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USMLE Wrong Answer Facts > UWorld QBank Facts - 1st round > Flashcards

UWorld QBank Facts - 1st round Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the treatment for restless leg syndrome?

A

First line - remove causative factors (e.g. treat kidney disease or iron deficiency, no alcohol/caffeine, no glucocorticoids, lithium, SSRIs)

2nd line - Dopamine agonist (e.g. Pramipexoloe)

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2
Q

A patient presents with MI and following thrombolytic therapy develops decreased level of consciousness, assymetric pupils and irregular breathing. What is occuring?

A

Intracerebral hemorrhage

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3
Q

What is the mechanism and side effects of streptokinase?

A

Cleaves plasminogen –> plasmin –> cleaves fibrin

Plasminogen+streptokinase complex –> destroys fibrinogen and factors 5 and 7

Side effects: intracerebral hemorrhage

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4
Q

What effect does parvovirus infection have on adults?

A

Arthritis of PIP joints, metacarpal, knee and ankle joints

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5
Q

What is the most common elbow injury in children and how does it occur?

A

Radial head subluxation (nursemaid’s elbow) - annular ligament tears from radial head

occurs when hand is sharply pulled with forearm pronated and elbow extended

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6
Q

What is a 72 kD enzyme that is often detected in inflammatory cells and macrophages, but often not present in normal tissue?

A

COX2

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7
Q

What does infliximab bind to?

A

TNF-alpha, an intercellular signaling protein

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8
Q

What effect does inspiration have on lungs and heart?

A

decreased pressure in pleural space and lung interstitium –> Increased pulmonary vascular capacitance –> drop in venous inflow to left heart

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9
Q

What drugs are first line in isolated systolic hypertension (non-diabetic and diabetic)?

A

Non-DM: Thiazides or dihydropiridine calcium antagonists (e.g. Amlodipine, NIfedpine)

Diabetic: ACE-I or ARB

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10
Q

What are some key side effects of Amlodipine?

A

bilateral ankle swelling and flushing

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11
Q

What is the most common side effect of nitrates?

A

Headache

Can also get flushing

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12
Q

What is the most common form of carpal bone fracture, and what is the patient at risk of?

A

Scaphoid fracture - tenderness in anatomical snuff box

risk for avascular necrosis

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13
Q

What is Dupuytren’s contracture?

A

benign slowly progressive fibroproliferative disorder of palmar fascia

Nodules form on palm and fingers lose flexibility

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14
Q

What are the signs of Tardive dyskinesia?

Acute dystonia?

A

TD - involuntary face and tongue movements, grimacing and writhing

AD - develops abruptly 4hrs - days after receiving AP Tx –> Muscle spasms/stiffness, tongue protrusion/twist, forced upward gaze

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15
Q

What is the most common cause of spontaneous lobar hemorrhages (especially in elderly >60 y/o)?

A

Cerebral amyloid angiopathy - weakens many vessels -> prone to rupture

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16
Q

What drug in conjunction with statins increases the risk of myopathy?

A

Fibrates - Gemfibrozil

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17
Q

What is the problem with giving statins with bile acid binding resins?

A

decreased absorption of statin

dose drugs 4 hrs apart

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18
Q

What drug can decrease circulating levels of catecholamines?

A

Stimulation of central alpha2 adrenergic receptors (e.g. Clonidine)

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19
Q

What muscles does the musculocutaneous nerve innervate?

Sensory innervation of medial arm?

A

Major upper arm flexors: biceps, choricobrachialis, and brachialis and sensation of lateral arm/forearm

ulnar nerve (medial cutaneous nerve)

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20
Q

What is the MoA of Etanercept?

A

TNF-alpha inhibitor for moderate/severe RA

Check PPD before using!!

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21
Q

What is deposited in joints and tissues in pseudogout?

A

CALCIUM PYROPHOSPHATE (hence, CPPD, calcium pyrophosphate deposition disease)

Rhomboid crystals with weakly positive bifiringence

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22
Q

What is seen in mycoardial tissue 0-4 hrs after MI? What about 4-12 hrs after MI?

