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USMLE Step 1 > Week 2 > Flashcards

Week 2 Flashcards

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USMLE® Step 1 flashcards
1
Q

Describe the culture characteristics of Listeria (4).

A

Gram positive rod, tumbling motility (actin rockets), grows at 2.5C, narrow zone of β hemolysis on sheep agar.

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2
Q

What is CVID?

A

A defect in B cell maturation such that antibody-secreting plasma cells are deficient. Causes deficiency in immunoglobulin, increased risk of autoimmune dz, and lymphoma

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3
Q

What is the effect of IL-12R deficiency?

A

Decreased TH1 response. This results in disseminated mycobacterial infections.

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4
Q

What is HyperIgE (Job) syndrome?

A

Th1 cells fail to produce IFNγ. Features are coarse facies, staph abscess, retained primary teeth, hyperIgE, and eczema

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5
Q

What is leukocyte adhesion deficiency?

A

Absent LFA-1 integrin on phagocytes. Results in recurrent bacterial infection, absent pus formation, retained umbilical cord, and neutrophilia.

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6
Q

What is Chediak-Higashi syndrome?

A

Microtubule dysfunction with failure to form phagolysosomes (LYST gene). Susceptibility to staph and strep infections. Partial albinism and peripheral neuropathy.

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7
Q

What is neuroleptic malignant syndrome? What are the s/s (4)

A

It is caused by antidopaminergic activity of neuroleptics (esp on D2 receptors). Causes hyperthermia, autonomic instability, hyperthermia, and altered mental status.

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8
Q

What drugs belong to the neuroleptic family?

A

Haloperidol and -azines: fluphenazine, thioridazine, chlorpromazine

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9
Q

What are the main features of osteogenesis imperfecta? What is the defect?

A

Fractured bones, blue sclerae, and poor wound healing. Defect in collagen I

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10
Q

What do structures do the bronchioles lack that the bronchi have?

A

Goblet cells, glands, cartilage

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11
Q

What leads to the formation of a cleft lip?

A

Failure of 1 of the maxillary prominences to fuse with the intermaxillary segment.

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12
Q

What leads to the formation of a cleft palate?

A

Failure of the palatine shelves to fuse with one another or with the primary palate (intermaxillary segment).

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13
Q

What are the side fx of niacin?

A

Hyperuricemia, hyperglycemia, and red, flushed face that decreases with aspirin use or prolonged use.

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14
Q

What are the reversible changes observed in cell death (5)?

A

Chromatin clumping, cellular swelling, glycogenation, fatty change, polysome detachment

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15
Q

What are the irreversible changes observed in cell death (4)?

A

Plasma membrane damage, nuclear fragmentation (pyknosis, karyorrhexis, karyolysis), lysosomal rupture, mitochondrial permeability.

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16
Q

What are the possible treatments of glaucoma?

A

Decrease synthesis of aqueous humor by the ciliary body epithelium with β blockers (timolol) or acetazolamide.
Increase outflow of aqueous humor by cholemimetics (carbachol, pilocarpine) or PGF2α analogs (letanoprost, unoprost, travaprost)

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17
Q

How is gardnerella vaginalis treated?

A

Metronidazole

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18
Q

What are the features of koilocytes?

A

Dark-staining nucleus, enlarged nucleus, convoluted nuclear membrane, perinuclear halo

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19
Q

What are the maternal and neonatal symptoms of Toxoplasmosis?

A

Maternal: usually asymptomatic. Neonate: chorioretinitis, hydrocephalus, intracranial calcifications.

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20
Q

What are the maternal and neonatal symptoms of Rubella?

A

Maternal: rash, LA, arthritis. Neonate: deafness, cataracts, PDA, sometimes blueberry muffin rash

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21
Q

What are the maternal and neonatal symptoms of CMV?

A

Maternal: asymptomatic or mono-like illness. Neonate: Deafness, seizures, petechiae, blueberry muffin rash

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22
Q

What conditions produce an S4 heart sound?

A

High atrial pressure associated with ventricular hypertrophy.

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23
Q

What bacteria contain a antiphagocytic d-glutamate capsule?

A

Bacillus anthracis

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24
Q

What are the pathogenic factors of bacillus anthracis?

A

Edema factor is a calmodulin-dependent adenylate cyclase. It upregulates cAMP, inhibits PMN function, and causes massive edema.
Lethal factor inhibits protein kinases and induces macs to release IL-1 and TNFα
Protective antigen is the B subunit.

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25
Q

What drugs can cause aplastic anemia?

A

Benzenes, chloramphenicol, antimetabolites, and alkylating agents.

