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USMLE Step 1: Part 1 COPY > USMLE-Rx: Week of 01/02/17 > Flashcards

USMLE-Rx: Week of 01/02/17 Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the possible sequelae of the disorder that presents with intermittent, colicky pain in young children?

A

Intussusception can lead to bowel ischemia, bloody stool, and obstruction of the colon with distended bowel loops.

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2
Q

Review the molecular mechanism that leads to beta cells secreting insulin.

A

Glucose enters beta cells through the constitutively active channel GLUT2. It is then metabolized and generates ATP. The increased ATP deactivates the ATP-sensitive potassium-influx channel. This depolarizes the cell, opening calcium channels and causing the efflux of insulin.

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3
Q

___________ is thought to work by decreasing hepatic gluconeogenesis and increasing the expression of GLUT4 on muscle cells.

A

Metformin

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4
Q

What antibiotics are often used to treat dental abscesses?

A

Amoxicillin is the first-line therapy (represented by the guy punching the other guy in Amino’s Cantina), but clindamycin is often used for those allergic to penicillins. These two are chosen because dental abscesses are usually polymicrobial, with Gram-negative and Gram-positive bacteria present.

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5
Q

______________ works by forming a metabolite that is toxic to DNA.

A

Metronidazole

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6
Q

Achalasia results from defective neurons in the _____________ plexus.

A

Auerbach (myenteric)

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7
Q

Esophageal candidiasis can cause ____________ in immunocompromised patients.

A

dysphagia to solids and liquids

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8
Q

The disorder caused by CTG repeats presents with what symptoms?

A 
Myotonic dystrophy: 
Wide gait
Cataracts
Myotonia (inability to relax muscles) 
Cardiac conduction abnormalities

“My Ticker (cardiac); My Toupee (baldness); My Testicles (testicular atrophy); My Tone (myotonia); My caTaracTs.”

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9
Q

True or false: Trousseau syndrome is when you get flexion of the wrist from hypocalcemia.

A

False! Trousseau syndrome is migratory thrombophlebitis from pancreatic adenocarcinoma, while Trousseau sign is flexion of the wrist from hypocalcemia.

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10
Q

High-protein diets are recommended to those with what glycogen storage disease?

A

McArdle, because they have recurrent myopathy

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11
Q

Using half-life and volume of distribution, how can you find clearance?

A

Clearance = (0.7 x volume of distribution) / half-life

(Think of Sufjan Stevens with swans –because of “Seven Swans” –next to a bucket representing volume in the CLEARANCE section of Target above a glass floor with Gordon from Half-Life fighting aliens beneath it.)

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12
Q

_____________ is a modified, artificial triglyceride that is too bulky to be digested or absorbed.

A

Olestra

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13
Q

Severing of the ____________ nerve would result in a defect in dorsiflexion.

A

deep peroneal nerve

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14
Q

How can you differentiate craniopharyngioma from pinealoma?

A

Pinealomas press on the tectum and cause defective upward gaze

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15
Q

What muscle defect accounts for the inward rotation found in Erb’s palsy?

A

Teres minor (which is innervated by C5 and C6)

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16
Q

The main hormone that opposes the function of insulin binds to a _____________ receptor.

A

G-protein coupled (being glucagon)

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17
Q

In addition to chronic alcoholism, the “twisted rope” sign within hepatocytes is also seen in ________________.

A

PBC, Wilson’s, HCC, and cholestatic syndromes

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18
Q

A woman is diagnosed with ALL and begins treatment with cytarabine. She returns several days after treatment initiation with hyperphosphatemia and anion gap acidosis. What medication should you have given her to prevent this?

A

This describes part of tumor lysis syndrome, for which allopurinol can help. TLS presents after administration of cytotoxic chemotherapy to someone with lymphoma or leukemia. Typical symptoms are metabolic acidosis, hypocalcemia, hyperphosphatemia, and renal failure (from uric acid crystals in the tubules).

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19
Q

Any disorder with elevated PTH will present with elevated alkaline phosphatase. Why?

