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UWorld mixed > usmle 2: block 1 > Flashcards

usmle 2: block 1 Flashcards

note: some are block 2

1
Q

pulling sensation in groin with..

ascites, hydrothorax, &..

A

ovarian fibroma: meig’s syndrome

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2
Q

hCG & LDL are elevated in what ovarian neoplasm

A

dysgerminoma

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3
Q

AFP is elevated in what ovarian neoplasm

A

yolk sac tumor, endodermal sinus

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4
Q

presentation of yolk sac tumor

A

in ovaries/testes or saccrococcegeal region

has schiller-duval bodies

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5
Q

drug eluting stents elute..

A

clopidogrel

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6
Q

paclitaxel

A

taxol

stabilizes MT, preventing mitosis

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7
Q

schiller-duval bodies

A

endodermal sinus, yolk sac tumor

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8
Q

call-exner body

A

granulosa cell tumor (malignant ovarian neoplasm)

resembles primitive follicle

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9
Q

CA-125

A

monitor progression of all ovarian neoplasms, but not good for screening

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10
Q

most common malignant ovarian neoplasm

A

serous cystadenocarcinoma

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11
Q

most common benign ovarian

A

serous cystadenoma

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12
Q

what is the cornea composed of

A
  1. endothelial layer: cellular, mitochondrial rich, translucent
  2. descement’s membrane (location of Cu2+ deposition
    basement membrane
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13
Q

probenicid on uric acid? on penicillin?

A 
LOWERS uric acid (inhibits reabsorption)
INCREASES penicillin (inhibits secretion)
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14
Q

input to cerebellum?

A 
cortex -> MCP (contralateral) via ipsilateral pontine nuclei
spinal cord (proprioception) -> ICP (ipsilateral)

via climbing and mossy fibers

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15
Q

output from cerebellum

A

purkinje fiber -> deep cerebellar nuclei (DEGF) -> contralateral cortex superior cerebellum peduncle

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16
Q

lateral lesions to cerebellum

A

voluntary movements of extremities; tendency to fall ipsilaterally

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17
Q

medial lesions to cerebellum?

A

midline structures;

truncal ataxia, nystagmus, head tilting.
wide-based (cerebellar) gait & defective truncal coordination

usu bilateral

ALCOHOLICS (thiamine-deficiency linked)

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18
Q

alcoholic wide based gait based on..

A

midline cerebellar defects; thiamine deficiency linked!

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19
Q

xanthomas are most characteristic of..

tendinous more specific for..

A

increased cholesterol (tendinous more specific)

severely increased triglycerides

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20
Q

urease breath test?

A

drink radiolabeled urease
H. ployri converts to CO2 + NH3
will breath out radiolabeled CO2

the NH3 raises the pH around bacteria & protects it

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21
Q

low-pitched, rumbling, mid-diastolic murmur in apex LLD

A

mitral stenosis

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22
Q

most common cause of mitral stenosis

A

rheumatic heart disease

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23
Q

cardiac manifestation of TB?

A

tuberculosis pericarditis

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24
Q

peutz-jeghers syndrome

A

autosomal dominant.
STK11 (serine/threonine kinase chr. 19) mutation

  1. pigmented mucocutaneous macules
    - lips, buccal muscosa (pathognomonic) hands & feet
  2. numerous hamaratomatous polyps in GI tract

usu benign
can: abdominal pain, GI bleed (intussuception, obstruction, malignant transformation)

develop during first few years of life

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25
Q

blue nails & dyspigmentation of lower legs

A

consider Wilson’s disease (hepatolentincular degeneration)

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26
Q

enzyme deficiency in gilbert’s syndrome

A

reduced activity of UDP-gluconornyl transferase

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27
Q

atrophic glossitis, megaloblastic anemia, shuffling gait in elderly women of Northern European descent

A

pernicious anemia presentation

gait: due to degeneration of dorsal column proprioception to cerebellum

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28
Q

liposarcoma vs. lipoma

A

liposarcoma: LIPOBLAST: nonmembrane bound cytoplasmic lipid characterestically causing nuclear indentations & scalloping of nuclear membrane
lipoma: mature fat cells, without pleomorphism

both present as slow growing, painless masses in deep connective tissue

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29
Q

most common malignant soft tissue tumor in adults? children?