A

MINIMAL CHANGE - normal mycoardium

4+ hrs = Cytoplasmic hypereosinophilia (early sign of COAGULATIVE NECROSIS), edema + punctate hemorrhages

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23
Q

After a stroke a patients brain is examined in autopsy showing a cystic cavity surrounded by gliosis. What is the cause for this lesion?

A

Lysosomal digestion of tissue (released from ischemic neurons in the region)

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24
Q

What results in granulomatous reaction in an area of necrosis?

A

Mycobacterial infections –> Caseous necrosis

Cheesy area surrounded by histiocytes and multinucleated giant cells

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25
Q

A patient exhibits intense pain when trying to extend leg, especially at the hip. What could be the problem and what muscle is most likely affected?

A

+ psoas sign (psoas major muscle)

-possible psoas abcess

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26
Q

What is the appearance of monosodium urate crystals under polarized light?

A

long and negatively bifiringent

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27
Q

What condition usually leads to poor ventricular wall compliance?

A

Cor pulmonale - RV thickening with eventual dilation of RV chamber

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28
Q

What is the heart sound associated with Mitral Stenosis?

A

Mid-diastolic heart sound heard best at apex

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29
Q

What is a key feature on serum labs for hemolytic anemia?

A

Increased serum indirect BR and lactate dehydrogenase

decrease in serum haptoglobin

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30
Q

What is sickle cell dactylitis?

A

Swelling of hands and feet and pain (hand and foot syndrome)

From vasoocclusive crysis leading to small infarctions of marrow and trabeculae of small bone

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31
Q

What is a unique characteristic of Class 1C antiarrhythmics? For fun, give some examples of this drug class…

A

Use-Dependance - sodium blocking effects intensify with increasing heart rate, because less time between action potentials for meds to dissociate from receptor.

Flecainide, Propafenone

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32
Q

What is the order of sodium channel binding strength among class 1 antiarrhytmics greatest to least? And what are the low binding strength ARs useful for?

A

1C > 1A > 1B

C more likely to stay on –> use dependance
B more likely to come off –> good for ischemic induced ventricular arrhythmias

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33
Q

What is the drug of choice in beta-blocker overdose and why?

A

Glucagon –> increases cAMP in cardiac myocytes

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34
Q

What is the most likely deficient enzyme in SCID?

A

Adenosine deaminase

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35
Q

If you reduced the flow through a vessel by a factor of 16 (compared to the same normal, healthy vessel), how much would the radius be reduced by? (assume all other variables are consistent)

A

50% (halving the radius results in 1/16th of normal flow)

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36
Q

Which disease results from a t(15;17)? t(14;18)? inv(16)?

A

Acute Promyelocytic Leukemia (APL) - a subtype of AML

non-Hodgkin Follicular small cleaved cell lymphoma

M4Eo (eosinophilic) - subtype of AML

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37
Q

Which chromosomal translocations are found in burkitt lymphoma?

A

t(8;14), t(8;22), t(8;2)

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38
Q

What genetic mutation results in classic galactosemia and what is the inheritance pattern?

A

Autosomal Recessive mutation of galactose-1-phosphate-uridyl transferase gene

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39
Q

What sort of genetic mutation leads to Hemophilia B (+inheritance pattern)?

A

X-linked recessive Factor IX deficiency

as such, mostly males will be affected

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40
Q

What problem can arise when a pregnant woman lies supine on her back?

A

Compression of IVC –> hypotension

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41
Q

What are patients with multiple myeloma at great risk of developing?

A
  1. Normocytic anemia
  2. Bone resorption (from IL1 and IL6 by cancer cells) –> Hypercalcemia
  3. Increased susceptibility to infection
  4. AL amyloidosis
  5. Renal Failure
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42
Q

What are the proto-oncogenes? Anti-oncogenes?

