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USMLE Step 1: Part 1 COPY > USMLE-Rx: Week of 09/12/16 > Flashcards

USMLE-Rx: Week of 09/12/16 Flashcards

1
Q

The drug that upregulates lipoprotein lipase also has what side effects?

A

Myopathy and cholesterol gallstones

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2
Q

What muscles are involved in abduction of the arm?

A

The supraspinatus performs the first part, and the deltoid takes over past 15 degrees. If the supraspinatus is torn –and it is the most commonly torn rotator cuff –then people often need help getting their arm going, but they can lift it fine after the assistance.

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3
Q

As you know, thiazides can cause four main side effects. What is the mnemonic hyperGLUC, again?

A 
Hyper- 
glycemia
lipidemia
uricemia
calcemia
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4
Q

In addition to necrotic cores, glioblastomas also display what histologic feature?

A

Pseudopalisading

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5
Q

Bouchard’s nodes are only found in ______________.

A

osteoarthritis

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6
Q

What defining test can diagnose antiphospholipid antibody syndrome?

A

Mixing with 1:1 FFP; the elongated PT and PTT will not correct

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7
Q

Ground-glass opacity = ______________.

A

interstitial pneumonia

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8
Q

How is desquamative interstitial pneumonia distinct from UIP?

A

There is no honeycombing in DIP; it is a rare disorder that affects middle-aged smokers – treated with steroids and smoking cessation.

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9
Q

What does ATP do in the actin/myosin cycle?

A

It allows myosin to release from actin.

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10
Q

Review the ATP/actin/myosin cycle.

A

1) Myosin is bound to actin
2) ATP binds myosin, causing release of actin by myosin
3) ATP is hydrolyzed, causing the myosin head to cock forward
4) Myosin binds actin, the act of which causes Pi to dissociate from the myosin head
5) The release of Pi causes the power stroke, which itself causes ADP to dissociate

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11
Q

What might be a cause of uric-acid stones?

A

Increased cell turnover –such as in cancer

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12
Q

How do beta-blockers affect end-diastolic volume and ejection time?

A

They can increase EDV in the setting of an MI, but in a healthy patient there is no effect – and may even decrease it (because of the decreased cardiac output).

The ejection time is increased because the heart rate is slower.

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13
Q

What is Conn syndrome?

A

Primary hyperaldosteronism

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14
Q

On what two receptors does ADH act?

A

V2: stimulating more aquaporins
V1: stimulating vasoconstriction

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15
Q

What is the difference between cluster A personality disorders and cluster B personality disorders?

A

Cluster A: inability to develop meaningful social bonds or impaired social function that is not due to psychosis – Awkward, Aloof, Accusatory

  • Paranoid: pervasive distrust
  • Schizoid: distant, content with social isolation, voluntarily withdrawn
  • Schizotypal: magical thinking, odd beliefs, eccentric clothing

Cluster B: dramatic, wild, moody (Bad to the Bone)

  • Histrionic: attention seeking, sexually provocative
  • Borderline: self-mutilation, emptiness, splitting
  • Antisocial: sociopathic, must have conduct disorder before age 15
  • Narcissistic: grandiosity, sense of entitlement, reacts to criticism with rage
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16
Q

Delusional disorder is not a personality disorder. How is it different from paranoid disorder?

A

Because paranoid disorder is a cluster A personality disorder, it is characterized as lifelong; its diagnosis requires longstanding paranoia and delusions. Delusional disorder, on the other hand, is characterized by a sudden onset. Also, paranoid personality disorder is pervasive and delusional disorder is specific (that is, a specific story or false belief that the person has).

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17
Q

Briefly discuss the embryology of the kidney.

A

Structurally derived from mesoderm, the kidneys first develop as the pronephros (which are never functional and disappear by week 5). The mesonephros then develop and function as the kidneys for the first trimester. Finally, the ureteric bud branches off of the caudal end of the mesonephros and interacts with nearby mesodermal tissue that becomes the metanephric blastema. The blastema becomes the kidney parenchyma from the glomerulus to the DCT.

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18
Q

The Müllerian ducts are also called the ______________.

A

paramesonephric ducts (think of a PARAchute made of a uterus–which the Müllerian duct becomes)

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19
Q

In the presence of Müllerian inhibitory factor, what does the paramesonephric duct become?

A

The appendix testes and the prostatic utricle

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20
Q

How do infants appear in hemolytic neonate syndrome?

A

Hepatosplenomegaly (due to excess hematopoiesis)

Ascites (from liver blockage)

Edema (see above)

Engorged placenta (due to hemolysis occurring here)

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21
Q

In what disorder does a mucoid exudate form a cast of the lungs?