A

Because PTH stimulates osteoblasts to activate osteoclasts (via RANK-ligand), and alkaline phosphatase is a marker of osteoblast activity

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20
Q

Achalasia can be treated with surgical approaches such as myotomy or pneumatic dilation, but it can also be treated medically with _________________.

A

calcium-channel blockers, nitroglycerin, or botox

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21
Q

By what mechanism do calcium-channel blockers cause smooth muscle relaxation?

A

Decreased intracellular calcium leads to decreased calmodulin-regulated activation of myosin light-chain kinase, which decreases contraction.

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22
Q

The disorder that presents with delayed detachment of the umbilical cord results from a defect in a protein that has two names. What are they?

A

The disorder described in leukocyte adhesion deficiency, and the two proteins are CD18 and LFA1.

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23
Q

Describe some features of desmosomes, tight junctions, and gap junctions seen on electron microscopy.

A

Tight junctions: continuous line outside the cell that is composed of three bands

Desmosomes: discrete “rivet” that holds the cell together; bands extend backward directly

Gap junctions: similar to a desmosome, but without a space between

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24
Q

What is athetosis?

A

Slow, writhing movements of the hands and fingers (seen in those with Huntington’s)

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25
Q

If a stem says a thyroidectomy was “uneventful,” then likely _______________.

A

the patient still has their parathyroid gland (because normally thyroidectomies preserve the parathyroid)

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26
Q

What does thyroid hormone do to glucose levels?

A

It stimulates gluconeogenesis.

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27
Q

What ALT, AST pattern is consistent with alcoholic hepatitis?

A

AST:ALT greater than 1.5

28
Q

Alkaptonuria results from a defect in ________________ and presents with ________________.

A

homogentistic acid oxidase; dark urine and dark connective tissue due to failed metabolism of tyrosine

29
Q

What vascular pathology is present in cANCA?

A

Granulomatous necrosis of small- and medium-sized arteries, particularly in the kidneys and lungs

30
Q

In a Lineweaver-Burk plot, the y-intercept represents _______________.

A

1/Vmax

31
Q

What does the slope of a Lineweaver-Burk plot indicate?

A

Km/Vmax

Think, it’s “rise over run,” but the units are inverse so it flips!

32
Q

What is the mechanism of gastrointestinal hemorrhage in a head-injury patient?

A

Cushing ulcer!

This is caused by increased vagal stimulation (from increased ICP) leading to increased gastric acid secretion.

33
Q

Antibodies to ________________ are commonly found in Hashimoto’s.

A

thyroid peroxidase

34
Q

What autoimmune disorders are associated with HLA-DR5?

A

Pernicious anemia and Hashimoto’s

35
Q

What intestinal channels allow for the absorption of glucose, galactose, and fructose?

A

Glucose and galactose: SGLT-1

Fructose: GLUT-5 (just like how fructose is a 5-membered ring)

36
Q

What is the formula for maintenance dose?

A

Maintenance dose = (target concentration x clearance rate x interval) / bioavailability

37
Q

Retinoblastoma protein works to _________________.

A

prevent synthesis of damaged DNA (thus stopping the G1/S checkpoint)

38
Q

True or false: Trendelenburg lesions present with dropping of the side that is affected.

A

False. The good side drops.

39
Q

What is transient myeloproliferative disorder?

A

A condition in which babies with Down syndrome have a transient elevation in megakaryoblasts; raises risk for AML later on

40
Q

In patients with _____________, macrophages react and appear purple.

A

Whipple

41
Q

When can kids use the pincer grasp?

A

10 months (“It’s the TENcer grip.”)

42
Q

True or false: smoking does not increase your risk of PUD.

A

False. Smoking doubles the risk of PUD.

43
Q

Which comes first in ischemic cell injury, ribosomal disaggregation or nuclear pyknosis?

A

Ribosomal disaggregation

44
Q

Which enzyme is defective in Hunter syndrome, iduronidase or iduronate sulfatase?

