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USMLE Step 1 practice exam flashcards > UWorld Mock blocks week 1/21-1/27 > Flashcards

UWorld Mock blocks week 1/21-1/27 Flashcards

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1
Q

Risk factors for pancreatic cancer

A

Smoking doubles the risk

Age 65-75

Diabetes

Chronic pancreatitis

Hereditary syndromes

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2
Q

Pancreatic cancer

A

Palpable, non-tener gall bladder, weight loss, obstructive jaundice (pruritus, dark urine, pale stools) = pancreatic cancer in head of pancreas

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3
Q

CMV retinitis

A

Affects HIV patients w/ CD$ <50

–> retinal detachment due to tearing of thin, atrophic scar tissue

Tx: ganciclovir - has greater activity against CMV c/w acyclovir

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4
Q

Herpes viruses

A

bud through and acquire membrane from host cell nuclear membrane

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5
Q

Pulmonary edema

A

decreased lung compliance

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6
Q

Dengue virus

A

ssRNA

4 serotypesSecondary infection w/ different serotype –> more severe infection

Hemmorrhagic: thrombocytopenia, prolonged fever, respiratory/cardiac failure, and shock. Hemmorhhage.

Primary: Flu like illness w/ myalgia, rtetroorbital pain, rash

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7
Q

abetalipoproteinemia

A

Enterocytes have clear or foamy cytoplasm (lipid accumulation)

Impaired formation of ApoB containing lipoproteins. Can’t synthesize apolipoprotein B

Auto recessive - loss of function in MTP gene

Manifests as malabsorption

Low plasma triglyceride and cholesterol levels. Chylomicrons, VLDLs and apoB are absent from blood.

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8
Q

Prolactin suppresses

A

GNRH–> DECREASED LH AND TESTOSTERONE

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9
Q

Gq

A

Phosphoinisitol second messenger system. Gq –> Phospholipase C –> IP3 –> PKC activation –> Ca2+ release

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10
Q

Ion pump failure in cardiac ischemia

A

Increased intracellular Na+ and Ca2+ –> free water is drawn into cell

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11
Q

myxomatous change

A

Pooling of proteoglycan in the media of large arteries

Predisposes to development of aortic dissection and aortic aneurysm

Medial degeneration seen in Marfan

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12
Q

Giant cell arteritis

A

granulomatous inflammation of the media and fragmentation of internal elastic lamina

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13
Q

De quervain thyroiditis

A

Painful thyroid enlargement. Follows viral illness

Bx: Lymphocytic infiltrate w/ macrophages and multinucleate giant cells

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14
Q

Hashimotos thyroiditis on Bx

A

Lymphocytes with germinal centers

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15
Q

Riedel thyroiditis

A

extensive fibrosis of thyroid glad extending into surrounding tissue

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16
Q

Papillary thyroid carcinoma

A

branching papillary structures w/ concentric calcifications (psammoma bodies)

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17
Q

Noncaseating granuloma, bloody diarrhea

A

Crohn’s

Also has transmural inflammation

Cobblestone appearance w/ skip lesions

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18
Q

Risk factors for epithelial ovarian cancer

A

Increased risk: BRCA, nulliparity, infertility

Decreased risk: OCPs, multiparty, breadtfeeding

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19
Q

Rivaroxaban and apixaban

A

Factor xa inhibitor

Used for venous thrombus or A. fib

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20
Q

Argatroban, bivalirudin, dabigatran

A

Direct thrombin inhibitors.

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21
Q

Aspleniz in sickle cell

A

Increased risk of infection w/ encapsulated organisms

Strep pneumo, and H. flu

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22
Q

Morbidity in rheumatic fever

A

pancarditis –> heart failure

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23
Q

effect of ACE inhibitors

A

Increased angiotensin I, renin, and bradykinin

Decreased angiotensin II and aldosterone

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24
Q

Nonbacterial thrombotic endocarditis

A

Chronic inflammatory disorders (e.g. Lupus) and advanced malignancy.

