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USMLE > UworldPracticeExams > Flashcards

UworldPracticeExams Flashcards

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USMLE® Step 1 flashcards
1
Q

What is globus hystericus. Pseudobulbar paresis?

A

Lump in the throat.no abnormalities on neck exam and no problems w/ barium swallow. Common - 45% of pt report having it sometime in their life. Triggered by emotions or other things. Pseudobulbar paresis - difficulty moving facial muscles etc. Often due to brin stem or upper motor neuron problem.

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2
Q

What vitamin ins highly teratogenic? What can it result in?

A

Vit A tox - lipid soluble PLUS TERATOGENIC.Other Vit DEK are okay.Vit A to can cause - fetal microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion.Think ATRA problem

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3
Q

What are two neuraminidase inhibitors? What do tehy do?

A

BLock releack of influenza - Zanamivir, Oseltamivir

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4
Q

DNA fragments of 180 base pairs - what is this called - what does it signify?

A

Called DNA LADDERING - sensitive for apoptosis - action of specific endonuclease during karyorrhesis - cleave DNA linker regions , which occur at 180 base pair intervals.

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5
Q

When genetic mutation is in offspring, but not in parents. What to think

A

Germline mosaicism - presence of two or more different gamete cell lines. toste

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6
Q

Inheritance of Osteogenesis Imperfecta?

A

AD.

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7
Q

Suggestion for diabetic patient?

A

Check feet daily.

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8
Q

What is produced exclusively by T cells?

A

IL2.

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9
Q

What is the most likley neurovascular (specific) possible damage w/ posterior displacement of tibia (breaking of PCL)

A

Popliteal artery. Most susceptible to tearing by traction forces. Artery is rigidly fixed to proxmial and distal knee joint by adductor magnus and soleus muscles. Popliteal vein courses more superficial - less likely injured.

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10
Q

Most common cause of endometritis?

A

Bacteroides - foul smelling.

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11
Q

Sublimiation - what is this? GIve example.

A

Channeling socially unacceptable thoughts to into ACCEPTABLE actions.Taking out physical abuse anger into aggressive in basketball matches - SUBLIMIATION - mature mechanism. This is NOT displacement - displacement -s shifting feelings from one situation/person to another.

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12
Q

Reflection vs summarization vs facilitation

A

Reflection - physician repeats what is told. (reflects back to pt)Summarization - encapsulated several ideas into one or two statements.Facilitation - “Tell me about XYZ” - encourages pt to talk more about experience.

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13
Q

After hemipherectomy - what is GFR immediately after sugery? Few weeks later?

A

50% immediately after (Duh), 80% 6 weeks out - never total recovers. DUH.

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14
Q

Where does PDE inhibot work in penis?

A

Corpus cavernosum (NOT NEAR THE URETHRA DUH!) - This is near top part of penis.

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15
Q

Which secrete bicarb and which secrete enymes in pancreas?

A

Think like the kidney tubule - ductal/lumen can secrete bicarb.Enzymes/acinar are more specialized lobuels at the end. Ductal - BicarbAcinar - enzymes

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16
Q

Timeline for acute stress disorder? Adjustment disorder?PTSD.

A

Less than 4 weeks Within 3 months of stressor - last usu less than 6 monthsPTSD - MORE than 4 weeks

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17
Q

Schizophreniform disordervsSchizophreniavsSchizoid personality disorder?

A

Brief psychotic episode - less than 1 monthSchizophreniform disorder - 1 month to 6 monthsSchizophrenia - beyond 6 monthsShizoid personality disorder - no desire - CHOOSE solitary activities - flat affect.

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18
Q

How to calculate number needed to treat

A

1/(ABSOLUTE risk reduction)

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19
Q

CHF - pleural fluid findings

A

Transudate - low protein, low LDHExudate - high protein, higher LDH (more near serum)

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20
Q

In spherocytosis - what is the main treatment? When to do it?

A

Splenectomy - so you dont get anemia, jaundice, and bilirubin gallsotesrbc are fine - they just are all spherocytes and spleen goes crazy. Splenectomy these pt ater age 6 - so they can receive pneumococcal meningococcal and h flu vaccines PT w/ hereditary spheocytosis are at INC risk of thrombotic events

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21
Q

Hormone levels in male genotype, femal phenotype in androgen insensitivity?

A

HIGH THIGH LHHIGH E. Normal FSH.

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22
Q

Phnoxybenazme half life and singel dose lasting power?

A

Half life - 24 hoursSingle dose lasts 3-4 days

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23
Q

What is the role of misoprostol in gastric mucosa?

A

PGE1 analog - sitmulates mucus production and DEC parietal cell acid secretion.

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24
Q

Most of CA in head or squamous.Where is the most common location?

A

Oral cavity - tongue, floor of mouth, lip, soft palate, gingiva. NOT thyroid gland, LN, or parotid gland.

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25
Q

How to INC protein hydrophobiticity? (think innner plasma membrane anchor?

