USMLE-Rx: Week of 09/05/16 Flashcards
Use of _________ can lead to a post-high crash with severe depression.
cocaine
What three cephalosporins can treat Pseudomonas? (You actually need to know this.)
Cefoperazone
Ceftazidime
Cefepime
(A guy PSEDUO-PARAgliding in the end-ZONE with his ZIPper down)
Gram negative, oxidase positive rod?
Pseudomonas
What anti-psychotic drug does not have oculomotor side effects?
Clozapine
One serious side effect of clozapine is ___________.
agranulocytosis (It claws away at your bone marrow)
ASD presents with what cardiac sound?
Loud S1 with fixed-split S2
Noncompetitive antagonists decrease ____________ of a drug.
the efficacy – not the potency, because the end result will be less than it otherwise would be
There are two kinds of bipolar disorder: I and II. Which has mania?
Type I –the other has only hypomania
What mnemonic can help you remember the side effects of hydrochlorothiazide?
HyperGLUC: high glucose, lipids, uric acid, and calcium
What is the official name of postpartum depression?
Major depressive episode with peripartum onset
How does cisplatin work?
It forms DNA cross links (it “plates” the DNA strands together)
Describe the Schilling test.
Stage I: give a patient radioactive oral B12 with intramuscular unlabeled B12
Stage II: give a patient radioactive oral B12 with intrinsic factor
Explain the appearance of pernicious anemia in a Schilling test.
In stage one of a Schilling test, a patient with PA will have a low level of radioactive B12 in their urine; this is because they are unable to get it from their stomach to their blood (whereas a person with insufficient intake of B12 will have a high level of radioactive B12 in their urine). In stage two of a Schilling test, a patient with PA will have high levels of radioactive B12 in their urine because the IF helped them get it across –recall that PA happens because antibodies are made to the parietal cells, not IF.
What cardiovascular anomalies do girls with Turner syndrome have?
Preductal coarctation of the aorta and bicuspid aortic valve
In the Ann Arbor staging, what is the difference between A and B?
A = asymptomatic B = fevers, night sweats, weight loss
Describe the Ann Arbor staging method.
I = one lymph node or extralymphatic site II = multiple lymph nodes on the same side of the body III = multiple lymph nodes above and below the diaphragm IV = dissemination to extranodal site
Explain the BEST mnemonic for the radial nerve.
Innervates the brachioradialis, extensors of the wrist and fingers, supinators, and triceps
Extension of the arm is predominantly controlled by the ______ nerve.
radial (Can’t give a high-five? That’s not RAD.)
Histrionic personality disorder is best described as _____________.
attention-seeking behaviors that present in early adulthood; commonly hypersexual; somatization also common
Facial plethora is another name for ____________.
moon facies
Other than facial plethora, centripetal weight gain, and abdominal striae, what is a common symptom of Cushing’s disease (whether iatrogenic or paraneoplastic)?
Poor wound healing
What is the genetic makeup of herpesviruses?
linear dsDNA (you’ve got a LINE of herpes on your face)
One of the antiarrhythmics can cause hyperthyroidism. What is the name of this medication and how does it work?
Amiodarone (think: amIOdarone mimics IOns and causes problems in the organ that deals with IOdine); it blocks the voltage-sensitive potassium channels, thereby prolonging the refractory period and lengthening the PR interval
True or false: in a healthy individual at rest, the V/Q system in the lungs is diffusion limited.
False. Diffusion is a rapid process and the body is normally perfusion limited.
Excessive lysine and arginine in the urine might indicate a hereditary defect in which part of the nephron?
The proximal-convoluted tubule; this disease, cystinuria, is a recessive disorder in which cystine, ornithine, arginine, and lysine are not reabsorbed. Kidney stones result. (Think COAL stones in the urine.)
Drepanocyte is another name for __________.
sickle cells
Howell-Jolly bodies are ________________.
bits of DNA usually removed by the spleen (seen in an individual s/p splenectomy); “how’ll you get rid of that DNA without your spleen?”
What are Pappenheimer bodies?
Just another name for sideroblasts
What is the difference between the mechanisms of montelukast and zileuton?
Zileuton is a lipoxygenase inhibitor (It ZIps the LIPs)
Montelukast is a leukotriene receptor antagonist –it MOuNTs the receptors
What medication inhibits the transcription factor nf-kappa B?
