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USMLE® Step 1 flashcards
1
Q

Jaundice + positive coombs test + INC retic count. What is this and tx?

A

Warm agglutination. IgG chronic anemia - from SLE, CLL, DRUGS (methydopa) Tx w/ STEROIDS

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2
Q

Where are majority of dopamine RECEPTORS located?

A

Dopamine neurons in substantia niagraRECEPTORS in Striatum! (putamen, caudate)

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3
Q

Which larger parasites invades mucosa?

A

CryptospordiumEntamoebaNOT giardia

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4
Q

WHAT HAPPENS IN ELISA? What is best confirmatory test for HIV?

A

Binding of protein (for example HIV protein) and ab (patients ab - tests to see if pt has ab) . Differs from Western blot in that the ab is linked to an enzyme. The activity of the enzyme changes color - intensity depends on amount of ab. Western blot is the least likely to have false positives and false negatives so it is the major CONFIRMATORY STEP.

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5
Q

Which 2 chemo drug types work on the G2 phase?

A

Topoisomerase (Etoposide) - (G2 and S)And Bleomycin - strand breaks. (G2)

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6
Q

Bevacizumab used in?

A

VEGF ab - colon CA, breast, nonsmall cell Lung CA.

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7
Q

Tx for alcohol related cardiomyopath?

A

ACE, Digoxin, diuretics

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8
Q

Longtime bikers can get handlebar palsy. What is this? What else innervated by this nerve?

A

Compression of ulnar nerve - cause difficulty spreading fingers and making a fist. Hook of hamate compresses ulnar nerve. Ulnar nerve dmg can cause ulnar claw hand, as well as lumbricals 3,4 (claw hand) and ADDUCTOR pollicis

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9
Q

Two treatments of serotonin syndrome?

A

Diphenhydramine and cyproheptadine

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10
Q

Tx for PCP in sulfa allergy pt?

A

Not TMP-SMXSecond would be AEOROZOLIZED PENTAMIDINE

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11
Q

Most common side effect of Odansetron? Mech of action?

A

5-HT3 receptor blocker.Headache, constipation, urinary retention, dizziness (blocks GU tract)

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12
Q

What are 3 ways to define AIDS?

A

Serologic evidence of HIV infection CD4 count less than 200CD4% less than 14%Presence of one or more opportunitistic infections

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13
Q

micronodules in liver?Macronodules in liver?

A

Micro - chronic liver disease - alcoholism, Wilsons, hemochromatosisMacro - postinfectious, drug induced hepatitis.

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14
Q

Antibiotics tha tcan cause ototox?

A

AG

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15
Q

Pagets lab findings?

A

Lytic findings on radiographcElevation of alk phosNORMAL partyhyroid, Ca, P

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16
Q

What is pre-ecmalpsia first line?

A

Delivery of baby.IV Magnesium to PREVENT SEIZURES - can see DEc deep tendon reflexes.Phenytoin and diazepam are second kline (phenytoin second line due to neural tube problems etc)

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17
Q

Red casts?WBC casts?Granular castS?Fatty casts?Waxy casts?Hyaline casts?

A

RBC - inflam - GN. ishemia, malignant HTNWBC - ifnection/pyleo, tx rejection.Fatty - nephroticGranular/muddy - Acute Tubular NecrosisWaxy - advanced/chronic renal failureHyaline - nonspecific. Can be seen in concentrated urine samples

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18
Q

As the prevalance INC, what happens to the PPV and the NPV?

A

PPV INCNPV DEC

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19
Q

SchizoaffectiveSchizophreniformShizophreniaSchizoid personalitySchizotypal personalityGeneral anxiety disorder must last how long?

A

shizoaffective - 2weeks +. Shizo plus mood/depressionSchizophreniform 1-6 monthsSchizophreniaShizoid - voluntary withdrawalShizotypal - magical thinkingGAD - 6 months+

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20
Q

What muscles are supplied by the radial nerve?

A

Brachioradialis, Extensors of wrist/fingers, Supinator, Triceps. (bEST)

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21
Q

Where do most pancreatic CA occur?

A

Ventral pacnreatic bud = obstructive jaundice, weight loss, ab pain radiating to back

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22
Q

What is more likely to cause MI?Plaque rupture or thromboembolic event?

A

Plaque rupture leading to possible thrombus.

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23
Q

What test can be used to dx Acromegaly?

