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USMLE Step 1 Facts > USMLE Step 1 > Flashcards

USMLE Step 1 Flashcards

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1
Q

Most common causes of Meningitis in Older Pts

A 
S. pneumoniae
N. meningitis 
H. influenzae type b
S. agalactiae (group B)
L. monocytogenes
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2
Q

Metronidazole adverse reaction

A

disulfiram-like reaction (pt should avoid alcohol)

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3
Q

bacterial vaginosis

A

organism: G. vaginalis
clinical findings: gray watery discharge, vaginal pH > 4.5, positive KOH whiff test
Microscopic findings: clue cells
treatment: metronidazole

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4
Q

Trichomoniasis

A

clinical findings: green-yellow discharge, strawberry cervix, dyspareunia
Vaginal pH: > 4.5
microscopy: motile trichomonads
treatment: metronidazole

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5
Q

vulvovaginal candidiasis

A

clinical findings: thick white discharge
vaginal pH: <4.5
microscopy: pseudohyphae
treatment: fluconazole

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6
Q

Vitamin C is a cofactor for what reaction?

A

It is a cofactor the propyl hydroxylase. It catalyzes the formation of hydroxyproline and hydroxylysine from proline and lysine. This relates to the development of symptoms seen in scurvy

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7
Q

ALK

A

adenocarcinoma of the lung

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8
Q

BRAF

A

melanoma, non Hodgkin lymphoma, papillary thyroid

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9
Q

c-MYC

A

Burkitt lymphoma

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10
Q

HER2/neu

A

breast and gastric carcinomas

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11
Q

JAK2

A

chronic myeloproliferative disorders

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12
Q

KRAS

A

colon cancer, lung cancer, pancreatic cancer

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13
Q

RET

A 
MEN 2A (pheochromocytoma, medullary thyroid, parathyroid)
MEN 2B (pheochromocytoma, medullary thyroid, mucosal neuromas), papillary thyroid cancer
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14
Q

APC

A

colorectal cancer (associated with FAP)

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15
Q

BRCA1 and BRCA2

A

breast and ovarian cancer

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16
Q

MEN1

A

MEN1 (pituitary, parathyroid, pancreatic)

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17
Q

NF1

A

NF1 (cafe au leit spots, leisch nodules, fibrodysplasia of bone, pernicious puberty)

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18
Q

NF2

A

NF2 (meningeoms, schwannomas, ependymomas)

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19
Q

Rb

A

retinoblastoma and osteosarcoma

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20
Q

TP53

A

Li-Fraumeni syndrome; associated with most cancers

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21
Q

VHL

A

von Hippel-Lindau disease (renal cell carcinoma, cardiac rhabdomyosarcoma, liver cysts)

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22
Q

What drug class is used for cervical ripening?

A

Prostaglandin analogs (-prost)

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23
Q

Treatment for Lyme disease

A 
doxycycline
amoxicillin (pregnant women and children younger than 8 years old)
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24
Q

