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UWorld questions Flashcards

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USMLE® Step 1 flashcards
1
Q

Which opioid side effect is the most persistent?

A

Constipation

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2
Q

How do opioids lead to urinary retention?

A

Block urinary voiding reflexes and increase sphincter tone and bladder volume

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3
Q

What is the anatomical location of the psoas muscle?

A

Anterior surface of transverse process and lateral surface of vertebral bodies T12-L5. Flex thigh at hip, lateral rotation and abduction of hip

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4
Q

Define ectopy

A

normal cells/tissues in an abnormal location due to embryonic maldevelopment (ex: Meckel diverticulum has ectopy)

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5
Q

Difference between ectopy and metaplasia

A

Ectopy is congenital, metaplasia is replacement with different tissue later on in life

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6
Q

How is the thyroid gland formed?

A

Evagination of pharyngeal epithelium and descent into lower neck

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7
Q

What is a cause of lingual thyroid?

A

Failure of migration

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8
Q

Which cells does a lingual thyroid lack?

A

C cells

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9
Q

What is metronidazole used to treat?

A

Trichomonal vaginitis and bacterial vaginosis

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10
Q

Which drug interaction with alcohol causes abdominal cramps, nausea, and headache?

A

Metronidazole or Disulfiram

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11
Q

Why does Metronidazole-alcohol interaction lead to a reaction?

A

Accumulation of acetaldehyde

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12
Q

What are the clinical features of hyperaldosteronism?

A

Hypertension due to water retention, Hypokalemic alkalosis (K+ and H+ being excreted excessive) leading to muscle weakness and parasthesias

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13
Q

How does the inhibition of proteosomes affect a cell?

A

Accumulation of toxic intracellular proteins leads to an excess of proapoptotic proteins–> induces cell apoptosis

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14
Q

Which condition are proteosome inhibitors (bortezomib) used for?

A

Multiple Myeloma

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15
Q

What is multiple myeloma?

A

Malignancy of plasma cells. Neoplastic B cells differentiate into plasma cells and secrete a lot of Ig fragments, leading to bone pain, fatigue, anemia, kidney disease, hypercalcemia

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16
Q

Which organ is the primary site of complement production?

A

Liver

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17
Q

What are the 2 functions of splenic red pulp?

A
  1. Destroy aged and abnormal RBCs and serve as emergency store for blood cells and platelets
  2. Clearance of circulating bacteria that become lodged in cords
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18
Q

How much of the body’s antibodies stores are produced by the spleen?

A

50%

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19
Q

Asplenic patients are at risk of infection and death by which organisms?

A

Encapsulated bacteria, it Strep pneumo, H. Influenzae, N. meningitidis

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20
Q

Patients with chronic granulomatous disease develop infections from which agents?

A

Catalase-positive (ie S. aureus)

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21
Q

Defects in Type I interferon increase susceptibility to

A

viral infections

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22
Q

Highly active antiretroviral therapy (HAART) is used for which virus?

A

HIV

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23
Q

What are the consequences of long-term HAART?

A

High mutation rate of HIV genome, pol gene mutations and emergent of drug-resistant HIV strains

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24
Q

HIV viral evasion of humoral immunity is more likely to occur with a mutation to which gene?

A

env

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25
Q

HIV Pol gene mutations cause resistance to which drugs?

A

reverse transcriptase inhibitors and HIV protease inhibitors

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26
Q

Which histopathologic finding is associated with Henoch-Schonlein purpura?

A

IgA deposition in mesangium

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27
Q

ATP binding to sarcomere causes

A

Myosin detachment from actin filament

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28
Q

What shifts tropomyosin away from myosin binding site on actin in muscle contraction?

A

Calcium binding to troponin C

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29
Q

What causes keloid or hypertrophic scar?

A

Excess collagen formation during remodeling phase of wound healing

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30
Q

which cytokine is expressed in excess in keloids

A

TGF-beta

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31
Q

What is the pathogenesis of homocystinuria?

A

AR mutation causing cystathionine synthase deficiency

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32
Q

Clinical findings of homocystinuria

A

optic lens dislocation, intellectual disability, marfanoid habitus (long limbs, long digits), thromboembolic complications

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33
Q

Which component is elevated in plasma and urine for homocystinuria?

A

Homocystine

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34
Q

Treatment for homocystinuria

A

B6, methionine restriction and cysteine supplementation

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35
Q

What is a dominant negative mutation

A

Abnormal gene negatively affects product of wild-type gene in same cell (ie cancer)

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36
Q

What is pleiotropy

A

Occurrence of multiple, seemingly unrelated phenotypic manifestations resulting from a single genetic defect

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37
Q

What is locus heterogeneity

A

Ability of one disease or trait to be caused by multiple mutations in multiple different genes (ie familial hypercholesteremia)

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38
Q

What is polycythemia vera?

