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USMLE Step 1: Part 1 COPY > USMLE Rx: Week 06/13/16 > Flashcards

USMLE Rx: Week 06/13/16 Flashcards

1
Q

By which route is cyclosporine metabolized?

A

Hepatic

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2
Q

Review the mechanism of cyclosporine.

A

Cyclosporine binds to cyclophilin and they together inhibit calcineurin. Calcineurin is a phosphatase that removes phosphate groups from NF-AT, thus activating it.

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3
Q

Clostridium difficile risk increases with __________.

A

antibiotic use

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4
Q

What two antibiotics kill Clostridium difficile?

A

Metronidazole and vancomycin

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5
Q

Cyclosporine can cause ________-toxicity.

A

nephro

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6
Q

Rheumatic fever can be caused by Streptococcus pyogenes (group A Strep.). What are the JoNES criteria that signify rheumatic fever?

A 
Joint pain
Nodules (collagenous deposits on the wrists) 
Erythema marginatum (rash that starts on the trunk and moves outward) 
Syndenham chorea (sudden jerky movements)
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7
Q

Treat symptomatic atrial fibrillation with _________.

A

Beta-blockers

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8
Q

Sarcoidosis, multiple myeloma, hemochromatosis, and radiation therapy all lead to what kind of cardiac complication?

A

Restrictive heart failure

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9
Q

Epstein-Barr virus is a ______-virus.

A

herpes

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10
Q

Tamponade leads to what ECG finding?

A

Alteration of QRS height with each beat

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11
Q

Sarcoidosis can lead to what elevated lab finding?

A

Hypercalcemia

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12
Q

Other than macrophages, what type of leukocytes are involved in the granulomas of sarcoidosis?

A

CD4

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13
Q

Sarcoidosis can cause hypercalcemia without high levels of ______________.

A

parathyroid hormone, because the extra macrophages in those with sarcoidosis convert vitamin D to its active form, thus increasing calcium absorption

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14
Q

Under normal circumstances, oxygen is a _______-limited gas. Exercising increases this, thus making oxygen more like carbon monoxide.

A

perfusion (thus, upon exercising oxygen becomes more like CO)

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15
Q

G-CSF binds to which cell receptor?

A

CD34

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16
Q

An opening snap, followed by a late rumbling diastolic murmur is characteristic of ___________.

A

mitral stenosis

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17
Q

Which type of anemia can present with neurologic symptoms?

A

B12 deficiency (not folate deficiency)

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18
Q

What inheritance pattern does hereditary spherocytosis display?

A

Autosomal dominant

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19
Q

Increased mean corpuscular hemoglobin concentration indicates which type of hematologic abnormality?

A

Hereditary spherocytosis

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20
Q

Where in the vascular circuit will the concentration of T hemoglobin be highest?

A

The peripheral capillaries, because the T form is the deoxy state

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21
Q

Which will patients with renal-artery stenosis have, hypernatremia or hypokalemia?

A

Hypokalemia, because hypernatremia usually results from decreased water intake, whereas hypokalemia results from high-aldosterone states

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22
Q

What do anti-Smith antibodies target?

A

snRNA

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23
Q

The presence of anti-nuclear antibodies is highly ________ for SLE.

A

sensitive, but not specific; almost 100% of people with lupus have this, but some have it and do not have SLE

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24
Q

How do beta-blockers affect stroke volume and mean arterial pressure?

A

They decrease both; although beta-blockers allow for more filling time, the negative inotropic effects overall decrease stroke volume.

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25
Q

CYP interactions typically only present while the drug is ____________.

A

in the system; as such, if a patient stops taking a CYP-affecting drug, then the interactions should stop

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26
Q

When do children usually potty train?

A

Age 3

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27
Q

What is the presentation of Plummer-Vinson syndrome?

A

Glossitis
Dysphagia
Iron-deficiency anemia
Esophageal web

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28
Q

Microcytic, hypochromic anemia is usually ___________.

A

iron-deficiency

29
Q

Other than aneurysms, to what are people with Ehlers-Danlos susceptible?

A

Scoliosis

Retinal detachment

30
Q

How will sepsis affect cardiac output, systemic vascular resistance, and pulmonary capillary wedge pressure?

A

CO: increased (in response to decreased tissue perfusion)
SVR: decreased (because of the cytokines released)
PCWP: decreased (because of the increased permeability of the pulmonary vasculature)

31
Q

There are four trinucleotide-repeat disorders. What are they, and what mnemonic is helpful in remembering them?

A 
Try Hunting for My Fried X
Huntington's 
Myotonic dystrophy
Friedrich ataxia
Fragile X
32
Q

What is dysarthria?

A

difficult or unclear articulation of speech that is otherwise linguistically normal

33
Q

On what chromosome is Friedrich ataxia found? What protein does that gene encode?

A 
Chromosome 9 (like Friedrich Nietzsche in the 18nine0s) 
Frataxin
34
Q

List some of the presenting signs of Friedrich ataxia?

