USMLE Step 1 Flashcards

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1
Q

Most common causes of Meningitis in Older Pts

A
S. pneumoniae
N. meningitis 
H. influenzae type b
S. agalactiae (group B)
L. monocytogenes
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2
Q

Metronidazole adverse reaction

A

disulfiram-like reaction (pt should avoid alcohol)

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3
Q

bacterial vaginosis

A

organism: G. vaginalis
clinical findings: gray watery discharge, vaginal pH > 4.5, positive KOH whiff test
Microscopic findings: clue cells
treatment: metronidazole

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4
Q

Trichomoniasis

A

clinical findings: green-yellow discharge, strawberry cervix, dyspareunia
Vaginal pH: > 4.5
microscopy: motile trichomonads
treatment: metronidazole

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5
Q

vulvovaginal candidiasis

A

clinical findings: thick white discharge
vaginal pH: <4.5
microscopy: pseudohyphae
treatment: fluconazole

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6
Q

Vitamin C is a cofactor for what reaction?

A

It is a cofactor the propyl hydroxylase. It catalyzes the formation of hydroxyproline and hydroxylysine from proline and lysine. This relates to the development of symptoms seen in scurvy

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7
Q

ALK

A

adenocarcinoma of the lung

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8
Q

BRAF

A

melanoma, non Hodgkin lymphoma, papillary thyroid

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9
Q

c-MYC

A

Burkitt lymphoma

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10
Q

HER2/neu

A

breast and gastric carcinomas

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11
Q

JAK2

A

chronic myeloproliferative disorders

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12
Q

KRAS

A

colon cancer, lung cancer, pancreatic cancer

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13
Q

RET

A
MEN 2A (pheochromocytoma, medullary thyroid, parathyroid)
MEN 2B (pheochromocytoma, medullary thyroid, mucosal neuromas), papillary thyroid cancer
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14
Q

APC

A

colorectal cancer (associated with FAP)

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15
Q

BRCA1 and BRCA2

A

breast and ovarian cancer

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16
Q

MEN1

A

MEN1 (pituitary, parathyroid, pancreatic)

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17
Q

NF1

A

NF1 (cafe au leit spots, leisch nodules, fibrodysplasia of bone, pernicious puberty)

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18
Q

NF2

A

NF2 (meningeoms, schwannomas, ependymomas)

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19
Q

Rb

A

retinoblastoma and osteosarcoma

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20
Q

TP53

A

Li-Fraumeni syndrome; associated with most cancers

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21
Q

VHL

A

von Hippel-Lindau disease (renal cell carcinoma, cardiac rhabdomyosarcoma, liver cysts)

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22
Q

What drug class is used for cervical ripening?

A

Prostaglandin analogs (-prost)

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23
Q

Treatment for Lyme disease

A
doxycycline
amoxicillin (pregnant women and children younger than 8 years old)
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24
Q

Penicillin MOA

A

block transpeptidase cross-linking of peptidoglycan in the cell wall

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25
Q

Doxycycline (tetracycline) MOA

A

blocks attachment of aminoacyl-tRNA at the 30S ribosomal subunit

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26
Q

Clindamycin MOA

A

blocks translocation at the 50S ribosomal subunit

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27
Q

Vancomycin MOA

A

inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of the cell wall

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28
Q

What class of diuretics can lead to hypercalcemia?

A

Thiazide diuretics (eg chlorthalidone). Decreased intracellular Na activates the Na/Ca antiporter. Leads to decreased intracellular Ca which causes enhanced calcium reabsorption within the convoluted tubule

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29
Q

Osteoprotegerin MOA

A

Acts as a physiologic decoy receptor that decreases binding of RANK-L to RANK. Inhibition of this reduces differentiation and survival of osteoclasts

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30
Q

A-I

A

HDL

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31
Q

B-48

A

chylomicrons, chylomicron remnants

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32
Q

B-100

A

IDL, LDL, VLDL

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33
Q

C-II

A

HDL, IDL, VLDL, chylomicrons

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34
Q

Apolipoprotein E

A

HDL, IDL, VLDL, Chylomicrons, chylomicron remnants

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35
Q

Acute Intermittent Porphyria

A

Affected enzyme: porphobilinogen deaminase

accumulated substrate: porphobilinogen and aminolevulinic acid (ALA)

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36
Q

Clinical presentation of acute intermittent porphyria

A

abdominal pain
polyneuropathy
port wine colored urine
psych disturbance

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37
Q

Exacerbation of acute intermittent porphyria

A

alcohol, tobacco, P-450 inducers

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38
Q

Porphyria cutanea tarda

A

affected enzyme: uroporphyrinogen decarboxylase
risk factor: Hep C
accumulated substrate: uroporphyrin

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39
Q

Clinical presentation of porphyria cutanea tarda

A

blistering cutaneous photosensitivity
hyperpigmentation
tea-colored urine
symptoms exacerbated by alcohol

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40
Q

Switch to what drug following HIT?