A

Myeloproliferative disorder characterized by uncontrolled erythrocyte production

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39
Q

What are the symptoms of polycythemia vera?

A

Aquagenic pruritus, facial plethora (reddish complexion), splenomegaly. Elevated erythrocyte, thrombocyte, leukocyte mass and low EPO.

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40
Q

What is mutated in polycythemia vera

A

Usually cytoplasmic tyrosine kinase (JAK2) of EPO receptor

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41
Q

What is c-myc?

A

Growth-stimulating transcription factor

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42
Q

In periods of starvation, what is the primary source of glucose for the first 12-18 hours?

A

Glycogenolysis (glycogen –> glucose-1-P)

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43
Q

After 18 hours of starvation, which process serves to maintain plasma glucose levels in the body?

A

Gluconeogenesis

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44
Q

Which enzyme is part of the committed step in gluconeogensis?

A

Pyruvate carboxylase

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45
Q

Which cofactor is involved in converting pyruvate to OAA via pyruvate carboxylase in gluconeogenesis?

A

Biotin

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46
Q

Which enzymes are unidirectional in Glucose metabolism?

A

hexokinase, phosphofructokinase and pyruvate kinase

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47
Q

McCardle disease is a disorder of which metabolic process?

A

Glycogen breakdown (Storage disease type V)

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48
Q

Which enzyme is deficient in McArdle disease?

A

Myophosphorylase

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49
Q

Clinical presentation of McArdle disease?

A

Poor exercise tolerance, muscle cramps, rhabdomyolysis (“feel like jelly” exercise, severe muscle cramping and urine discoloration), no rise in blood lactate after exercise

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50
Q

Treatment for McCardle?

A

Consume simple sugars before beginning physical activity

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51
Q

Which sequence at the 5’ site do spliceosomes recognize

A

GU

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52
Q

Which sequence at the 3’ end of an intron do spliceosomes recognize?

A

AG

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53
Q

What is the Pringle maneuver?

A

Occlusion of hepatoduodenal ligament to prevent bleeding from hepatic artery (can also be used to ID source of bleeding after RUQ trauma)

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54
Q

Which structures are contained in hepatoduodenal ligament?

A

Hepatic artery, portal vein, and common bile duct

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55
Q

If bleeding does not cease after Pringle maneuver, what is the likely source?

A

Inferior vena cava or hepatic vein

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56
Q

What is carcinoid syndrome?

A

Excess release of neurohormonal mediator like serotonin (5-HIAA) from metastatic midgut neuroendocrine tumor

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57
Q

How do carcinoid syndrome patients typically present?

A

Facial flushing, bronchospasm, diarrhea and hypotension

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58
Q

What is internuclear ophthalmalgia?

A

Disorder of conjugate horizontal gaze in which affected eye cannot adduct and contralateral eye abducts with nystagmus

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59
Q

which structure is typically damaged in internuclear ophthalmalgia?

A

MLF in dorsal pons of eye that cannot adduct

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60
Q

Which condition causes bilateral internuclear ophthalmalgia?

A

Multiple Sclerosis

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61
Q

What is the most common cause of blood-tinged discharge from the breast?

A

Intraductal papilloma (Papillary cells with fibrovascular core)

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62
Q

How does intraductal papilloma present?

A

Blood-tinged discharge at breast nipple without masses or skin changes

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63
Q

What are some ionic complications of tumor lysis syndrome

A

Hyperkalemia (K+ leaks out of cell), Hyperuricemia due to rapid turnover

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64
Q

What is the function of rasburicase?

A

Reduce uric acid levels in body by breaking it down into soluble metabolits (allantoin)

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65
Q

What are neoplastic colonic polyps?

A

Serrated

Adenomatous (tubular, villous, tubulovillous)

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66
Q

What are non-neoplastic colonic polyps?

A

Hyperplastic, submucosal, inflammatory, mucosal

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67
Q

Does fibroblast migration occur in PNS, CNS or both?

A

PNS only

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68
Q

What is a rheumatoid factor an antibody against?

A

Fc component of IgG

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69
Q

How does rheumatoid factor lead to synovitis and joint destruction?

A

Binds Fc portion of IgG, which binds ACPA, forming immune complex that deposits in cartilage and synovium. Complexes activate complement

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70
Q

Which condition are anti-centromere antibodies specific for?

A

CREST syndrome

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71
Q

Which condition are anti-dsDNA antibodies specific for?

