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USMLE_STEP1 > USMLE WORLD > Flashcards

USMLE WORLD Flashcards

1
Q

alkaptonuria is due to genetic deficiency of what?

A

homogentisate oxidase (you can’t take tyrosine and eventually make fumurate; has black urine if urine undergoes oxidation; causes ochronosis ( a blue-black pigmentation that is seen in ears, nose, & cheeks

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2
Q

what kind of BVs does nitroglycerin work on?

A

venodilator of mainly large veins

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3
Q

what is the name of the protein that is required for neutrophils to undergo diapedesis?

A

PECAM

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4
Q

what is the MC location for brain germinoma?

A

pineal region

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5
Q

what are the clinical features of brain germinoma?

A

tumor in pineal region, can cause preccocious puberty (may be seen in males due to increased beta-HCG prod.)
-aqueductal compression causing hydrocephalus, & parinaud syndrome (which is characterized by upward gaze and convergence, due to compression of the tectal area of the midbrain)

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6
Q

6-MP is metabolized by what enzyme?

A

xanthine oxidase (it is also activated by HGPRT)

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7
Q

what is the only GLUT transporter that is responsive to insulin?

A

GLUT4 (found in tissues like adipocytes and skeletal muscles)

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8
Q

what kind of cardiac abnormality is seen in turner’s syndrome?

A

coarctation of the aorta

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9
Q

which parts of the nephron are most susceptible to ischemic injury?

A

the proximal tubules and the thick ascending limb

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10
Q

what is contraction alkalosis?

A

can happen with thiazide & loop diuretics, both classes increase renal loss of Na, followed by loss of Cl-, there is reabsorption of bicarb to maintain electric neutrality in cells, the volume contraction stimulates aldosterone secretion (acts to resorb Na+ and water from distal tubule while excreting K+ & H+); overall Cl- concentration in body is low due to renal losses; giving saline improves acid-base status

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11
Q

the amount of coronary blood flow is determined by what?

A

duration of diastole

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12
Q

what drug do you use to treat essential tremor?

A

propanolol

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13
Q

which bacteria causes ecthyma gangrenosum?

A

pseudomonas aeruginosa: cutaneous necrotic dz w/ bacteremia & septicemia; pseudomonas invades perivascularly & releases tissue destructive exotoxins causing vascular destruction & decreased blood flow to skin which becomes edematous and necrotic

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14
Q

what are the 3 P’s of MEN 1 syndrome?

A 
Pituitary tumors (prolactinoma, or GH secreting)
Pancreatic tumors (gastrinoma)
Parathyroid tumors
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15
Q

how do you calculate the number needed to harm?

A

NNH = 1 / attributable risk

attributable risk = event rate in treatment - event rate in placebo

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16
Q

in what part of the nephron would you see uric acid precipitate, like in the case of tumor lysis syndrome?

A

most likely to precipitate in collecting ducts b/c of the low pH

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17
Q

which types of molecules/cytokines stimulates neutrophil chemotaxis/

A 
IL-8
C5a
LTB4
n-formylated peptides
5-HETE
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18
Q

what class represents the drugs of choice for heparin induced thrombocytopenia?

A

direct thrombin inhibitors (argatroban)

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19
Q

describe the innervation to the ear?

A

post. canal of the ear = CN X (small auricular branch)

Remainder of EAC & External part of TM = CN V3 (auriculotemporal branch)

Inner part of TM = CN IX (tympanic branch)

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20
Q

what is the mechanism of amatoxins (mushrooms)

A

potent inhibitors of RNA polymerase II, halting mRNA synthesis

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21
Q

which drug would you use on a lady with PCOS who wants to get pregnant?

A

CLOMIPHENE, an estrogen receptor modulator that decreases the negative feedback on the hypothalamus by the high amount of circulating estrogen

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22
Q

what is the enzyme deficiency in Tay-Sach’s dz?

A

AR deficiency of beta-hexosaminidase A, leads to built up of GM2 ganglioside

Features: progressive neurodegeneration, cherry red macula, weird startle response & no hepatosplenomegaly

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23
Q

bacillus anthracis has what unique component of its antiphagocytic capsule?

A

D-glutamate instead of polysaccharide

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24
Q

fenoldopam MOA

A

selective dopamine-1 receptor agonist

causes arteriolar dilation & natriuresis–> decreased PVR;

only drug that improves renal wolunction and decreases BP (can be used in pts w/ HTN & renal insufficiency)

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25
Q

what is the drug of choice for mucormycosis?

A

amphotericin B

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26
Q

name the type of cell: pyknotic superficial or immature squamous cells w/ dense irregulary staining cytoplasm and PERINUCLEAR CLEARING

A

koilocyte (HPV)

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27
Q

name the drug: opioid narcotic designed to produce analgesia w/ no abuse; it has partial agonist & weak antagonist activity at mu receptors; so it can produce withdrawal in opioid addicts

A

pentazosine

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28
Q

what is the mechanism of disease in vitiligo?

A

caused by loss of EPIDERMAL MELANOCYTES

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29
Q

name the term: changes seen in body of neuron after axon has been cut, there are enlarged rounded cells with peripherally located nuclei and dispersed granular Nissle substance (this reflects increased protein synthesis that is supposed to help in repair)

A

axonal reaction

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30
Q

what is the MCC of retinitis in HIV pts?

A

CMV (treat with ganciclovir)

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31
Q

what is trousseau’s syndrome?

A

migratory superficial thrombophlebitis; can be seen as paraneoplastic syndrome in visceral cancers

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32
Q

what is the most common site of injury in aortic rupture?

A

aortic isthmus (area b/w the ascending and descending aorta after the place where L. subclavian artery branches off the aorta)

note: MC due to motor vehicle accidents

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33
Q

what is the enzyme deficiency in Lesch-Nyhan syndrome?

A

x linked disorder of HGPRT deficiency

results in failure of purine salvage pathway

leads to increased amounts of purine bases like hypoxanthine & guanine that get degraded to uric acid

end results is you lose a lot of purine bases so now you have to increase de novo purine synth. to replace the lost purine bases (PRPP increases)

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34
Q

Drugs of choice for treating GC & chlaydia together

A

GC - Ceftriaxone

Chlamydia - Azithromycin

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35
Q

niacin moa

A

used to treat dyslipidemia; lowers levels of VLDL & raises levels of HDL

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36
Q

what is the atopic triad?

A

atopic dermatitis (eczema)

allergic rhinitis

asthma

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37
Q

what is the chi square test used for?

A

used to test the assoc. b/w 2 categorical variables

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38
Q

what is the mechanism of the genetic defect in fragile x syndrome?

A

there is increased number of CGG repeats that leads to hypermethylation of cytosine bases and subsequent gene inactivation

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39
Q

what are two drugs used to treat CMV retinitis?

A

Ganciclovir (DOC)

Foscarnet

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40
Q

how do you treat postop urinary retention?

A

the problem is decreased micturition reflex and decreased contractility of the bladder (holding on to too much urine) so the treatment is bethanechol or an alpha-1 blocking drug

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41
Q

which vitamin can be used to treat measles?

A

vitamin A

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42
Q

which 2 beta blockers are nonselective blockers of both alpha & beta receptors?

A

carvedilol

labetalol

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43
Q

describe the murmur of hypertrophic cardiomyopathy

A

systolic ejection murmur

decreases with maneuvers that increase the afterload and preload

-this is b/c increasing these parameters decreases the L. ventricular outflow tract obstruction by increasing L. ventricular volume

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44
Q

describe the clinical presentation of congenital hypothyroidism

A

hypotonia, poor feeding, jaundice, macroglossia, constipation, and UMBILICAL HERNIA

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45
Q

describe the MOA of atrial natriuretic peptide

A

causes peripheral vasodilation and increased urinary excretion of sodium & water

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46
Q

MOA and clinical use of buspirone

A

moa = stimulates 5-HT1A receptors

clinical use = Gen. anxiety disorder, doesn’t cause sedation, addiction or tolerance, so good for use in pts prone to abusing BNZs

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47
Q

what is Kussmaul sign?