A

alternative non-heparin, non-warfarin anticoagulants. This can include direct thrombin inhibitors and indirect factor Xa inhibitors

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41
Q

Mirtazapine MOA

A

alpha2 antagonist, 5-HT2 and 5-HT3 antagonist, H1 antagonist

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42
Q

acetaminophen

A

N-acetylcysteine (NAC)

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43
Q

anticholinergic toxicity

A

physostigmine (AChE inhibitor, crosses BBB)

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44
Q

Benzodiazepines

A

flumazenil

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45
Q

beta blockers

A

atropine

glucagon

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46
Q

carbon monoxide

A

100% O2

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47
Q

cyanide

A

nitrite + thiosulfate

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48
Q

digoxin

A

anti-digoxin antibody fragments

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49
Q

heparin

A

protamine sulfate

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50
Q

lead

A

dimercaprol
EDTA
succimer (for children)

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51
Q

Methanol and ethylene glycol

A

fomepizole
ethanol
dialysis

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52
Q

methemoglobin

A

methylene blue

vitamin C

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53
Q

opioids

A

naloxone

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54
Q

salicylates

A

sodium bicarbonate

dialysis

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55
Q

serotonin syndrome

A

dantrolene (also for malignant hyperthermia)

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56
Q

TCAs

A

sodium bicarbonate

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57
Q

warfarin

A

vitamin K

fresh frozen plasma (if rapid reversal is needed)

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58
Q

Urea cycle produces what amino acid

A

arginine

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59
Q

Albendazole MOA

A

inhibition of microtubule synthesis by inhibiting tubulin polymerization

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60
Q

Treatment for latent TB

A

9 month course of isoniazid monotherapy

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61
Q

treatment for active TB

A

9 month course of rifampin, isoniazid, pyrazinamide, and ethambutol

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62
Q

Treatment for hypertensive emergency and MOA

A

Nitroprusside: increases cGMP via direct release of NO
Fenoldopam: dopamine D1 agonist

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63
Q

diagnosis of A. lumbricoides

A

visualization of characteristic eggs in concentrated stool samples

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64
Q

Function and associations of Apolipoprotein E

A
  • Clearance of lipoprotein and chylomicron remnants from circulation
  • IDL,HDL,VLDL, chylomicrons and chylomicron remnants
  • associated with late-onset Alzheimer disease
  • type 3 familial dyslipidemia
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65
Q

function of apolipoprotein A-I

A
  • structural protein for HDL

* activation of LCAT

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66
Q

Apolipoprotein B-48

A

required for the assembly and secretion of chylomicrons

*chylomicrons and chylomicron remnants

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67
Q

Apolipoprotein B-100

A
  • LDL, IDL, VLDL
  • assembly and secretion of VLDL
  • type 2 familial dyslipidemia
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68
Q

apolipoprotein C-II

A
  • cofactor for lipoprotein lipase

* dysfunction leads to type 1 familial dyslipidemia

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69
Q

Functions of Vitamin C

A

antioxidant
collagen synthesis
conversion of dopamine to norepinephrine
facilitates iron absorption

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70
Q

Treatment for MDD

A

first line: cognitive behavioral therapy, SSRI

second line: bupropion (contraindicated in a pt with hx of seizures

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71
Q

Differentiate between failed regression of allantois and vitelline duct.

A

allantois: urinary leakage through the umbilicus

vitelline duct: purulent or feculent umbilical drainage

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72
Q

Marfan syndrome

A

pathology: AD, FBN1 gene, chromosome 15

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73
Q

Marfan syndrome clinical presentation

A

major criteria: ectopia lentis (up and out), dilation of aortic root, aortic dissection
mitral valve prolapse in majority of pts

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74
Q

Adverse effect of Mannitol

A

Pulmonary edema
heart failure
dehydration
electrolyte imbalance

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75
Q

What drug/drug class would enhance the effects of levodopa/carbidopa?

A

Selegiline (MAO-B inhibitor) slows metabolism of levodopa. Avoid use if pt is on an SSRI

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76
Q

Signs of decreased synthetic function of the liver

A
  • decreased albumin
  • increased PTT
  • increased unconjugated bilirubin
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77
Q

Which inflammatory cytokines cause an increase in levels of acute phase reactants?