A

Systemic Lupus Erythematous

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72
Q

Which condition are antimitochondrial antibodies specific for?

A

Primary biliary cholangitis

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73
Q

Antinuclear antibodies are found in which patients

A

Connective tissue disorders (nonspecific)

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74
Q

Which cytokine is anti-inflammatory?

A

IL-10 (reduces production of TH1 cytokines and MHCII expression)

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75
Q

Which leg nerve is most commonly injured?

A

Common peroneal

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76
Q

What can lead to peroneal nerve injury?

A

Prolonged immobility (hospitalization, surgery, casting) or fibular neck fractures

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77
Q

What are the side effects of antimuscarinic/anticholinergic drugs?

A

Blurry vision, dry mouth, urinary retention, constipation

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78
Q

Which nuclei is responsible for perception of motion and orientation and which neurostransmission pathways does it use?

A

Vestibular nuclei, muscarinic and histaminic

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79
Q

What is the presentation of DiGeorge syndrome? (CATCH)

A

Conotruncal cardiac defects (Tetrology of Fallot, truncus arteriosus, interrupted aortic arch)
Abnormal facies
Thymic hypoplasia/aplasia (T cell deficiency)
Craniofacial deformities (cleft palate)
Hypocalcemia/hypoparathyroidism

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80
Q

What is the mutation in DiGeorge syndrome?

A

22q11 deletion

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81
Q

What causes thymic and parathyroid hypoplasia/aplasia in DiGeorge syndrome?

A

Lack of 3rd and 4th pharyngeal pouches (failed migration of NC cells)

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82
Q

Which cardiovascular abnormality does Marfan syndrome present with?

A

medial necrosis of aorta

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83
Q

Which gene defect leads to Marfan syndrome?

A

Fibrillin mutation

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84
Q

Which syndrome presents with crowded teeth and a narrow face?

A

Marfan syndrome

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85
Q

What are the serum levels of calcium and phosphorus in primary hyperparathyroidism?

A

High calcium, low phosphorus

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86
Q

What bone change is seen in primary hyperparathyroidism?

A

Subperiosteal resorption with cystic degeneration

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87
Q

Which three mechanisms lead to hypercalcemia in PHP?

A
  1. increased renal tubular Ca+2 resorption
  2. Increased vitamin D production to increase GI Ca+2 rabsorption
  3. Bone resorption via osteoclast activation
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88
Q

Disorganized lamellar bone structure in mosaic pattern is characteristic of which disease?

A

Paget’s disease

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89
Q

Osteoid matrix accumulation around trabeculae is seen in which bone issue?

A

Vitamin D deficiency

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90
Q

Persistence of primary spongiosa in medullary cavity with no mature trabeculae is a classic finding in

A

Osteopetrosis

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91
Q

Which cell is defective in osteopetrosis?

A

Osteoclast

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92
Q

Trabecular thinning with fewer interconnections is characteristic of

A

Osteoporosis

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93
Q

Which clinical feature is characteristic of PTSD?

A

flashbacks to traumatic event

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94
Q

How long is the duration of symptoms for diagnosing PTSD?

A

over 1 month

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95
Q

Where does cutaneous fungi sporothrix schenckii reside?

A

Bark of trees, shrubs, garden plants and plant debris

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96
Q

What is the mode of transmission for Sporotrichosis?

A

Thorn prick (breaks in skin)

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97
Q

How does sporotrichosis spread in the body?

A

Lymphatics

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98
Q

How does a biopsy of sporotrichosis present?

A

Granuloma consisting of histiocytes, multinucleated giant cells, and neutrophils surrounded by plasma cells

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99
Q

What are the clinical features of Wernicke encephalopathy?

A 
Oculomotor dysfunction (horizontal nystagmus, bilateral abducens palsy)
Ataxia
Encephalopathy (mental status changes)
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100
Q

What are the clinical features of Korsakoff syndrome?

A

Memory loss and confabulation (fabricating stories); anterograde amnesia

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101
Q

Which lesion causes Korsakoff syndrome?

A

damage to anterior and dorsomedial thalamic nuclei

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102
Q

During which trimester is there a greatest risk of vertical CMV transmission/

A

1st trimester

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103
Q

What are CMV-related complications in a newborn?

A

chorioretinitis, sensorineural deafness, seizures, jaundice, hepatosplenomegaly, microcephaly

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104
Q

Which congenital viral infection is associated with cataracts?

A

Rubella

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105
Q

How do you calculate TPR of vessels arranged in parallel?

A

1/TPR= 1/R +1/R’ +….

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106
Q

How do you calculate TPR of vessels arranged in series?

A

TPR = R + R’ + R’‘….