A

seen with paradoxical rise in JVP during inspiration, seen in constrictive pericarditis

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48
Q

which renal disease is associated with IgG4 antibodies to the phospholipase A2 receptor?

A

membranous nephropathy

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49
Q

what is cheyne-stokes respiration?

A

cyclic breathing where there is apnea, then gradually increasing tidal volume, then decreasing tidal volumes until the next apneic period; seen in heart failure

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50
Q

what is Kussmaul breathing?

A

deep and labored breathing pattern seen in DKA

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51
Q

how do you treat TCA cardiotoxicity?

A

treat with sodium bicarbonate (b/c TCAs can block fast sodium channels and cause QRS prolongation)

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52
Q

what is the defect in essential fructosuria?

A

defective fructokinase (AR), can’t trap fructose in cells, generally asymptomatic w/ finding of fructose in blood and urine

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53
Q

what is the t-test used for?

A

used to compare the means of 2 groups of subjects

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54
Q

which viral vaccines are live attenuated?

A 
Smallpox
Yellow Fever
Chickenpox (VZV)
Sabin Polio virus
MMR
Influenza (intranasal)

“Live! One night only! See Yellow Chickens get vaccinated w/ Sabin & MMR. It’s INcredible”

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55
Q

which viral vaccines are killed?

A

Rabies
Influenza (injection)
Salk Polio
HAV

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56
Q

which viral vaccines are recombinant?

A

HBV (antigen = recombinant HBsAg)

HPV (6, 11, 16, 18)

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57
Q

which atypical antipsychotic can cause hyperprolactinemia and subsequently amennorhea?

A

risperidone

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58
Q

midshaft fracture of the humerus is most likely to damage what 2 structures?

A

radial nerve

deep brachial artery

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59
Q

hematogenous osteomyelitis is most common in children and usually affects which part of the long bones?

A

metaphysis (due to slow blood flow and capillary fenestrae in the area)

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60
Q

which two bacteria both make toxins that work by ribosylating & inactivating EF-2, thus inhibiting protein synthesis?

A
  1. Diptheria toxin

2. Exotoxin A (pseudomonas)

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61
Q

what is the mechanisms of the AE of angioedema with ACE inhibitors?

A

build up of bradykinin (which is a vasodilator and promotes edema)

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62
Q

Vitamin A toxicity presentation

A

papilledema & seizures
-due to increased ICP

Hepatitis

bone pain (periosteal proliferation)

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63
Q

what kind of drugs can cause pulmonary htn?

A

taking appetite suppressants (fenfluramine or phentermine) for about 3 months, presents with dyspnea on exertion and leads to RVH, possibly sudden cardiac death

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64
Q

name the disorder: AR, resulting from defective DNA-repair genes, pts are hypersensitive to ionizing radiation w/ features like cerebellar atxia, oculocutaneous telangiectasias, repeated sinopulmonary infections & increased risk of malignancy

A

ataxia-telangiectasia

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65
Q

how can you treat the opthalmopathy in graves dz?

A

use glucocorticoids to reduce severity of inflammation and decrease the extraocular volume

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66
Q

how can you treat urge incontinence?

A

the problem is too much bladder contraction

treat with oxybutynin (M3 receptor) that will prevent overcontraction of the bladder

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67
Q

how do we treat listeriosis?

A

AMPICILLIN

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68
Q

MOA of phenoxybenzamine

A

irreversible alpha-1 & alpha-2 antagonist, reduces the # of receptors available for NE binding, so you can’t overcome the action of the drug by adding more NE

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69
Q

how does carotid massage cause increased parasympathetic tone on the heart?

A

baroreceptors sense too much pressure–> INCREASED FIRING via CN IX, the CNS responds by causing vagal nerve to prolong AV nodal refractory period

this can be used to stop re-entrant tachycardias

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70
Q

what are the 2 most common causes of eugonadotropic amenorrhea?

A
  1. mullerian agenesis

2. imperforate hymen

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71
Q

what is the arteriovenous concentration of an inhaled anesthetic mean?

A

reflects overall tissue solubility of an anesthetic

if there is high tissue solubility then there will be large arteriovenous concentration gradient and a slower onset of action

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72
Q

what is the blood supply to the proximal 1/3 of the ureter?

A

comes from branches of the renal artery, this is the reason that the prox. 1/3 of donor ureter can stay after renal transplant

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73
Q

which part of the anal canal is damaged with anal fissures?

A

in the posterior midline distal to the dentate line (this happens b/c there is poor perfusion to this area, and this makes the area sensitive to trauma by hard fecal masses)

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74
Q

which metabolite accumulates in galactokinase deficiency?

A

galactitol accumulates

galactose can’t be phosphorylated so it is made into galactitol by aldose reductase

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75
Q

what is the hawthorne effect?

A

the tendency of a study population to affect an outcome due to the knowledge of being studied

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76
Q

what is the MCC of primary amenorrhea in a women with fully developed secondary sex traits?

A

MC = imperforate hymen

other is mullerian duct anomaly

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77
Q

which drug can you give to people exposed to radioactive iodine isotopes?

A

give potassium iodide, which can prevent the uptake of the radioactive iodine by competitively inhibiting the transporter

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78
Q

what is the enzyme deficiency in maple syrup urine dz?

A

defect in alpha-ketoacid dehydrogenase

can’t degrade branched chain amino acids beyond their deaminated alpha-ketoacid state

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79
Q

how do you treat a lung abscess?

A

use clindamycin which has activity against oral anaerobes & also covers aerobic gram-positive bacteria like streptococcus

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80
Q

which enzyme is missing in hereditary fructose intolerance?

A

aldolase B

fructose-1-phosphate accumulates leading to decreased availability of PO4, this leads to inhibition of glycogenolysis & gluconeogenesis

Symptoms: hypoglycemia, jaundice, cirrhosis vomiting

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81
Q

what can precipitate biotin deficiency?

A

caused by antibiotic use or excessive ingestion of raw egg whites

Features: dermatitis, alopecia, enteritis

note: biotin is a cofactor for several carboxylase enzymes

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82
Q

naloxone has greatest affinity for which opioid receptors?

A

Mu - which when activated would normally cause euphoria, respiratory & cardiac depression, and decreased GI Motility

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83
Q

what clinical maneuver can you do to better hear an S3 heart sound?

A

have pt lie down on their left side and have them fully exhale

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84
Q

what are some of the clinical features of friedreich’s ataxia?

A

cerebellar ataxia (w/ degeneration of the spinocerebellar tracts), loss of proprioception & vibration, kyphoscoliosis, hypertrophic cardiomyopathy, and high foot arches, also DM

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85
Q

how can you prevent the nephrotoxicity assoc. with cisplatin?

A

use amifostine, which is a free radical scavenger

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86
Q

what are the two MCC of aseptic meningitis?

A

enteroviruses like coxsackievirus & echovirus

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87
Q

what is meconium ileus?

A

distal small bowel obstruction in CF neonate due to abnormally dehydrated meconium

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88
Q

what is hartnup disease?

A

AR disorder that has deficiency of neutral amino acid (e.g. tryptophan) transporters in proximal renal tubular cells and on enterocytes

leads to neutral aminoaciduria and can cause pellagra-like symptoms

note: hartnup dz can lead to niacin deficiency

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89
Q

which enzyme is deficient in classic galactosemia?

A

deficiency of galactose-1-phosphate uridyl transferase

Features: vomiting, lethargy & failure to thrive right after breastfeeding is started

“Fructose is to Aldolase B as Galactose is to UridylTransferase -FAB GUT”

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90
Q

which pancreatic bud forms the accessory pancreatic duct?

A

dorsal pancreatic bud

note: this forms body, tail, isthmus and accessory pancreatic structure

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91
Q

which pancreatic bud forms the main pancreatic duct?

A

ventral pancreatic bud

remember: this forms pancreatic head and main pancreatic duct, and uncinate process is only formed from ventral pancreatic bud

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92
Q

what are all the functions of thyroid peroxidase?

A

catalysis iodide oxidation, formation of mono & diiodotyrosine, and coupling that forms T3 & T4

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93
Q

which drug can you use to prevent perinatal transmission of HIV?

