USMLE-Rx: Week of 09/05/16

Question 1

Use of _________ can lead to a post-high crash with severe depression.

Answer 1

cocaine

Question 2

What three cephalosporins can treat Pseudomonas? (You actually need to know this.)

Answer 2

Cefoperazone
Ceftazidime
Cefepime

(A guy PSEDUO-PARAgliding in the end-ZONE with his ZIPper down)

Question 3

Gram negative, oxidase positive rod?

Answer 3

Pseudomonas

Question 4

What anti-psychotic drug does not have oculomotor side effects?

Answer 4

Clozapine

Question 5

One serious side effect of clozapine is ___________.

Answer 5

agranulocytosis (It claws away at your bone marrow)

Question 6

ASD presents with what cardiac sound?

Answer 6

Loud S1 with fixed-split S2

Question 7

Noncompetitive antagonists decrease ____________ of a drug.

Answer 7

the efficacy – not the potency, because the end result will be less than it otherwise would be

Question 8

There are two kinds of bipolar disorder: I and II. Which has mania?

Answer 8

Type I –the other has only hypomania

Question 9

What mnemonic can help you remember the side effects of hydrochlorothiazide?

Answer 9

HyperGLUC: high glucose, lipids, uric acid, and calcium

Question 10

What is the official name of postpartum depression?

Answer 10

Major depressive episode with peripartum onset

Question 11

How does cisplatin work?

Answer 11

It forms DNA cross links (it “plates” the DNA strands together)

Question 12

Describe the Schilling test.

Answer 12

Stage I: give a patient radioactive oral B12 with intramuscular unlabeled B12

Stage II: give a patient radioactive oral B12 with intrinsic factor

Question 13

Explain the appearance of pernicious anemia in a Schilling test.

Answer 13

In stage one of a Schilling test, a patient with PA will have a low level of radioactive B12 in their urine; this is because they are unable to get it from their stomach to their blood (whereas a person with insufficient intake of B12 will have a high level of radioactive B12 in their urine). In stage two of a Schilling test, a patient with PA will have high levels of radioactive B12 in their urine because the IF helped them get it across –recall that PA happens because antibodies are made to the parietal cells, not IF.

Question 14

What cardiovascular anomalies do girls with Turner syndrome have?

Answer 14

Preductal coarctation of the aorta and bicuspid aortic valve

Question 15

In the Ann Arbor staging, what is the difference between A and B?

Answer 15

A = asymptomatic 
B = fevers, night sweats, weight loss

Question 16

Describe the Ann Arbor staging method.

Answer 16

I = one lymph node or extralymphatic site
II = multiple lymph nodes on the same side of the body
III = multiple lymph nodes above and below the diaphragm 
IV = dissemination to extranodal site

Question 17

Explain the BEST mnemonic for the radial nerve.

Answer 17

Innervates the brachioradialis, extensors of the wrist and fingers, supinators, and triceps

Question 18

Extension of the arm is predominantly controlled by the ______ nerve.

Answer 18

radial (Can’t give a high-five? That’s not RAD.)

Question 19

Histrionic personality disorder is best described as _____________.

Answer 19

attention-seeking behaviors that present in early adulthood; commonly hypersexual; somatization also common

Question 20

Facial plethora is another name for ____________.

Answer 20

moon facies

Question 21

Other than facial plethora, centripetal weight gain, and abdominal striae, what is a common symptom of Cushing’s disease (whether iatrogenic or paraneoplastic)?

Answer 21

Poor wound healing

Question 22

What is the genetic makeup of herpesviruses?

Answer 22

linear dsDNA (you’ve got a LINE of herpes on your face)

Question 23

One of the antiarrhythmics can cause hyperthyroidism. What is the name of this medication and how does it work?

Answer 23

Amiodarone (think: amIOdarone mimics IOns and causes problems in the organ that deals with IOdine); it blocks the voltage-sensitive potassium channels, thereby prolonging the refractory period and lengthening the PR interval

Question 24

True or false: in a healthy individual at rest, the V/Q system in the lungs is diffusion limited.

Answer 24

False. Diffusion is a rapid process and the body is normally perfusion limited.

Question 25

Excessive lysine and arginine in the urine might indicate a hereditary defect in which part of the nephron?

Answer 25

The proximal-convoluted tubule; this disease, cystinuria, is a recessive disorder in which cystine, ornithine, arginine, and lysine are not reabsorbed. Kidney stones result. (Think COAL stones in the urine.)

Question 26

Drepanocyte is another name for __________.

Answer 26

sickle cells

Question 27

Howell-Jolly bodies are ________________.

Answer 27

bits of DNA usually removed by the spleen (seen in an individual s/p splenectomy); “how’ll you get rid of that DNA without your spleen?”

Question 28

What are Pappenheimer bodies?

Answer 28

Just another name for sideroblasts

Question 29

What is the difference between the mechanisms of montelukast and zileuton?

Answer 29

Zileuton is a lipoxygenase inhibitor (It ZIps the LIPs)

Montelukast is a leukotriene receptor antagonist –it MOuNTs the receptors

Question 30

What medication inhibits the transcription factor nf-kappa B?