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107
Q

Why is visual acuity in the macula greater than any other area of the retina?

A

Each macular cone synapses to a single bipolar cell, which synapses to a single ganglion cell

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108
Q

Define scotoma

A

Visual defect surrounded by relatively unimpaired field of vision

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109
Q

What causes arcuate scotomas ?

A

Damage to optic nerve head

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110
Q

Why do adolescents typically have irregular menstrual cycles?

A

Immature hypothalamic-pituitary axis leads to presence of anovulatory cycle

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111
Q

What is an anovulatory cycle and what does it cause?

A

Failure of LH to induce ovulation, leading to high estrogen levels and low progesterone so uterus remains in proliferative phase. Can lead to irregular periods with heavy bleeding

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112
Q

Which patients are at risk of atypical hyperplasia of endometrium?

A

Older obese women and women receiving estrogen without progesterone (HRT)

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113
Q

Which settings lead to hypertonic volume contraction (increased serum osmolarity, decreased ICF and ECF)

A

Free water loss (Diabetes insipidus, excess sweating, dehydration)

114
Q

Which setting leads to isosmotic volume contraction? (lower ECF, no change in ICF)

A

GI hemorrhage (diarrhea) because you’re losing both water and electrolytes

115
Q

Which ICF and ECF compartment changes does adrenal insufficiency lead to?

A

Loss of salt in ECF leads too ICF expansion and ECF contraction (decreased osmolarity)

116
Q

Which gene mutation is found in follicular thyroid cancer and some follicular adenomas?

A

RAS gene mutation (MAP kinase)

117
Q

Which gene mutation leads to familial medullary thyroid cancers?

A

RET proto-oncogene (MEN2)

118
Q

What is the histologic presentation of medullary thyroid cancer
(parafollicular calcitonin C cell cancers)?

A

spindle-shaped cells in amorphous background

119
Q

Which nerve is associated with the first pharyngeal arch?

A

Trigeminal (CN V)

120
Q

Which bony derivatives are associated withe first pharyngeal arch?

A

Maxilla, zygoma, mandible, incus, malleus

121
Q

What are the muscular derivatives of the first pharyngeal arch?

A

muscles of mastication

122
Q

Which nerve is associated with the second pharyngeal arch?

A

Facial (CN VII)

123
Q

Which bony and muscular derivatives come from the 2nd pharyngeal arch?

A

styliod process of temporal bone, lesser horn of hyoid, stapes; muscles of facial expression

124
Q

List the nerves affiliated with pharyngeal arches 1, 2, 3, 4 and 6 respectively

A

CN V, VII, IX, X

125
Q

What is Osgood-Schlattler disease?

A

Overuse injury to second ossification center of tibial tubercle?

126
Q

What causes Osgood-Schlatter disease?

A

Repetitive quadriceps contraction, common in adolescent athletes after growth spurt

127
Q

Runners presenting with anteromedial knee pain likely hav ewhich condition?

A

Pes anserinus bursitis

128
Q

List the 5 stages of Elizabeth Kubler-Ross’s grief model

A

Denial, Anger, Bargaining, Depression, Acceptance

129
Q

What is the micturition reflex?

A

Autonomic spinal reflex at S2-S4 that regulates urination

130
Q

What causes urge incontinence in MS patients?

A

Demyelination of S2-S4 leads to loss of communication with cortical inhibitory centers so detrusor and internal urethral sphincter are hyperactive

131
Q

Monitoring the degree of chest expansion in a patient with HLA-B27 antigen serves to monitor which disease?

A

Ankylosing spondylitis

132
Q

What is the most common cardiovascular complication of ankylosing spondylitis?

A

Ascending aortitis (can lead to aortic insufficiency)

133
Q

What is the respiratory complication of ankylosing spondylitis?

A

Involvement of thoracic spine and costovertebral/costosternal junctions leading to hypoventilation

134
Q

What is a visual complication in patients with ankylosing spondylitis?

A

Anterior uveitis (pain, blurred vision, conjunctiva, photophobia)

135
Q

Lateral epicondylitis of the elbow can lead to issues with which muscular function?

A

Wrist extension

136
Q

Where are receptors containing zinc-fingers (zinc bound to cysteine and histamine) likely found?

A

Intracellularly in cytoplasm or nucleus interacting with DNA

137
Q

Which molecules usually bind zinc-finger receptors?

A

Steroids, steroid hormones, thyroid hormones, and fat-soluble vitamins

138
Q

How does estrogen activity influence Thyroid binding globulin, free T4 and T3 levels?