A

zidovudine-retroviral reverse transcriptase inhibitor

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94
Q

renal cell carcinoma results from neoplastic transformation of what type of cells?

A

proximal tubule cells (they are polygonal clear cells that are filled with lipids & carbs)

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95
Q

which two types of cells can’t use ketones for energy?

A

RBC’s (they have no mitochondria)

hepatocytes: have mitochondria but they can’t turn acetoacetate into acetyl CoA

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96
Q

what is a crossover study?

A

where subjects are randomly allocated to sequence of 2 or more treatments given consecutively, a washout period is given b/w the first and 2nd treatment

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97
Q

what is primidone?

A

anticonvulsant; drug is metab. to phenobarbital and phenylethylmalonamide (PEMA), all 3 parts are active anticonvulsants

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98
Q

which anticholinesterase drug can be used to reverse both CNS & peripheral effects of atropine toxicity?

A

physostigmine-this is the only anticholinesterase that has tertiary amine structure and so it can cross the BBB

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99
Q

what drug do you use to treat low HDL levels?

A

niacin

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100
Q

what is orotic aciduria?

A

inability to convert orotic acid to UMP (de novo pyrimidine synth. pathway) b/c of defect in UMP synthase, autosomal recessive

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101
Q

how do pts with orotic aciduria present?

A

hypochromic megaloblastic anemia, neurologic abnormalities, growth retardation & excretion of orotic acid in the urine

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102
Q

how do you treat orotic aciduria?

A

treat w/ uridine supplementation which improves symptoms by inhibiting CPSII (which is the regulatory step in this pathway)

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103
Q

describe the normal aging of the heart

A

decreased left ventricular volume

develop. of sigmoid-shaped ventricular septum

myocyte atrophy w/ interstitial fibrosis & accumulation of cytoplasmic lipofuscin

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104
Q

what is apple-peel atresia?

A

intestinal atresia distal to the duodenum & is due to vascular accident in utero, happens where there is obstruction of the SMA & this leads to blind-ending proximal jejunum w/ absence of long length of small bowel & dorsal mesentery, the terminal ileum distal to the atresia assumes a spiral configuration around an ileocolic vessel

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105
Q

what is the MCC of impaired FA beta oxidation?

A

MC due to Acyl-CoA dehydrogenase deficiency, the enzyme that catalyzes the first step in the beta-oxidation pathway

features: hypoglycemia after prolonged fasting with INAPPROPRIATELY LOW LEVELS OF KETONE BODIES

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106
Q

which classes of drugs are proven to improve survival and reduce hospitalizations in chronic CHF?

A

ACEIs (e.g. captopril)
Angiotensin II Receptor blockers (e.g. -artans)
Aldosterone antagonist (e.g. spironolactone)
Certain Beta-blockers (Metoprolol, carvedilol, Bisoprolol)

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107
Q

which drugs provide symptomatic relief in CHF ?

A

Diuretics (loops, thiazides)

Digoxin

Vasodilators (nitrates)

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108
Q

hit me with the mnemonic for the CYP-450 inhibitors?

A 
C-cimetidine
R-ritonavir (protease inhibitors
A-amiodarone
C-ciprofloxacin
K-ketoconazole
A-acute alcohol use
M-macrolides
I-isoniazid
G-grapefruit juice
O-omeprazole
S-sulfonamides
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109
Q

hit me with the mnemonic for the CYP-450 inducers?

A

“Guiness, Coronas & PBRS induce Chronic alcoholism”

G-griseofulvin
C-carbamazepine
P-phenytoin
B-barbiturates
R-rifampin
S-st. john's wort
Chronic Alcoholism
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110
Q

describe the defect in type I dyslipidemia- hyperchylomicronemia

A

AR, deficiency of lipoprotein lipase or altered apolipoprotein C-II

Causes pancreatitis, hepatosplenomegaly, & eruptive/pruritic xanthoma; there is no increased risk for atherosclerosis

increased blood levels of chylomicrons, TG, cholesterol

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111
Q

describe the defect in Type II dyslipidemia-familial hypercholesterolemia

A

AD, absent or decreased LDL receptors

causes accelerated atherosclerosis, tendon xanthomas, & corneal arcus

increased blood levels of LDL & cholesterol

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112
Q

describe the defect in type IV dyslipidemia-hypertriglyceridemia

A

AD, hepatic overprod. of VLDL, causes pancreatitis

increased blood levels of VLDL & triglycerides

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113
Q

describe the genetic defect in abetalipoproteinemia?

A

AR, defect in MTP gene leading to decreased B-48 & b-100–> decreased chylomicron & VLDL synthesis and secretion

symptoms appear in first few months of life

findings: failure to thrive, steatorrhea, acanthocytosis, ataxia, night blindness

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114
Q

describe type I glycogen storage disorder-Von Gierke’s dz

A

deficiency in glucose-6-phosphatase, AR

findings: severe fasting hypoglycemia, way too much glycogen in liver, increased blood lactate, hepatomegaly

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115
Q

Name the dz: lysosomal alpha-1,4-glucosidase (acid maltase) deficiency

A

Type II Glycogen storage dz-Pompe’s Dz

findings: cardiomegaly & systemic findings leading to early death

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116
Q

name the dz: deficiency in debranching enzyme (alpha-1,6-glucosidase)

A

Type III glycogen storage dz-Cori’s dz, AR
Gluconeogenesis is intact

findings: milder form of type I w/ normal blood lactate levels

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117
Q

name the dz: deficiency in skeletal muscle glycogen phosphorylase

A

Type V glycogen storage dz- McArdle’s Dz, AR

findings: increased glycogen in muscle, can’t break it down, leads to painful muscle cramps, myoglobinuria with strenuous exercise

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118
Q

name the dz: deficient in alpha-galactosidase A

A

Fabry’s dz (lysosomal storage dz), X-linked recessive

findings: increased ceramide trihexoside buildup, peripheral neuropathy of hands/feet, angiokeratomas, cardiovascular/renal dz

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119
Q

name the dz: deficiency in glucocerebrosidase

A

Gaucher’s disease (MC lysosomal storage dz)

features: hepatosplenomegaly, aseptic necrosis of femur, bone crises, Gaucher’s cells (mphages that look like crumpled tissue paper)

accumulate substrate = glucocerebroside

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120
Q

Niemann-Pick dz has a deficiency in what enzyme?

A

sphingomyelinase
accumulated substrate = sphingomyelin

features: prog. neurodegeneration, hepatosplenomegaly, cherry-red spot on macula, foam cells

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121
Q

Tay-Sach’s dz has a deficiency in what enzyme?

A

Hexosaminidase A
Lysosomal storage dz
Accumulated substrate = GM2 Ganglioside

Features: prog. neurodegen., developmental delay, cherry-red spot on macula, lysosomes w/ onion skin, NO HEPATOSPLENOMEGALY

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122
Q

what enzyme is deficient in Krabbe’s dz?

A

Galactocerebrosidase
Lysosomal Storage Dz
accumulated substrate = Galactocerebroside

features: peripheral neuropathy, developmental delay, optic atrophy, globoid cells

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123
Q

what is the genetic defect in metachromatic leukodystrophy?

A

arylsulfatase A deficiency
Lysosomal storage dz
accumulated substrate = cerebroside sulfate

features: central & peripheral demyelination w/ ataxia, dementia

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124
Q

name the dz: deficiency in alpha-L-iduronidase

A

Hurler’s syndrome
Mucopolysaccharidoses-Hurler’s syndrome
accumulated substrate = heparan sulfate, dermatan sulfate

features: developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly

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125
Q

name the dz: deficiency of iduronate sulfatase

A

Mucopolysaccharidoses-Hunter’s syndrome (X-linked recessive)
accumulated substrate = heparan sulfate, dermatan sulfate

features: mild hurler’s + aggressive behavior, no corneal clouding

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126
Q

what is your mnemonic for NON-ENVELOPED viruses?