A

adults: liposarcoma
children: rhabdomyoscarcoma

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30
Q

FAP
osteoma in skull
fibroma (desmoid tumor)
congenital hypertrophy of retinal pigmented epithelium

A

gardener syndrome (autosomal dominant)

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31
Q

FAP + malignant CNS tumor

A

turcot syndrome

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32
Q

dermoepidermal junction autoantibodies (against type VII collagen)

A

epidermolysis bullosa acquisita

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33
Q

basement membrane IgG auto-antibodies in skin

A

bullous pemphigoid

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34
Q

lung surfactant maturation screen

A

L/S
lecithin/sphingomyelin 2:1

note: lecithin = DPPC = dipalmitoyl phosphatidyl choline

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35
Q

purpose of surfactant

A

decrease surface tension of alveoli
reduce pressure needed to keep alveoli inflated

(increased compliance)

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36
Q

sympathetic innervation to eye

A

3 neuron system

  1. hypothalamus -> descend to lateral horn spinal cord
  2. enters sympathetic trunk & ascends to superior cervical trunk
  3. superior cervical trunk, along internal carotid, joins branches of opthalmic division of CN V

go to pupil dilators & superior tarsal

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37
Q

bulbar vs. pseudobulbar

A

bulbar:
- LOWER motor neuron
- cranial nuclei from medulla (CN IX, X, XI, XII) & nerves

pseudobulbar:
- UPPER motor neuron
- corticobulbar tracts in mid pons
- for these lesions to be apparent, must be bilateral, as these nuclei receive bilateral input

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38
Q

bromocriptine

A

dopamine receptor agonist

rx: prolactinoma

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39
Q

clomiphene

A

SERM

  • blocks estrogen receptors in hypothalamus (blocks negative feedback)
  • increase release of pituitary gonadotropins
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40
Q

what can be used to trigger ovulatory cascade when follicles are mature? (i.e. in an oocyte donor)

A

hCG therapy, triggers ovulation

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41
Q

can a person w/ turner have a baby?

A

w/ IVF

ovaries don’t work, but uterus is fine

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42
Q

lithium side effects

A

LMNOP

motor (tremors)
nephrogenic diabetes insipidus
hypothyroidism
pregnancy: teratogen: ebstein anomaly

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43
Q

mood disorder history

A

THINK LITHIUM

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44
Q

3 problems in hypertrophic cardiomyopathy

A
  1. diastolic dysfunction: rigid, less volume
  2. LVOT: increased afterload
  3. increased cardiac work: MI
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45
Q

2 causes of renal artery stenosis

A
  1. atherosclerosis

2. fibromuscular dysplasia (females)

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46
Q

when giving blood to patient w/ IgA deficiency..

A

must be blood from someone else w/ IgA deficiency!

if IgA is in blood, they will have anaphylaxis (they’ll make anti-IgA)

could be in: RBC, platelet, FFP, IVIG

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47
Q

DNA Pol III? DNA Pol I?

A

DNA Pol III: continues from RNA primer

DNA Pol I: removes primer (5’-3’ exonuclease), & places new DNA

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48
Q

receiver operating characteric ROC curve? measure of accurary?

A

sensitivity vs. 1-specificity

want rectangular test
area under curve: accuracy!

true positive rate vs. false positive rate

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49
Q

accuracy formula

A

TP + TN / all observations

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50
Q

false positive rate

A

1-specificity

specificity: without disease, test negative
false positive rate: without disease, test negative

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51
Q

true positive rate

A

sensitivity

with disease, test positive

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52
Q

false negative rate

A

1-sensitivity

with disease, test negative

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53
Q

CA-125

A

high specificity,
low sensitivity

(low false + rate, low PPV)