A

Asthma (this description could also apply to CF, given how they present)

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22
Q

Stable angina presents with stenosis of greater than __________ percent.

A

70

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23
Q

Although St. John’s wort decreases the effectiveness of most drugs that it interacts with, there is a big exception. What is it?

A

SSRIs –in which it can lead to serotonin syndrome

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24
Q

There are two disorders that can affect alcoholics who stop drinking. What are they?

A

Alcoholic hallucinosis: seeing hallucinations in the absence of autonomic symptoms; occurs within the first day

Delirium tremens: hallucinations with autonomic symptoms (such as diaphoresis, tachycardia, and hypertension); develops 2 - 5 days after cessation of drinking

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25
Q

The coagulopathy that presents with enlarged platelets has what inheritance pattern?

A

Autosomal recessive (this is Bernard-Soulier)

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26
Q

True or false: there are three types of structural defects that can cause Eisenmenger syndrome.

A

True!

ASD, VSD, PDA

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27
Q

Describe the pathophysiology of tricuspid atresia.

A

The right atrium fails to develop, leading to a hypoplastic right heart and a right-to-left shunt via a VSD; presents with cyanosis at birth

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28
Q

Patients with Turner syndrome have decreased levels of what?

A

Estrogen

29
Q

Trace the heme synthesis pathway and note the disorders that can occur.

A

1) Glycine + succinyl CoA + B6 -> aminolevulinic acid (by ALA synthase –defect of which leads to X-linked sideroblastic anemia) *** rate-limiting step
2) ALA -> porphobilinogen (by ALA dehydratase –inhibited by lead)
3) Porphobilinogen -> hydroxymethylbilane (by porphobilinogen deaminase –defect of which causes acute intermittent porphyria)
4) Hydroxymethylbilane -> uroporphyrinogen III
5) Uroporphyrinogen III -> coproporphyrinogen (by uroporphyrinogen decarboxylase –defect of which leads to porphyria cutanea tarda)
6) Coproporphyrinogen -> protoporphyrin
7) Protoporphyrin -> Heme (by ferrochetalase –also inhibited by lead)

30
Q

A patient who presents with physical pain that leads to much anxiety and depression should be recommended what treatment?

A

CBT, SSRIs, and SNRIs (this is somatic symptom disorder –analgesia is not usually helpful)

31
Q

A middle-aged woman presents with an eczematous lesion of the nipple. Under histologic examination it appears with large, clear cells that look like halos; their nuclei are hyperchromatic. This woman likely has ____________.

A

mammillary Paget disease

32
Q

Potassium-channel-blocking drugs prolong which phase of the action potential?

A

Phase 3 (the steep repolarization is slowed and made less steep by agents like amiodarone)

33
Q

A patient with abdominal pain and gingival lines should be given what antidote?

A

Dimercaprol –the antidote for lead poisoning (common in construction workers)

34
Q

Restrictive lung diseases and obstructive lung diseases are, by many pulmonary function tests, opposites. In what two values are they the same, though?

A

Vital capacity is down in both (in OLDs because you can’t get enough air out and in restrictive lung diseases because you can’t get enough air in). For the same parenthetical reasons, inspiratory reserve volume is also down in both conditions.

35
Q

Glucose-6-phosphate dehydrogenase produces the substrate for what enzyme?

A

Glutathione reductase

36
Q

Painful muscle spasm of the neck is called _________.

A

torticollis

37
Q

Haldol blocks what neurotransmitter?

A

Dopamine (hence why it is given to patients with exces of dopaminergic systems – such as schizophrenia)

38
Q

Blockade of dopamine in the CNS can lead to ______________.

A

unopposed cholinergic activity (necessitating administration of benztropine)

39
Q

Angiotensin II preferentially constricts the _________.

A

efferent arteriole

40
Q

TRAP is an example of a ___________. It is found in __________.

A

fetoprotein; tartrate-resistant acid phosphatase (TRAP) –a B cell neoplasm

41
Q

Notably, not having thiamine can lead to what serum abnormalities?

A

Increased lactic acid and low pH; thiamine is a cofactor for the enzyme pyruvate dehydrogenase, without which lactic levels will rise due to another pathway

42
Q

AIDS patients can inhale particles that lead to a pneumonia that stains with India ink. What organism is this usually, and what side effects does the main therapeutic agent cause?

A

Cryptococcal pneumonia (a kind of yeast that is very round on microscopic examination); treat with amphotericin B – can cause fevers, chills, and low levels of calcium, magnesium, and potassium

43
Q

In what situations might you prescribe digoxin and furosemide to a patient?