A

“Give PAPP smears & CPR to a naked Heppy”
(DNA = PAPP, RNA = CPR & hepevirus)

Papillomavirus (HPV)
Adenovirus
Parvovirus
Polyomavirus (JC virus)

Calicivirus (Norwalk)
Picornavirus
Reovirus (Rotavirus & Coltivirus)
Hepevirus (HEV)

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127
Q

what is your mnemonic for the negative strand viruses?

A

“Always Bring Polymerase Or Fail Replication”

Arenaviruses

Bunyaviruses (bunyavirus & Hantavirus)

Paramyxoviruses

Orthomyxoviruses (influenza virus)

Filoviruses (Ebola)

Rhabdoviruses (rabies virus)

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128
Q

what is your mnemonic for the segmented viruses?

A

BOAR (all are RNA viruses)

Bunyaviruses (Bunyavirus & hantavirus)

Orthomyxoviruses (influenza)

Arenaviruses

Reoviruses (rotavirus & coltivirus)

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129
Q

what is the main lab marker used to confirm menopause?

A

FSH; note LH goes up but this happens later

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130
Q

what type of amyloid is found in cardiac amyloidosis?

A

derived from ANP

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131
Q

how does tetrodotoxin (pufferfish toxin) work?

A

it is a neurotoxin that binds voltage-gated sodium channels in nerve & cardiac tissue, preventing Na+ influx & depolarization

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132
Q

what are 3 major congenital cyanotic heart dzs that result from a failure of neural crest migration?

A

Tetrology of fallot

Transposition of the Great Vessels

Truncus Arteriosus

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133
Q

which two classes of drugs are assoc. w/ fat redistribution syndrome?

A

HIV protease inhibitors

glucocorticoids

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134
Q

what is the only bacterial DNA polymerase w/ 5’ to 3’ exonuclease activity?

A

DNA polymerase I (has same functions as DNA polymerase III but also excises RNA primer w/ 5’ to 3’ exonuclease)

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135
Q

what effect does myelination have on the length constant and time constant of a nerve?

A

increases the length constant

decreases the time constant

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136
Q

what is the major virulence factor for strep pyogenes, it is responsible for inhibiting phagocytosis and complement activation, it also activates bacterial adherence & is the target of type-specific humoral immunity to strep pyogenes?

A

Protein M

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137
Q

parasite that causes terminal hematuria and bladder cancer

A

Schistosoma haematobium; caused by contact w/ freshwater snails

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138
Q

what is the usual cause of neonatal tetanus?

A

colonization of C. tetani in the umbilical stump (can be prevented by proper immunization)

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139
Q

name the dz: defect in ATM gene that codes for a protein involved in DNA break repair; immune deficiency has IgA deficiency and predisposes to infections of the upper and lower airways; has increased risk of sinopulmonary infections w/ cerebellar ataxia, & telangiectasias

A

ataxia-telangiectasia (AR)

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140
Q

name the dz: subtype of lung adenocarcinoma, uncommon, arises in non-smokers, arises from alveolar epithelium, often peripheral & multifocal; histology shows tall, columnar cells that line the alveolar septa w/o evidence of vascular or stroma invasion

A

bronchoalveolar carcinoma

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141
Q

40-60% of pts with melanoma have what mutation?

A

BRAF V600E

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142
Q

name the defense mechanism: immature defense mechanism that substitutes an imaginary, less disturbing view of the world to avoid awareness of painful feelings

A

fantasy

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143
Q

name the dz: has saddle anesthesia, loss of anocutaneous reflex; assoc. w/ S2-S4 damage

A

cauda equina syndrome

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144
Q

name the dz: lymphatic malignancy assoc. w/ persistent lymphedema like in a post-radical mastectomy

A

lymphangiosarcoma

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145
Q

what are the lab markers of Ca2+, PO4, & PTH in osteoporosis?

A

NORMAL

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146
Q

name the dz: defect in cystathionine beta synthetase (converts homocystine to cystathionine), and subsequently cysteine becomes an essential amino acid

A

homocystinuria

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147
Q

name the dz: AD dz caused by abnormal nucleotide mismatch repair; genes include MSH2 & MLH1, which codes for components of human MutS & MutL homologs

A

HNPCC (Lynch syndrome)

the mutations in MSH2 & MLH1 account for ~90% of cases of lynch syndrome

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148
Q

which type of colonic polyp can cause symptoms of secretory diarrhea?

A

villous adenomas

-tend to be larger, sessile, and more severely dysplastic than tublar, can also cause bleeding, secretory diarrhea is due to secretion of large amounts of mucus; can also cause partial intestinal obstruction

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149
Q

which mood stabilizer drug has side effects which include hypothyroidism and polyuria (nephrogenic diabetes insipidus)?

A

Lithium

150
Q

what is Parakeratosis?

A

hyperkeratosis with retention of nuclei in the stratum corneum (seen in psoriasis)

151
Q

what is hyperkeratosis?

A

increased thickness of stratum corneum (seen in psoriasis, calluses)

152
Q

what is spongiosis?

A

epidermal accumulation of edematous fluid in intercellular spaces (seen in eczematous dermatitis)

153
Q

what is acantholysis?

A

separation of epidermal cells (seen in pemphigus vulgaris)

154
Q

what is acanthosis?

A

epidermal hyperplasia (increased stratum spinosum)

e.g. acanthosis nigricans

155
Q

what is the most likely location for colon adenocarcinoma?

A

rectosigmoid colon

156
Q

Lacunar infarcts are most often due to what?

A

hypertensive arteriolosclerosis of small, penetrating arterioles

157
Q

ZES causes recurrent ulcers in what parts of the GI tract?

A

distal duodenum and jejunum

158
Q

name the vitamin deficiency: causes degeneration of spinocerebellar tracts, dorsal column of spinal cord and peripheral nerves, also hemolytic anemia, acanthocytosis, and muscle weakness

A

Vitamin E deficiency

note: this presentation is similar to Friedreich’s ataxia

159
Q

22q11 syndromes are associated with which cardiac defects?

A

truncus arteriosus & Tetralogy of Fallot

160
Q

Which dz may cause these congenital cardiac defects: ASD, VSD, AV septal defect (endocardial cushion defect)

A

Down syndrome

161
Q

Which congenital cardiac defects are assoc. w/ congenital rubella?

A

Septal defects

PDA

pulmonary artery stenosis

162
Q

which dz is assoc. w/ these congenital heart defects: bicuspid aortic valve (MC in this disorder), coarctation of the aorta (preductal)

A

turner syndrome

163
Q

Marfan syndrome is assoc. with which congenital heart defects?

A

MVP

thoracic aortic aneurysm & dissection

aortic regurgitation

164
Q

which cardiac defect is associated with infants of diabetic mothers?

A

transposition of the great vessels

165
Q

name the drug: PDE inhibitor used for intermittent claudication, inhibits platelet aggregation & is a direct arterial vasodilator, has been shown to be superior to aspirin in treatment of peripheral arterial dz

A

cilostazol

166
Q

name the class of antiarrhythmics: potent Na channel blockers that exhibit strong-use dependence by prolonging the QRS duration to a greater extent at higher heart rates

A

Class IC antiarrythmics

Flecainide & Propafenone

167
Q

what is your mnemonic for retroperitoneal structures?

A

SAD PUCKER

S-suprarenal (adrenal glands)
A-Aorta & IVC
D-duodenum (2nd-4th parts)

P-Pancreas (except tail)
U-Ureters
C-Colon (ascending & descending)
K-kidneys
E-Esophagus (lower 2/3)
R-rectum (partially)
168
Q

name the dz: have small jaws, small eyes, and malformed low set ears, rocker-bottom feet; note: presence of CLENCHED HANDS w/ OVERLAPPING FINGERS is distinguishing feature

A

Edwards syndrome (trisomy 18)

169
Q

name the dz: triad of tinnitus, vertigo, sensorineural hearing loss; pathogenesis is related to increased volume & pressure of endolymph in the vestibular apparatus

A

Meniere’s dz

170
Q

these are adverse effects for which drug: changes in color vision and anorexia, can cause ventricular dysrhythmias, headache, fatigue, and confusion

A

digoxin

171
Q

what’s the diagnosis: sudden onset abdominal/flank pain, hematuria & left sided-varicocele in a pt with membranous glomerulopathy

A

renal vein thrombosis

nephrotic syndrome is a hypercoagulable state and renal vein thrombosis is a common complication of nephrotic syndrome

172
Q

how does C. diff toxin A work?