A

Increase in estrogen increases TBG levels, leading to reduced free T4 and T3

139
Q

What is the transient effect of increased estrogen on TBG, total T4 and T3

A

Leads to an increase total T4 and T3 until increase TBG is saturated

140
Q

What is the clinical presentation of acute arsenic poisoning?

A

Nausea, vomiting, watery diarrhea, delirium, hypotension, QTc prolongation and garlic odor of breath**

141
Q

How does arsenic poisoning lead to sx?

A

binds to sulfhydrl groups, disrupts cell respiration and halts gluconeogenesis and glutathione metabolism

142
Q

What is the first-line treatment for arsenic poisoning?

A

Dimercaprol

143
Q

How does dimercaprol treat arsenic poisoning?

A

Increases urinary excretion of heavy metals by forming stable, nontoxic chelates

144
Q

What does CaNa2EDTA treat?

A

Acute lead poisoning

145
Q

How does acute lead poisoning present?

A

constipation, anemia, irritability and confusion

146
Q

What is the antidote for cyanide poisoning?

A

Hydroxycobalamin (B12 precursor)

147
Q

How does cyanide poisoning present?

A

Confusion, skin flushing, abdominal pain, vomiting

148
Q

What is the Tensilon test (edrophonium infusion) used for?

A

dx myasthenia gravis (sx improve) and cholinergic crisis (sx do not improve)

149
Q

What causes a cholinergic crisis in a myasthenia gravis patient?

A

Overstimulation of nicotinic receptors leading to prolonged refractory periods

150
Q

How does one treat cholinergic crisis in a myasthenia gravis patient?

A

Temporarily stop AchE inhibitor (pyridostigmine)

151
Q

What is pralidoxime used for?

A

Organophosphate poisoning

152
Q

What does minimal alveolar concentration serve to measure?

A

potency of an inhaled anesthetic (lower MAC = higher potency)

153
Q

What measures solubility of an anesthetic in tissues?

A

Arteriovenous concentration gradient (onset of action… high = slow)

154
Q

What measures solubility of anesthetic in blood?

A

Blood/gas partition coefficient (higher coefficient = slower onset)

155
Q

Where in the cell is structural (rRNA) syntehsized?

A

nucleolus

156
Q

How does insulin promote glycogen synthesis?

A

Activates PI3K, which activates protein phosphatase, which activates glycogen synthase

157
Q

What is the surface receptor for insulin?

A

Intrinsic tyrosine kinase

158
Q

Which second messenger system do peptide hormones and and cytokines rely on?

A

JAK kinase

159
Q

What is Colchicine used for?

A

Acute or chronic gout

160
Q

What is the mechanism of Colchicine?

A

Binds tubulin and inhibits microtubule polymerization to inhibit neutrophil chemotaxis and phagocytosis to reduce inflammation

161
Q

Which drugs are the most affective for acute treatment of RA?

A

Glucocorticoids and NSAIDs

162
Q

Which drugs is first-line for chronic management of RA?

A

Methotrexate

163
Q

Which lesion leads to a positive Babinski sign?

A

UMN

164
Q

Describe Metronidazole’s bacteriocidic function

A

Disrupts DNA structure and causes strand breakage

165
Q

Describe vancomycin’s bactericidal function

A

Inhibits cell wall synthesis.

166
Q

Which three antibiotics are used to treat C Diff?

A

Metronidazole, Vancomycin and Fidaxomicin

167
Q

How is Fidaxomicin bacteriocidal against C. Diff?

A

Inhibits sigma subunit of RNA polymerase (protein synthesis impairment)

168
Q

Which part of the intestine is commonly involved with Crohn’s disease?

A

Terminal ileum

169
Q

Which substances are absorbed at the terminal ileum?

A

Bile acids and Vitamins ADEK

170
Q

What is status epilepticus?

A

Long-lasting, continuous seizures that can be life-threatening (treat with benzos)

171
Q

Which caspases are activated by the extrinsic pathway? (FasL-Fas)

A

Caspases 8 and 10–> 3 and 6 (executioners)

172
Q

How does defective Fas-FasL lead to autoimmune disease?

A

Allows accumulation of autoreactive T cells

173
Q

Which interaction stimulates isotype switching?

A

CD40 on B cells interact with CD40L on T cells

174
Q

Clinical signs of Multiple Myeloma

A

60s, bone pain, fatigue, anemia, kidney disease, hypercalcemia

175
Q

How do proteosome inhibitors lead to apoptosis?

A

Allow accumulation of toxic intracellular proteins, which leads to excess of proapoptotic proteins

176
Q

Which structures does the femoral nerve run through?

A

Laterally between psoas and iliacus, and beneath inguinal ligament into thigh

177
Q

Which enzyme breaks down glycogen in glycogenolysis?