Answer 30

Steroids

Question 31

Increased levels of 2,3-BPG do what to hemoglobin’s oxygen affinity?

Answer 31

Decrease it

Question 32

What parasite causes bladder cancer?

Answer 32

Schistosoma haematobium (the Schistosoma that causes HEMATuria)

Question 33

Differentiate the mechanisms of tacrolimus and cyclosporine.

Answer 33

Both medicines bind to an intracellular protein and then inhibit calcineurin. The key difference, however, is that cyclosporine associates with cyclophilin while tacrolimus binds with FK-binding protein 12. Both ultimately inhibit IL-2 production, therefore limiting the activation of T cells.

Question 34

How does azathioprine work?

Answer 34

It mimics purines and thence disrupts DNA synthesis.

Question 35

Other than hyperthyroidism, what other side effects does a certain class III antiarrhythmic have?

Answer 35

Pulmonary fibrosis (caused by amiodarone)

Question 36

Digoxin toxicity mimics what other toxicity?

Answer 36

Cholinergic, though with yellow vision (think Van Gogh)

Question 37

What enzymes does lead poisoning inhibit?

Answer 37

Ferrochetalase and aminolevulinic acid dehydratase (Pb2+ leads to 2 enzymes being incapacitated;

Question 38

Irregular masses in the liver are often ______________.

Answer 38

hepatocellular carcinoma

Question 39

Where do dihydropyridine calcium blockers and non-dihydropyridine blockers act?

Answer 39

Dihydro: vascular smooth muscle (there are two vascular branches –venous and arterial – so the DIHYDROs act here)
Non-dihydro: the heart has four chambers, so it is non-dihydro (i.e., it is tetrahydro)

Question 40

Which kidney is higher?

Answer 40

The left

Question 41

The kidneys lie at what approximate vertebral levels?

Answer 41

T12 - L3 (you To go #1, you need 2 kidneys)

Question 42

Azathioprine (particularly when used with __________) leads to what toxic metabolite?

Answer 42

allopurinol; 6-mercaptopurine

Question 43

What is panniculitis?

Answer 43

Inflammation of subcutaneous fat

Question 44

Erythema nodosum is what cellular process?

Answer 44

Inflammation of fat with concomitant fibrin exudation and infiltration of neutrophils

Question 45

What disorder often presents with erythema nodosum?

Answer 45

Crohn’s

Question 46

What mnemonic helps you remember the symptoms of sarcoidosis?

Answer 46

GRAIN 
Gamma globulinemia
Rheumatoid arthritis
ACE elevated
Interstitial fibrosis 
Noncaseating granulomas

Question 47

First-line treatment of sarcoidosis includes ___________.

Answer 47

steroids

Question 48

“Parkinson’s and schizophrenia can be thought of as lying on the same continuum.” Explain this.

Answer 48

Parkinson’s is thought to arise from insufficient dopamine, while schizophrenia is thought to arise from too much dopamine. Many antipsychotics try to lower dopaminergic activity, and can even cause Parkinson’s if used for a long time.

Question 49

The testicles should normally rise if you stroke the inner part of the thigh. If they don’t, blood supply to what muscle might be occluded?

Answer 49

The internal oblique (which becomes the cremaster in the scrotum)

Question 50

Typical antipsychotics block the ____________ receptors.

Answer 50

dopamine

Question 51

Atypical antipsychotics block ______________.

Answer 51

both serotonin and dopamine receptors

Question 52

Describe the presentation of antisocial personality disorder.

Answer 52

Criminality, lack of remorse for others’ rights and feelings, conning others –all present before age 15

Question 53

Someone with antisocial personality disorder is likely to have which other problem?

Answer 53

Substance abuse

Question 54

Cyclosporine ultimately works to ______________.

Answer 54

stop the production of IL-2 and its receptor, thereby blocking the differentiation and activation of T cells

Question 55

Explain the psychiatric phenomenon of splitting.

Answer 55

Splitting is when someone divides things as all-good or all-bad; for example, someone might say “that nurse is the ONLY person who understands me… no one else does!”

Question 56

Self-harm, suicide attempts, drug use, and splitting are characteristic of what psychiatric disorder?

Answer 56

Borderline-personality disorder

Question 57

What protein is elevated in yolk sac tumors? What other cancer expresses this marker?

Answer 57

Alpha-fetoprotein

Hepatocellular carcinoma

Question 58

What nephritic syndrome might present with a maculopapular rash?

Answer 58

IgA nephropathy (what is the systemic version called???)

Question 59

What medication can treat enuresis?

Answer 59

Desmopressin

Question 60

In acid base disturbances, how can you differentiate the effects of excessive vomiting from excessive diarrhea?

Answer 60

Vomiting leads to loss of HCl and thus an increase in blood pH, while diarrhea leads to loss of bicarb and a decrease in pH.

Question 61

Why is there visual disturbance and headache in someone with the disorder that presents with high IgM?

Answer 61

Waldenström macroglobulinemia leads to viscous blood that prevents flow, thus producing headaches and visual problems.