A

attracts neutrophils causing mucosal inflammation, loss of water into the gut lumen and diarrhea, as well as mucosal death

173
Q

how does C. diff toxin B work?

A

cytotoxin that causes actin depolymerization, loss of cellular cytoskeleton integrity cell death and mucosal necrosis

174
Q

treatment of choice in arsenic poisoning?

A

dimercaprol

175
Q

what is the MC benign liver tumor?

A

cavernous hemangioma

note: don’t biopsy b/c this can cause fatal bleeding and doesn’t help with the diagnosis

176
Q

what is the drug of choice in trigeminal neuralgia?

A

carbamazepine

177
Q

the vaccine for haemophilus influenzae type b is composed of what?

A

polyriboysl-ribitol-phosphate, which is a component of the Hib capsule and it is conjugated to diptheria or tetanus toxoid

178
Q

what is the formula for power?

A

1-beta

power is the probability of finding a true relationship

179
Q

name the tumor: benign capillary hemangioma of infancy; appears in first few wks of life, grows rapidly & regresses spontaneously at ~5-8 y/o

A

strawberry hemangioma

180
Q

name the tumor: benign capillary hemangioma of the elderly, does not regress, increased frequency w/ age

A

cherry hemangioma

181
Q

name the tumor: polypoid capillary hemangioma that can ulcerate & bleed, assoc. w/ trauma and pregnancy

A

pyogenic granuloma

182
Q

name the tumor: cavernous lymphangioma of the neck, assoc. w/ turner’s syndrome

A

cystic hygroma

183
Q

name the tumor: benign painful, red-blue tumor under the fingernails, arises from modified smooth muscle cells of the glomus body

A

glomus tumor

184
Q

name the tumor: rare BV cancer occurring in the head, neck, and breast areas, usually in elderly, on sun-exposed areas, assoc. w/ radiation therapy & arsenic exposure, very aggressive and difficult to resect due to delay in diagnosis

A

angiosarcoma

185
Q

name the tumor: lymphatic malignancy assoc. w/ persistent lymphedema (e.g. post-radical mastectomy)

A

lymphangiosarcoma

186
Q

name the dz: chronic musculoskeletal pain disorder affecting women 20-50 y/o, pain is diffuse and found at multiple symmetrical tenderspots, other features include insomnia & emotional disturbances

A

fibromyalgia

187
Q

name the dz: pain and stiffness in shoulders and hips, often w/ fever, malaise, & weight loss, doesn’t cause muscular weakness, more common in women over 50 y/o

A

polymyalgia rheumatica

labs: increased ESR, CRP, with a normal CK

188
Q

what is the MCC of croup (viral laryngotracheitis)?

A

parainfluenza virus

189
Q

what is the MCC of viral bronchiolitis?

A

RSV

190
Q

what is a common complication of prematurity that can lead to long-term neurodevelopmental impairment characterized by a hemorrhage into the fragile germinal matrix?

A

neonatal intraventricular hemorrhage

increases in freq. w/ decreasing age & birthweight

common complication of prematurity

191
Q

name the drug: requires an acidic environment (like in the mphage phagolysosomes) to exert antimicrobial effects

A

pyrazinamide

192
Q

Pts w/ Fabry dz (deficiency in alpha-galactosidase A) who don’t receive enzyme replacement will die of what?

A

renal failure

193
Q

name the dz: due to deficient Porphobilinogen deaminase (aka HMB synthase, converts PBG –> HMB), features: abd. pain & neuro manifestations, no photosensitivity, urine darkens upon standing, increased urinary ALA & PBG; give glucose which will decrease activity of ALA synthase and thus alleviating the abd. pain & neuropsych manifestations

A

acute intermittent porphyria

194
Q

what are the 3 stop codons?

A

UGA
UAA
UAG

195
Q

name the dz:
characterized by sacral agenesis causing lower extremity paralysis & urinary incontinence, COMMONLY ASSOC. W/ MATERNAL DM

A

Caudal regression syndrome

196
Q

taking which two classes of drugs used to treat hyperlipidemia will increase your risk of getting myopathy?

A

statins + fibrates

197
Q

the combination of taking fibrates and bile acid-binding resins increases your risk for what adverse effect?

A

cholesterol gallstones

198
Q

what kind of insulin do you use when treating DKA?

A

regular insulin

199
Q

name the dz: caused by cystathionine synthetase deficiency; pts present with symptoms that resemble marfans, like a ectopia lentis (dislocated lens) and some have developmental delay; they have high risk of thromboembolism; about half of these pts respond to Vitamin B6 (pyridoxine) which is a cofactor for the deficient enzyme

A

homocystinuria

200
Q

breast milk lacks what two important fat soluble enzymes?

A

Vitamin D (black kids at higher risk of deficiency)

Vitamin K (given parenterally to prevent hemorrhagic dz of newborn)

201
Q

what is the drug of choice for hairy cell leukemia?

A

cladribine

this is a purine analog that achieves high intracellular concentrations b/c it is resistant to degradation by adenosine deaminase

202
Q

name the drug: COMT inhibitor that serves to increase the bioavailability of levodopa by inhibiting peripheral methylation

A

entacapone

used in Parkinson’s

203
Q

name the glcyogen storage disorder: leads to incomplete glycogen degradation. Alpha-1,6-glucosidic branch points can’t be degraded, so small chain dextrin-like material accumulates w/I the cytosol of hepatocytes; Present w/: hypoglycemia hypertriglyceridemia, ketoacidosis, and hepatomegaly

A

Cori Dz (AR debranching enzyme deficiency)

204
Q

name the dz: cerebellar hemangioblastoma w/ congenital cysts of the kidneys, liver, and/or pancreas, AD

A

von hippel lindau dz

205
Q

what is the most common location for colonic diverticula?

A

sigmoid colon

206
Q

what is the cofactor for amino acid transamination and decarboxylation reactions?

A

pyridoxal phosphate (B6)

207
Q

what anatomical structure is damaged in nursemaid’s elbow?

A

annular ligament

results from sudden traction on the outstretched and pronated arm of a kid; kids don’t hurt until they move the arm

208
Q

what is your mnemonic for encapsulated bacteria?

A

“Even Some Pretty Nasty Killers Have Shiny Bodies”

E-E. coli (some strains)
S-Strep pneumoniae
P-Pseudomonas
N-Neisseria meningitidis
K-Klebsiella
H-Haemophilus influenzae
S-Salmonella
B-group B strep
209
Q

Name the lymph node cluster: drains head and neck

A

cervical

210
Q

Name the lymph node cluster: drains lungs

A

hilar

211
Q

Name the lymph node cluster: drains trachea and esophagus

A

mediastinal

212
Q

Name the lymph node cluster: drains upper limb, breast, skin above umbilicus

A

axillary

213
Q

Name the lymph node cluster: drains liver, stomach, spleen, pancreas, upper duodenum

A

celiac

214
Q

Name the lymph node cluster: drains lower duodenum, jejunum, ileum, colon to splenic flexure

A

superior mesenteric

215
Q

Name the lymph node cluster: drains colon from splenic flexure to upper rectum

A

inferior mesenteric

216
Q

Name the lymph node cluster: drains lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate

A

internal iliac

217
Q

Name the lymph node cluster: testes, ovaries, kidneys, uterus

A

Para-aortic

218
Q

Name the lymph node cluster: drains the anal canal (below pectinate line), skin below umbilicus (except popliteal territory)

A

superficial inguinal

219
Q

Name the lymph node cluster: drains the dorsolateral foot, posterior calf

A

popliteal

220
Q

What is the rate limiting step in glycolysis?

A

PFK1

221
Q

What is the rate limiting step in gluconeogenesis?