A

Glycogen phosphorylase

178
Q

What activates glycogen phosphorylase?

A

Phosphorylase kinase

179
Q

What activates phosphorylase kinase in the liver for glycogenolysis?

A

cAMP (via increased Gs protein activation by epinephrine and glucagon)

180
Q

What activates phosphorylase kinase in the muscle?

A

Increased intracellular calcium for glycogenolysis?

181
Q

Clinical presentation of Acute Rheumatic Fever pancarditis

A

Young child, new holosystolic murmur, nonspecific fever, fatigue and anorexia. Biopsy shows Aschoff body.

182
Q

What is an Aschoff body?

A

Plump macrophage with abundant cytoplasm and central, slender chromatin; replaced by fibrous scar tissue

183
Q

How does hypersensitivity myocarditis manifest?

A

Interstitial infiltrate of eosinohils after medication admin (antibiotics, diuretics)

184
Q

Which two anthracyclines cause dilated cardiomyopathy?

A

Doxorubicin, danorubicin

185
Q

Biopsy of doxorubicin cardiomyopathy

A

Patchy fibrosis with vacuolization and lysis of myocytes

186
Q

What agent causes Chagas disease?

A

Trypanosoma Cruzi (from South America)

187
Q

What causes hypoxic-ischemic encephalopathy?

A

Profound systemic hypotension (eg due to cardiogenic shock or arrest)

188
Q

How does hypoxic-ischemic encephalopathy appear on biopsy?

A

Bilateral Wedge-shaped strips of necrosis over cerebral convexity

189
Q

Which 2 neural cells are most vulnerable to ischemic injury?

A

Pyramidal cells of hippocampus and Purkinje cells of cerebellum

190
Q

What would cause unilateral wedge-shaped infarcts in the brain?

A

Severe carotid artery stenosis

191
Q

Hemorrhage involving deep brain structure (basal ganglia, pons, thalamus) occurs due to

A

Charcot-Bouchard aneurysm rupture (hypertension, smoking)

192
Q

Lacunar infarcts in the BG, internal capsule, pons or thalamus occur due to

A

Hypertensive arteriolar sclerosis in pts with long-standing hypertension

193
Q

Clinical presentation of hypertensive encephalopathy

A

Headache, vomiting, confusion– eventual coma and death

194
Q

In cardio, “right and left” refer from perspective of

A

patient

195
Q

What is capitation?

A

Arrangement in which payor (individual, employer, government entity) pays a fixed, predetermined fee to cover all the medical services required by a patient (underlies HMO provider networks)

196
Q

What is global payment

A

Insurer pays doctor a single payment to cover all expenses associated with care (elective surgery)

197
Q

Antibiotic/antifungal CYP450 inhibitor (increase potency)

A

Metronidazole, -azoles

198
Q

List 8 CYP450 inhibitors

A
  1. Acetominophen/NSAIDs
  2. metronidazole, -azoles
  3. Amiodarone
  4. Cimetidine
  5. Cranberry juice, Ginkgo biloba, Vitamine E
  6. Omeprazole
  7. Thyroid hormone
  8. SSRI
199
Q

List 5 CYP450 inducers (decrease efficacy)

A
  1. Carbamazepine/phenytoin
  2. Ginseng, St. John’s wort
  3. oral contraceptives
  4. phenobarbital
  5. rifampin
200
Q

Weaknness in thumb opposition indicates damage to

A

median nerve

201
Q

Weakness in thumb adduction and finger abduction indicates damage to

A

ulnar nerve

202
Q

In which two parts of the arm is the radial nerve vulnerable to injury?

A

humeral midshaft and superficial course of axilla

203
Q

Which precursor gives rise to beta-endorphins, ACTH, and MSH (melanin precursor)?

A

POMC (proopiomelanocortin)

204
Q

Which hormone is prolactin structurally similar to?

A

Growth hormone

205
Q

Which hormone is Somatomedin C similar to?

A

Insulin

206
Q

What is the function of Somatomedin C?

A

Released in response to growth hormone, stimulates growth in target cells

207
Q

What is the difference between inactivated (killed/component) viral vaccines and live-attenuated viral vaccines?

A

Inactivated vaccines generate a humoral immune response (B cells). Live attenuated vaccines generate a strong cell-mediated response in addition to humoral immunity

208
Q

How do inactivated vaccines prevent viral entry into cell?

A

Humoral antibodies bind to viral glycoproteins and inhibit its entry

209
Q

What is the function of interferon alpha and beta released from infected cells?

A

Induce synthesis of antiviral proteins in neighboring cells to reduce viral infectivity (replication and assembly)

210
Q

How do alkylating agents in chemotherapy induce damage?