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25
Q

bosentan

A

Endothelin antagonist

treatment for idiopathic pulmonary arterial hypertension

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26
Q

Complete mole

A

46 XX

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27
Q

Hep B histology

A

finely granular, pale eosinophilic, ground-glass appearing inclusions

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28
Q

Chronic transplant rejection

A

Bronchiolitis obliterates - small airways

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29
Q

Finasteride

A

5alpha-reductse inhibitor

Used in male pattern baldness

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30
Q

Insulin resistance

A

Phosphorylation of serine and threonine residues of insulin receptor and insulin receptor substrate by serine kinase

This can be induced by TNF-alpha, catecholamines, glucocorticoids, and glucagon

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31
Q

Parvovirus

A

ssDNA

Children 0 fifth disease

adults - acute systemic arthropathy (similar to RA)

Chronic hemolytic anemia: transient aplastic crisis.

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32
Q

Trigeminal neuralgia treatment

A

Carbamazapine

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33
Q

Pyshostigmine vs. neostigmine

A

Physostigmine - penetrates CNS

Neostigmine - does Not cross BBB - quaternary ammonium structures prevents CNS penetration

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34
Q

Thiazolidinediones

A

Pioglitazone

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35
Q

Thiazolidinediones

A

decrease insulin resistance by finding PPAR-y - a transcriptional regulator of genes in glucose and lipid metabolism.

Delay of days-weeks since it effects gene expression and protein synthesis

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36
Q

Vitamin E deficiency

A

Vitamin E is an anti-oxidant

Neurologic sx like friedrich ataxia (degerneration of spinocerebeallar tracts). Loss of position and vibration sense (degeneration of dorsal collumn, loss of DTR (peripheral nerve degeneration).

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37
Q

candida

A

branching pseudohyphae and blastoconidia

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38
Q

dexamethasone suppression test

A

Suppressed ACTH:
Adrenal adenoma, adrenal malignancy, exogenous glucocorticoids

Elevated ACTH:
- Suppresion of ACTH/cortisol –> pituitary adenoma

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39
Q

Dexamethasone test cont…

A

ACTH & cortical unchanged –> ectopic ACTH (e.g. paraneoplastic)

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40
Q

Plycythemia vera

A

Uncontrolled erythrocyte production - mutation in Jak2 - cytoplasmic tyrosine kinase a/w EPO receptor

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41
Q

IgA nephropathy (berger Dz)

A

Recurrent, self-limited painless hematuria w/in 5 days of URI.

Mesangial IgA deposits on immunofluorescence.

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42
Q

PSGN

A

coarse IgG and c3 deposits on immunofluoresense.

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43
Q

Alport

A

Disorder of Type 4 collagen - renal failure by age 40, hearing loss, ocular abnormalities.

EM: lamellate basement membrane w/ irregular thinning and thickening (basket-weave)

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44
Q

Ornithine transport into mitochondria

A

Essentail for urea cycle function - nitrogen waste catabolism

Defects –> neurologic damage d/t accumulation of ammonia

Restrict protein to reduce AA turnover

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45
Q

IgE independent mast cell degranulation

A

opioids, radio contrast, vancomycin - diffuse itching and pain, bronchospasm, local swelling

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46
Q

CAndidal antigen skin test

A

Tests T cell immunity

Cd4+, CD8+, and macrophages - Type IV hypersensitivity reaction

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47
Q

Factor V Leiden

A

Factor Va resistance to inactivation by activated protein C

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48
Q

most abundant AA in collagen

A

Glycine - occupies every third amino acid position

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49
Q

secondary hyperaldosteronism

A

Elevated renin and aldosterone - causes: renovascular hypertension, malignant hypertension, renin-secreting tumor, diuretic use

Primary hyperaldosteronism (e.g. adrenal adenoma) have low renin d/t feedback of aldosterone on renin

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50
Q

Acyl-CoA dehydrogenase

A

catalyzes the first step in beta-oxidation of fatty acids. It is the most commonly deficient enzyme in beta-oxidation. Deficiency results in hypoketotic hypoglycemia after fasting

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51
Q

BCL-2

A

Anti-apoptotic gene over expressed in follicular lymphoma - found on chr. 18 - B cell tumor 14:18 translocation

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52
Q

C-MYC

A

Burkitt lymphona on chromosome 8 (8:14)

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53
Q

N-MYC

A

Neuroblastoma and small cell carcinoma

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54
Q

Vitamin A deficiency

A

Nightblindness and hyperkeratosis - deficiency of fat soluble vitamins forms in patients with biliary disorders, exocrine pancreatic insufficiency, or malabsorption

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55
Q

glargine

A

Basal long acting insulin

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56
Q

lsspro, aspart, and glulisine

A

short acting insulin given 3x/day w/ meals.