A

Fructose-1,6-bisphosphatase

222
Q

What is the rate limiting step in TCA cycle?

A

isocitrate dehydrogenase

223
Q

What is the rate limiting step in glycogen synthesis?

A

glycogen synthase

224
Q

What is the rate limiting step in glycogenolysis?

A

glycogen phosphorylase

225
Q

What is the rate limiting step in HMP shunt?

A

G6PD

226
Q

What is the rate limiting step in de novo pyrimidine synthesis?

A

CPS II

227
Q

What is the rate limiting step in de novo purine synthesis?

A

Glutamine-PRPP amidotransferase

228
Q

What is the rate limiting step in urea cycle?

A

CPS I

229
Q

What is the rate limiting step in fatty acid synthesis?

A

Acetyl-CoA carboxylase

230
Q

What is the rate limiting step in fatty acid oxidation?

A

carnitine acyltransferase I

231
Q

What is the rate limiting step in ketogenesis?

A

HMG-CoA Synthase

232
Q

What is the rate limiting step in cholesterol synthesis?

A

HMG-CoA reductase

233
Q

what are the regulators of PFK1 (RLS of glycolysis)?

A

stimulates: AMP, fructose-2,6-BP
inhibits: ATP, citrate

234
Q

what stimulates Fructose-1,6-bisphosphatase (RLS of gluconeogenesis)?

A

ATP

235
Q

What inhibits fructose-1,6-bisphosphatase (RLS of gluconeogenesis)?

A

AMP

Fructose-2,6-BP

236
Q

what stimulates isocitrate dehydrogenase (RLS of TCA cycle)?

A

ADP

237
Q

what inhibits isocitrate dehydrogenase (RLS of TCA cycle)?

A

ATP

NADH

238
Q

What stimulates glycogen synthase (RLS of glycogen synthesis)?

A

Glucose

Insulin

239
Q

What inhibits glycogen synthase (RLS of glycogen synthesis)?

A

epinephrine

glucagon

240
Q

what stimulates glycogen phosphorylase (RLS of glycogenolysis)?

A

AMP
epinephrine
glucagon

241
Q

what inhibits glycogen phosphorylase (RLS of glycogenolysis)?

A

insulin

ATP

242
Q

What stimulates G6PD (RLS of HMP shunt)?

A

NADP+

243
Q

What inhibits G6PD (RLS of HMP shunt)?

A

NADPH

244
Q

What molecules inhibit glutamine-PRPP amidotransferase (RLS of de novo purine synthesis)?

A

AMP
IMP
GMP

245
Q

What molecule stimulates CPS I (RLS of urea cycle)?

A

N-acetylglutamate

246
Q

what stimulates Acetyl-CoA Carboxylase (RLS of fatty acid synthesis)?

A

insulin

citrate

247
Q

what inhibits acetyl-CoA carboxylase (RLS of fatty acid synthesis)?

A

glucagon

palmitoyl-CoA

248
Q

what molecule inhibits carnitine acyltransferase I (RLS of fatty acid oxidation)?

A

malonyl-CoA

249
Q

What stimulates HMG-CoA reductase (RLS in cholesterol synthesis)?

A

Insulin

Thyroxine

250
Q

What inhibits HMG-CoA reductase (RLS of cholesterol synthesis)?

A

Glucagon

Cholesterol

251
Q

name the drug: short acting balanced venous and arterial vasodilator that decreases both preload and afterload; this has balanced changes, so SV stays the same

A

nitroprusside

252
Q

which types of vasculitis are considered granulomatous?

A

Large vessel: Temporal arteritis & Takayasu’s arteritis

Small vessel: Wegener’s, Churg-Strauss

253
Q

Which types of vasculitis are considered immune complex mediated?

A

Medium vessel: PAN

small vessel: HSP (IgA deposition)

254
Q

why do we use beta blockers in thyrotoxicosis?

A

decreases the effect of sympathetic adrenergic impulses reaching target organs & DECREASES THE RATE OF PERIPHERAL CONVERSION OF T4 to T3

255
Q

name the drug: this is a lipopeptide antibiotic w/ activity against MRSA, causes depolarization of bacterial cell membrane and inhibition of DNA, RNA, and protein synthesis; AE = INCREASED CPK LEVELS & INCREASED INCIDENCE OF MYOPATHY

A

daptomycin

256
Q

which antiarrhythmic has Class III activity but does not predispose to torsades de pointes like other class III drugs?

A

amiodarone

257
Q

what are two reasons that pregnant women and women taking OCPs are at an increased risk for gallstones?

A
  1. estrogen induces cholesterol hypersecretion

2. Progesterone induces gallbladder hypomobility

258
Q

name the pathology: Pharyngoesophageal false diverticulum A Herniation of mucosal tissue at Killian triangle between the thyropharyngeal and cricopharyngeal parts of the inferior pharyngeal constrictor. Presenting symptoms: dysphagia, obstruction, foul breath from trapped food particles (halitosis). Most common in elderly males.

A

Zenker diverticulum

259
Q

Name the bacterial virulence factor:binds to the Fc part of IgG at the complement-binding site and so prevents activation of complement; this leads to decreased production of C3b and thus impaired opsonization

A

Protein A (Staph aureus)

260
Q

Name the alzheimer’s drug: NMDA receptor antagonist; helps prevent excitotoxicity (mediated by Ca2+)

A

memantine

261
Q

what is donepizil used for?

A

Cholinesterase inhibitor used in Alzheimer’s dz; this works b/c there is decreased ACh in Alzheimer’s

262
Q

stimulating what sympathetic receptor inhibits insulin release?

A

alpha2-adrenergic receptors

263
Q

Stimulating what sympathetic receptor causes insulin to be released?

A

beta2-adrenergic receptors

264
Q

how do you diagnose von Willebrand dz?

A

prolonged bleeding time

prolonged PTT

decreased response to RISTOCETIN (which activates GP Ib-IX receptors on platelets and makes them available for vWF binding)

265
Q

name the childhood leukemia: presents w/ large anterior mediastinal mass that can compress the great vessels causing SVC syndrome and possible compressing the esophagus causing dysphagia & stridor

A

T-cell ALL (only ~15% of all ALL)

266
Q

Name the pathological finding: interstitial myocardial granulomas; seen in rheumatic carditis

A

Aschoff Bodies

267
Q

name the pathology: plump macrophages w/ abundant cytoplasm & central, round-to-ovoid nuclei w/ central slender ribbons of chromatin; seen in Aschoff bodies

A

Anitschkow cells

268
Q

name the pathology: has NON-CASEATING GRANULOMAS, cobblestone appearance to mucosa, transmural inflammatory infiltrate

A

Crohn’s dz

269
Q 
name the dz: AD Inherited disorder of blood vessels. Findings: telangiectasia, recurrent epistaxis, skin discolorations,
arteriovenous malformations (AVMs), GI bleeding, hematuria
A

Hereditary Hemorrhagic Telangiectasia (aka Osler-Weber-Rendu syndrome)

270
Q

Name the dz: Neurocutaneous disorder characterized by café-au-lait spots and cutaneous neurofibromas.
Autosomal dominant, 100% penetrance, variable expression

A

NF 1 (aka von Recklinghausen dz)

AD, caused by mutations in the NF1 gene on chromosome 17

mnemonic: 17 letters in von Recklinghausen

271
Q

name the dz: Findings: bilateral acoustic schwannomas, juvenile cataracts, meningiomas, and ependymomas

A

Neurofibromatosis type 2

NF2 gene on chromosome 22

272
Q

name the dz: Neurocutaneous disorder with multi-organ system involvement, characterized by numerous benign
hamartomas, angiofibromas, mitral regurg, ash-leaf spots, cardiac rhabdomyoma, mental retardation, renal angiomyolipoma, seizures, shagreen patches, increased incidence of subependylmal astrocytomas & ungual fibromas

A

Tuberous sclerosis, AD

273
Q

Name the dz: features cavernous hemangiomas in skin, mucosa, organs; bilateral renal cell carcnomas; hemangioblastoma in retina, brainstem, and cerebellum and pheochromocytomas

A

von Hippel-Lindau dz

AD mutation in VHL tumor suppressor gene on chromosome 3, which results in constitutive expression of HIF

274
Q

name the dz: features port-wine stain of the face, ipsilateral leptomeningeal angiomas that cause seizures/epilepsy, intellectual disability and episcleral hemangioma –> increased IOP –> early onset glaucoma

A

Sturge-Weber Syndrome

Mnemonic: “STURGE”

S-sporadic, port-wine Stain
T-tram track Ca2+ (opposing gyri)
U-unilateral
R-retardation
G-Glaucoma, GNAQ gene
E-epilepsy
275
Q

what is the genetic defect in Sturge-weber syndrome?