A

High GH -> high Insulin like growth factor - confirmed via glucose tolerance test - Normally - growth hormone is suppressed after glucose load.Lack of suppression indicates GH excess that is not responsive to negative feedback loop. Acromegalic pt usu display hyperglycemia!SUMAMRY: ACROMEGALY ALWAYS HAVE ILGF floating around. THEREFORE desensitive to insulin. THEREFORE HYPERGLYCEMIC.

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24
Q

BartonellaFrancisellaPasteurella

A

Bartonella - regional LAN,. low gaade feverFrancisella - LAN + ULCER. wild rabbits and ticksPasteurella - cat/dog - RAPID inflam (w.in hours) and purulent discharge.

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25
Q

Standard tx for C diff diarrhea?

A

Metronidazole or Vanc

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26
Q

Malignant hyperthermia due to mutation where?

A

Ryanodine receptor!!! RYR1!!!DHP is normal and triggers Ryanodine.

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27
Q

Potters disease is due to failure of what to form?

A

URETERIC bud - (outgrowth that arises from mesonephric duct) Fialure of ureteric buds to form -> potters.

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28
Q

Treatment for E Coli O157H7>

A

Most Ecoli including O157H7 - supportive - hydration - AVOID antibiotic therapy.

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29
Q

phosphodiesterase inhbiitors such as sildenafil INC what levles?

A

cGMP levels - relaxes smooth muscles and INC penile blood flow.

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30
Q

N-acetyl cysteine is?

A

A reducing agent - the sulfhydryl group reduces glutathionine, so that glutathionine can reduce again.

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31
Q

where is the ilioinguinal nerve located?

A

ilioinguinal nerve located in inguinal canal - pass es through the inguinal ligament on top of the spermatic cord.Supplies cutaneous scrotum/labia and medial aspect of thigh. NOT part of spermatic cord - must be islated separately from cord during hernial surgeries so there is no loss of sensation.

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32
Q

Tx of salmonella?

A

Usu dont try to treat w/ antibiotics - PROLONGS fecal excretion.Also dont treat E coli HUS. Unless UTI (TMp-SMX, penicillin) or meningitisShigella you can treat.

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33
Q

What maneuver DEC preload.What maneuver INC afterload?

A

DEC preload w/ valsalva (INC intrathyoracid pressure DEC venous return) - Mitral valve prolapse murmur INC w/ valsalva maneuver. Hand grip INC afterload

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34
Q

Pros and cons of hormone replacement therapy?

A

Pros: Helps w/ menopaus symtpoms,. DEC colorectaCA and osteoporotic fractureCons - INC MI risk, Stroke risk, Venous thromboembolism risk, Breast CA risk.

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35
Q

Where woudl you want to ablate in parkinsons disease?

A

Not enough dopamine from substantia nigra.Ablate globus paladus (GPi/e)

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36
Q

polyhydramnios and congenital diaphragmatic hernia due to?

A

failure of pleuroperitoneal folds to derive. Often have flat stomach (w/ contents visible) and heart dispalced to right.

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37
Q

Prerenal Intrarenal has what ratio?Postrenal has what ratio?

A

Pre - ratio greater than 20:1. Intra - ratio below 15:1Post - ratio greater than 15:1.

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38
Q

Normal pressure hydrocephalus usu due to?

A

Communicating hydrocephalus - some type of problem w/ resorption in villi

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39
Q

Mutation in burkitts?

A

c-mycEBcstary sky8:14

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40
Q

Ceramic working. THink?

A

Lead posioning. Thus ALAD blocked.(second enzyme in pathway)

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41
Q

Replacement of heparin after HIT?

A

Direct thrombin inhibitor. Argatroban, bivalirudin, lepirudinShort half life do not cross react.

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42
Q

Best treatment for bulimia?

A

Fluoxetine.perhaps mirtazapine and trazadonie

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43
Q

What should you do before giving DOC for ankylosing spondylosis?

A

Tx is infliximab - anti-TNFa monoclonal ab - must check PPD (purified protein derivative skin test)

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44
Q

What does mom chlamydia -> birth -> kid usu yield?

A

Inclusion conjunctivitis - D-K.See inclusions w/ special stain.Also pneumonia between 4 to 11 weeks of life.

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45
Q

Severe diarrhea leads to what plasma changes?

A

Loss of bicarb (acidosis)INC in Cl reabs (to get NaCl from dehydration) -> non-anion gap metabolic acidosis. Often can see hyperventilation to blow CO2 off.

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46
Q

Tx for cryptosporidium?

A

There is no tx - supportive care. (esp for immunocompromised. Can give nitazoxanide to immunocompetentn AKA DONT TREAT ECOLI HUS, SALMONELLA, CRYPTO

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47
Q

Chediak Higashi mech?