A

Palmitoylation - INC protein hydrophobicity by anchoring repctor carboxyl tail to plasma membrane

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26
Q

What are the findings in Albright hereditary osteodystrophy? inheritance?

A

AD - Pseudohypoparathyroidism aka Albright heredtiary osteodystrophyShort stature, short metacarpal and metatarsal - NED ORGAN RESISTANCE TO PTH, TSH, AND LH, FSH which all stiml Gs).PTH resistance is most notable.Get Hypocalcemia, hyperphosphatemia, and INC PTH.

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27
Q

What is the name of the difference in expression between Duchennes or Beckers?

A

One X frameshift loss of function, one is X point mutation - called Allelic heterogeneity - different mutations in same gene locus cause similar phenotypes. This is NOT genetic heterogenity- in which different GENES cause similar pheontypes. allelic is at the same location! This is also not variable expressivity because it is not the same mutation causing different expression.

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28
Q

Achondroplasia inheritance?

A

AD. Always active fibroblast growth factor 3. on Chr 4.

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29
Q

What maintains high levels of local concentration of testosterone in seminiferous tubules/epididymis? Where is this made?

A

Androgen binding protein (ABP) - synthesized by Sertoli cells in seminiferous epithelium. Maintains hgih local CONC of T necessary for normal sperm production.So male might have normal T levels in blood and normal secondary sex characteristiics, but low T in testes.ABP from SERTOLI!

30
Q

What does red safranin O stain for?

A

Stains CARTILAGE, MAST CELL GRANULES, AND MUCIN RED. Articular cartilage - see chondrocytes embedded in matri of proteoglycan ans collagen.

31
Q

Blodog as and pH of pt w/ PE?

A

V/Q mismatch - > hypoxemialeads to respiratory alkalosis. INC pAO2, DEc PaCO2, BASIC (pH 7.5)

32
Q

What phospholipid can cause severe bronchoconstriction, vasoconstrction, and platetelt aggregation w/ microthrombus formation?

A

Platelet activating factor (PAF) -> IP3/Gq.

33
Q

Why are PPIs insufficient t/x in peptic ulcer disease?

A

Need antibiotics to DEC h. pylori infection - this prevents RECURRENCES. PPI may only provide symptomatic relief.

34
Q

Pt w/ brown spots over body. THen has soft flshe colored nontender papules. What is this?

A

NF1The first bit is cafe au lait spots.The second bits are enign tumors - cutaneous neurofibromas. Also may see otpic nerve glioms, bony lesions, iris lisch nodules, first degree relative w/ NF.neurofibromas are growths of schwann cells and other elements - rarely maglintnat transformation.

35
Q

What does germline mosaicism mean? How is this clinically applicable?

A

if you see a family w/ AD disorder (such as NF), and the parents have no NF and all children do. This can be due to 1. incorrect family tree - cheating 2 germline mutation3. Failure to diagnose parents.I 1 and 3 are wrong, then it is GERMLINE MOSAICISM - one of the parents has an AD mutation. NF is 100% penetrance w/ variable expressivity. Novel germline mutations in family w/ no prior disease.

36
Q

Classic leiomyoma presentation

A

Black female - palpable mass, heaviness.heavy menses. passes clots occasionally. May have prob w/ fertility. Some are asymptomatic - others are associated w/ the above.

37
Q

Mucosal hemorrhage and patchy areas of necorsis in elderly pt w/ heart valvel problem?

A

Ischemic colitis.

38
Q

First step of beta oxidation?

A

Acy coA dehydrogenase.Most common genetic defect in b-oxidation.

39
Q

What is Ras? What does it do, where is it located?

A

Ras - oncoprotein - MPA kinase pathway.Active w/ GTP.Inactive w/ GP. When phosphorylated, trasmits stimuli from RECEPTOR ON CELL SURFACE - t> nucleus. promotes mitogenesis.cancer often has Ras locted in GTP state -> continuous stim of growth. c-myc - nuclear phosphoroteinRb - nuclear phosphorprotein that regus G1->SCyclin D - G1->S BRCA1 - DNA repair enzyme! p53 - halts in G1 stage if DNA damage IDed. RAS IS A GTP BINDING SIGNAL TRANSUDCTION ONCOPROTEIN

40
Q

Proto-oncogenesTumor suppressorMain differences?

A

Protooncogene - stim growth. Only 1 mutation/knock out required usu.Tumor suppressor - block cell cycling. Require 2 knock outs.

41
Q

Most powerful risk factor for osteoarthritis?

A

Age

42
Q

What too buggies are resistance to penicillins?

A

Chlamydia - double membrane -no cell wallMycoplasma - plasa membrane but no cell wall. GN are haploid w/ petidoglycan cell wall sandwiched between outer and inner plasma membrane.

43
Q

Osteomalacia due to?