Penicillin MOA

A

block transpeptidase cross-linking of peptidoglycan in the cell wall

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25
Doxycycline (tetracycline) MOA
blocks attachment of aminoacyl-tRNA at the 30S ribosomal subunit
26
Clindamycin MOA
blocks translocation at the 50S ribosomal subunit
27
Vancomycin MOA
inhibits cell wall peptidoglycan formation by binding the D-Ala-D-Ala portion of the cell wall
28
What class of diuretics can lead to hypercalcemia?
Thiazide diuretics (eg chlorthalidone). Decreased intracellular Na activates the Na/Ca antiporter. Leads to decreased intracellular Ca which causes enhanced calcium reabsorption within the convoluted tubule
29
Osteoprotegerin MOA
Acts as a physiologic decoy receptor that decreases binding of RANK-L to RANK. Inhibition of this reduces differentiation and survival of osteoclasts
30
A-I
HDL
31
B-48
chylomicrons, chylomicron remnants
32
B-100
IDL, LDL, VLDL
33
C-II
HDL, IDL, VLDL, chylomicrons
34
Apolipoprotein E
HDL, IDL, VLDL, Chylomicrons, chylomicron remnants
35
Acute Intermittent Porphyria
Affected enzyme: porphobilinogen deaminase | accumulated substrate: porphobilinogen and aminolevulinic acid (ALA)
36
Clinical presentation of acute intermittent porphyria
abdominal pain polyneuropathy port wine colored urine psych disturbance
37
Exacerbation of acute intermittent porphyria
alcohol, tobacco, P-450 inducers
38
Porphyria cutanea tarda
affected enzyme: uroporphyrinogen decarboxylase risk factor: Hep C accumulated substrate: uroporphyrin
39
Clinical presentation of porphyria cutanea tarda
blistering cutaneous photosensitivity hyperpigmentation tea-colored urine symptoms exacerbated by alcohol
40
Switch to what drug following HIT?
alternative non-heparin, non-warfarin anticoagulants. This can include direct thrombin inhibitors and indirect factor Xa inhibitors
41
Mirtazapine MOA
alpha2 antagonist, 5-HT2 and 5-HT3 antagonist, H1 antagonist
42
acetaminophen
N-acetylcysteine (NAC)
43
anticholinergic toxicity
physostigmine (AChE inhibitor, crosses BBB)
44
Benzodiazepines
flumazenil
45
beta blockers
atropine | glucagon
46
carbon monoxide
100% O2
47
cyanide
nitrite + thiosulfate
48
digoxin
anti-digoxin antibody fragments
49
heparin
protamine sulfate
50
lead
dimercaprol EDTA succimer (for children)
51
Methanol and ethylene glycol
fomepizole ethanol dialysis
52
methemoglobin
methylene blue | vitamin C
53
opioids
naloxone
54
salicylates
sodium bicarbonate | dialysis
55
serotonin syndrome
dantrolene (also for malignant hyperthermia)
56
TCAs
sodium bicarbonate
57
warfarin
vitamin K | fresh frozen plasma (if rapid reversal is needed)
58
Urea cycle produces what amino acid
arginine
59
Albendazole MOA
inhibition of microtubule synthesis by inhibiting tubulin polymerization
60
Treatment for latent TB
9 month course of isoniazid monotherapy
61
treatment for active TB
9 month course of rifampin, isoniazid, pyrazinamide, and ethambutol
62
Treatment for hypertensive emergency and MOA
Nitroprusside: increases cGMP via direct release of NO Fenoldopam: dopamine D1 agonist
63
diagnosis of A. lumbricoides
visualization of characteristic eggs in concentrated stool samples
64
Function and associations of Apolipoprotein E
* Clearance of lipoprotein and chylomicron remnants from circulation * IDL,HDL,VLDL, chylomicrons and chylomicron remnants * associated with late-onset Alzheimer disease * type 3 familial dyslipidemia
65
function of apolipoprotein A-I
* structural protein for HDL | * activation of LCAT
66
Apolipoprotein B-48
required for the assembly and secretion of chylomicrons | *chylomicrons and chylomicron remnants
67
Apolipoprotein B-100
* LDL, IDL, VLDL * assembly and secretion of VLDL * type 2 familial dyslipidemia
68
apolipoprotein C-II
* cofactor for lipoprotein lipase | * dysfunction leads to type 1 familial dyslipidemia
69
Functions of Vitamin C
antioxidant collagen synthesis conversion of dopamine to norepinephrine facilitates iron absorption
70
Treatment for MDD