A

disorder of microtubule polymerization.

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48
Q

What else do you see in Kawasakis besides necrotizing vasculitis, fever, cervical LAD, hand rash, racing heart, aneurysm in future?

A

INJECTED CONJUNCTIVAE, strawberry tongue.hand foot rash PLSU EDEMA ON DORSAL ASPECT OF HANDS.

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49
Q

What does PCP look like on gross xray?PCP tx in sulfa allergy?

A

microscopic cysts. Pentamidine, dapsone, atovaquone. Atovaquone - INHIBITS MITO ELECTRON TRANSPORT.

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50
Q

DIC blood smear?

A

Schistocytes

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51
Q

Tx of GAS in penicillin allergic pt?

A

erythromycin - has activity agasinst GP (pneumo, strep, staph, corynebactera, enterococci and gram negative.

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52
Q

Male - hernia protrudes w/ effort and reduces in rest. What is this?

A

direct! Medial!Indirect do not disappear - are always in your sac ish.

53
Q

mitral stenosis sound?

A

Opening snap followed by late diastolic rumble

54
Q

Common tx for achalasia?

A

Chalcium channel blocker, nigroglycerin, botulinum.First 2 can help DEC cAMP. Achalisa often due to failure to relax. So help the muscle to relax.

55
Q

First like tx for strep pneumo?

A

penicillin/amoxicillinhigh incidience of resistance -> vanc 2nd line

56
Q

IgA def puts you at risk for?

A

URI and GI infections (giardiasis)both are needed in the mucus spaces.

57
Q

Hb taut vs relaxed O2 affinities?

A

Hb taut - has low O2 affinity. Meaning a right shift (Cl, H, co2, 23,BPG) - drops off O2 easily.Hb relax - high O2 affinity - left shift.So Taut in Tissue.Relaxed in respiratory!

58
Q

Pain w/ leg hyperextention?

A

Appendicitis! Iliopsoas pushes agaisnt appendix - sig pain and iritation. Innervated by lumbar plexus and formal nerve.

59
Q

What type of HSR is SLE? What else is in that same category?

A

Type 3 - polyarteritis nodosa, PSGN, Serum sicknes, Arthrus reaction (swelling following tetanus rx)T4 - MS, Guillain barre, graft vs host, PPD, Candida skin test, contact dermatitis

60
Q

Other than prematurely, what else INC risk of hyaline membrane disease?

A

Hyaline membrane disease = neonatal respiratory DS. Prematurity, diabetes (large for gestational age), C-section. YOU KNEW THIS! Diabetes = too much sugar, cortisol impaired.

61
Q

Tx for DNA viral meningitis?Tx for RNA viral meningitis?

A

DNA viral - herpes - acycloviRNA - supportive care for most RNA.

62
Q

Bipolar 1BIpolar 2Cyclothymic?

A

BP1 - 1 or more MANIC episodes, with or without hypomania/depressionBP2 - Requires MDD episode AND! hypomanic. NOT Manic.Manic automatically makes it BP1.Cyclothymic - hypomania and dysthmia. Milder. Lasts at least 2 YEARS.

63
Q

When is C section indicated?

A

If either one or both are distressed (baby or mother). If netiher are, it is usually not indicated. Perhaps elective tho.

64
Q

Sumatriptan mech of action?

A

Serotonin agonists - can cause serotonin syndrome and CORNOARY VASOCONSTRICTION. so THINK CONSTRICTION of migraine. Be cautious of use in CAD pt.

65
Q

PT w/ INC ICP. What to do?

A

Intubate and hyperventilate - DEC in CO2 causes vasoconstriction. Buys you time - ios shortlived.Mannitol also works. Would want to ELEVATE head to allow for venous outflow.

66
Q

Young kid. No Auer rods. ALL or AML?

A

ALL - usu under 15. Esp if lack auer rods. AML - median onset 65. Presence of auer rods.

67
Q

RoseolaRubellaRubeola

A

Roseala - HV6Rubella - Rubeola - Measles

68
Q

How does Iron tox affect blood levels?

A

It is the I in mudpile s- anion gap metabolic acdiosis

69
Q

First of line for cardiogenic shock?

A

Dobutamine. NOT epinephrine. Because epi can cause arrhythmias.

70
Q

Where do you see Howell Jolly bodies?

A

Splenectomy.ALSO AUTOSPNEECOMTY IN SICKLE CELL PT.

71
Q

wHAT DOES PULSUS PARADOXUS make yous suspicious with? Where else is it seen?What confrims suspicion?