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54
Q

17-hydroxyprogresterone elevation

A

CAH due to 21-hydroxylase deficiency

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55
Q

PTHrP

A

squamous cell carcinoma of lung

hypercalcemia

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56
Q

CA-19-9

A

pancreatic adenocarinoma

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57
Q

cyclosporine

A

calcineurin inhibitor (binds CYCLOphilin)

prevents IL-2 transcription

– can’t convert NFAT-P to NFAT
[NFAT is TF for IL-2 gene]

use:
transplant rejection prophylaxis
psoriasis
rheumatoid arthritis

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58
Q

tacrolimus

A

calcineurin inhibitor (binds FKBP)

prevents IL-2 transcription

–can’t convert NFAT-P to NFAT
[NFAT = TF for IL-2 gene)

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59
Q

oprelvekin

A

IL-11

good for thrombocytopenia

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60
Q

filgrastim

A

G-CSF (recover bone marrow)

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61
Q

sargramostin

A

GM-CSF (recover bone marrow)

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62
Q

aldesleukin

A

IL-2

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63
Q

IFN-a

A 
rx:
chronic hep B
chronic hep C
hairy cell leukemia
condyloma acuminatum
renal cell carcinoma
malignant melanoma
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64
Q

IFN-b

A

multiple sclerosis

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65
Q

IFN-c

A

chronic granulomatous disease

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66
Q

IL-2 transcription

A

calcineurin
NFAT-P -> NFAT

NFAT -> transcription factor for IL-2 gene

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67
Q

cyclosporine toxicity

A 
NEPHROTOXIC
HTN
hyperlipidemia
hyperglycemia
tremor
hirsuitism
gingival hyperplasia
68
Q

-limus drugs (tacrolimus & sirolimus)

A

binds FKBP

69
Q

calcineurin inhibitors (cyclosporine & tacrolimus) are both..

A

nephrotosix

70
Q

tacrolimus toxicity

A

like cyclosporine: MAIN: NEPHROTOXIC
MORE risk of diabetes & neurotoxicity
LESS risk of hirsuitism & gingival hyperplasia

nephrotoxic
hyperlipidemia
tremor

71
Q

sirolimus (rapamycin)

A

binds FKBP
mTOR inhibitor
(TF for proliferation genes)

blocks T cell activation & B cell differentiation

prevents IL-2 signal transduction

NON-NEPHROTOXIC

72
Q

basiliximab

A

monoclonal Ab to IL-2

like sirolimus / rapamycin, blocks IL-2 reception

73
Q

immunosuppressant effects of glucocorticoids

A

inhibits NF-kB

inhibits cytokine transcription

74
Q

NFAT & NFkB

A

both transcription factor for IL-2 (cytokine)

75
Q

azathiopurine blocks

A

blocks rapidly dividing T & B cells
like 6-MP

PRPP amidotransferase
(rate limiting step for purine synthesis)

converts PRPP -> 5-phosphoribosylamine
(then add base + carbon)

cleared by xanthine oxidase
(increase w/ allopurinol rx)

76
Q

mycophenolate mofetil

A

like azathiopurine, blocks rapidly dividing T & B cells

blocks IMP dehydrogenase (can’t make de novo GMP)

77
Q

muromonab

A

Ab against CD3 on T cells

immunosupressants

78
Q

gingival hyperplasia (4)

A

verapamil
phenytoin
cyclosporine
nifidipine

79
Q

drug induced parkinson’s (3)

A

anti psychotics
reserpine
metoclopromaide

cog-wheel ARM

80
Q

metoclopromide

A

rx: nausea & gastroparesis

D2 receptor antagonist
increase resting tone, contractility, LES tone, motility.

does not influence colonic transport time.

contraindicated in parkinsons

81
Q

alkaptonuria (ochronosis)

A

autosomal recessive, bengin.
deficiency of homogentisate oxidase
can’t break down tyrosine -> fumarate

major problem: debilitating arthralgia
(homogentisic acid = toxic to cartilage)

urine black on standing
dark blue/grey on sclerae & ear

(no mental retardation)

82
Q

major long-term consequence of alkaptonuria?