A

IL-6, IL-1, and TNF-alpha

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78
Q

IL-1

A

secreted by: macrophage

USMLE association: causes inflammation

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79
Q

IL-6

A

secreted by: macrophage

USMLE association: increase ESR and CRP

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80
Q

TNF-alpha

A

secreted by: macrophage

USMLE association: cachexia in malignancy, maintain granulomas in Tb

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81
Q

IL-8

A

secreted by: macrophage

USMLE: association: recruits neutrophils

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82
Q

IL-12

A

secreted by: macrophage

USMLE association: activated NK cells

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83
Q

IL-2

A

secreted by: all T cells

USMLE association: stimulate T cell and NK cell proliferation

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84
Q

IL-3

A

secreted by: all T cells

USMLE association: growth and differentiation of bone marrow stem cells

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85
Q

Interferon-gamma

A

secreted by: Th1 cells

USMLE association: stimulates macrophages, stimulates granuloma formation, activate NK cells

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86
Q

IL-4

A
secreted by: Th2 cells
USMLE association: T cell differentiate into Th2 cells, class switching of antibodies
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87
Q

IL-5

A

secreted by: Th2 cells

USMLE association: growth and differentiation of eosinophils

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88
Q

IL-10

A

secreted by: Th2 cells

USMLE association: IL-10 and TGF-beta are the main anti-inflammatory cytokines

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89
Q

Topoisomerase inhibitors: drug name and target

A

etoposide: II
teniposide: II
irinotecan: I
topotecan: I

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90
Q

Muscle activity involved in micturition

A

Relaxation of the levator ani muscles and contraction of detrusor muscle

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91
Q

Hunter syndrome

A

inheritance: x-linked recessive
pathophysiology: deficiency of iduronate-2-sulfatase
accumulated substance: heparan sulfate and dermatan sulfate

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92
Q

Why can’t newborns synthesize vitamin K?

A

Lack intestinal flora that are seen in adults. Will have bleeding issues and require IM vitamin K injections after birth

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93
Q

Clinical features of Digeorge syndrome

A

CATCH-22

  • cardiac defects
  • abnormal facies
  • thymic dysplasia
  • cleft palate
  • hypocalcemia
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94
Q

Folate deficiency clinical features

A
  • megaloblastic anemia without neurologic symptoms (differentiate from B12)
  • in pregnancy, neural tube defects
  • hyper segmented neutrophils
  • increased homocysteine
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95
Q

Niacin (B3) deficiency clinical features

A

diarrhea, dermatitis, dementia

glossitis

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96
Q

Vitamin A deficiency clinical features

A

Nyctalopia (night blindness)
xeropthalmia
keratomalacia
complete blindness

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97
Q

Wet beriberi clinical features

A
B1 deficiency
cardiovascular symptoms
leg swelling
dyspnea
jugular vein distention
high output heart failure
98
Q

Dry beriberi clinical features

A
B1 deficiency
peripheral nervous system symptoms
ataxia
weakness
loss of DTRs
paralysis
99
Q

Wernicke Encephalopathy clinical features

A
B1 deficiency
Seen in alcoholics
Paralysis of eye movements
Abnormal gait
Deranged mental functioning
Korsakoff syndrome; confabulation
100
Q

Pyridoxine (B6) deficiency clinical features

A
Seborrheic dermatitis
Atrophic glossitis
Angular cheilitis 
Conjunctivitis 
intertrigo
neurologic symptoms: somnolence, confusion, peripheral neuropathy
101
Q

Cobalamin (B12) deficiency clinical features

A

Megaloblastic anemia with neurologic symptoms
Fatigue
Ataxia
Cognitive deficits
hyper segmented neutrophils
increased homocysteine and methylmalonic acid

102
Q

Vitamin C deficiency clinical features

A

easy bruising

bleeding from gums

103
Q

Vitamin E deficiency clinical features

A
Peripheral neuropathy
Ataxia
Myopathy
Retinopathy
Poor immune response
Hemolytic anemia
104
Q

Vitamin K deficiency clinical features

A

Bleeding
Prolonged PT and PTT
affects factors 2, 7, 9, 10

105
Q

What genetic mutation predisposes pt to adenocarcinoma of the lungs

A

ALK gene overexpression

106
Q

MOA of amoxicillin

A

block transpeptidase cross-linking of peptidoglycan in the cell wall
used to treat Lyme disease in pregnant women and children younger than 8 years old

107
Q

Which class of medication can lead to hypercalcemia?