A

Cardiac Tamponade.Also seen in PERICARDITIS asthma, obstructive sleep apnea, croupBecks triad - muffled heart sounds, hypotension, distened neck veins CONFRIMS cardiac tomponade w/ pulsus paradoxus.

72
Q

What does corticobulbar control

A

muslces of face, head neckCorticospinal does rest of body.

73
Q

What is a transplant from an identical twin?AutogeneicAllogeneicSynergeneic

A

Autgeneic - self onlyAllogeneic -s oemone elseSynergeneic - twin.

74
Q

DOC for gout?

A

Acute - NSAIDS. Then glucocoirtoicds, colchicine.Chronic/preventive - Xanthin oxidase inhibitors. (febuxostat, allopurinol)

75
Q

Periods in 8 year old. what tumor?

A

Granulosa theca - produce estrogen.Although in a young kid usually jump to yolk sac/endodermal sinus tumor.

76
Q

How to measure anestheticPOTENCYSpeed to Induction?

A

Potency - inverse of MAC.Speed to induction - lower the blood solubility, the faster it has an affect.

77
Q

Irqa - HSM, fever, peripheral eosinophilia

A

Katayama fever. Middle easy, Africa, south america. Esp if exposed to fresh water.From Shistosoma mansoni Similarly Shistosoma haematobium can cause SCCA of bladder, and liver/spleen granulomas, fibrosis/inflam

78
Q

First step in curing digoxin tox? Then what?

A

Slowly normalize K levels. Then you can do whatever 0 lidocaine, anti-dig Fab, Mg etc.

79
Q

How does indirect hernia originateHow does direct originate?

A

Indirect- patent processus vaginalisDirect - weakness of ab wall

80
Q

First line for OCD?

A

SSRi.

81
Q

Ultrasound of pyloric stenosis?Duodenoal stenosis?

A

Pyloric stenosis -s ee thickened pylorusDUodenoal stenosis - see double bubble.

82
Q

Congo red stain in pt w/ lytic back bone lesions?What is the stain of?

A

MM. Ig light chain. PRIMARY AMYLOIDOSIS.

83
Q

What are the major sources of estrogen post-menopaus?

A

Adrenals - androsteinodioneAndrosteinodione taken in peripheral adiopcytes and aromatize it into Estrone.

84
Q

What is the cell type of the epididymis?

A

Pseudostratified columnar epi w/ stereocilia

85
Q

What is desquamative intestitial pneumonia?

A

DIp is a restrictive lung type - resmelbes idiopathic pul firosis in early stage - can see “honeycomb appearance”

86
Q

Calcium algate swab, w/ plating on potato agar/regn lowe medium for?

A

Brodetella pertussis. Bugs dont transfer well on cotton swab.

87
Q

What does folate do in the body?

A

One carbon transcers

88
Q

Difference between gel electrophoresis and Soutehrn blot?

A

GEel electrophoresis ends w/ gel being stainied and visualized udner UV lightSOtuerh blot - you give it a radiolabled probe.

89
Q

short palpebral fissures, cleft lip, MR?

A

Fetal alcholol syndrome

90
Q

Meissner vs Pacinian, Merkel?

A

Meissner - fine touchPacinian - pressure/vibrationmMerkel - deel pressure

91
Q

Primary intervention for NMS?

A

Dantrolene.L-dopa etc are later.

92
Q

When should you have concern for HIT?

A

Pt who have had Hep before, then have Hep again.Can have immune ab build up. Have plt counted every 2-3 days

93
Q

What fibers carry visceral pain?

A

Sympathetic fibers?

94
Q

How does osteoarthritis affect heme?

A

It does not cause anemia of chronic diasesa

95
Q

Excessive melatonin production presentation?

A

Pineoblastoma - drowsiness or VIVID DREAMS

96
Q

Who is at risk to have tendon rupture w/ fluoroquinolones?

A

over 50, renal disease hx, hemodialsis, renal transplant, long term steroid use.

97
Q

How does protamine sulfate work?

A

Heparin is neg charged.Protamine sulfate is highly cationic and binds it.

98
Q

Only solo treatment for TB prophylaxis?

A

Isoniazid?Although in the actually dsease isoniazid is never given alone.

99
Q

preeclampsia before 20 weeks suggests?

A

ectopic preg.

100
Q

Who can produce exotoxins? Endotoxins?

A

Exotoxins - both GN and GPEndotoxin - only GN

101
Q

What is ribavarin used to treat? What can it result in?