first line: cognitive behavioral therapy, SSRI | second line: bupropion (contraindicated in a pt with hx of seizures
71
Differentiate between failed regression of allantois and vitelline duct.
allantois: urinary leakage through the umbilicus | vitelline duct: purulent or feculent umbilical drainage
72
Marfan syndrome
pathology: AD, FBN1 gene, chromosome 15
73
Marfan syndrome clinical presentation
major criteria: ectopia lentis (up and out), dilation of aortic root, aortic dissection mitral valve prolapse in majority of pts
74
Adverse effect of Mannitol
Pulmonary edema heart failure dehydration electrolyte imbalance
75
What drug/drug class would enhance the effects of levodopa/carbidopa?
Selegiline (MAO-B inhibitor) slows metabolism of levodopa. Avoid use if pt is on an SSRI
76
Signs of decreased synthetic function of the liver
* decreased albumin * increased PTT * increased unconjugated bilirubin
77
Which inflammatory cytokines cause an increase in levels of acute phase reactants?
IL-6, IL-1, and TNF-alpha
78
IL-1
secreted by: macrophage | USMLE association: causes inflammation
79
IL-6
secreted by: macrophage | USMLE association: increase ESR and CRP
80
TNF-alpha
secreted by: macrophage | USMLE association: cachexia in malignancy, maintain granulomas in Tb
81
IL-8
secreted by: macrophage | USMLE: association: recruits neutrophils
82
IL-12
secreted by: macrophage | USMLE association: activated NK cells
83
IL-2
secreted by: all T cells | USMLE association: stimulate T cell and NK cell proliferation
84
IL-3
secreted by: all T cells | USMLE association: growth and differentiation of bone marrow stem cells
85
Interferon-gamma
secreted by: Th1 cells | USMLE association: stimulates macrophages, stimulates granuloma formation, activate NK cells
86
IL-4
``` secreted by: Th2 cells USMLE association: T cell differentiate into Th2 cells, class switching of antibodies ```
87
IL-5
secreted by: Th2 cells | USMLE association: growth and differentiation of eosinophils
88
IL-10
secreted by: Th2 cells | USMLE association: IL-10 and TGF-beta are the main anti-inflammatory cytokines
89
Topoisomerase inhibitors: drug name and target
etoposide: II teniposide: II irinotecan: I topotecan: I
90
Muscle activity involved in micturition
Relaxation of the levator ani muscles and contraction of detrusor muscle
91
Hunter syndrome
inheritance: x-linked recessive pathophysiology: deficiency of iduronate-2-sulfatase accumulated substance: heparan sulfate and dermatan sulfate
92
Why can't newborns synthesize vitamin K?
Lack intestinal flora that are seen in adults. Will have bleeding issues and require IM vitamin K injections after birth
93
Clinical features of Digeorge syndrome
CATCH-22 * cardiac defects * abnormal facies * thymic dysplasia * cleft palate * hypocalcemia
94
Folate deficiency clinical features
* megaloblastic anemia without neurologic symptoms (differentiate from B12) * in pregnancy, neural tube defects * hyper segmented neutrophils * increased homocysteine
95
Niacin (B3) deficiency clinical features
diarrhea, dermatitis, dementia | glossitis
96
Vitamin A deficiency clinical features
Nyctalopia (night blindness) xeropthalmia keratomalacia complete blindness
97
Wet beriberi clinical features
``` B1 deficiency cardiovascular symptoms leg swelling dyspnea jugular vein distention high output heart failure ```
98
Dry beriberi clinical features
``` B1 deficiency peripheral nervous system symptoms ataxia weakness loss of DTRs paralysis ```
99
Wernicke Encephalopathy clinical features
``` B1 deficiency Seen in alcoholics Paralysis of eye movements Abnormal gait Deranged mental functioning Korsakoff syndrome; confabulation ```
100
Pyridoxine (B6) deficiency clinical features
``` Seborrheic dermatitis Atrophic glossitis Angular cheilitis Conjunctivitis intertrigo neurologic symptoms: somnolence, confusion, peripheral neuropathy ```
101
Cobalamin (B12) deficiency clinical features
Megaloblastic anemia with neurologic symptoms Fatigue Ataxia Cognitive deficits hyper segmented neutrophils increased homocysteine and methylmalonic acid