A

thiazide diuretics (HCTZ and chlorthalidone)

108
Q

Apo A-I

A

HDL

109
Q

Apo B-48

A

Chylomicron, chylomicron remnants

110
Q

Apo B-100

A

IDL, LDL, VLDL

111
Q

Apo C-II

A

HDL, IDL, VLDL, chylomicrons

112
Q

Apo E

A

HDL, IDL, VLDL, Chylomicrons, Chylomicron remnants

113
Q

Treatment Acute Intermittent Porphyria

A

Dextrose

Hemin

114
Q

If pt presents with muscle pain and weakness in the setting of hypokalemia what drug most likely caused this?

A

Thiazide diuretics
other lab abnormalities include hyperuricemia, hyperglycemia, hypercalcemia, and dyslipidemia
Need to replace with a potassium sparing diuretic

115
Q

3 diagnostic markers of UTI

A
  1. positive leukocyte esterase
  2. positive nitrite test (indicates reduction of urinary nitrates by gram-negative bacteria)
  3. urine white blood cells
116
Q

urine pH >8.5 is indicative of?

A

infection caused by urease-producing organism such as Proteus, S. saprophyticus, or Klebsiella

117
Q

Increased LAP score is associated with?

A

leukemoid reactions

leukemias typically have a low LAP score

118
Q

How does procalcitonin help determine what is causing the infection?

A

levels are typically normal in the setting of a viral infection

levels rise to detectable levels with bacterial infections

119
Q

Adverse effects of Amphotericin B

A
Nephrotoxicity
Renal Tubular Acidosis 
Arrhythmias 
Anemia
Hypotension
Fever, chills, vomiting
120
Q

Krabbe Disease: etiology, clinical features, histo

A

etiology: accumulation of galactocerebroside
clinical features: developmental delay, feeding difficulty, seizures, peripheral neuropathy, optic atrophy
Histo: multinucleated globoid cells

121
Q

Heparin primarily affects what test?

A

PTT (12, 11, 9, 8, 10, 5)

122
Q

Warfarin primarily affects what test?

A

PT (7, 10, 5)

123
Q

Antibiotic treatment for acne

A

first line: doxycycline

use minocycline instead if pt requires being outside for extended periods of time

124
Q

which element is found only in gram-negative bacterial cell membranes?

A

lipopolysaccharide

this is what keeps the stain out making it gram negative

125
Q

Which bacteria acquires its toxin by specialized transduction by a lysogenic bacteriophage?

A

Cholera

126
Q

Which vitamin is predominantly stored in the liver?

A

vitamin B12 (cobalamin)

127
Q

Individuals who have a long history of using insecticides have been exposed to what which has caused what disease?

A

Rotenone

Parkinson disease

128
Q

How to differentiate between the two groups of local anesthetics

A

amide: i before -caine
ester: no i before -caine

129
Q

Enzyme and reactions involved in Lesch-Nyhan syndrome

A

enzyme: HGPRT
Reactions:
guanine –> GMP
hypoxanthine –> IMP

130
Q

Name the drugs that cause gynecomastia

A
DISCO
Digitalis
Isoniazid
Spironolactone
Cimetidine, ketoconazole
Oestrogen/anti-testosterone
131
Q

Treatment for organophosphate poisoning

A

Atropine: inhibition of muscarinic receptors
Pralidoxime: reactivation of AChE
Supportive care

132
Q

Use subluxation of lens to determine disease

A

Up and out: Marfan syndrome

Down and in: Homocysteinuria

133
Q

Linezolid is contraindicated on pts taking what medication?

A

SSRIs due to linezolid having weak activity as a MAO-I and could lead to serotonin syndrome

134
Q

Classification and treatment of intermittent asthma

A
  1. daytime symptoms < 2 times per week
  2. < 2 nocturnal awakenings per month
  3. ability to carry out normal activities without interference by asthma symptoms

SABA (beta 2): causes bronchial smooth muscle relaxation

135
Q

Cyclosporine: MOA, what is it used to treat, and adverse effects

A

MOA: calcineurin inhibitor
Tx: steroid-resistant nephrotic syndrome
Adverse: nephrotoxicity, headache, and GI upset

136
Q

First line treatment for focal and focal tonic-clonic seizures

A

Prolonging inactivation of Na channels in rapidly firing nerves

  1. Carbamazepine (agranulocytosis)
  2. Phenytoin (gingival hyperplasia)
137
Q

Clinical features of hereditary fructose intolerance

A

AR
deficient in fructose 1-phosphate aldolase (aldolase B)
Pt needs to avoid fructose and sucrose in their diets

138
Q

Clinical features of Vitamin A toxicity

A

dry scaly skin, nausea, vomiting, and blurry vision

Can be a side affect of a pt on isotretinoin

139
Q

Pathophysiology of toxic shock syndrome caused by S. aureus

A

Cytokine storm secondary to unregulated activation of T-cells.