A

Ataxia
Scoliosis
Dysarthria
Hypertorphic cardiomyopathy

35
Q

Other than treating acetaminophen overdose, what does N-acetylcysteine do?

A

It loosens mucus, and thus is used to treat cystic fibrosis.

36
Q

Although hereditary spherocytosis leads to an increased reticulocyte count, it is considered a ______-cytic anemia.

A

normocytic

37
Q

G6PD deficiency is passed on in a _________ pattern.

A

X-linked recessive

38
Q

In RBCs, the only source of glutathione is ____________.

A

G6PD

39
Q

The chief symptom of G6PD deficiency is ___________.

A

hemolytic anemia after oxidative stress

40
Q

If you have high sensitivity, then you have few _______.

A

false negatives

41
Q

If you have low specificity, then you have lots of ___________.

A

false positives

42
Q

Vitamin D undergoes two hydroxylations: first in the _______, then in the ________.

A

liver; kidney (under the influence of parathyroid hormone)

43
Q

Vitamin D deficiency will lead to low levels of ____________ and high levels of __________.

A

phosphate and calcium; parathyroid hormone

44
Q

Calcium absorption in the distal tubule is controlled by _____________.

A

parathyroid hormone

45
Q

Type III collagen is necessary for ___________.

A

vascular synthesis

46
Q

There are two types of Ehlers-Danlos syndrome: _______________.

A

classical (type V collagen; hypermobility) and vascular (type III; no joint-hypermobility)

47
Q

Describe Fanconi anemia.

A

An inherited aplastic anemia resulting from DNA repair defects; leads to short stature, bifid thumbs, and cognitive impairment

48
Q

If a patient has been receiving broad-spectrum antibiotics, which coagulation factors could be deficient?

A

All of the vitamin K-dependent ones, because vitamin K participates in enterohepatic recirculation – which is aided by bacteria; as such, factors II, VII, IX, and X could be low

49
Q

High altitude stimulates ______________ 2,3-BPG.

A

production of (which then lowers the oxygen affinity of hemoglobin by stabilizing the deoxygenated state)

50
Q

Of Sjögren and Sjögren-Larsson syndrome, which is autoimmune?

A

Sjögren syndrome (SL is a disorder of fatty-acid metabolism)

51
Q

On what chromosomes are the genes for ADPKD and ARPKD?

A

ARPKD = 6
ADPKD = 16
(Think, both have a six, and the one that presents at a younger age is smaller.)

52
Q

Which arteries communicate between the radial and ulnar branches in the hand?

A

The deep and superficial palmar arch

53
Q

Sometimes fetuses are born with only one _____________; it is a nonspecific finding that can be associated with other congenital abnormalities.

A

umbilical artery (as opposed to the normal two)

54
Q

Kidneys participate in gluconeogenesis. What is the rate-limiting enzyme there?

A

Fructose-1,6-bisphosphatase

55
Q

Describe Gilbert syndrome.

A

Gilbert syndrome results from a defect in the promoter region of the gene for uridine glucuronyl transferase; without this, bilirubin cannot be conjugated and icterus can result from fasting

56
Q

Ankylosing spondylitis and ulcerative colitis both have associations with what HLA?

A

B27

57
Q

From what aortic arch does the dutus arteriosus arise?

A

The sixth (think… having six in public [PDA] is not ok)

58
Q

Which platelet receptor normally binds fibrinogen? What drug targets this receptor?

A

GP IIb/IIIa
Abciximab
Mnemonic: think of Abbie with a six pack (abcix-) reciting “to be, or not three a” and fibbing about reading poems at Carnegie Hall

59
Q

What do the Plavix drugs (-dogrel) target?

A

ADP receptor

60
Q

What does a PF-4 positive result indicate?

A

That antibodies have been made to heparin and platelets (heparin-induced thrombocytopenia)
Mnemonic: PF = “platelets falling”

61
Q

LMWH decreases __________.

A

factor Xa

62
Q

Describe the presentation and pathophysiology of Liddle syndrome.

A

AD disorder
Constitutive expression of aldosterone-inducible ENaC channels (on the principal cells)
Leads to hypertension, low renin, and low aldosterone
Treat with triamterene or amiloride

63
Q

What enzyme is defective in Pompe disease?

A

Alpha-1,4-glucosidase; absence of this leads to glycogen deposition on the heart

64
Q

What is given with isoniazid?

A

Pyridoxine (vitamin B6), because isoniazid causes vitamin B6 deficiency

65
Q

All of the anesthetics ending in __________ can cause malignant hyperthermia.

A

-flurane

66
Q

What are two worrisome complications of malignant hyperthermia?

A

Rhabdomyolysis and arrhythmias

67
Q

What is a dromotropic effect?

A

Speed through the AV node

68
Q

What cardiac problem can some anesthetics cause?

A

The -icaine anesthetics block sodium channels and can cause AV heart block

USMLE Step 1: Part 1 COPY (243 decks)

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