A

In a patient with refractory hypertension (who has been compliant with ACEIs, ARBs, and beta-blockers); digoxin and furosemide can induce arrhythmias due to their effects on potassium, so use with caution

44
Q

How does the drug that turns bodily fluids orange work?

A

Rifampin works by inhibiting DNA-dependent RNA polymerase

45
Q

Why might OCPs not work in a patient from a third-world country?

A

The tuberculosis rate is much higher in people from developing countries; women who test positive need to take rifampin, which is an INDUCER of the CYP450 system. OCPs are also metabolized this way, so induction will lead to a lower effective dose of OCPs.

46
Q

Stretching or damaging what trunk leads to the “claw hand” palsy?

A

Lower (C8 and T1)

47
Q

True or false: the faster metabolizing benzodiazepines have low risk of CNS depression.

A

True! Oxazepam, midazolam, alprazolam, and triazolam have low risk of CNS depression. The risk of dependence goes up with short half life, however.

48
Q

What is a key pharmacodynamic difference between direct and indirect sympathomimetics?

A

Direct sympathomimetics bind to the postsynaptic neurons and don’t enter the CNS; this is how they can stimulate specific peripheral effects without causing diffuse activation.

Indirect sympathomimetics work at the presynaptic neurons (in the CNS) and tend to cause diffuse activation with many undesirable effects.

49
Q

Why does bone density decrease in those with chronic renal disease?

A

Because the elevated phosphate leads to decrease production of 1,25-dihydroxycholecaliciferol (from its precursor 25-hydroxyvitamin D), which then stimulates decreased calcium absorption. This stimulates parathyroid hormone to pull calcium from bone.

50
Q

What medication used in treating bipolar disorder can cause birth defects?

A

Lithium –it causes Epstein anomaly (a feature in which the tricuspid valve is displaced inferiorly – think of how lithium makes people feel numb… “their hearts fall out”)

51
Q

What organism causes osteomyelitis most often in the general population? What about in sickle-cell patients?

A

General population: S. aureus

Sickle-cell: salmonella

52
Q

A Japanese man has hepatosplenomegaly. What might his cells look like under the microscope?

A

“Flower” cells – like little spike balls –are characteristic of ATL

53
Q

A common antihypertensive leads to cough mediated by overproduction of a cytokine. What else does that cytokine cause?

A

Bradykinin can also cause a diffuse, erythematous and pruritic rash

54
Q

Diagnosis of schizophrenia requires two things: _______________.

A

either two positive symptoms (hallucinations, delusions, disorganized speech, etc.), or one positive and one negative (such as flat affect)

55
Q

Falsely believing that things or people are directed toward oneself is called ____________.

A

an idea of reference

56
Q

Exemestane is an __________ inhibitor, which prevents the __________________.

A

aromatase; conversion of testosterone to estradiol

57
Q

Which histamine receptor mediates the symptoms of allergic reaction?

A

H1 (“say h1 to allergy season”)

58
Q

What pathologic process is IV endocarditis similar to?

A

Pulmonary embolism, because they give off septic emboli

59
Q

Streptococcus pneumoniae produces what characteristic sputum?

A

Rusty –give a Z pack

60
Q

According to ACLS protocol, which drugs should be given to someone with ventricular fibrillation that fails to correct with defibrillation?

A

Epinephrine and amiodarone

61
Q

What radiographic sign is characteristic of atypical pneumonias?

A

“Fluffy”

62
Q

The macrolides inhibit a specific part of the 50S subunit. What is it called?

A

The 23S subunit

63
Q

Liver metastases most commonly come from ____________.

A

the colon (because of the abundant blood supply that passes from the colon to the liver)

64
Q

What drug used to treat a circular skin infection has CYP-inhibiting effects and inhibits an androgen enzyme?

A

Ketoconazole – can lead to skin hyperpigmentation as in Addison’s disease

65
Q

Fluorescent tests for treponemal antibody might be present in those with what cardiovascular condition?

A

Calcified aortas (treponemas are syphilis)

66
Q

What bone-forming step is impaired in those with the most common type of dwarfism?

A

In achondroplasia, the chondrocytes fail to develop. Chondrocytes lay down a cartilaginous template on which osteoblasts secrete osteoid. Without them, this process does not occur.

67
Q

Severing the posterior cord of the brachial plexus leads to what movement deficits?

A

The posterior cord provides the axillary and radial nerves. As such, abduction and the extensor muscles of the wrist will fail.

68
Q

What might you see in the retina of someone with endocarditis?

A

Roth spots –bits of septic emboli

USMLE Step 1: Part 1 COPY (243 decks)

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