A

ras, myc, ERB-B1/2, TGF-alpha, sis, abl

p53, BRCA, NF1, APC/beta-catenin, DCC, Rb, WT1

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43
Q

What is Fabry disease, and what are patients with it at greatest risk for developing?

A

Angiokeratoma corporis diffusum –> inherited def. of alpha-galactosidase A –> build up of ceramide trihexoside

Increased risk of Renal insufficiency –> Renal Failure

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44
Q

Which enzyme is deficient in Pompe’s disease? (hint: type II glycogen storage disease)

A

acid (lysosomal) alpha-glucosidase

Muscle hypotonia, feeding difficulties, hepatomegaly and severe cardiomegaly

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45
Q

What is Li-Fraumeni syndrome and how is it acquired?

A

Autosomal dominant mutation of p53 that leads to early cancer formation

-Be suspicious when there are multiple family members with various cancer types

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46
Q

What blocks peripheral conversion of T4 –> T3?

A

Propylthiouracil, beta blockers, ipodate (contrast agent)

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47
Q

Which muscles does the nerve passing through the obturator foramen innervate?

A

Obturator nerve –> Adductors of the leg

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48
Q

Which muscles are innervated by the femoral nerve?

A

Quadriceps femoris muscle group –> leg extension

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49
Q

Which bones are derivative of the first pharyngeal arch?

Second pharyngeal arch?

A

Assoc w/ CN V –> Maxilla, zygoma, mandible, vomer, palatine, incus, malleus

Assoc. w/ CN VII –> Styloid process, lesser horn of hyoid, stapes (hint closer into the ear like CN VIII)

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50
Q

What are the two major side effects of metformin use?

A

GI upset and lactic acidosis (contraindicated in renal failure!!)

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51
Q

Which drugs increase the risk of inducing mania in susceptible patients?

A

anti-depressants (previous unnoticed bipolar disorder etc.)

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52
Q

Which 3 drugs are mood-stabilizers often used in acute mania and maintenance of bipolar disorder?

A

Carbamazepine, Lithium, and Valproate

53
Q

What are the effects of Prostacyclin and what diseases is it used in synthetic form?

A

Inhibits platelet aggregation and adhesion to vascular endothelium, vasodilates, increases vascular permeability, and stimulates leukocyte chemotaxis

Tx for: Pulmonary hypertension, peripheral vascular disease, and Raynaud Syndrome

54
Q

What are some alpha1 agonists and what effect would they have on the vagal influence on the heart?

A

Phenylephrine and Methoxamine

causes vasoconstriction and increase systemic BP –> stimulates baroreceptors in carotid sinus and aortic arch –> reflex increase on vagal influence on heart –> inhibit SA node activity –> slowed conduction through AV node –> decreased HR, contractility and conductance

55
Q

Which amino acids are exclusively ketogenic? (hint: would not lead to increased lactic acid)

A

Leucine and Lycine

56
Q

What happens when there is a deficiency of pyruvate dehydrogenase?

A

increased conversion of pyruvate into lactate via lactic acidosis

57
Q

What is the difference between a gastric ulcer and erosion?

A

Ulcer extends into submucosa and muscularis propria

Erosions may extend into but not past muscularis mucosa

58
Q

How do you calculate number needed to treat?

A

NNT = 1/ARR

ARR = Control rate - Treatment Rate

59
Q

How do you calculate number needed to harm?

A

NNH = 1 / AR

Attributable Risk = Difference in risk between exposed and unexposed groups

60
Q

What happens to the hemoglobin concentration in RBCs in hereditary spherocytosis?

A

INCREASED

61
Q

Which enzyme allows for fructose to still be utilized even with fructokinase deficiency?

A

HExokinase

62
Q

What is the purpose the enzyme aldose reductase?

A

Converts glucose –> sorbitol

63
Q

Which immune deficiency is likely to present with absent thymic shadow? What are other characteristics of this disease?

A

SCID -> DEF. of T Cells!!

Severe bacterial and viral infections in infancy, chronic diarrhea, and mucocutaneous candidiasis

64
Q

What is deficient in Alkaptonuria and what is the presentation in later adulthood?