102
Vitamin C deficiency clinical features
easy bruising | bleeding from gums
103
Vitamin E deficiency clinical features
``` Peripheral neuropathy Ataxia Myopathy Retinopathy Poor immune response Hemolytic anemia ```
104
Vitamin K deficiency clinical features
Bleeding Prolonged PT and PTT affects factors 2, 7, 9, 10
105
What genetic mutation predisposes pt to adenocarcinoma of the lungs
ALK gene overexpression
106
MOA of amoxicillin
block transpeptidase cross-linking of peptidoglycan in the cell wall used to treat Lyme disease in pregnant women and children younger than 8 years old
107
Which class of medication can lead to hypercalcemia?
thiazide diuretics (HCTZ and chlorthalidone)
108
Apo A-I
HDL
109
Apo B-48
Chylomicron, chylomicron remnants
110
Apo B-100
IDL, LDL, VLDL
111
Apo C-II
HDL, IDL, VLDL, chylomicrons
112
Apo E
HDL, IDL, VLDL, Chylomicrons, Chylomicron remnants
113
Treatment Acute Intermittent Porphyria
Dextrose | Hemin
114
If pt presents with muscle pain and weakness in the setting of hypokalemia what drug most likely caused this?
Thiazide diuretics other lab abnormalities include hyperuricemia, hyperglycemia, hypercalcemia, and dyslipidemia Need to replace with a potassium sparing diuretic
115
3 diagnostic markers of UTI
1. positive leukocyte esterase 2. positive nitrite test (indicates reduction of urinary nitrates by gram-negative bacteria) 3. urine white blood cells
116
urine pH >8.5 is indicative of?
infection caused by urease-producing organism such as Proteus, S. saprophyticus, or Klebsiella
117
Increased LAP score is associated with?
leukemoid reactions | leukemias typically have a low LAP score
118
How does procalcitonin help determine what is causing the infection?
levels are typically normal in the setting of a viral infection levels rise to detectable levels with bacterial infections
119
Adverse effects of Amphotericin B
``` Nephrotoxicity Renal Tubular Acidosis Arrhythmias Anemia Hypotension Fever, chills, vomiting ```
120
Krabbe Disease: etiology, clinical features, histo
etiology: accumulation of galactocerebroside clinical features: developmental delay, feeding difficulty, seizures, peripheral neuropathy, optic atrophy Histo: multinucleated globoid cells
121
Heparin primarily affects what test?
PTT (12, 11, 9, 8, 10, 5)
122
Warfarin primarily affects what test?
PT (7, 10, 5)
123
Antibiotic treatment for acne
first line: doxycycline | use minocycline instead if pt requires being outside for extended periods of time
124
which element is found only in gram-negative bacterial cell membranes?
lipopolysaccharide | this is what keeps the stain out making it gram negative
125
Which bacteria acquires its toxin by specialized transduction by a lysogenic bacteriophage?
Cholera
126
Which vitamin is predominantly stored in the liver?
vitamin B12 (cobalamin)
127
Individuals who have a long history of using insecticides have been exposed to what which has caused what disease?
Rotenone | Parkinson disease
128
How to differentiate between the two groups of local anesthetics
amide: i before -caine ester: no i before -caine
129
Enzyme and reactions involved in Lesch-Nyhan syndrome
enzyme: HGPRT Reactions: guanine --> GMP hypoxanthine --> IMP
130
Name the drugs that cause gynecomastia
``` DISCO Digitalis Isoniazid Spironolactone Cimetidine, ketoconazole Oestrogen/anti-testosterone ```
131
Treatment for organophosphate poisoning
Atropine: inhibition of muscarinic receptors Pralidoxime: reactivation of AChE Supportive care
132
Use subluxation of lens to determine disease
Up and out: Marfan syndrome | Down and in: Homocysteinuria
133
Linezolid is contraindicated on pts taking what medication?
SSRIs due to linezolid having weak activity as a MAO-I and could lead to serotonin syndrome
134
Classification and treatment of intermittent asthma
1. daytime symptoms < 2 times per week 2. < 2 nocturnal awakenings per month 3. ability to carry out normal activities without interference by asthma symptoms SABA (beta 2): causes bronchial smooth muscle relaxation
135