A

Iduronate sulfatase (two words = HunTWOr)

45
Q

True or false: you should decrease the loading dose of a renally excreted medication in someone with renal failure.

A

False. The loading dose is dependent only on the volume of distribution. Thus, the loading dose is not affected by impaired excretion.

46
Q

Fluoroquinolones are ____________ excreted.

A

renally

47
Q

Why does acetaminophen toxicity affect the centriobular region?

A

The centrilobular region has the highest concentration of CYP-450 enzymes, so drugs that have toxic metabolites will display centrilobular necrosis. Substances that are frankly toxic, such as phosphorus, will cause periportal necrosis.

48
Q

_______________ increases the absorption of calcium in the distal convoluted tubule.

A

Parathyroid hormone

49
Q

The function of thyroxine can be explained by “four Bs”. Explain.

A

Beta-adrenergic potentiation
Brain maturation
Bone growth (with hypercalcemia)
Basal metabolic rate increase

50
Q

Which anti-tuberculosis medication can cause hepatitis?

A

Isoniazid (prescribed for nine months’ prophylaxis)

51
Q

Which genetic syndrome presents with spots on the iris?

A

Down syndrome

Brushfield spots are deposits of connective tissue on the periphery of the iris.

52
Q

What cardiopulmonary problems present in Edwards syndrome?

A

Pulmonary hypoplasia and VSD

53
Q

In class, you learned that Bell’s palsy presents with complete loss of facial expression. What other symptoms are often present?

A

Because Bell’s palsy is caused by disruptions in the facial nerve, the symptoms are all manifestations of that nerve’s loss:

  • ipsilateral loss of taste on the anterior two-thirds of the tongue
  • increased sensivity of the ipsilateral ear due to lack of modulation by the stapedius muscle
  • dry ipsilateral eye due to impaired lacrimation (because CN VII carries parasympathetic innervation)
54
Q

In a person with nephrogenic diabetes insipidus, what will their urine osmolarity be?

A

Roughly that of the DCT: 100 mOSM/kg

55
Q

What causes cleft palate and cleft lip?

A

Palate: failure of the medial or lateral palatine processes to fuse
Lip: failure of the medial nasal processes to fuse

56
Q

In addition to PDA, fetal rubella infection can cause ________________.

A

pulmonary artery stenosis, deafness, and cataracts

57
Q

Where, in the electron transport chain, do oligomycin and cyanide act?

A

Cyanide: final electron acceptor
Oligomycin: ATP synthase

58
Q

Who is more likely to complete suicide, the elderly or adolescents?

A

The elderly

59
Q

True or false: the elderly typically have less interest in sex.

A

False.

60
Q

What histologic findings are seen in the neurons and muscles of those with ALS?

A

Neurons: Bunina bodies – acid-fast positive globules
Muscles: small, angulated muscle fibers with fatty atrophy

61
Q

Both Duchenne’s and ALS present with fatty replacement of muscle tissue. How are they different, though?

A

Duchenne’s presents with an increase in overall mass, leading to the classic finding of pseudohypertrophy.

62
Q

What is another name for the central sulcus?

A

The fissure of Rolando

Just think: centRal and Rolando both have Rs, while Lateral and syLvian both have Ls.

63
Q

Lesion’s to the left temporparietal area will lead to loss of what four things?

A

Writing
Calculation
Left-right distinction
Finger agnosia

This is Gerstmann syndrome.

64
Q

Which kind of colonic polyp has the most malignant potential, tubular or villous?

A

Villous. (“VILLous are the VILLains.”)

65
Q

Fluoroquinolones have a unique side effect among the antibiotics: __________________.

A

tendonitis

66
Q

Histologically, basal plasmacytosis, mucin granulomas, and crypt abscesses are all characteristic of ______________.

A

ulcerative colitis (think: all of these are surface problems, so they’re more commonly found in UC than Crohn’s)

67
Q

How is Bell’s palsy treated?

A

With a course of steroids

USMLE Step 1: Part 1 COPY (243 decks)

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