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57
Q

MSUD

A

defect in alpha-ketoacid dehydrogenase - involved in metabolism of branched chain AA’s (leucine, isoleucine, valine)

alpha-ketoacids accumulate in blood and urine

Sweet smelling urine, CNDS defects, mental retardation, and death

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58
Q

Inheritance of NF-2

A

Auto dominant - chr. 22

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59
Q

Main component of surfactant

A

phosphitidylcholine

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60
Q

Horseshoe kidney

A

Gets caught on IMA`

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61
Q

Mycoplasma pneumonia

A

Looks worse on CXR than patient presents

requires cholesterol in media to grow

Military recruits

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62
Q

Malignancy

A

Monoclonal proliferation

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63
Q

Gallstone ileus

A

Air in the biliary tree

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64
Q

Ureter

A

Anterior to internal iliac artery

Posterior to ovarian and uterine arteries

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65
Q

Glucagon

A

Activates GPCR’s on cardiac myocytes –> adenylate cyclase activation –> increased cAMP –> increased SA firing

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66
Q

Osteoclastic activity in multiple myeloma

A

Increased serum Ca2+
Decreased PTH production
Hypercalciuria
Renal failure - reduced 1,25 vit D synthesis

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67
Q

Thiazides

A

Raise: serum Ca, uric acid, glucose, cholesterol, and triglyceride

Lower: serum sodium, potassium, and magnesium

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68
Q

omega-aminolevulinate synthase

A

Catalyzes the rate limiting step in heme synthesis

uses pyridoxine (B6) as cofactor

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69
Q

Midsystolic click w/ mid-late systolic murmur at cardiac apex that disappears w/ squatting

A

Mitral valve prolapse in MR

Squatting tenses the chord - increased venous return + increased LV volume

Myxomatous degeneration

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70
Q

Gaucher disease

A

Auto recessive lysosomal storage disorder

beta-glucocerebrosidase deficiency –> accumulation of glucocerebroside

Presentation: bone pain abdominal distention - hepatosplenomegale, easy bleeding, bruising, pallor, and fatigue from pancytopenia.

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71
Q

Fanconi anemia

A

Inherited aplastic anemia, increased risk of malignancy, hypo/hyperpigmented skin patches, short stature, hypo plastic thumbs.

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72
Q

Transient aplastic crisis

A

Parvo B19

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73
Q

Hormone levels anorexia

A

Impaired GNrh release from hypothalamus –> decreased LH< FSH, and estrogen

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74
Q

Pemphigus vulgaris

A

Desmosomes

Present in the mouth/mucosal membranes

Painful flaccid bull and erosions. Bullae spread laterally with pressure, and blisters form w/ gentle rubbing.

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75
Q

Myotonic dystrophy

A

Sustained muscle contraction followed by weakness and atrophy. Cataracts, frontal balding, and gonadal atrophy

Auto dominant - increased tirnucleotide repeats on myotonia protein kinase gene.

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76
Q

Colon cancer progression

A

APC - normal –> small adenoma
KRAS - increased size of adenoma
TP53 - malignant transformation

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77
Q

Basal ganglia atrophy

A

present in Wilson’s disease

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78
Q

Opsoclonus-myoclonus

A

Paraneoplastic syndrome a/w neuroblastoma

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79
Q

Osteolytics vs. osteoblastic

A

Osteolytic - lucent on imaging - Aggressive - MM, non-small cell lung cancer, non-hodgkin lymphoma, RCC< melanoma

Mixed - G.I. and breast

Osteoblastic - sclerotic on imaging - indolent - Prostate, small cell lung cancer, hodgkin lymphoma

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80
Q

Isoproterenol

A

Beta-1 and beta-2 agonist - causes increased myocardial contractility and decreased SVR

81
Q

Human placental lactogen

A

Hyperglycemia in second and third trimester

82
Q

Echinococcus granulosus

A

Most common cause of hydatid cysts - spilling of cyst contents results in anaphylaxis - do not perform surgery, treat chemically w/ albendazole.

