USMLE Rx: Week of 08/19/16

Question 1

What is the first thing you should do when you suspect that a child has minimal change disease?

Answer 1

Administer steroids. Although definitive diagnosis requires renal biopsy, that test should only be considered for children with nephrotic syndrome that does not respond to steroids.

Question 2

What cell types are often found in the alveoli of those with chronic bronchitis?

Answer 2

Macrophages and CD8+ T cells

Question 3

Other than cigarette smoking, what is a known cause of Goodpasture syndrome?

Answer 3

Exposure to hydrocarbon solvents (such as those used in dry cleaning)

Question 4

In terms of PT, PTT, and platelets, how can you differentiate DIC from TTP?

Answer 4

TTP will have low platelets but normal PT and PTT times, whereas DIC will have low platelets and elevated PT and PTT.

Question 5

What type of drug is beclamethasone?

Answer 5

It is a corticosteroid.

Question 6

Once again, what mnemonic lists the drugs that can cause SLE?

Answer 6

SHIPP-E
Sulfa drugs
hydralazine
Isoniazid
Phenytoin
Procainamide
Etanercept

Question 7

The only rotator cuff muscle that medially rotates the arm is the ____________.

Answer 7

subscapularis

Question 8

What is hematochezia?

Answer 8

Pooping out fresh, red blood

Question 9

Although not as striking as the surface lesions, Kaposi’s sarcoma can appear anywhere – including the __________.

Answer 9

lungs, biliary tract, or gastrointestinal tract (which can present as hematochezia or melena)

Question 10

What type of cancer often shows T-cell mediated tumor shrinkage? Consequently, what medication is given to amplify this effect?

Answer 10

Renal cell clear cell carcinoma; IL-2 (called aldesleukin)

Question 11

What factor (produced by tumors) may contribute to migratory thrombophlebitis?

Answer 11

Tissue factor

Question 12

Ranibizumab, which targets __________, has been approved for the treatment of which type of cancer?

Answer 12

Vascular endothelial growth factor; colon cancer

Question 13

Describe the life cycle of heme and bilirubin.

Answer 13

Macrophages engulf RBCs and process the hemoglobin into heme and protein. Heme is converted to biliverdin by heme oxygenase and then to indirect (aka unconjugated) bilirubin. Bilirubin is passed into the bloodstream to then be carried by albumin to the liver, where it will be conjugated to bilirubin glucuronide (aka direct bilirubin). Conjugated bilirubin is sent to the colon, where bacteria degrade it to urobilinogen. Some urobilinogen gets reabsorbed and excreted in the urine (hence the name)

Question 14

What three organs are most affected by graft-versus-host disease?

Answer 14

Skin (itchiness, erythema, and hives)
Liver (elevated ALT/AST)
Gut (diarrhea)

Question 15

Recall that sulfa-containing drugs can cause interstitial nephritis. Which diuretics contain those?

Answer 15

Most loop and thiazide diuretics

Question 16

Recall that radiolucent stones include __________.

Answer 16

uric and cysteine stones

Question 17

Why do those with hyperparathyroid syndrome urinate excessively?

Answer 17

Because calcium inhibits ADH

Question 18

Hepatitis B often precedes which vasculitis?

Answer 18

Polyarteritis nodosa (Plan B = “PAN B”)

Question 19

How is polyarteritis nodosa treated?

Answer 19

Cyclophosphamide

Question 20

What fracture is common in child abuse?

Answer 20

Spiral fracture (such as from an adult twisting a child’s arm)

Question 21

What is rheumatoid factor?

Answer 21

Anti-IgG IgM

Question 22

What molecule does etoposide inhibit?

Answer 22

Topoisomerase II – thus, etoposide leads to the breaking of DNA during attempted unwinding

Question 23

Carcinoid syndrome is a disorder in which GI tumors secrete vasoactive amines. What are the symptoms?

Answer 23

Facial flushing, wheezing, and episodic diarrhea

Question 24

What is sepsis defined as?

Answer 24

At least two of the four SIRS criteria: 
HR > 90
WBC > 12,000 or  10%
Fever or hypothermia
RR > 20

Question 25

Review the structures derived from the branchial arches.

Answer 25

1: mastication, CN V, masseter and mandible
2: facial expression, CN VII
3: CN IX, stylopharyngeus
4 and 6: CN X, vocal cords, swallowing

Question 26

What joint disorder sometimes (15% of the cases) occurs with giant cell arteritis?

Answer 26

Polymyalgia rheumatica

Question 27

What renal disorder is often a side effect of lithium therapy?

Answer 27

Nephrogenic diabetes insipidus (think of LMNOP: Lithium can cause Movement disorders (tremor), Nephrogenic diabetes insipids, hypOthyroidism, and Pregnancy problems)

Question 28

What drug is known to trigger asthma attacks, particularly in those with nasal polyps?