A

Cause DNA cross-linking

211
Q

What is pulsus parvus et tardus

A

slow-rising, low amplitude pulse due to diminised stroke volume and prolonged LV ejection time (due to aortic stenosis or LV outflow tract obstruction)

212
Q

How are acute obstructive pulmonary exacerbations treated?

A

beta-adrenergic agonists (relax bronchial smooth muscle)

213
Q

What is the second messenger of the Gs pathway in beta2 receptors?

A

cAMP

214
Q

Increased calcium influx in smooth muscle leads to

A

Increased contraction (worsens shortness of breath)

215
Q

Which pathogens are most often responsible for secondary bacterial pneumonia following a viral infection?

A

Strep pneumo, Staph aureus, H. influenzae

216
Q

Which pathogen is most responsible for pneumonia in alcoholics and IV drug users

A

Klebsiella pneumoniae

217
Q

What is heteroplasmy

A

The condition of having different mitochondrial genomes within a single cell, affecting severity of mitochondrial dz based on proportion of abnormal to normal mitochondria

218
Q

Baker’s cysts and peripheral artery aneurysms are usually due to dysfunction in which artery

A

Popliteal

219
Q

Penetrating the anterior superior iliac spine would damage which nerve/

A

Lateral cutaneous nerve of thigh

220
Q

Presence of cord factor in TB, giving it a “serpentine” appearance corresponds with its

A

Virulence (Mycobacteria without cord factor cannot cause disease)

221
Q

What is the function of cord factor in TB

A

Inactivate neutrophils, damage mitochondria and indce release of TNF

222
Q

What is the function of sulfatides in TB/

A

Inhibit formation of phagolysosomes, allowing mycobacteria to persist intracellularly iin macrophage

223
Q

What type of channel is the CFTR protein?

A

ATP binding cassette

224
Q

Which ion does the CFTR channel transport

A

Cl- out of the cell

225
Q

What is the probe in a Southwestern blot and what does it detect?

A

dsDNA, DNA-binding proteins (transcription factors)

226
Q

What is probe in Northern blot and what does it detect

A

RNA; ssDNA or RNA

227
Q

What is probe in Southern blot and what does it detect

A

DNA; ssDNA or RNA

228
Q

What is probe in Western blot and what does it detect?

A

Antibody; protein

229
Q

Which two factors affect separation on gel electrophoresis?

A

Size and charge

230
Q

What type of molecules are c-Jun and c-Fos

A

Nuclear transcription factors that directly bind DNA via leucine zipper motif

231
Q

What does Ras code for

A

membrane-bound G protein (MAP kinase pathway)

232
Q

What type of molecule is S-100

A

Homodiemeric calcium-binding protein; marker for cells of neural crest derivation, Langerhans cells and other dendritic cells

233
Q

Which enzyme metabolizes cGMP in cells?

A

Phosphodiesterase

234
Q

What causes severe hypotension when Nitrates and PDE inhibitors are taken together

A

Accumulation of cGMP

235
Q

How does pregnancy increase the risk of venous thromboembolic disease?

A

compression of vena cava and internal iliac veins leading to stasis and increase in coagulation factor production

236
Q

Best management of early pregnancy thromboembolic disease

A

Low-molecular-weight heparins (enoxaparin)

237
Q

Clopidogrel mechanism and 3 uses

A

Blocks platelt ADP receptor and limits aggregation; used for coronary artery disease, acute coronary syndrome and prevenvtion of ischemic strokes

238
Q

Reddish skin discoloration, tachypnea, headache, tachycardia and N/V with confusion and weakness indicates which poisoning?

A

Cyanide

239
Q

How do inhaled amyl nitrites treat cyanide poisoning?

A

Convert Fe+2 to Fe+3 (methemoglobin), which binds cyanide more avidly and precipitates out in urine

240
Q

Hydroxycobalamin (B12 precursor) and sodium thiosuflate are antidotes for which poisoning

A

Cyanide

241
Q

Nutritional deficiencies (wet beriberi, chronic anemia) can result in which type of cardiomyopathy?

A

Dilated

242
Q

What is the vascular origin of IVH in neonates?

A

Germinal matrix

243
Q

Which murmur is best heard over cardiac apex while patient is in left lateral decubitus position at end of expiration?

A

S3 (brings heart closer to chest wall)

244
Q

Arterial puncture of the common femoral artery above the inguinal ligament increases risk of hemorrhage in which location?

A

Retroperitoneal space

245
Q

Where does a ruptured ectopic pregnancy bleed into?