83
Q

Cryptococcus

A

Latex agglutination test

84
Q

Papillary carcinoma

A

Orphan annie eyes - Large cells with overlapping nuclei and finely dispersed cytoplasm.

Numerous intranuclear inclusion bodies and grooves can be seen

Cause >70% of thyroid nodules

85
Q

MSH2 and MLH1

A

Mismatch repair genes - Mutations in these account for lynch syndrome

86
Q

Propionyl CoA deficiency

A

Propionyl CoA is derived from metabolism of valine, met, threonine, and odd chain fatty acids. Deficiency in propionyl coa carboxyl’s usually convert propionyl CoA to methylmalonylCoA.

Deficiency in the carboxylase –> propionic acidemia

lethargy, poor feeding, vomitting, and hypotonic 1-2 weeks after birth

87
Q

Craniopharyngioma

A

Suprsellar tumor in children

Composed of calcified cysts containing cholesterol crystals. Dystrophic calcification on imaging.

Remnant of rathke’s pouch - surface ectoderm

88
Q

Dystrophin

A

Sarcolemme-cytoskeleton linker protein

Stabilizer between the sarcolemma and intracellular contraction apparatus - disruption of this protein –> membrane damage and myonecrosis.

Frameshift mutation causes duchenne muscular dystrophy

89
Q

Clomiphene

A

Estrogen receptor modulator - decreases negative feedback inhibition by circulating estrogen –> increased gonadotropin production

90
Q

Amyloidosis

A

Can cause ventricular hypertrophy resulting in restrictive cardiomyopathy and diastolic heart failure

91
Q

Aortic stenosis

A

Loudest over right second intercostal - radiates to neck and carotids

92
Q

Conn syndrome

A

Primary hyperaldosteronism - aldosterone secreting adenoma

Treat w/ spironolactone or eplenerone

93
Q

Pseduogout

A

Calcium pyrophosphate crystals

Rhomboid shaped - positively birefringent

94
Q

Minimal change disease

A

massive poretinuria –> hypoalbuminemia –> decreased plasma oncotic pressure –> fluid shifts into the interstitial space resulting n edema.

Low oncotic pressure triggers increased lipoprotein production in the liver

95
Q

Arteries penetrated by gastric ulcers on lesser curvature

A

Left and right gastric arteries

96
Q

PSGN prognosis

A

Complete recovery in children, poor prognosis in adults –> increased risk of chronic hypertension and renal insufficiency

97
Q

Colchicine

A

Second-line therapy in acute gout - used in patients w/ contraindication to NSAID’s

Binds tubules inhibiting tubules polymerization –> decreased leukocyte migration –> reduced inflammation.

SE’s: diarrhea, nausea, vomitting, abdominal pain

98
Q

DKA potassium

A

Normal to increased serum potassium, total body potassium defect

MUST replace K+ in DKA

99
Q

Brain stimulation to treat Parkinson’s

A

Stimulate globus pallidus internen or subthalamic nucleus to inhibit firing of these nuclei (which are inhibitory)

–> thalami-cortical disinhibition with improved mobility

100
Q

Chronic lymphedema

A

Predisposes to angiosarcoma development

101
Q

Villous adenomas

A

Most likely colon polyp to undergo malignant transformation

Large, sessile, and more severely dysplastic

Can secrete large quantities of watery mucus resulting in secretory diarrhea, hypovolemia, and electrolyte abnormalities

102
Q

Hamartomatous polyps

A

Disorganize mucosal glands, smooth muscle, and CT.

Peutz-jeghers or Juvenile polyposis.

Can cause bleeding and intessuception

103
Q

Crystalline nephropathy

A

Can be caused by acyclovir which is nephrotoxic

Prevent w/ adequate hydration and slowed infusion

104
Q

Rabies

A

Rhabdovirus - ssRNA - bullet shaped capsule studded by glycoprotein spikes that bind nicotinic Each receptors.