TSST-1 binds to MHC class II and TCRs

140
Q

WHO guidelines for treatment of P. falciparum

A

Artemisinin-based combination therapy (ACT). Most common is dihydroartemisinin and piperaquine

141
Q

Treatment and MOA of malignant hyperthermia

A

dantrolene: inhibition of calcium release from the sarcoplasmic reticulum

142
Q

Adverse effects of TCAs

A

dry mouth and other symptoms consistent with anti-cholinergic properties

143
Q

Clinical presentation of Measles

A

3 C’s: cough, conjunctivitis, and coryza
Koplik’s spots: clustered white lesions on the buccal mucosa
Maculopapular, erythematous rash covering the whole body

Give live attenuated vaccine

144
Q

What drugs can precipitate digoxin toxicity?

A

Verapamil and diltiazem (CCB)

145
Q

Where in the cell does gluconeogenesis occur?

A

cytoplasm and mitochondria

146
Q

What medications are contraindicated in the treatment of Mono?

A

Amoxicillin or ampicillin

147
Q

Virulence factor of Neisseria species

A

Antigenic variation of pili

148
Q

How does Hep B facilitate infection by Hep D virus?

A

Production of proteins that coat HDV viral particles. Hep D cannot complete virion assembly and secretion independently

149
Q

Pt presents with diffuse abdominal pain, urine that is red in color, and urine shows elevated levels of porphobilinogen. What is the diagnosis?

A

Acute intermittent porphyria

150
Q

What accumulates in urine in a pt with lead poisoning? What enzymes are blocked?

A

ALA and coproporphyrin

ferrochelatase and ALA dehydratase

151
Q

MOA and adverse effects of Ethambutol

A

MOA: inhibit arabinosyl transferase, interfering with the mycobacterial cell wall
Adverse: visual problems including lack of acuity and color blindness

152
Q

Adverse effects seen with Myco Tb drugs (RIPE ON GO)

A

Rifampin: orange sweat, urine, and tears
Isoniazid: neuropathy, B6 deficiency, Drug induced SLE, hemolysis in G6PD deficiency pyrazinamide: gout, hepatotoxicity
Ethambutol: optic neuritis, visual problems, lack of acuity, and color blindness

153
Q

Production of what is decreased in carnitine deficiency?

A

Acetyl-CoA and Ketone bodies

154
Q

What drug is used to prevent side effects seen with using Doxorubicin?

A

dexrazoxane is an FDA approved cardioprotective agents used to prevent some of the side effects of anthracyclines

155
Q

MOA of dobutamine

A

enhance contractile ability of the heart by acting as a beta 1 agonist
Beta 1 = Gs = increased cAMP

156
Q

Clinical presentation of infective endocarditis

A

-fever
-clubbing of the distal fingers
-Roth spots (on retina)
-Osler nodes
Janeway lesions (palms and soles)
-Petechiae
-Splinter hemorrhages

157
Q

Clinical Presentation of McArdle’s disease

A
  • muscle cramping

- myoglobinuria with strenuous exercise

158
Q

How does MRSA become resistant to methicillin

A

Altered penicillin binding protein

159
Q

Adverse effects of Sildenafil (used to treat ED)

A
  • “blue vision”

- blurred vision

160
Q

What enzyme is deficient and what accumulates in pts with Tay-Sachs disease?

A

Enzyme: hexosaminidase A
Accumulation: GM2 ganglioside

161
Q

What is the most feared complication of a chronic infection with Onchocerca volvulus?

A

Blindness

162
Q

Enzyme deficient in McArdle’s disease

A

skeletal muscle glycogen phosphorylase

163
Q

Clinical presentation of Porphyria cutanea tarda

A
  • deficiency of uroporphyrinogen decarboxylase leading to accumulation of uroporphyrin in the urine
  • cutaneous blisters
  • liver involvement
164
Q

Shape of crystals seen in a pt with Cystinuria

A

hexagonal crystals “6tinuria”

165
Q

Enzyme deficient in PKU

A

phenylalanine hydroxylase leading to an accumulation of phenylalanine and phenylpyruvate

166
Q

Clinical presentation of PKU

A
  • fair skin
  • eczema
  • musty body odor or diaper
167
Q

Caplan’s syndrome is seen only in patients with these two diseases at the same time

A

rheumatoid arthritis and pneumoconiosis related to coal, asbestos, and silica exposure

168
Q

Clinical presentation of lactose intolerance

A

abdominal pain, bloating, diarrhea, and a decreased stool pH

169
Q

Diagnostic findings of Lactose Intolerance

A
  1. Positive hydrogen breath test
  2. Decreased stool pH: <5.5 normal ~6.0
  3. Increased stool osmolarity
  4. Intestinal biopsy will show that the pt has normal-appearing villi
170
Q