A

debilitating arthralgia (3-4th decade)

knee, hip, shoulder, intervertebral joints

83
Q

parkinsons symptoms mnemonic

A

TRAPS

resting Tremor
Rigiditiy (cogwheel)
Akinesia (or brady)
Postural instability
Shuffling (festinating) gait

degradation of neurons in substantia nigra pars compacta

84
Q

location of substantia nigra pars compacta

A

ventral midbrain
near cerebral peduncles (corticobulbar tracts)
‘mickey mouse’ ears

85
Q

lesion to occipital lobe? lesion to PCA

A

if occipital lobe: homonymous hemianopsia

if PCA: homonymous hemianopia w/ MACULAR SPARING

can be quadrants if only lingual / cuneate lobe of cortex involved

86
Q

where are juxtaglomerular cells located

A

modified smooth muscle cells in afferent arteriole, near glomerulus

in close contact w/ macula densa of DCT

87
Q

3 stimuli for renin release

A
  1. decrease tubular NaCl in macula densa
  2. B1 receptor sympathetics
  3. decreased pressure in afferent arteriole
88
Q

Tamm-Horsfall glycoprotein

A

exclusively secreted by renal tubular epithelial cells of TAL

if low urine flow, can form hyaline casts

89
Q

normal albumin excretion in urine

A

< 30mg/day

90
Q

amniotic fluid acetylcholinesterase AChE

A

open neural tube defect

bc its present in blood cells, muscle, and nerve tissue

91
Q

neural tube defect, elevated..

A

AFP and AchE

92
Q

thyroxine deficiency on bone

A

usu NOT fracture

instead: pain, ache, stiff

93
Q

presentation of cystathione-beta-synthase deficiency (3)

A

homocysteinuria from methionine breakdown.
cysteine becomes essential amino acid.

  1. ectopia lentis (downward lens displacement)
  2. osteoperosis
  3. mental retardation
  4. thin, fair hair & skin: marfanoid
  5. propensity for arterial & venous thromboelmbolism
94
Q

presentation of phenylketonuria? (4)

A
  1. fair pigmentation
  2. mousy odor
  3. seizures
  4. mental retardation

mutation in phenylalanine hydroxaylase, can’t make tyrosine

95
Q

presentation of maple syrup urine disease

A

mutation in branched-chain alpha-keto acid dehydrogenase

can’t decarboxylate the alpha-keto acid derivatives of leucine, isoleucine, valine.

96
Q

proline synthesized from..

A

glutamate

97
Q

level of pancreas

A

L2

98
Q

what types of drugs cross placenta? what types of drugs do not?

A

CROSS: lipid soluble

DO NOT CROSS: water soluble

99
Q

why can heparin be given during pregnancy but not warfarin

A

heparin sulfate: charge: water soluble, will not cross placenta

warfarin: lipophilic: will cross palcenta

100
Q

what type of bilirubin can cross placenta

A

unconjugated can cross: lipid soluble

conjugated = water soluble = won’t cross

101
Q

differentiating gonorrhea vs. chlamydia infection

A

often, treat for both

gonorrhea:

  • purulent discharge
  • microscopy: multiple WBC w/ intracellular gram - cocci

chlamydia
-microscopy: neutrophils w/ NO pathogens
(bc chlamydia lacks muramic acid, won’t gram stain)
- also causes epididmyitis!

102
Q

common cause of epididymitis?

A

chlamydia

103
Q

unique feature of neisseria (gonococcal & meningococcal LPS

A

lack repeating O antigen in LPS!

104
Q

which neisseria ferments maltose & has capsule

A

meningococcus

gonococcus: NO capsule, NO maltose, NO vaccine

105
Q

difference between..
acyclovir, famciclovir & ganciclovir
vs.
zidovudine, cytarabine, vidarabine

A

acyclovir, famciclovir & ganciclovir
activated by viral kinase first (then host)

zidovudine, cytarabine, vidarabine
activated by host cell kinase

106
Q

CMS retinitis T cell count

A

<50

107
Q

PCP pneumonia T cell count

A

<200

108
Q

chloroquine mechanism

A

blocks detoxification of heme into hemozin
heme accumulates & is toxic to plasmodia

note: most falciparium -> resistant

109
Q

rx for p. falciparium

A

artemether/lumefantrine
or
atovaquone/proguanil

life threatening, use quinidine or atesunate

110
Q

what enzyme does ribavarin block

A

IMP dehydrogenase, can’t make GMP

111
Q

cidofovir & foscarnet

A

do not need viral kinase activation

112
Q

tenovovir

A

only NRTI that does not need to be phosphorylated by host kinases

is a nucleoTIDe

113
Q

smoking cessation on lung functoin

A

will stop further damage, but does not IMPROVE.