A

AR def. of homogenistic acid oxidase –> accumulation of homogenistic acid throughout connective tissue

Apparent in sclera and ear cartilage

65
Q

What structure lies between the external and internal iliac arteries in the female pelvis?

A

Ureter

66
Q

What cofactor is necessary in the conversion of glutamate to aspartate, with oxaloacetate as a substrate in the reaction as well?

A

Pyridoxine (V. B6)

67
Q

What is the purpose of NF-kB?

A

transcription factor responsible for cytokine production

68
Q

What allows for valve colonization in bacterial endocarditis with S. Aureus? How does damage get propagated?

A

Minor endothelial disruption/damage

Tissue factor expression –> platelet and fibrin deposition –> Valve vegetation

69
Q

What are the signs of hyperaldosteronism (as with Conn’s Syndrome)? What is the treatment?

A

Hypertension, hypokalemia, Metabolic alkalosis, decreased plasma renin activity

Tx: Aldosterone antagonist (Spironolactone, Eplerenone)

70
Q

Which hepatitis virus results in high mortality among pregnant women?

A

Hep E –> NON-enveloped single stranded RNA virus

71
Q

What acid/base abnormality results with pulmonary embolism?

A

V/Q Mismatch –> Respiratory alkalosis

Hypoxemia stimulates respiratory drive

72
Q

A child presents with many blast cells what is the most likely diagnosis?

A

ALL

73
Q

How might a child with pre-T lineage ALL present?

A

Anterior mediastinal mass –> SVC Syndrome + dysphagia + dyspnea + inspiratory stridor

74
Q

What are the features of SVC syndrome?

A

Neck and upper extremity edema (with increased JVD)

Check for facial plethora (blanching after finger tip pressure)

75
Q

How can you diagnose thiamine deficiency in an alcoholic?

A

Increase in erythrocyte transketolase activity after thiamine infusion

76
Q

What is the first line treatment for essential tremor?

A

Propranolol

77
Q

What is the purpose of Benztropine?`

A

Anti-cholinergic used to treat tremor in Parkinson’s and to counteract extra-pyramidal side effects of neuroleptics like Haloperidol

78
Q

What is the most common cancer in non-smokers? (hint: usually on periphery of lung)

Smokers? (usually central)

A

Adenocarcinoma

Squamous Cell Carcinoma

79
Q

What decreases risk of non-hereditary ovarian cancer?

A

OCPs, multiparity, and breast feeding

80
Q

What is moxifloxacin used to treat?

A

bacterial infections that cause exacerbation of COPD, sinusitis and community acquired pneumonia

not good for Pseudomonas infections

81
Q

What drugs have good coverage against pseudomonas infections (like after a burn surgery)?

A

Cephalosporins - e.g. Cefepime and Ceftazidime

82
Q

What effects does high concentrations of fructose-2,6-BP have on metabolism?

A

inhibits gluconeogenesis and increases glycolysis

e.g. decreased conversion of alanine –> glucose

83
Q

What deficiency leads to methylmalonic acidemia?

A

deficient in ISOMERIZATION of methylmalonyl CoA –> Succinyl CoA –> TCA

84
Q

What are some key signs of hypothyroidisim?

A

weight gain, dry skin, hair loss, constipation and bradycardia

85
Q

What are key side effects of Lithium toxicity?

A

LMNOP - Lithium causes

Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems (ebstein’s anomaly)

86
Q

What is a major pathophysiological abnormality with chronic NSAID use (like in patients with joint pain)?

A

Chronic interstitial nephritis

  • Decreased prostaglandins –> constriction of medullary vasa recta –> ischemia –> papillary necrosis
  • uncoupled oxidative phosphorylation in renal mitochondria –> direct cell damage
87
Q

Nitric Oxide (NO) leads to vasodilation, but how is it formed?

A

Arginine, NADPH, O2 via endothelial NO synthase (eNOS) –> NO –> INcreased cGMP

88
Q

What effect does hypophosphorylated Rb have on the cell?