A

VitD def - depositions of excessive unmineralized osteoid in matrixCan have secondary hyperparathyroidism

44
Q

Diabetic pt. What kind of vascular changes to be concerned w/

A

Oerioheral arterial disease (PAD) - rologned venous filling time, shiny colored skin, skin atrophy, hair loss, nail changes.

45
Q

Li Fraumeni syndrome

A

Germline mutation in p52 suppressor. Only requires 1 ore allele deletion.

46
Q

Hashimotos gross and histo

A

Nonpainful - enlarged thyorid gland. Fatigue/sleepingHurthle cells, lymphocytic infiltrate, germinal center formation. Follicular destruction.

47
Q

What nerves are unmyelinated?

A

Some afferent (slow pain, heat, olfaction)Efferents are MYELINATED (Except those from postganglionic autonomic neurons)Unmyelinated have smaller diameter and conduct potentials slowly.

48
Q

Two or more people w/ shared delusion is called? What is delusional disorder?

A

Shared psychotic disorder. Development of delusion in person who is close to antoher delusioned person. Delusional disorder - NONBIZARRE - (unlikely but possible) - being follwed, ceated, posioned. PReserve occupation/social functioning. aka failure to meet schizophrenia.

49
Q

What is high baseline plasma insulin w/ normogylcemia a sign of?

A

Insulin resistanc ein perphera ltissue - EARLY PHASE.

50
Q

COnjunctiitis, urethritis, arthritisWhat is this called. What is this called b?

A

Reactive arthritis - seronegative spondylopathies.(in PAIR)Shigella, salmonella, yersinia, campylobacter, chlamydiaEYE SYMPTOMS ARE NEVER SEEN W/ DISSEMINATED GONOCOCCAL.

51
Q

neonatal hypotonia, obesity, small hands and feet, facies.

A

Prader Willi. Paternal knock out - or maternal uniparental disomy

52
Q

Callus caused by?

A

Stratum corneum thickening. may be from external pressure or friction

53
Q

Hormone levels in PCOS?

A

All up except FSH, which is fishy.

54
Q

What cell signal causes differentiation?

A

TRANSCRIPTION FACOTR.Transcirption factor milieu in nuclei favors expression of those genes. All nucelated cells have entire genome. Transcription factors specificy differnetiation.

55
Q

What gastric hormone levels are changed w/ Pernicious anemia?

A

ab knockout parietal cells - knock out both B12 intrinsic factor AND acid producing ability. Leasd to INC gastrin levels trying to compensate.

56
Q

If scrotal mass disappears when lying down and apepars when standing.. what is this?

A

Varicocele - venous drainage.Hydrocele, spermatocele, testicular CA, and torsion all remain w/ standing/lying.

57
Q

Prophylaxis for a no-risk factor only mechanical valve?

A

Warfarin.

58
Q

Di George Cardiac defect?

A

Persistent trucucs arteriosus, tetrology.

59
Q

DNA Methylation

A

silences gene transcription.typically methylated regions are rich in C-G dinucleotid repeats.

60
Q

Tissue paper cells + aseptic necrosis of bone.

A

Gauchers.

61
Q

Aspergillus other formation?

A

COnidiophore - BROOK like RADIATIONS Fungal ball seen in post TB vacules/cavitations

62
Q

Mutations in HoxA13 lead to?

A

hand foot genital syndrome. (HFG)bicornuate uterus and ectopic ureteral openings - hypopastic toes and thumbs.

63
Q

Piogliazone mech?

A

Activates peroxisome poliferatinv activator receptor gamma (PPARg) -> INC synthesis of translocation of the glucose transporter GLUT 4.

64
Q

How does vit D affect phosphate?

A

Vit D INC intestinal absorption of Ca and P!Also vit D downregulates PTH, so this alo inc P!

65
Q

sudden onset back pain, hematuria, oliguria w/ anion gap?

A

Ethylene glycol posioning - back pain in calcium oxalate crystal deposits.

66
Q

Damage to the MCA can cause what occular effects?

A

unilateral Homonymous hemianopsia - damage to optic radiations ANY VISUAL LESION BEYOND OPTIC CHIASM CAN CAUSE HOMONYMOUS HEMIANOPSIA.

67
Q

What is the first artery off of the internal carotid?

A

Opthalmic artery

68
Q

muscle velocity indireclty proportionate to ?

A

afterload. highest contraction velocity achieved when afterload is zero.

69
Q

Portal HTN results in what findings in spleen?

A

congestion - epansion of red pulp (sinusoids)

70
Q

DOC for esophageal variceal hemorrhages?

A

Octreotide. (somatostatin)Octroetide reduces splanchinic blodo flwo and diverts blood from portal to systemic. in causing splanchnic vascular constrictino.

71
Q

MCA stroke vs PCA stroke?Eyes + body

A

MCA - body defects (motor + sensory)+ Homonymous hemianopia WITH macular involvementPCA stroke - macular sparing. AKA MACULA IS BASICALLY SUPPLIED BY MCA.

USMLE (16 decks)

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