WILL decrease risk of lung cancer

is associated w/ weight gain (food to replace smoking)

114
Q

recidivism

A

resumption of harmful activity after abstinence / rehab

115
Q

what allows chicken virus to infect humans

A

often: genetic reassortment

116
Q

genetic reassortment

A

responsible for sudden shifts

2 distinct influenza strains (ie that infect diff animals) infect same cell, HA from 1 and NA from other packaged together –> new virion

novel strain of virus to which we have NO susceptibility

HA and NA are surface proteins, also targets of immune system

117
Q

antigenic drift

A

point mutations in HA and NA
slightly alters product proteins
can slightly increase infectivity, etc

gradual drift

118
Q

phenotypic mixing

A

2 viruses infect same cell

progeny have coat or envelope proteins not coded for by genetic material packaged within them

119
Q

hypoglycemia in McArdle?

A

NO
mutation in muscle glyocgen phosphorylase.

muscle glycogen doesn’t release glucose into circulation anyways.

liver glyocgen phosphorylase is fine –> no hypoglycemia

120
Q

presentation of McArdle

A

deficiency muscle glycogen phosphorylase

no hypoglycemia (bc liver fine)
muscle pain on exertion, exercise intolerance
can have myoglobinuria / renal failure
121
Q

hyperkalemia on EKG

A
  1. peaked T waves
  2. loss of P
  3. prolonged PR
  4. wide QRS

slow HR

122
Q

hypokalemia on EKG

A
  1. flattening T waves
  2. appearance of U waves
  3. ST segment depression

can cause Tdp

123
Q

hypocalcemia on EKG

A

QT prolongation

124
Q

hypercalcemia on EKG

A

QT interval shortening

T-wave flattening or inversion in severe cases

125
Q

peaked T wave

A

earliest EKG sign of hyperkalemia

126
Q

T wave flattening

A

in hyPO K+

and

hyPER Ca2+

127
Q

graves disease proptosis/exopathalmosis

A
  1. TSH antibodies stimulate fibroblasts to make GAG
  2. draws in water –> extraocular muscle EDEMA

note: NOT extraocular muscle hypertrophy

128
Q

communication between suprachiasmatic nucleus & pineal gland

A

SCN -> NE -> pineal -> melatonin

129
Q

parinaud syndrome (4)

A

pinealoma

  1. upwave gaze palsy,
  2. absent pupillary light reflex,
  3. failure of convergence,
  4. wide-based gait

superior colliculus
oculomotor & trochlear n.
edinger westphal

all involved (mass effect)

130
Q

where are stem cells located in GI system

A

crypts of Lieberkuhn

131
Q

coarse, rhythmic, postural tremor in fingers & arms of alcoholic

A

thiamine deficiency –> alcoholic cerebellar degeneration

132
Q

alcoholic cerebellar degeneration pathology

A

loss of Purkinje cells in anterior lobe & vermis

presentation:

  • wide-based gait ataxia
  • intention tremor of hands & fingers
  • rhythmic parkinsonian tremor of fingers & hands too
  • truncal instability
133
Q

medial medullary lesions cause

A
  1. contralateral spastic paralysis
  2. contralateral paresis
  3. ipsilateral CN XII (tongue) problems
134
Q

korsakoff syndrome specifically refers to

A

temporal lobe damage w/ alcoholics

135
Q

phenylephrine

A

alpha-1 agonist

increases PVR
increases systolic BP
decreases PP
decreases HR (reflex)

136
Q

dobutamin

A

B1 agonist

increase HR
increase contractility

no effect on SVR

137
Q

isoproterenol

A

nonselective B agonist

increase HR
increase contractility
increase pulse pressure
decrease PVR
decrease diastolic BP
138
Q

epinephrine

A

both alpha & beta agonist

increase HR
increase pulse pressure
decrease PVR (dominant effect on beta 2 over alpha 1)