A

congenital, non-inherited (somatic), developmental anomaly of neural crest derivatives due to activating mutation of GNAQ gene

Mnemonic: “STURGE”

S-sporadic, port-wine Stain
T-tram track Ca2+ (opposing gyri)
U-unilateral
R-retardation
G-Glaucoma, GNAQ gene
E-epilepsy
276
Q

what is the genetic defect in von Hippel-Lindau disease?

A

AD mutation in VHL tumor suppressor gene on chromosome 3, which results in constitutive expression of HIF

277
Q

The skin tumors of NF-1 have what embryological derivative?

A

neural crest cells

278
Q

what is the most important risk factor for pancreatic cancer?

A

smoking

279
Q

when you see an elderly female who presents with painless jaundice, what should you start thinking about?

A

pancreatic cancer (compressing the common bile duct)

280
Q

what are the two main drugs used to treat narcolepsy?

A

Amphetamines

Modafinil (psychostimulant)

281
Q

how can you prevent acyclovir induced crystalline nephropathy?

A

GIVE ADEQUATE HYDRATION

282
Q

pure red cell aplasia is associated with what other dzs?

A

Thymoma
Lymphocytic leukemias
Parvovirus B19

283
Q

what is the drug of choice for the prevention and treatment of post-MI Arrhythmias?

A

lidocaine

b/c lidocaine binds rapidly depolarizing and depolarized cells (like ischemic myocardium)

284
Q

what is your mnemonic for the glycogen storage diseases?

A

“Very Poor Carbohydrate Metabolism”

V-von Gierke’s-Type I, deficiency = Glucose-6-phosphatase

P-Pompe’s-Type II, deficiency = Lysosomal alpha-1,4-glucosidase aka acid maltase

C-Cori’s-Type III, deficiency = debranching enzyme (alpha-1,6-glucosidase)

M-Mcardle’s-Type V, deficiency = skeletal muscle glycogen phosphorylase

285
Q

what does the LAD supply?

A

anterior 2/3 of interventricular septum

anterior papillary muscle

anterior surface of L. ventricle

286
Q

what does the posterior descending/interventricular artery supply?

A

posterior 1/3 of interventricular septum

Posterior walls of ventricles

287
Q

what is the ECG triad of WPW syndrome?

A

ECG triad: shortened PR-interval, delta wave at start of QRS, widened QRS interval

288
Q

What are the hyper problems of thiazides?

A

Hyperuricemia
Hypercalcemia
Hyperglycemia
Hyperlipidemia

289
Q

what is the MCC of increased AFP?

A

underestimation of gestational age

290
Q

which types of insulin are long-acting?

A

Glargine

Detemir

291
Q

Which types of insulin are rapid-acting?

A

Lispro
Aspart
Glulisine

292
Q

which type of insulin is considered short-acting?

A

regular insulin

293
Q

which type of insulin is considered intermediate acting?

A

NPH (used in DKA)

294
Q

what is the most common tumor of the adrenal medulla in children, usually < 4 y/o?

A

Neuroblastoma

295
Q

name the pathology: presents in young child w/ abdominal distension & a firm, irregular mass that can cross the midline

A

neuroblastoma

Note: derived from neural crest cells, can occur anywhere along the sympathetic chain

296
Q

what lab tests could help you diagnose a neuroblastoma?

A

HVA (breakdown product of dopamine) in urine

Bombesin +

297
Q

neuroblastomas are associated with overexpression of what oncogene?

A

N-myc

298
Q

Which leads will show Q waves with an infarct in the anterior wall (LAD)?

A

V1-V4

299
Q

Which leads will show Q waves with an anteroseptal (LAD) infarct?

A

V1-V2

300
Q

Which leads will show Q waves with an anterolateral (LAD or LCX) infarct?

A

V4-V6

301
Q

which leads will show Q waves in a lateral wall (LCX) infarct?

A

I, aVL

302
Q

Which leads will show Q waves in an inferior wall (RCA) infarct?

A

II, III, aVF

303
Q

Name the murmur: in early diastole during rapid ventricular
filling phase. Associated with  filling pressures
(e.g., mitral regurgitation, CHF) and more
common in dilated ventricles (but normal in
children and pregnant women).

A

S3

304
Q

Name the murmur: in late diastole. High
atrial pressure. Associated with ventricular
hypertrophy. Left atrium must push against stiff LV wall

A

S4 “atrial kick”

305
Q

What is your mnemonic for ring enhancing lesions in the brain?

A

“MAGIC DR L”

M-mets
A-abscess
G-GBM
I-infarct
C-contusion

D-demyelinating dz
R-Radiation necrosis

L-lymphoma

don’t forget toxoplasmosis

306
Q

which kinds of endocrine hormones and cytokines are receptor-associated tyrosine kinase (JAK/STAT pathway?

A

Prolactin

Immunomodulators (e.g. cytokines-IL-2, IL-6, IL-8, IFN)

GH

Mnemonic: JAK PIGs

307
Q

which type of endocrine hormones and molecules have intrinsic tyrosine kinase activity?

A 
Insulin
IGF-1
FGF
PDGF
EGF

MAP Kinase, think growth factors

308
Q

which hormones use steroid receptors?

A 
Vitamin D
Estrogen
Testosterone
T3 & T4
Cortisol
Aldosterone
Progesterone
309
Q

which hormones & molecules use IP3 signaling pathways?

A 
GnRH
Oxytocin
ADH (V1-receptor)
TRH
Histamine (H1-receptor)
Angiotensin II
Gastrin
310
Q

which two vasodilators use the cGMP signaling pathway?

A

ANP

NO

311
Q

Which hormones use the cAMP signaling pathway?

A

FLAT ChAMP

FSH
LH
ACTH
TSH

CRH
hCG
ADH (V2 receptor)
MSH
PTH

others: calcitonin, GHRH, glucagon

312
Q

name the pathology: assoc. w/ IgG4 abs to the phospholipase A2 reeptor

A

membranous nephropathy

313
Q

what are the three gram negative bacteria that are oxidase + ?

A 
Pseudomonas aeruginosa
Vibrio cholerae (also glucose +)
Moraxella catarrhalis (diplococcus)
314
Q

what is your mnemonic for the adult brain tumors?

A

“MGM Studios”

Mets
GBM
Meningioma
Schwannoma

315
Q

prolonged exposure to loud noises causes hearing loss due to damage of what?

A

stereociliated hair cells of the organ of corti

316
Q

term for: the proliferation of astrocytes in an area of neuron degeneration, leads to the formation of a glial scar which compensates for the volume loss that occurs after neuronal death

A

gliosis

317
Q

what are the 3 drugs of choice for tonic clonic seizures?

A

phenytoin
carbamazepine
valproate

318
Q

what is the DOC for myoclonic seizures?

A

valproic acid

319
Q

what is the DOC for absence sezirues?

A

ethosuximide

2nd choice is valproate

320
Q

what is the DOC for simple partial seizures?

A

carbamazepine

321
Q

what is the DOC for complex partial seizures?

A

carbamazepine

322
Q

name the pathology: features myxomatous changes in media of large arteries, this predisposes to development of aortic dissections & aortic aneurysms; frequently seen in marfan’s

A

cystic medial degeneration

323
Q

these are the only kidney stones that are RADIOLUCENT; can be detected on ultrasound or CT

A

uric acid stones

324
Q

what is the MC complication of SAH hemorrhage?