Steroids
Increased levels of 2,3-BPG do what to hemoglobin’s oxygen affinity?
Decrease it
What parasite causes bladder cancer?
Schistosoma haematobium (the Schistosoma that causes HEMATuria)
Differentiate the mechanisms of tacrolimus and cyclosporine.
Both medicines bind to an intracellular protein and then inhibit calcineurin. The key difference, however, is that cyclosporine associates with cyclophilin while tacrolimus binds with FK-binding protein 12. Both ultimately inhibit IL-2 production, therefore limiting the activation of T cells.
How does azathioprine work?
It mimics purines and thence disrupts DNA synthesis.
Other than hyperthyroidism, what other side effects does a certain class III antiarrhythmic have?
Pulmonary fibrosis (caused by amiodarone)
Digoxin toxicity mimics what other toxicity?
Cholinergic, though with yellow vision (think Van Gogh)
What enzymes does lead poisoning inhibit?
Ferrochetalase and aminolevulinic acid dehydratase (Pb2+ leads to 2 enzymes being incapacitated;
Irregular masses in the liver are often ______________.
hepatocellular carcinoma
Where do dihydropyridine calcium blockers and non-dihydropyridine blockers act?
Dihydro: vascular smooth muscle (there are two vascular branches –venous and arterial – so the DIHYDROs act here)
Non-dihydro: the heart has four chambers, so it is non-dihydro (i.e., it is tetrahydro)
Which kidney is higher?
The left
The kidneys lie at what approximate vertebral levels?
T12 - L3 (you To go #1, you need 2 kidneys)
Azathioprine (particularly when used with __________) leads to what toxic metabolite?
allopurinol; 6-mercaptopurine
What is panniculitis?
Inflammation of subcutaneous fat
Erythema nodosum is what cellular process?
Inflammation of fat with concomitant fibrin exudation and infiltration of neutrophils
What disorder often presents with erythema nodosum?
Crohn’s
What mnemonic helps you remember the symptoms of sarcoidosis?
GRAIN Gamma globulinemia Rheumatoid arthritis ACE elevated Interstitial fibrosis Noncaseating granulomas
First-line treatment of sarcoidosis includes ___________.
steroids
“Parkinson’s and schizophrenia can be thought of as lying on the same continuum.” Explain this.
Parkinson’s is thought to arise from insufficient dopamine, while schizophrenia is thought to arise from too much dopamine. Many antipsychotics try to lower dopaminergic activity, and can even cause Parkinson’s if used for a long time.
The testicles should normally rise if you stroke the inner part of the thigh. If they don’t, blood supply to what muscle might be occluded?
The internal oblique (which becomes the cremaster in the scrotum)
Typical antipsychotics block the ____________ receptors.
dopamine
Atypical antipsychotics block ______________.
both serotonin and dopamine receptors
Describe the presentation of antisocial personality disorder.
Criminality, lack of remorse for others’ rights and feelings, conning others –all present before age 15
Someone with antisocial personality disorder is likely to have which other problem?
Substance abuse
Cyclosporine ultimately works to ______________.
stop the production of IL-2 and its receptor, thereby blocking the differentiation and activation of T cells
Explain the psychiatric phenomenon of splitting.
Splitting is when someone divides things as all-good or all-bad; for example, someone might say “that nurse is the ONLY person who understands me… no one else does!”
Self-harm, suicide attempts, drug use, and splitting are characteristic of what psychiatric disorder?
Borderline-personality disorder
What protein is elevated in yolk sac tumors? What other cancer expresses this marker?
Alpha-fetoprotein
Hepatocellular carcinoma
What nephritic syndrome might present with a maculopapular rash?
IgA nephropathy (what is the systemic version called???)
What medication can treat enuresis?
Desmopressin
In acid base disturbances, how can you differentiate the effects of excessive vomiting from excessive diarrhea?
Vomiting leads to loss of HCl and thus an increase in blood pH, while diarrhea leads to loss of bicarb and a decrease in pH.
Why is there visual disturbance and headache in someone with the disorder that presents with high IgM?
Waldenström macroglobulinemia leads to viscous blood that prevents flow, thus producing headaches and visual problems.