139
Q

clonidine

A

alpha 2-agonist

decreases sympathetic outflow
decreases BP

140
Q

CAAT & TATA box

A

both promote transcription intiation
RNA pol II binding

CAAT: 80 bp upstream
TATA: 25 bp upstream

141
Q

lysyl hydroxylase deficiency

A

kyphoscoliosis variant of Ehlers-Danlos
autosomal recessive

hypermobile, hyperextensible, fragile joints

similar to vitamin C deficiency (scurvy)

142
Q

sublimation

A

convert unacceptable feelings or drives into more socially acceptable

murder -> surgeon

143
Q

stellate cells in liver

A

perisinusoidal space, store beitamin A

can differentiate into myofibroblast upon injury -> help produce fibrosis

144
Q

lambert-eaton associated w/

A

paraneoplastic syndrome of small cell lung cancer

145
Q

genetic association w/ small cell lung cancer (note 4 A’s)

A

ACTH, ADH, Autoimmune (lambert-eaton)

Amplification of myc

146
Q

genetic associated w/ adenocarcinoma

A

k-Ras, eGFR, ALK

147
Q

3 C’s of squamous cell carcinoma

A

cavitation, cigarretes, hyperCalcemia (PTHrP)

148
Q

BMI calculation

A

weight / height^2

149
Q

what antibiotic binds to 23sRNA

A

macrolides & clindamycin

maCROlides binds to twenty-THREE

150
Q

mechanism of chloramphenicol

A

binds to 50S subunit, blocks peptidyl-transferase

[does not bind to 23s)

151
Q

mechanism of macrolide & clindamycin

A

bind 23sRNA in 50S subunit
block translocation

macRO blocks transLOcation
binds to twenty-THREEsubunit

152
Q

resistance to macrolides

A

mutation in 23s rRNA subunit of 50s

153
Q

resistance to chloramphenicol

A

acetylation of antibiotic

154
Q

what topoisomerase do fluoroquinolones blocks?

A 
topo II (DNA gyrase
topo IV

(like etoposide)

155
Q

what topoisomerase dose etoposide block?

A

topo II (like fluoroquinolone)

156
Q

what topoisomerase does irinotecan, topotecan block

A

topo !

157
Q

presentation of cystic hydroma? association!

A

loose areolar tissue of head and neck, often left side

painless, compressible mass that transilluminates

when lymphatics don’t connect to venous, bud abnoramlly, or retain embryonic growth potential & expand into adjacent structures along facial planes.

associated w/ turner, trisomy 12, 13, 21!

NOT JUST TURNER

158
Q

what type of patients can have cystic groma (2)

A

turner

trisomies (13,18, 21)

159
Q

what ultimately determines amplitude of AP in neurons?

A

Nernst equation equilibrium potential for Na+

increase: w/ increase extracellular Na+ decrease intracellular Na+

160
Q

how can amplitude of AP be altered?

how can likelihood of firing be altered?

A

amplitude: equilibrium potential for Na+ (increase extracellular, decrease intracellular

likelihood of firing: bring membrane potential closer to threshold
- since K+ determines resting potential, decrease intracellular K+

161
Q

linear erythematous rash after hiking

A

suggests poisin ivy – hypersensitivity

type IV HSR

162
Q

drug-induced photosensitivity

A

SAT For Photo

sulfonamides
amiodarone
tetracylcin
5-FU

163
Q

presentation of rocky mountain spotted fiber

A

rash BEGIN: at ankles/wrists,
—->
SPREAD to TRUNK & PALM

dermacentor ticks

164
Q

where do rickettsiae live

A

obligate intracellular: need CoA and NAD+, cannot synthesize ATP

165
Q

ehrlichiosis

A

monocytes w/ morula

tick vector

166
Q

anaplasmosis

A

granulocytes w/ morulae

tick vector

167
Q

Q fever

A

no arthropod vector!
coxiella burnetti

tick feces & cattle placenta, aerosol

present: pneumonia + hepatitis

UWorld mixed (60 decks)

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