A

RSV -and chronic Hep C - IMP blocker - competitive inhibitionHemolytic anemia. TERATOGENIC.

102
Q

What is a sidefx of Macroline?

A

cholestatic hepatitis, Arrhitmia, rash, eosinophilia

103
Q

Pregnant women - vaginal bleedign after 20 months. Suggets? Risk factors?

A

Placenta previaRisk factors - prior C section, INC number of prior preg, twin gestation, hx of prior curretage for elcetive abortions.

104
Q

Trousseaus syndrome. What is it? When is it seen? What is it caused by?

A

Unique migratory thrombophelebitis - occurs as a result of RELEASE OF CLOTTING FACTORS (suchj as TISSUE FACTOR) by PANCREATIC /gliomas/lung TUMORS.

105
Q

Contraindication of TPA therapy.

A

BP over 190, hx of stroke/ehad trauma w/in 3 months, INR over 1.7, platelet count less than 100,000

106
Q

TX of SLE?

A

First NSAIDS for rash/arthralgias - usualyl need to add steroids on top for an effec.tFor SEVERE SLE, serositis and visceral involvement, such as Diffuse proliferative GN - IMMUNOSUPPRESNANTS (such as cyclophoshamide)

107
Q

Tx for Rheumatoid Arhtritis?

A

NSAIDS, Corticoids, Disease modifying (METHOTREXATE etc)

108
Q

Probenecid used for?

A

Gout tx - exp cronic gout - prevents reabs of uric acid in PCT - promotes secretion -

109
Q

Drug cocktail to treat hodgkins?

A

ABVD - adiramycin (doxorubicin), Bleomycin, Vinblastin, Dacarbazine

110
Q

C diff from Enterococcus treatment. What was used?

A

Ampicillin.Clindaymcin cannot treat entercocci -s oampicililn would have been giving gto cause it.

111
Q

Congenital diaphragmatic hernias most commonly from failure of?

A

Pleuroperitoneal folds to form and fuse. Can get heart to be shfited over and lung hypoplasia and bowel sounds in lung.

112
Q

In horners what type of sympathetic neuron is usually dmaged?

A

Second order preganglionic sympathetic

113
Q

Post splenectomy - what is seen in peripheral blood slide?

A

Howell Jolly and Target cells.

114
Q

Where are JG cells located?

A

Modified msooth muscles of AFFERENT ARTERIOLE - sense DCT delviery.

115
Q

Dorsal penis from? In girls?Ventral penis from? In girls?

A

Dorsal penis (epispadia)-genital tubercle - clitoris Ventral penis (hyposadia) - urogenital folds - labia minora

116
Q

What cells in body have SGLUT?

A

Neprhons and enterocytes

117
Q

First line in to treat COPD/asthmatic that is LEAST LIKELY to cause cardiac arrhythmias?

A

Ipratropium

118
Q

Elisa used to detect?

A

proteins - such as Ab.

119
Q

What age kids have testicular tumor w/ INC AFP?

A

Yolk Sac tumor - average age is 3 y.o. INC AFP.Embryonal CA would be around 30 y.o

120
Q

Where in the body do you get pale infarcts?

A

Single blood supply - heart, kidney, spleen. Red infarct - loose tissue w/ multiple supplies - liver, lung, intestine.

121
Q

Boerdrline personality?

A

Cluster B - emotional, impulseive, labile mood, unstable relationships - SPLITTING (all good or all bad)may engage in self destructive behaviors in attemps to gain attention

122
Q

Statins are what kind of biochemical class of drugs for HMGcoA reductase?

A

competitive inhibitors. DEC Km,. Same Vmax.

123
Q

What are risk factors for endometrial CA

A

Anything that INC Estrogen.Obesity(peripheral androgens)Late menopausNulliparity Smoking is not a risk

124
Q

Serum sickness - what kind of HSR is this? presentation?

A

T3 - rash, Glomerulephritis, arthritis, fever.

125
Q

durable power of autorny vs livving will? who wins?

A

Durable power of autorney.

126
Q

Neural tube defects are a failure of what to close?

A

Neural folds. Not notochord.

127
Q

Guillame barre affets what cells?

A

peripheral schwann demyelinationNOT SPINAL CORD.

128
Q

pOSSIBLE MECH OF THE PROBLEM W/ FETAL ALCOHOL SYNDROME?

A

inhibits CELL MIGRATION during 3-8 weeks.Impaired differnetiation, apoptosis, cell metabolism. MICROCEPHALY, HEART DEFECTS, LIMB DISLOCATION

USMLE (16 decks)

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