Answer 28

Aspirin

Question 29

Mannitol should not be given to patients with what condition?

Answer 29

Congestive heart failure – think, mannitol helps pull fluid from the brain and leads to eventual increase in diuresis, but it has a temporary effect of increasing fluid retention with potential to cause pulmonary edema. Thus, patients with volume overload should not be given mannitol.

Question 30

What is the overall effect of acetazolamide on the nephron?

Answer 30

Increases bicarb excretion; decreases proton excretion (A deCEitful LAMb riding a BIke out of the tubule with two ACEs)

Question 31

The fibrate drugs have what three effects?

Answer 31

Increase HDL
Decrease LDL
Decrease triglycerides

Question 32

Cholesterol gallstones are a side effect of a drug that lowers ___________.

Answer 32

Triglycerides (specifically, the fibrates)

Question 33

Major basic protein is a component of which cell type?

Answer 33

Eosinophils (“Many Blobs of Pink” because eosinophilic means pink-loving)

Question 34

What is the basic idea behind Paget’s disease? What is the unique lab profile?

Answer 34

Paget disease is abnormal construction and destruction of the bone; it presents with a normal Ca, normal Phos, but an elevated Alk Phos.

Question 35

In terms of biomechanics, what does purse-lip breathing do?

Answer 35

It increases pressure in the smaller airways, which need that because their increased compliance causes them to shut.

Question 36

What is the standard therapy for prophylactic PCP treatment in an AIDS patient?

Answer 36

Bactrim

Question 37

What kind of pneumonia do fungi cause?

Answer 37

Diffuse interstitial

Question 38

What is the best alternative to bactrim to treat PCP in an AIDS patient (for a person with a sulfa allergy)?

Answer 38

Aerosolized pentamidine

Question 39

___________ is administered with methotrexate to treat its unpleasant side effects.

Answer 39

Leucovorin (aka folinic acid)

Question 40

Isoniazid reduces the body’s store of what necessary molecule?

Answer 40

B6 (so TB patients often need B6)

Question 41

What disorder leads to increased production of IgM? What disorder leads to increased production of IgG?

Answer 41

IgM = Waldenström macroglobulinemia (think of the IgM basketball in Waldenbooks) 
IgG = multiple myeloma (think of a CRAB – hypercalcemia, renal problems, anemia, and lytic bone lesions –wearing Gangster attire)

Question 42

Histologically, how can you differentiate mast cells and eosinophils?

Answer 42

Mast cells are bluish/purple; eosinophils are pink

Question 43

___________ blocks the conversion of plasminogen to plasmin and can be used to treat negative reactions to ____________.

Answer 43

Aminocaproic acid; tPA

Question 44

What cell lineage do SLL/CLL cancers most resemble?

Answer 44

B cells (expressing CD19 and CD20)

Question 45

Describe the presentation of Langerhans cell histiocytosis.

Answer 45

Fever
Lytic lesions
Rash
Birbeck granules on EM

Question 46

What positive titer has a strong correlation with polyarteritis nodosa?

Answer 46

Hepatitis B

Question 47

What is the pathologic appearance of polyarteritis nodosa?

Answer 47

Transmural, fibrinoid necrosis (different – “POLY” – stages may coexist)

Question 48

____________ is a syndrome in which there is general failure of the proximal convoluted tubule, resulting in increased excretion of bicarb, amino acids, and phosphate.

Answer 48

Fanconi syndrome

Question 49

What genetic disorder leads to a defect in the channel targeted by furosemide?

Answer 49

Bartter (think of BART Simpson skateboarding up the ascending loop of Henle)

Question 50

Gitelman syndrome is a disorder of the channel targeted by __________.

Answer 50

hydrochlorothiazide

Question 51

What is the classic description of basal cell carcinoma?

Answer 51

Pearly borders with telangiectasias

Question 52

Contact dermatitis is an example of a type _____ immune reaction.

Answer 52

IV

Question 53

Immediate transfusion reactions are a type ___________ hypersensitivity reaction.

Answer 53

II (because IgM immediately targets RBCs –so it is organ-specific)

Question 54

EBV targets which cells?

Answer 54

B lymphocytes –think of what cancers are caused by EBV: Burkitt’s lymphoma, DLBCL

Question 55

What will the basement membranes of those with mesangial-proliferative nephritic disease demonstrate?

Answer 55

“Thickening and splitting” (think MPGN = mesangial proliferation with splitting because they’re Gripping the edges of the Nephron filter)

Question 56

What drug (strangely) blocks the effects of ACTH (and can thus be used to treat disorders in which ACTH is overexpressed)?

Answer 56

Ketoconazole (think of the KEy that unlocks the moon [facies])