle glycogen doesn't release glucose into circulation anyways.
liver glyocgen phosphorylase is fine --> no hypoglycemia
120
presentation of McArdle
deficiency muscle glycogen phosphorylase
```
no hypoglycemia (bc liver fine)
muscle pain on exertion, exercise intolerance
can have myoglobinuria / renal failure
```
121
hyperkalemia on EKG
1. peaked T waves
2. loss of P
3. prolonged PR
4. wide QRS
slow HR
122
hypokalemia on EKG
1. flattening T waves
2. appearance of U waves
3. ST segment depression
can cause Tdp
123
hypocalcemia on EKG
QT prolongation
124
hypercalcemia on EKG
QT interval shortening
| T-wave flattening or inversion in severe cases
125
peaked T wave
earliest EKG sign of hyperkalemia
126
T wave flattening
in hyPO K+
and
hyPER Ca2+
127
graves disease proptosis/exopathalmosis
1. TSH antibodies stimulate fibroblasts to make GAG
2. draws in water --> extraocular muscle EDEMA
note: NOT extraocular muscle hypertrophy
128
communication between suprachiasmatic nucleus & pineal gland
SCN -> NE -> pineal -> melatonin
129
parinaud syndrome (4)
pinealoma
1. upwave gaze palsy,
2. absent pupillary light reflex,
3. failure of convergence,
4. wide-based gait
superior colliculus
oculomotor & trochlear n.
edinger westphal
all involved (mass effect)
130
where are stem cells located in GI system
crypts of Lieberkuhn
131
coarse, rhythmic, postural tremor in fingers & arms of alcoholic
thiamine deficiency --> alcoholic cerebellar degeneration
132
alcoholic cerebellar degeneration pathology
loss of Purkinje cells in anterior lobe & vermis
presentation:
- wide-based gait ataxia
- intention tremor of hands & fingers
- rhythmic parkinsonian tremor of fingers & hands too
- truncal instability
133
medial medullary lesions cause
1. contralateral spastic paralysis
2. contralateral paresis
3. ipsilateral CN XII (tongue) problems
134
korsakoff syndrome specifically refers to
temporal lobe damage w/ alcoholics
135
phenylephrine
alpha-1 agonist
increases PVR
increases systolic BP
decreases PP
decreases HR (reflex)
136
dobutamin
B1 agonist
increase HR
increase contractility
no effect on SVR
137
isoproterenol
nonselective B agonist
```
increase HR
increase contractility
increase pulse pressure
decrease PVR
decrease diastolic BP
```
138
epinephrine
both alpha & beta agonist
increase HR
increase pulse pressure
decrease PVR (dominant effect on beta 2 over alpha 1)
139
clonidine
alpha 2-agonist
decreases sympathetic outflow
decreases BP
140
CAAT & TATA box
both promote transcription intiation
RNA pol II binding
CAAT: 80 bp upstream
TATA: 25 bp upstream
141
lysyl hydroxylase deficiency
kyphoscoliosis variant of Ehlers-Danlos
autosomal recessive
hypermobile, hyperextensible, fragile joints
similar to vitamin C deficiency (scurvy)
142
sublimation
convert unacceptable feelings or drives into more socially acceptable
murder -> surgeon
143
stellate cells in liver
perisinusoidal space, store beitamin A
can differentiate into myofibroblast upon injury -> help produce fibrosis
144
lambert-eaton associated w/
paraneoplastic syndrome of small cell lung cancer
145
genetic association w/ small cell lung cancer (note 4 A's)
ACTH, ADH, Autoimmune (lambert-eaton)
| Amplification of myc
146
genetic associated w/ adenocarcinoma
k-Ras, eGFR, ALK
147
3 C's of squamous cell carcinoma
cavitation, cigarretes, hyperCalcemia (PTHrP)
148
BMI calculation
weight / height^2
149
what antibiotic binds to 23sRNA
macrolides & clindamycin
maCROlides binds to twenty-THREE
150
mechanism of chloramphenicol
binds to 50S subunit, blocks peptidyl-transferase
[does not bind to 23s)
151
mechanism of macrolide & clindamycin
bind 23sRNA in 50S subunit
block translocation
macRO blocks transLOcation
binds to twenty-THREEsubunit
152
resistance to macrolides
mutation in 23s rRNA subunit of 50s
153
resistance to chloramphenicol
acetylation of antibiotic
154
what topoisomerase do fluoroquinolones blocks?
```
topo II (DNA gyrase
topo IV
```
(like etoposide)
155
what topoisomerase dose etoposide block?
topo II (like fluoroquinolone)
156
what topoisomerase does irinotecan, topotecan block
topo !
157
presentation of cystic hydroma? association!
loose areolar tissue of head and neck, often left side
painless, compressible mass that transilluminates
when lymphatics don't connect to venous, bud abnoramlly, or retain embryonic growth potential & expand into adjacent structures along facial planes.
associated w/ turner, trisomy 12, 13, 21!
NOT JUST TURNER
158
what type of patients can have cystic groma (2)
turner
| trisomies (13,18, 21)
159
what ultimately determines amplitude of AP in neurons?
Nernst equation equilibrium potential for Na+
increase: w/ increase extracellular Na+ decrease intracellular Na+
160
how can amplitude of AP be altered?
| how can likelihood of firing be altered?
amplitude: equilibrium potential for Na+ (increase extracellular, decrease intracellular
likelihood of firing: bring membrane potential closer to threshold
- since K+ determines resting potential, decrease intracellular K+
161
linear erythematous rash after hiking
suggests poisin ivy -- hypersensitivity
| type IV HSR
162
drug-induced photosensitivity
SAT For Photo
sulfonamides
amiodarone
tetracylcin
5-FU
163
presentation of rocky mountain spotted fiber
rash BEGIN: at ankles/wrists,
---->
SPREAD to TRUNK & PALM
dermacentor ticks
164
where do rickettsiae live
obligate intracellular: need CoA and NAD+, cannot synthesize ATP
165
ehrlichiosis
monocytes w/ morula
| tick vector
166
anaplasmosis
granulocytes w/ morulae
| tick vector
167
Q fever
no arthropod vector!
coxiella burnetti
tick feces & cattle placenta, aerosol
present: pneumonia + hepatitis