Clinical features of chronic mesenteric ischemia

A
  • postprandial abdominal pain

- food aversion which leads to weight loss

171
Q

Defect seem with Xeroderma Pigmentosum

A

AR defect in nucleotide excision repair. UV light exposure damages DNA and leads to the presence of pyrimidine dimer; patients with xeroderma pigmentosum are unable to repair DNA pyrimidine dimers

172
Q

Pathology and associated conditions of Chiari I malformation

A

Pathology: displacement of the cerebellar tonsils through the foramen magnum
Associated: spinal cavitation such as syringomyelia

173
Q

Pathology and associated conditions of Chiari II malformation

A

Pathology: herniation of cerebellar vermis and tonsils through the foramen magnum
Associated: Lumbosacral myelomeningocele

174
Q

Pathology and associated conditions of Dandy-Walker malformation

A

Pathology: agenesis of cerebellar vermis
Associated: agenesis of the corpus callosum and occipital encephalocele

175
Q

Empiric treatment of meningitis in newborns (0-6 months)

A

ceftriaxone and ampicillin

176
Q

Empiric treatment of meningitis in pts 6-60 years old

A

Vancomycin + third gen cephalosporin (ceftriaxone or cefotaxime)

177
Q

Empiric treatment of meningitis in pts >60 years old

A

Vancomycin + third gen cephalosporin (ceftriaxone or cefotaxime) + ampicillin

178
Q

Name tumors associated with all 3 MEN syndromes

A

1: pituitary adenoma, parathyroid hyperplasia, pancreatic tumors
2A: Parathyroid hyperplasia, pheochromocytoma, medullary thyroid carcinoma
2B: pheochromocytoma, medullary thyroid carcinoma, mucosal neuromas

179
Q

Common Peroneal Nerve Injury: vertebrae level, MOI, and Symptoms

A

Nerve: L4-S2
MOI: -fibular neck fracture
-trauma or compression of the lateral leg
Symptoms: -loss of dorsiflexion
-loss of ankle eversion
-decreased sensation on the dorsum of the foot

180
Q

Femoral nerve injury: vertebrae level, MOI, and symptoms

A

nerve: L2-L4
MOI: pelvic fracture
Symptoms: - decreased leg extension, patellar reflex, and sensation on the anterior and lateral thigh

181
Q

Inferior Gluteal nerve injury: vertebrae level, MOI, and symptoms

A

Nerve: L5-S2
MOI: posterior hip dislocation
Symptoms: -weakness climbing stairs or rising from a seated position
-decreased hip extension

182
Q

Obturator nerve injury: vertebrae level, MOI, and symptoms

A

Nerve: L2-L4 (just like femoral)
MOI: Pelvic surgery (not pelvic fracture as seen with femoral)
Symptoms: decreased thigh adduction and sensation on the medial thigh

183
Q

Pudendal nerve injury: vertebrae level, MOI, symptoms

A

Nerve: S2-S4
MOI: stretch injury during childbirth
symptoms: -decreased sensation in the perineum and genital area
-fecal and/or urinary incontinence

184
Q

Sciatic nerve injury: vertebrae level, MOI, symptoms

A

Nerve: L4-S3
MOI: -herniated disc
-posterior hip location (same as inferior gluteal)
symptoms: -pain and paresthesia along the posterior leg
-decreased motor and sensory function in the ankle and foot

185
Q

Tibial nerve injury: vertebrae level, MOI, symptoms

A
Nerve: L4-S3
MOI: -Baker cyst
-knee trauma 
-tarsal tunnel syndrome
symptoms: -decreased plantar flexion
-inability to curl the toes
-loss of ankle inversion (opposite of common peroneal nerve)
-decreased sensation on the sole of the foot
186
Q

What is the most common pituitary tumor in adults?

A

Prolactinoma

187
Q

Name the 4 tumors associated with psammoma bodies

A
  • concentric spherules with dystrophic calcifications
  • meningiomas
  • papillary thyroid carcinoma
  • serous epithelial ovarian carcinoma
  • mesothelioma
188
Q

Foster Kennedy Syndrome: most common cause and symptoms

A

Cause: meningiomas arising from the olfactory groove
Symptoms: -anosmia
-ipsilateral anopia
-contralateral papilledema

189
Q

Describe subclavian steal syndrome and the vessels involved

A

blood flow through the subclavian artery to the ipsilateral upper limb is diminished: perfusion to the affected extremity is maintained through the ipsilateral vertebral artery. This occurs through the basilar artery

190
Q

Brugada syndrome: What is it, who does it affect, and what will you see on EKG?