Travels retrograde to CNS

Agitation, disorientation, pharyngospasm, and photophobia –> coma –> death

Treat w/ post-exposure-prophylaxis prior to neurologic symptoms

105
Q

Diastolic heart failure

A

Decreased ventricular compliance

Normal LVEF, normal LVEDV, elevated LV filling pressure

106
Q

Curling vs. Cushing ulcer

A

Curlings - severe trauma/burns

Cushing’s - intracranial injury - caused by direct vagal stimulation

107
Q

Myasthenia gravis

A

Thymoma - Ab’s against Each receptor

Lambert eaton Myasthenic syndrome - proximal muscle weakness - small cell lung cancer. Autoantibodies against presynaptic calcium channel resulting in reduced ACh release

Myasthenia NOT myasthenic syndrome would have diplopia

108
Q

GP41

A

HIV transmembrane envelope protein - involved in fusion.

Enfuvirtide - binds HR1 of GP41 preventing fusion

109
Q

Citrate and kidney stones

A

Citrate binds free calcium, reducing risk of stones

Increased citrate = less stones

Potassium citrate sometimes supplemented to prevent recurrent calcium stones

110
Q

Kallman syndrome

A

Absence of GnRH secretory neurons in the hypothalamus due to defective migration from the olfactory placed.

Central hypogonadism and anosmia

111
Q

Buerger’s disease (thromboangiitis obliterans)

A

Segmental thrombosing vasculitis with segmental vasculitis extending into contiguous veins and nerves

Heavy smokers before the age of 35 - hypersensitive intradermal injection of tobacco extract.

112
Q

Barret’s esophagus

A

Metaplasia of the esophagus from squamous cell –> intestinal type columnar cells with goblet cells

Predisposes to adenocarcinoma

113
Q

Squamous cell carcinoma of esophagus risk factors

A

cigarette smoke, achalasia, N-nitrosamine (smoked) foods, and alcohol use

114
Q

Adenocarcinoma of esophagus risk factors

A

Barrett’s, GERD, obesity, tobacco

115
Q

Gastric varices in the fundus

A

Blockage of splenic vain –> increased pressure in short gastric veins –> gastric varies ONLY in the fundus

116
Q

First step in valvular vegetation pathogenesis

A

fibrin platelet nidus for bacteria to adhere to.

117
Q

Parvovirus

A

Propensity for erythroid precursors - replicates in bone marrow

118
Q

Teniae coli

A

surgical landmark for appendectomy

3 separate smooth muscle ribbons that travel longitudinally on the outside of the colon - originate at the cecal base

119
Q

Kozak sequence

A

consensus sequence that helps start translation in eukaryotes - prior to the met start codon AUG

Analogous o to shine-dlagarno sequence in E. coli

120
Q

Mitral regurg

A

blowing holosystolic murmur best heard over the cardiac apex with radiation to the axilla

Observed with rheumatic heart disease

121
Q

Hypercalcemia in sarcoidosis

A

caused by parathyroid hormone independent formation of 1,25-dihydroxyvitamin D by activated macrophages –> increased intestinal absorption of calcium

122
Q

C-peptide

A

Marker for endogenous beta-cell insulin secretion

Levels increase with sulfonylurea (glyburide) use (which increase the insulin secretion rate of residual pancreatic islet beta-cells to reduce blood glucose levels)

123
Q

Auer rods

A

Stain positively for peroxidase

124
Q

Strawberry hemangioma

A

Benign, infants/children

125
Q

Shcistocytes

A

Microangiopathic hemolytic anemias

HUS, TTP,, DIC, mechanical (prosthetic valve)

126
Q

Sydenham chorea

A

involuntary rapid, irregular jerking movements of the face, arms, and legs

Occurs months after GAS infection, and is a clinical manifestation of rheumatic fever.

127
Q

Bisphosphonates (risendronate)

A

inhibit mature osteoclast mediated bone resorption

Treats osteoporosis

128
Q

Henoch Schönlein purpura

A

Effects young children, preceded by URI.