A

Pelvic artery

246
Q

Define orthostatic hypotension

A

Frequent cause of lightheadedness and syncope; significant drop in systolic and diastolic BP on standing from supine position

247
Q

Common cause of orthostatic hypotension

A

alpha-1 antagonists (terazosin, doxazosin)

248
Q

Two malignancies associated with EBV

A

Nasopharyngeal carinoma and Burkitt lymphoma

249
Q

Which to autoantibodies are highly specific for SLE?

A

Anti-Smith (snRNP) and Anti-dsDNA

250
Q

What is tachyphylaxis?

A

Rapidly declining effect of medicine after a few days of use due to body’s compensatory response

251
Q

Long bone fractures increases the risk of which type of embolism and how is it stained?

A

Fat embolism, black stain with osmium tetroxide

252
Q

Three key features of fat embolism

A

Respiratory distress, thrombocytopenia (petechiae), non-focal neurologic symptoms (confusion)

253
Q

Side effect of Methotrexate when used for RA

A

Insterstitial pneumonitis and fibrosis

254
Q

Performed between 6th and 8th ribs along midclavicular line, 8th and 10th ribs along midaxillary line, or 10th and 12th ribs along paravertebral line

A

Thoracentesis

255
Q

Which ultrastructural change indicates irreversible cell injury?

A

Vacuolization and appearance of phospholipid-containing amorphous densities within mitochondria

256
Q

What are psammoma bodies?

A

Laminated calcium deposits

257
Q

What is a hallmark of ischemic injury

A

Cytoplasmic Ca++ accumulation

258
Q

Why do cells depolarize in ischemic injury?

A

Intracellular ATP is depleted, Na+/K+ ATPase stops functioning so Na+ leaks into cell, K+ leaks out causing depolarization

259
Q

Autosomal dominant mutation of fibrillin-1. Presents as Marfanoid habitus, aortic root dilation, upward lens dislocation

A

Marfan syndrome

260
Q

Autosomal recessive mutation of Cystathione beta synthase. Presents with intellectual disability, thrombosis, downward lens, megaloblastic anemia, fair complexion and Marfanoid habitus

A

Homocystinuria (buildup of methionine and homocysteine in body)

261
Q

Autosomal dominant disorder of joint hypermobility, skin laxity, abnormal wound healing and easy bruising- mutation in Type V collagen

A

Ehler-Danlos syndrome

262
Q

Binds b-tubulin of microtoubules to inhibit their breakdown and halt cells in M phase. Coats stents to prevent intimal hyperplasia

A

Paclitaxel

263
Q

Most common cause of congenital hyperammonemia

A

Deficiency of Ornithine transcarbamylase

264
Q

What builds up in ornithine transcarbamylase deficiency?

A

Carbamoyl phosphate–> orotic acid

265
Q

Which cerebral herniation compresses CN III

A

Uncal herniation (inner temporal lobe)

266
Q

Which cerebral herniation compresses ACA

A

Subfalcine herniation

267
Q

Hemangioblastoma in the cerebellum, cysts in kdneys in pancreas, clear cell renal carcinoma and pheochromocytoma are associated with which condition

A

Von Hippel Lindau syndrome

268
Q

De novo pyrimidine synthesis with CO2 occurs in the

A

cytosol

269
Q

De novo purine synthesis occurs in the

A

cytosol

270
Q

Maturity onset diabetes of the young is a mild form of diabetes due to mutation in

A

Glucokinase

271
Q

Which molecule stains positively with acid-Schiff

A

Glycogen

272
Q

Pathogen that causes osteomyelitis in patients with SCD

A

Salmonella (H2S producing)

273
Q

Vasogenic edema results from

A

Disruption of blood brain barrier, typically due to tumors

274
Q

Best treatment for peripheral artery disease

A

Cilostazol

275
Q

Treats PAD by reducing platelet activation. Inhibits platelet phosphodiesterase and dilates arteries to reduce claudication sx.

A

Cilostazol

276
Q

Treatment of hepatic encephalopathy

A

Rifaximin and Lactulose

277
Q

How does lactulose decrease serum ammonia

A

It’s a sugar that is digested by intestinal flora, which release H+ and convert ammonia to soluble ammonium

278
Q

How does Rifaximin treat hepatic encephalopathy

A

Nonabsorbable anitbiotic that acts on GI flora to decrease intestinal production and absorption of ammonia

279
Q

Which diuretics are recommended in patients with acute decompensated heart failure and reduced ejection fraction?

A

Mineralocroticoid receptor antagonists (potassium sparing) like Spiirnolactone, eplerenone

280
Q

What is the initial step in pathogenesis of beta thalassemia?

A

DNA mutations affect mRNA processing

USMLE (36 decks)

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