A

vasospasm ~ 4-12 days after initial insult; you can prescribe nimodipine to prevent this vasospasm

325
Q

happens most commonly in pts < 2 y/o around the ileocecal valve; manifests w/ severe, colicky abdominal pain, currant jelly stools and sometimes a palpable mass in the RLQ

A

intussusception

326
Q

Name the drugs: anion inhibitors block iodide absorption by the thyroid gland via COMPETITIVE INHIBITION

A

perchlorate, pertechnetate

327
Q

assoc. w/ sickle cell dz or trait, DM, analgesic nephropathy or severe obstructive pyelonephritis; features acute colicky flank pain, gross hematuria and passage of tissue fragments in urine

A

papillary necrosis

328
Q

what is the main source of glucose from 12-18 hrs of fasting?

A

glycogenolysis

329
Q

what is the main source of glucose after 18 or more hours of fasting?

A

gluconeogensis

330
Q

exposure to: arsenic, thorotrast, PVC, tumor cells express CD31 an endothelial cell marker

A

hepatic angiosarcoma

331
Q

which sympathetic receptors inhibit uterine contraction (tocolysis) when stimulated?

A

beta-2

332
Q

which sympathetic receptors cause contraction of the ocular papillary dilator muscle resulting in mydriasis?

A

alpha-1

333
Q

DOC for paroxysmal supraventricular tachycardia?

A

adenosine

334
Q

name the drug: slows conduction through the AV node by hyperpolarizing the nodal pacemaker and conducting cells; AE include flushing, chest burning, hypotension and high grade AV block

A

adenosine

335
Q

what is the greatest risk factor for aortic dissection?

A

HTN

336
Q

what is the first step in the development of aortic dissection?

A

intimal tearing of the artery

337
Q

this is an acute inflamm. of the gallbladder that is INITIATED 90% OF THE TIME BY OBSTRUCTION OF THE GALLBLADDER NECK OR CYSTIC DUCT

A

acute calcuous cholecystitis

338
Q

cofactor for alpha-ketoglutarate DH, transketolase, and pyruvate dehydrogenase

A

thiamine

339
Q

name the murmur: murmur features wide, fixed splitting of S2; can produce irreversible pulmonary htn as a result of left to right shunting, eventually there is late onset reversal from left to right to RIGHT TO LEFT (eisenmanger syndrome) and this causes cyanosis

A

atrial septal defect

340
Q

moa = inhibits synthesis of polysaccharide glucan, which is part of fungal CELL WALL

A

echinocandins (caspofungin & micafungin)

341
Q

name the drug: AE: hirsutism, coarse facial features, acneiform skin rash, gingival hypertrophy, also causes GENERALIZED LYMPHADENOPATHY (pseudolymphoma)

A

phenytoin

342
Q

how do you distinguish b/w the similar presentations of rubella and rubeola (measles?

A

both feature a rash that starts on the face and spreads to the trunk

Only rubella has additional finding of postauricular lymphadenopathy

343
Q

what lab test can you perform on a pt’s urine to determine if there are cystine stones present?

A

SODIUM CYANIDE-NITROPRUSSIDE TEST detect’s cystine’s sulfhydryl groups, turns the urine purple after several mins

344
Q

what is cystinuria?

A

inborn defect of transporter of cystine, ornithine, arginine, and lysine, AR; presents as: nephrolithiasis in pts in their teens and 20’s, UA shows pathognomonic hexagonal cystine crystals

345
Q

what is the PAS stain used to diagnose?

A

stains glycogen & mucopolysaccharides

used for: Whipple’s dz, AAT in liver, some adenocarcinomas that secrete mucins

346
Q

which nucleotide analog used to treat HIV does not have to be activated?

A

Tenofovir

347
Q

What are the 3 non-nucleoside reverse transcriptase inhibitors?

A

Nevirapine
Efavirenz
Delavirdine

Mnemonic “NED’s not a nucleoside”
note: don’t require phosphorylation to be active

348
Q

what is the name of the HIV drug that inhibits HIV genome integration into host cell chromosome by reversibly inhibiting HIV integrase?

A

Raltegravir

Mnemonic: “INTEGRAVIR”

349
Q

Name the drug: moa = slows conduction through the AV node by hyperpolarizing the nodal pacemaker and conducting cells; AE = flushing, chest burning (due to bronchospasm), hypotension & high grade AV block; note this is the DOC for PSVT; very short half life ~10 seconds

A

Adenosine

350
Q

DOC in hypertensive emergecy

A

nitroprusside

351
Q

What’s the diagnosis? presents as: escalating fever w/ initial diarrhea or constipation followed by hepatosplenomegaly, formation of rose spots on abdomen and possible hemorrhagic enteritis w/ bowel perf

A

typhoid fever

352
Q

name the drug: increases the peripheral metabolism of levodopa which decreases its effectivenes

A

vitamin b6 (pyridoxine)

353
Q

Pts w/ an imperforate anus may have what other congenital malformations?

A

urogenital tract anomalies

354
Q

chronic rejection of a lung transplant usually affects which part of the lungs?

A

small airways, causing bronchiolitis obliterans syndrome

(inflammation and fibrosis of the bronchiolar walls leading to narrowing and obstruction of the bronchioli); symptoms include dyspnea and wheezing

355
Q

name the drug: MOA = inhibits carbohydrate polymerization, specifically inhibits arabinosyl transferase (enzyme that makes a constituent of the mycobacterial cell wall); AE include OPTIC NEURITIS which typically presents in conjunction with decreased visual acuity, central scotoma and color blindness

A

ethambutol

356
Q

Name the pathology: results from the passage of a large gallstone through a cholecyst-enteric fistula into the small bowel where it ultimately causes obstruction at the ILEOCECAL VALVE; GAS IS SEEN w/I the gallbladder & biliary tree on abdominal x-ray due to the presence of the fistula, and pts presents w/ signs of small bowel obstruction

A

gallstone ileus

357
Q

What is the virulence factor that allows the e. coli to survive hematogenous spread and to establish meningeal infection?

A

K-1 antigen

358
Q

name the types of short acting insulin

A

Glulisine, Aspart, Lispro;

menmonic “Short GALs are Sweet”

359
Q

What is formed by the union of the right and left common iliac veins at the level of L4-L5?

A

IVC

360
Q

What is formed from the joining of the superior mesenteric vein with the splenic vein?

A

portal vein

361
Q

Name the murmur: asssoc. w/ a low-pitched, holosystolic murmur that accentuates during maneuvers that increase afterload (e.g. handgrip maneuver)

A

VSD

362
Q

which drugs are first line treatment for hypertriglyceridemia?

A

fibrates (gemfibrozil & fenofibrate)

363
Q

Name the drug: an integrase inhibitor that disrupts the ability of HIV to integrate its genome into the host cell’s chromosomes’s thus preventing host cell machinery from being used to synthesize HIV mRNA.

A

Raltegravir

364
Q

What is the MC cardiac abnormality predisposing to native valve bacterial endocarditis (15 -60 y/o)?

A

mitral valve prolapse

365
Q

what is the marker for monocyte-macrophage lineage?

A

CD14

366
Q

Which vessel was occluded? transmural ischemia of inferior left ventricular wall, producing ST elevation in leads II, III, & aVF & possibly SA node dysfunction with bradycardia

A

RCA

367
Q

Which vessel was occluded? anteroseptal transmural ischemia w/ ST elevations in leads V1-V4

A

Proximal LAD

368
Q

Which vessel was occluded? transmural ischemia of lateral wall of left ventricle, w/ ST elevations in V5 & V6

A

LCX

369
Q

Name the pathology: features: diffuse increased thickness of glomerular BM on light microscopy, nephrotic syndrome, spike and dome appearance on silver stain and granular deposits on immunofluorescence are diagnostic

A

membranous nephropathy

370
Q

what are the two main AE of statins?

A

myopathy

hepatotoxicity

371
Q

which antineoplastic drug inhibits ribonucleotide reductase?

A

hydroxyurea

372
Q

which antineoplastic drug blocks de novo purine synthesis?

A

6-Mercaptopurine

USMLE_STEP1 (5 decks)

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