IgA mediated hypersensitivity vasculitis

Abdominal pain, joint pain, lower extremity (buttocks) palpable purport, and hematuria

129
Q

Types of nevi

A

Junctional: limited to dermoupidermal junction. Flat brown-black macule darker in the center

Compound: aggregates of nevus cells that extend into dermis. Raised papule with uniform pigmentation. Dermal and epidermal involvement

INtradermal: epidermal nests of nevi cells have been lost. Produce little to to pigment.

130
Q

increased C peptide

A

Preproinsulin cleaved –> insulin + C-peptide

increased production of endogenous insulin - sulfonylurea use or insulinoma

Hypoglycemic drug assay positive only in oral hypoglycemic agents

131
Q

Decreased c-peptide

A

exogenous insulin

132
Q

Diphenoxylate

A

Anti-dirrheal - mu opiod receptor against in GI tract that slows motility.

Low dose for diarrhea, high dose produce morphine like euphoria and physical dependence. Combined w/ atropine to discourage high dosage

133
Q

Tumor lysis syndrome treatment

A

Rasburicase or xanthine oxidase and aggressive fluid hydration

Rasburicase reduces uric acid levels - catalyzes conversion of uric acid to allantoin which is soluble

Allopurinol inhibits uric acid formation

134
Q

Steroids

A

Increase neutrophil count acutely due to “demmargination” of neutrophils previously attached to vessels

135
Q

Artery damaged in mid shaft humerus fracture

A

deep brachial

136
Q

Cystinuria

A

Defective dibasic amino acid transport in intestinal and proximal renal tubular epithelial cells.

Recurrent stones at your age from decreased cysteine absorption in urine

HEXAGONAL cystine crystal and AMINOACIDURIA

137
Q

K1 capsular antigen

A

E. coli strain that causes neonatal meningitis

K1 capsule is a virulence factor that allows the bacteria to survive in the bloodstream and establish meningeal infection

138
Q

Measles

A

fever, cough, rhinorrhea, and conjunctivitis followed by maculopapular rash starting on the face and spreading downward

KOPLIK SPOTS - white or blue-gray lesions in buccal mucosa

139
Q

Mumps

A

Parotitis, orchitis, aseptic meningitis

140
Q

Odds ratio

A

(a/b)/(c/d)

e.g.
Odds of developing in exposed group 20/90 (20 w/ 70 w/o)
Odds of developing in unexposed group 30/70 w/o condition (30 w/ 40 w/o)

Total number NOT used to calculate odds ratio

= (20/70)/(30/40)
= (20x40)/(30x70)

141
Q

KRAS

A

GPCR - constitutively active RAS-MAPK signaling –> malignant tumor development

Active-GTP
Inactive-GDP

142
Q

Location of AG I–> AG II conversion

A

small vessels of lungs

Concentration of AT II is higher in pulmonary vein than pulmonary artery when RAAS is activated

143
Q

Class IC antiarrhythmics

A

Use dependent, have increased effect at faster heart rates.

More effective for treating tacchyrhythmias.

Prolonged QRS at high heart rate

Fleicanide and propanefone

144
Q

Collagen in scars

A

Type I - also found in dermis, bone, tendon, ligaments, dentin, cornea, blood vessels and scar tissue

a/w osteogenesis imperfecta

145
Q

Etanercept

A

TNF-alpha inhibitor added to MTS for moderate to severe RA

Fusion protein - links TNF-a to Fc portion of human IgG1.

Reduces TNF-a activity by acting as decoy receptor

Suffixes

  • cept = receptor
  • nib = kinase inhibitor (e.g. imatinib inhibits BCR/ABL)
  • mab = monoclonal Ab
146
Q

Foscarnet

A

Sometimes used in ganciclovir-resistant CMV

Hypocalcemia and hypomagnesemia –> promotes seizures

147
Q

Acyclovir toxicity

A

crystal nephropathy and neurotoxicity (delirium of tremor)

148
Q

Cidofovir

A

Used in CMV retinitis

Nephrotoxic w/ proteinuria or elevated CK

149
Q

Lamivudine

A

NRTI - rare SE’s - occasionally peripheral neuropathy or lactic acidosis

150
Q

Sofosbuvir

A

Inhibits nonstructural protein 5B - RNA dependent RNA polymerase in Hep C infection