A
  • AD mutation that affects sodium channels within the heart. This pts are at risk of developing ventricular tachyarrhythmias that can result in cardiogenic syncope and sudden cardiac death
  • most commonly affects Asian males
  • pseudo-right bundle branch block and ST-segment elevations in leads V1-V3
191
Q

What medical condition is a contraindication for using mannitol?

A

Congestive Heart Failure. The drug causes water to move into the extracellular space leading to pulmonary edema. A pt with CHF is already experiencing this and could not handle the exacerbation

192
Q

Name 4 hormones that have nuclear receptors that contain DNA-binding domains

A
  • aldosterone
  • cortisol
  • estradiol
  • thyroxine
193
Q

Does prolactin have a plasma membrane or nuclear receptor?

A

plasma membrane receptor

194
Q

Pathology behind why older people can’t see up close

A

age-related hardening of the lens and loss of accommodative ability (aka presbyopia). It can no longer relax and curve to see object up close. Corrected with positive power lenses

195
Q

What is the role of IkB in the NF-kB signal transduction pathway from IL-1 binding to IL-6 induction?

A

Releases NF-kB after undergoing phosphorylation

196
Q

Adverse effects of Metformin

A

nausea, abdominal discomfort, diarrhea, and lactic acidosis

197
Q

Remodeling of a scar is primarily mediated by what enzyme?

A

matrix metalloproteinases

198
Q

How to distinguish parietal cells on histo

A

parietal cells can be identified by their large size, central, round, nucleus, and intensely acidophilic cytoplasm

199
Q

What is the vector for Yersinia pestis?

A

Most often transmitted by infected fleas, and the direct handling of animals infected with those fleas

200
Q

What is self-selection sampling technique?

What type of bias is seen with this?

A

Self-selection occurs when individuals select for themselves to participate in a study.
Self-selection bias

201
Q

What diseases will show an M-protein spike (M-spike)?

A

B cell malignancies including Waldenstrom macroglobulinemia, plasma cell leukemia, smoldering myeloma, amyloidosis, or plasmacytoma

202
Q

How is multiple myeloma diagnosed?

A

Confirmed by bone marrow biopsy where there are at least 10% clonal plasma cells. Disease is only suspected when an M-spike is seen

203
Q

Lack of input from which neural pathway would lead to priapism?

A

sympathetic fibers from the prostatic plexus.

Cavernous and pudendal nerves carry sympathetic fibers that release NE to stop erection

Parasympathetic=Erection
Sympathetic=no erection

204
Q

Vitamin E deficiency can have a similar presentation to deficiency of what other vitamin?

A

Vitamin B12. Pts will not have megaloblastic anemia, hyper segmented neutrophils, or increased serum methylmalonic acid concentrations

205
Q

Tissue biopsy of a pt with Kaposi sarcoma (HHV-8) will show what?

A

Proliferating spindle cells forming slit-like spaces filled with blood

206
Q

If a new drug prevents polymerization of actin filaments, what leukocyte function will most likely be inhibited?

A

Phagocytosis
actin provides a mechanical superstructure for the phagocyte to maintain shape, shuttles enzymes and their substrates together to augment signaling, aids in the endocytosis of large particles

207
Q

What age related change causes older people to not be able to concentrate urine as well as a younger pt?

A

Decreased renal tubule responsiveness to ADH (vasopressin)

208
Q

If the MCA ruptures on the dominant side of the brain what symptoms will be seen?

A

Global aphasia as a result of the involvement of Broca and Wernicke areas, along with the arcuate fasciculus

Also presents with paralysis and sensory loss of the contralateral face and arm

209
Q

What is Pierre Robin syndrome and what pharyngeal arch is altered?

A

Pierre Robin: small lower jaw, downward displacement or retraction of the tongue, and cleft palate

First pharyngeal arch: maxilla, mandible, masseter, pterygoids, and mylohyoid, CN V2 and V3

210
Q

What is a critical component of Extracellular matrix found in human renal mesangial cells?

A

Fibronectin

211
Q

What is the location of the lymph nodes which first drain the ovaries on their way to the para-aortic lymph nodes?

A

along the ovarian vessels.

Most lymph vessels follow the arterial supply

212
Q

What PE findings are suggestive of a pleural effusion?

A

unilateral decreased breath sounds, dullness to percussion, and decreased tactile fremitus are most suggestive of a pleural effusion

213
Q

How is Cryptosporidium parvum characterized?

A

Fever, watery diarrhea, and cramping abdominal pain. Light microscopy shows intraluminal oocysts on acid-fast stain

214
Q

What component of Myco Tb can be directly cytotoxic to macrophages?