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26
Q

What infections can cause aplastic anemia?

A

Parvovirus B19, EBV, HIV, HCV

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27
Q

What is acanthosis and its associated condition?

A

Thickening of the spinosum layer; psoriasis

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28
Q

What is dyskeratosis and its associated condition?

A

Abnormal premature keratinization of keratinocytes; squamous cell ca.

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29
Q

What is hyperparakeratosis and its associated condition?

A

Retention of nuclei in stratum corneum. It signifies incomplete keratinization. Actinic keratoses.

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30
Q

What is hypergranulosis and its associated condition?

A

Abnormal granulation in the stratum granulosis. Lichen planus

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31
Q

What are the characteristics of neuroblastoma (7)?

A

Most common extracranial childhood cancers. Children under 2, small blue round cells, retroperitoneal mass, anorexia, weight loss, increased HVA, nMYC amplification.

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32
Q

What paraneoplastic syndrome is associated with neuroblastoma?

A

Opsoclonus-myoclonus: non-rhythmic conjugate eye movements associated with myoclonus

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33
Q

What metastases are associated with neuroblastoma?

A

Dumbbell tumor (epidural), bone marrow, liver, skin, periorbital

34
Q

What are the diseases of schistoma? How is it treated?

A

Granulomatous inflammation and fibrosis of the spleen, liver, GI tract, and bladder. Treated w/ praziquentel.

35
Q

Axillary n. injury (spinal nerves, cause of injury, motor deficit, sensory deficit, physical sign)

A

C5, C6. Caused by fracture of the surgical head of the humerus. Decreased deltoid action (abduction); decreased sensation over deltoid; flattened deltoid

36
Q

Radial n. injury (spinal nerves, cause of injury,motor deficit, sensory deficit, physical sign)

A

C5-C8. Fracture of the humeral shaft or prolonged axillary compression. BEST extensors (brachialis, extensors of wrist and fingers, supinators, triceps); dorsum of hand and thumb, posterior arm; wrist drop.

37
Q

Proximal median n. injury (spinal nerves, cause of injury, motor deficit, sensory deficit, physical sign)

A

C5-T1. Supracondylar injury to the humerus. Thumb opposition; lateral 3 1/2 fingers, thenar eminence; ape hand (thenar atrophy and loss of thumb opposition)

38
Q

Distal median n. injury (spinal nerves, cause of injury,motor deficit, sensory deficit, physical sign)

A

C5-T1. Carpal tunnel syndrome. Flexion of lateral fingers and wrist; lateral 3 1/2 fingers; ulnar claw - ulnar deviation on wrist flexion.

39
Q

Proximal ulnar n. injury (spinal nerves, cause of injury,motor deficit, sensory deficit, physical sign)

A

C8, T1. Lateral epicondyle injury (funny bone). Flexion of medial fingers; medial 1 1/2 fingers, hypothenar eminence. Radial claw.

40
Q

Distal ulnar n. injury (spinal nerves, cause of injury, motor deficit, sensory deficit, physical sign)

A

C8, T1. Hook of the hamate injury. Extension of 4th and 5th fingers (lumbricals), abduction and adduction of fingers (interossei), adduction of the thumb; no sensory deficit. Hand of benediction.

41
Q

Musculocutaneous injury (spinal nerves, cause of injury, motor deficit, sensory deficit, physical sign)

A

C5-C7. Upper trunk compression. Loss of elbow flexion (biceps brachii, brachioradialis, coracobrachialis). No sensory deficit.

42
Q

Treatment of coag (-) staph.

A

Vancomycin w/ or w/o rifampin and/or gentamicin

43
Q

What are the symptoms of systemic mastocytosis?

A

GI: increased gastric acid secretion, inactivation pancreatic enzymes, diarrhea
CV: tachycardia, flushing, syncope
Bronchospasm
Skin: urticaria and pruritus

44
Q

For what enzymes is lipoic acid a cofactor?

A

Pyruvate DH, αKG-DH, branched chain ketoacid DH

45
Q

What changes are seen 12 hours after a stroke?

A

Macroscopic changes: hypodense region on CT w/ edema and loss of gray-white junction

46
Q

What changes are seen 36-48 hours after stroke?

A

Microscopic changes: irreversible injury to neurons (red neurons). Infiltration with PMNs and then macs

47
Q

What changes are seen 3-5 days after a stroke?

A

Neurons disintegrate and their fragments are taken up by macs (lipid sin the cytoplasm)

48
Q

What changes are seen 2 weeks after a stroke?

A

Gliosis: cystic space lined by astrocytes and new capillaries.