SE’s: fatigue and nausea

151
Q

SE of ganciclovir

A

severe neutropenia

152
Q

SIBO in gastric bypass

A

Small intestinal bacterial overgrowth

153
Q

Glucagon effect on HR

A

Glucagon activates GPCR’s on cardiac myocytes –> adenylate class –> increased intracellular cAMP –> ca release and increased SA firing

Use din beta-blocker OD to increase HR and contractility independent of adrenergic receptors

154
Q

Glucagon effect on HR

A

Glucagon activates GPCR’s on cardiac myocytes –> adenylate class –> increased intracellular cAMP –> ca release and increased SA firing

Use din beta-blocker OD to increase HR and contractility independent of adrenergic receptors

155
Q

Prevention of CAD in patients that are ASA sensitive

A

clopidogrel 2pY12 blocker prevents platelet aggregation

156
Q

Hep B virus

A

dsDNA circular DNA - replicates through fever stranscription

dsDNA –> +ssRNA –> translation of viral proteins AND reverse transcription into ssDNA intermediate –> partially double stranded DNA

157
Q

IL-12

A

Stimulates differentiation to TH1 subpopulation.

Deficiency in IL-12 –> severe mycobacterial infections d/t inability to mount strong cell-mediated granulomatous immune response

Treat w/ IFN-y (which also stimulates TH1 differentiation

158
Q

TH1

A

Activate macrophages and CD8

Mediate delayed type hypersensitivity

159
Q

TH2

A

Initiate antibody response

Regulate Ig class switching

160
Q

Primary myelofibrosis

A

Severe fatigue, splenomegaly, hepatomegaly, anemia, bone marrow fibrosis

Over activation of JAK2 proteins (cytoplasmic tyrosine kinase) –>constitutive activation (also seen in polycythemia and essential thrombocytosis) –> transcription factor STAT activation

161
Q

Lymphedema and cystic hygroma in neonate

A

Turner syndrome

162
Q

Diarrhea w/ Vibrio or E. coli

A

Toxin mediated - no leukocytosis on stool microscopy

163
Q

Scopolamine

A

Antimuscarininc agent - can treat muscarinic overstimulation (e.g. treatment of MG w/ AChE inhibitors)

164
Q

Pilocarpine

A

Nonselective muscarinic AGONIST

165
Q

Ethosuximide

A

T-type Calcium channel blocker - absence seizures

166
Q

phenytoin and carbamazipine

A

Na+ channel blockers

167
Q

Levitiracetam

A

Modulates GABA/glutamate release

168
Q

Valproic acid

A

Blocks Na+ channels and increases GABA levels

169
Q

Meglitindes

A

Short-acting glucose-lowering meds that close ATP dependent K+ channel in the pancreatic beta cell membrane, inducing depolarization and stimulating insulin release. STIMULATE INSULIN RELEASE

Given w/meals and reduce postprandial glucose excursions.

170
Q

Phenylephrine

A

Alpha-1 agonist - vasoconstrictor and increases SVR and BP –> baroreceptor mediated decrease in stroke volume and HR.

Decreased pulse pressure

171
Q

Papillary thyroid carcinoma histology

A

“orphan annie eyes”

large cells with nuclei containing finely dispersed chromatin w/ ground glass appearance

Papillary is the most common thyroid cancer

172
Q

Primary hyperaldosteronism

A

Increase HCO3, decreased K+, Normal Na+

Bicarb is produced d/t excess H+/K+ excretion –> metabolic alkalosis

increased Na+ reabsorption, but there is no hypernatremia d/t aldosterone escape. (increased blood flow –> pressure natures_ augmented release of ANP - limits sodium retention and prevents volume overload

173
Q

Pathogenesis of atherosclerotic plaque

A

Release of PDGF by locally adherent platelets, endothelial cells, and macrophages –> migration of smooth muscle cells from media into the intima

174
Q

alpha-glucosidease deficiency

A

POMPE - Type II

Presents in infancy with cardiomegaly, macroglossia, and muscular hypotonia.