A

cord factor: prevents fusion of the vesicles containing MTB with the lysosome

The acid-fast guy is using his whip in the sketchy video. That is what is used to show Cord Factor

215
Q

How will S. Aureus and S. pyogenes appear on culture?

A

S. aureus: clusters

S. pyogenes: chains

216
Q

What is the immune reaction seen with an Acute allograft rejection?

A

Host CD8+ T lymphocytes recognize class 1 MHC molecules on renal allograft cells

Type 4 hypersensitivity

217
Q

What PE finding would there be with an occlusion of the posterior cerebral artery (PCA)?

A

Infarction of the ipsilateral occipital lobe and a contralateral homonymous hemianopsia with macular sparing

218
Q

Why are premature neonates with hyaline membrane disease given O2 at a saturation between 92% and 95%?

A

Prevent retinopathy of prematurity by maintaining the chemical gradient of VEGF. High O2 saturation would eliminate this and blood vessel growth which isn’t complete would stop, leading to ROP

219
Q

MOA of topical erythromycin used on newborns. What is it used to prevent?

A

MOA: inhibits bacterial protein synthesis by binding to bacterial ribosomal 50s subunits

220
Q

If pt presents with abdominal pain, vomiting, and presence of large white worms in the stool what is the most likely organism?

A

Ascaris lumbricoides

221
Q

Which enzyme is needed to convert trypsinogen to trypsin?

A

Enteropeptidase

Results in the inability to convert numerous digestive proenzymes into their active forms

222
Q

Clinical presentation of scabies

A

intensely pruritic erythematous papules of the sides or webs of the fingers, wrist, axillae, areolae, or genitalia, and burrows may be visible

223
Q

When embolizing a leiomyomata what is the route of the catheter when entering through the femoral artery?

A

external iliac –> internal iliac artery –> uterine artery

224
Q

What type of lung tumor will lead to the production of PTHrP?

A

squamous cell carcinoma

225
Q

What are the primary inflammatory mediators that promote vasodilation in the initial innate immune response?

A

Histamine, Prostaglandin-E2, and bradykinin

Prostaglandin-E2 and bradykinin also sensitize nociceptive nerve endings

226
Q

Which nerves located near the posterior aspect of the prostate , when damaged, could lead to erectile dysfunction?

A

Pelvic splanchnic

Parasympathetic= erection
sympathetic= no erection
227
Q

Which two organs participate in gluconeogenesis?

A

liver and kidney

228
Q

What causes roseola and clinical presentation of the disease?

A

HHV-6
several days of high fevers followed by a macular eruption that starts on the neck and trunk which then spreads outward to the face and extremities

229
Q

Which tumor causes precocious puberty or virilization?

A

Ovarian sertoli-leydig cell tumor

230
Q

Side effects of Beta 2 adrenergic agonists

A

tremor, hypokalemia, hyperglycemia, tachycardia, hypertension, and headache

231
Q

Which spinal tract is responsible for temperature and pain?

A

lateral spinothalamic tract. Crosses the body two levels up so contralateral side is affected

232
Q

What is the dysfunction in Leukocyte Adhesion Deficiency (LAD) and what would this cause to be wrong in the leukocyte?

A

LFA-1 (CD18) which would inhibit migration of the cell

233
Q

Describe esophageal peristalsis and lower esophageal sphincter tone in a pt with CREST syndrome

A

esophageal peristalsis: decreased

lower esophageal sphincter tone: decreased

234
Q

What does CREST syndrome stand for?

A
calcinosis cutis
Raynaud phenomenon
esophageal dysmotility 
sclerosis
telangiectasias
235
Q

Function of cytochrome c

A

released from mitochondria as the intrinsic and extrinsic apoptotic pathways converge. Cytochrome c then activates caspases that potentiate apoptosis. This leads to cell shrinkage, nuclear, pyknosis, karyorrhexis, and blebbing of the cellular membrane

236
Q

MOA of fluroquinolones

A

Inhibit DNA gyrase, which disrupts DNA synthesis

237
Q

Glipizide: Class and MOA

A

second-generation sulfonylurea

inhibits potassium pump, depolarizing the insulin cells, leading to calcium induced exocytosis of insulin into the blood

238
Q

Best way to decrease the number of sudden cardiac deaths

A

placement of external automatic defibrillators in public spaces

239
Q

Which cells contain high-affinity glutamate transporters?

A

astrocytes

240
Q

Relationship between mean and median according to the skew of a chart

A

right skew: mean > median

left skew: mean < median

241
Q

Lab findings seen with von Willebrand disease

A

increased bleeding time
decreased factor VIII activity
suppressed ristocetin cofactor activity