49
Q

What are the outcomes for hepatitis B infection?

A

60-65% are subclinical
20-25% have acute hepatitis that resolves
5-10% become chronic carries
4% have chronic hepatitis, 20-30% of which develop cirrhosis.

50
Q

What is the formula for a 95% confidence interval?

A

Mean ± 1.96*σ/√n

51
Q

What is metyrapone test?

A

Metyrapone is an inhibitor of 11β hydroxylase, thus inhibiting cortisol production. Negative feedback is removed from ACTH. It is used to detect an interruption in the HP axis. In a normal individual there is elevated 17(OH)steroids.

52
Q

What are the normal pressures of the right ventricle?

A

5 and 25

53
Q

What are the normal pressures of the pulmonary artery?

A

10 and 25

54
Q

What are the normal pressures of the left atrium?

A

2 and 12

55
Q

What are the normal pressures of the left ventricle?

A

130 and 10

56
Q

What are the normal pressures of the aorta?

A

130 and 70

57
Q

What are the signs and symptoms of liporotein lipase deficiency (6)?

A

Elevated chylomicrons, hyperlipidemia, skin xanthalesmas, lipema retinalis, pancreatitis, hepatosplenomegaly

58
Q

What drug can be used to help diagnose lipoprotein lipase deficiency?

A

Heparin, because normally it liberates lipase bound to endothelium, which encourages the clearance of TGs from circulation.

59
Q

Describe the pathology of mucormycosis.

A

It tends to infect the paranasal sinuses in patients w/ DKA and immunosuppression. The fungi proliferate in the blood vessels when abundant glucose and ketones are available.

60
Q

How is volume of distribution calculated?

A

= drug in the body/plasma drug concentration

61
Q

What is the calculation for loading dose?

A

Cp * Vd / F

62
Q

What is the calculation for maintenance dose?

A

Cp * CL / V

63
Q

What drugs have antimuscarinic side effects?

A

atropine, mertazapine, TCAs

64
Q

What conditions have a type IV hypersensitivity reaction (7)?

A

Contact dermatitis, T1DM, Guillain-Barre, Multiple sclerosis, Hashimoto’s, GVH, PPD

65
Q

What is the calculation for attributable risk percent?

A

=(1-RR)/RR

66
Q

What is the calculation for attributal risk?

A

[a/(a+b]-[c/(c+d)]

67
Q

What is the calculation for type I error?

A

b/(b+d)

68
Q

What is the calculation for type II error?

A

c/(a+c)

69
Q

What is methylmalonic acidemia?

A

Methylmalonic acid fails to isomerize to succinyl CoA.

70
Q

What are the treatment options for rheumatoid arthritis? What are the features of each?

A

NSAIDs for acute relief. Corticosteroids provide the most rapid relief and are very potent. Disease modifying drugs (methotrexate, sulfasalazine, hydroxychloroquine) take weeks for a response

71
Q

What are the pathogenic factors for pertussis (4)?

A

Pertussis toxin (activates adenylate cyclase and kinases), extracellular adenylate cyclase (interferes w/ H2O2 & WBC chemotaxis), hemagglutinin, and tracheal cytotoxin.

72
Q

What factors are in cryoprecipitate?

A

Fibrinogen, CF VIII, and CF XIII

73
Q

What is the clinical significance of the first dose of ACE-inhibitors?

A

First dose hypotension. It is caused by a decreased venous return to the heart, which induces vagally mediated hypotension and bradycardia. Potentiated by hyponatremia or hypovolemia due to concurrent thiazide or loop diuretic use.

74
Q

What is lamotrigine?

A

It is used for simple, complex, and tonic-clonic seizures. It blocks VG Na channels.

75
Q

What is the most dangerous side effect of lamotrigine?

A

Steven Johnson syndrome

76
Q

What complaints must be present for somatization disorder?

A

4 pain, 2 GI, 1 sexual, 1 pseudoneurologic

77
Q

What is conversion disorder?

A

Sudden loss of sensory or motor function. It usually follows an acute stressor. The patient is aware but indifferent to the symptoms.

78
Q

What is pain disorder?

A

Prolonged pain with no physical findings. Psychologic factors play a role in severity, exacerbation, and maintenance.

79
Q

What can be used in the treatment of PCOS?

A

Weight loss and oral contraceptives. If the patients wants to be pregnant, clomiphene can be used.

80
Q

What is the MOA of clomiphene?

A

It is a SERM that prevents negative feedback inhibition on the hypothalamus by circulating estrogen, which increases FSH & LH.

USMLE Step 1 (3 decks)

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