A

prevention of G1/S transition in cell cycle

89
Q

What is characteristic of anesthetics that have large arteriovenous gradients?

A

Slow onset of action and high tissue solubility

90
Q

What is the most common cause of death in patients with TCA overdose? How can you prevent?

A

refractory hypotension and cardiac arrhythmia from inhibition of fast sodium ion channels in cardiac myocytes (His-Purkinje system)

Tx: Fluid resuscitation with normal saline and hypertonic sodium bicarbonate

91
Q

What is the best way to prevent cerebral vasospasm in patients with SAH following berry aneurysm rupture?

A

Ca-channel blockers (nifedipine)

92
Q

What neurological abnormality is associated with Adult PCKD?

A

Berry aneurysm

93
Q

What potentially dangerous complication can result from Type 1 hyperlipoproteinemia (familial chylomicronemia syndrome)?

A

Acute pancreatitis (and hepatosplenomegaly can occur)

94
Q

Name 3 non neuropsych drugs that can lead to serotonin syndrome:

A
  1. Linezolid (antibiotic)
  2. Tramadol (analgesic)
  3. Ondansetron (anti-emetic, 5-Ht3-R antagonist)
95
Q

Which heritable disease would increase both bleeding time and PTT and why?

A

vonWillebrand’s Disease

Because vWF is a mediator of platelet adhesion to endothelium and also a carrier protein for Factor VIII –> absence would cause a platelet deficiency and absence of functional factor VIII

96
Q

What is the control group in a case-control study?

A

all people WITHOUT disease who may or may not have been exposed to the risk factor in question

97
Q

What family is CMV a part of and what is a unique common histological presentation for it?

A

Herpesviridae - double stranded enveloped DNA virus

Owl-Eye nuclei on histology

98
Q

What is a patient with acute necrotizing pancreatitis at major risk for developing? What would be seen on autopsy of involved organs?

A

ARDS - Alveolar hyaline membranes

DIC - Microthrombi

diffuse fat necrosis - Saponification and calcium deposits long term

Pancreatic pseudocyst - lined by granulation tissue –> can rupture easily and hemorrhage

99
Q

What is a child with polyribitol ribose phosphate (PRP) antibodies protected from?

A

Epiglottitis which is almost exclusively caused by H. Flu

The PRP-Ab is a component of the Hib Vaccine

100
Q

What is fever, rash and oliguria 1-3 weeks after treatment with beta-lactam antibiotic highly suggestive of? What else can cause this?

A

Drug induced acute interstitial nephritis - damages interstitium leaving glomeruli intact

NSAIDs, Sulfonamides, rifampin, and diuretics

101
Q

What do you give a patient with depression who is not tolerating SSRIs well?

A

Bupropion - atypical antidepressant

MAOIs and TCAs are last resort

102
Q

What amino acid is an immediate source of nitrogen for the Urea cycle?

A

Aspartate

103
Q

What is the significance of glutamine in the blood?

A

Transports ammonia from peripheral tissues to the kidney

104
Q

Vitamin B12 deficiency results in build up of which compound in the blood?

A

Methylmalonic acid

105
Q

What is the pathogenesis leading to pure red cell aplasia? What disorders may it be associated with?

A

inhibition of erythropoietic precursors/progenitors by IgG antibodies or cytotoxic T-lymphocytes

  • Associated with Thymomas and lymphocytic leukemias
  • Could be from parvovirus B19 infection
106
Q

What deficiency are patients with sickle cell disease prone to developing and why?

A

Folic Acid deficiency –> Megaloblastic anemia

Because of the high turn-over of cells (same is the case with other hemolytic anemias)

107
Q

NF1 leads to pigmented spots and rubbery cutaneous tumors, what is the origin of these tumors?

A

Schwann Cells

108
Q

What is the MoA of Leuprolide?

A

long-acting GnRH agonist –> causes continuous GnRH activity

109
Q

Which purine analog is resistant to degradation by adenosine deaminase and what is it used to treat?