Abnormal glycogen accumulation in enlarged lysosomal vesicles - positive for PAS - Glycogen can’t be broken down in lysosomes.

175
Q

Canagliflozin

A

SGLT inhibitor (sodium glucose cotranporter 2)

SGLT2 is responsible for resorbing 90% of filtered glucose in the proximal tubule –> inhibition urinary glucose loss

SE’s: UTI and genital mycotic infections secondary to glucosuria - diuresis can cause hypotension

176
Q

Activating mutation in PRPP synthetase

A

Leads to increased production and degradation of purines –> gout

177
Q

PD-l1

A

PD-1 is a programmed cell death receptor - PD-L1 down regulates the immune response against tumor cells by inhibiting cytotoxic T cells.

Tumors have increased expression of PD-L1

MAB’s that block PD-1 help prevent T cell inhibition –> promotes apoptosis of tumor cell

178
Q

First pharyngeal arrch

A

trigeminal nerve, mandible, maxilla, zygoma, incus

179
Q

Second pharyngeal arch

A

facial nerve, stapes, soloed process, lesser horn of hyoid

180
Q

Treacher collins

A

Defect of 1st and 2nd pharyngeal arch –> hypoplasia of zygomatic and mandibular bones

181
Q

Structure injured with lateral displacement of proximal supracondylar humerus fracture fragment

A

Radial nerve

182
Q

SE’s of amphoterecin

A

Renal toxicity –> hypokalemia and hypomagnesemia

183
Q

Polyribosylribitol phosphate

A

Capsule component and virulence factor of HIB

184
Q

Precursos B-ALL

A

TdT+, CD10+, CD19+

185
Q

Precursor T-ALL

A

CD2, CD3, CD4, CD5, CD7, CD8

186
Q

Treatment for post-op hypoparathyroidism

A

Calcitonin + Vitamin D to prevent post hypocalcemia

187
Q

Thiamine is a cofactor for

A

Pyruvate dehydrogenase - pyruvate –> acetyl CoA (enters TCA)

Alpha-ketoglutarate dehydrogenase (TCA)

Branched chain alpha-ketoacid dehydrogenase (essential for catabolism of branched chain AA’s)

Transketolase - Pentose phosphate pathway

188
Q

Thiamine deficiency

A

Decreased glucose utilization, especially in CNS

Glucose infusion in chronic thiamine deficiency –> acute cerebral damage

Supplement thiamine w/ glucose infusion

189
Q

Highly oxygenated blood in fetus

A

Umbilical vein –> IVC (via ductus venosus)

190
Q

Defect in interferon gamma signaling

A

macrophages can’t respond to IL-12 which stimulates T cells and NK cells to produce IFN-gamma which activates janus kinases 1/2 via SAT –> promote mycobacterial killing by phagocytes

disseminated mycobacterial disease in infants/children.

Lifelong treatment w/ anti-mycobacterial agents

191
Q

Cromolyn and nedocromil

A

Mast cell-stabilizing agents - inhibit mast cell degranulation independent of triggering stimulus.

Second line for allergic rhinitis and bronchial asthma

192
Q

Aspirin toxicity

A

Initial respiratory alkalosis –> mixed respiratory alkalosis and anion gap metabolic acidosis

Normal pH w/ PaCO2 and HCO3 out of range

193
Q

Flutamise

A

non steroid anti-androgen that competitively inhibits testosterone receptors

Used w/ long-acting GNrh agonists in prostate cancer treatment.

194
Q

Candida morphology

A

Branching pseudohyphae with blastoconidia

195
Q

Low volume of distribution

A

3-5 L - High molecular weight, high plasma protein bending, high charge, and hydrophilicity trap drug in the plasma compartment resulting in low Vd

196
Q

Valproate

A

Effective against Absence and generalized tonic-clinic

197
Q

Theosuximide

A

blocks Ca channels

198
Q

Glyburide and glimepiride

A

High incidence of hypoglycemia in elderly

Sulfonylureas - increase insulin secretion by pancreatic beta cells.

USMLE Step 1 practice exam flashcards (16 decks)

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