A

Cladribine - Tx for Hairy Cell Leukemia

110
Q

What is a common treatment for painful diabetic neuropathy? And what are the common receptors affected by these drugs?

A

TCA like amitriptyline

Inhibit 5HT and NE uptake - Tremor, insomnia
Blocks cardiac fast sodium channels - conduction defects, hypotension, arrhythmia
Muscarinic Ach-R antagonism - Urinary retention, flushing, ileus, dilated pupils,
Alpha1 antagonism- periph. vasodilation, orthostatic hypotension
H1 antagonism - Sedation

111
Q

What effect would Tamoxifen have on bone? What is a main side effect?

A

Partial estrogen antagonism –> increase in bone mineral density

Endometrial hyperplasia –> polyps etc.

112
Q

What is the primary MoA of digoxin?

A

INhibits sodium potassium ATPase –> intracellular Na buildup –> decreased fxn of Na/Ca exchanger –> Calcium buildup in cardiac myocytes

Acts on vagus nerve –> increase PANS tone –> decreased rate of AV node conduction

113
Q

What is the earliest lesion that leads to atherosclerotic plaque and could result in a AAA for example?

A

Intimal streak

114
Q

What can occur from the release of IL6 into systemic circulation?

A

Release of Acute Phase Reactants, like fibrinogen which will increase ESR by causing RBCs to form Rouleaux

115
Q

What are the most common clinical manifestations of Vit. E deficiency?

A

Neuromuscular disease (skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy)

Hemolytic anemia

116
Q

What is the benefit of a slowly growing atherosclerotic plaque?

A

Development of vascular collaterals which may keep region perfused in the event of an MI

117
Q

What is the primary MoA of diphenoxylate and what is this drug structurally related to?

A

This is an opiate anti-diarrheal similar structurally to meperidine, and it primarily affects MOTILITY

118
Q

Which drugs inhibit secretory diarrhea?

A

Bismuth subsalicylate, probiotics and octreotide

119
Q

What is one of the main side effects of highly active antiretroviral therapy (HAART)?

A

HIV-associated lipodystrophy: Redistribution of fat from extremities to trunk

  1. Lipoatrophy - from face, extremities and buttocks
  2. Central fat deposition - increased abdominal girth and buffalo hump
120
Q

What is a common side effect of thyroperoxidase inhibitors (methimazole, propylthiouracil)?

A

Bone marrow suppression (anemia and agranulocytosis)

121
Q

What is the effect of cholinomimetics on bladder wall? What is its effect on blood vessels?

A

Increase tone of detrusor stimulating contraction –> makes you pee

Stimulates release of endothelium-derived relaxing factor (Nitric Oxide)

122
Q

Which antibiotic used to treat MRSA causes increased serum creatine kinase and severe muscle pain? What is its MoA?

A

Daptomycin - causes depolarization of the cellular membrane

123
Q

Which nitrate has the greatest oral bioavailability?

A

Isosorbide mononitrate

124
Q

What is severe hypoxic CNS injury almost always followed by?

A

Liquefactive necrosis –> associated with large amounts of lipids and lysosomal enzymes in the area

125
Q

Acid-fast bacterial infection in HIV infected person with CD count

A

Mycobacterium avium complex (MAC)

Tx: Azithromycin

126
Q

What is the indication for using MAOIs?

A

Atypical depression and treatment resistant depression

Atypical depression includes - mood reactivity, rejection sensitivity, increased sleep and appetite

127
Q

Which drug used for the treatment of claudication is also known to have direct arterial vasodilatory effects? What type of tx would it be good for?

A

Cilostazol - a phosphodiesterase inhibitor

Claudication and decreased sexual function

128
Q

Which is the MoA of Timolol?

A

Along with other beta blockers it decreases the aqueous humor production by ciliary epithelium

129
Q

Which compounds mediate Cachexia?

A

TNF-alpha, IFN-gamma, IL1 and IL6

USMLE Wrong Answer Facts (9 decks)

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