Cyclosporine: MOA, what is it used to treat, and adverse effects
MOA: calcineurin inhibitor Tx: steroid-resistant nephrotic syndrome Adverse: nephrotoxicity, headache, and GI upset
136
First line treatment for focal and focal tonic-clonic seizures
Prolonging inactivation of Na channels in rapidly firing nerves 1. Carbamazepine (agranulocytosis) 2. Phenytoin (gingival hyperplasia)
137
Clinical features of hereditary fructose intolerance
AR deficient in fructose 1-phosphate aldolase (aldolase B) Pt needs to avoid fructose and sucrose in their diets
138
Clinical features of Vitamin A toxicity
dry scaly skin, nausea, vomiting, and blurry vision | Can be a side affect of a pt on isotretinoin
139
Pathophysiology of toxic shock syndrome caused by S. aureus
Cytokine storm secondary to unregulated activation of T-cells. TSST-1 binds to MHC class II and TCRs
140
WHO guidelines for treatment of P. falciparum
Artemisinin-based combination therapy (ACT). Most common is dihydroartemisinin and piperaquine
141
Treatment and MOA of malignant hyperthermia
dantrolene: inhibition of calcium release from the sarcoplasmic reticulum
142
Adverse effects of TCAs
dry mouth and other symptoms consistent with anti-cholinergic properties
143
Clinical presentation of Measles
3 C's: cough, conjunctivitis, and coryza Koplik's spots: clustered white lesions on the buccal mucosa Maculopapular, erythematous rash covering the whole body Give live attenuated vaccine
144
What drugs can precipitate digoxin toxicity?
Verapamil and diltiazem (CCB)
145
Where in the cell does gluconeogenesis occur?
cytoplasm and mitochondria
146
What medications are contraindicated in the treatment of Mono?
Amoxicillin or ampicillin
147
Virulence factor of Neisseria species
Antigenic variation of pili
148
How does Hep B facilitate infection by Hep D virus?
Production of proteins that coat HDV viral particles. Hep D cannot complete virion assembly and secretion independently
149
Pt presents with diffuse abdominal pain, urine that is red in color, and urine shows elevated levels of porphobilinogen. What is the diagnosis?
Acute intermittent porphyria
150
What accumulates in urine in a pt with lead poisoning? What enzymes are blocked?
ALA and coproporphyrin | ferrochelatase and ALA dehydratase
151
MOA and adverse effects of Ethambutol
MOA: inhibit arabinosyl transferase, interfering with the mycobacterial cell wall Adverse: visual problems including lack of acuity and color blindness
152
Adverse effects seen with Myco Tb drugs (RIPE ON GO)
Rifampin: orange sweat, urine, and tears Isoniazid: neuropathy, B6 deficiency, Drug induced SLE, hemolysis in G6PD deficiency pyrazinamide: gout, hepatotoxicity Ethambutol: optic neuritis, visual problems, lack of acuity, and color blindness
153
Production of what is decreased in carnitine deficiency?
Acetyl-CoA and Ketone bodies
154
What drug is used to prevent side effects seen with using Doxorubicin?
dexrazoxane is an FDA approved cardioprotective agents used to prevent some of the side effects of anthracyclines
155
MOA of dobutamine
enhance contractile ability of the heart by acting as a beta 1 agonist Beta 1 = Gs = increased cAMP
156
Clinical presentation of infective endocarditis
-fever -clubbing of the distal fingers -Roth spots (on retina) -Osler nodes Janeway lesions (palms and soles) -Petechiae -Splinter hemorrhages
157
Clinical Presentation of McArdle's disease
- muscle cramping | - myoglobinuria with strenuous exercise
158
How does MRSA become resistant to methicillin
Altered penicillin binding protein
159
Adverse effects of Sildenafil (used to treat ED)
- "blue vision" | - blurred vision
160
What enzyme is deficient and what accumulates in pts with Tay-Sachs disease?
Enzyme: hexosaminidase A Accumulation: GM2 ganglioside
161
What is the most feared complication of a chronic infection with Onchocerca volvulus?
Blindness
162
Enzyme deficient in McArdle's disease
skeletal muscle glycogen phosphorylase
163
Clinical presentation of Porphyria cutanea tarda
- deficiency of uroporphyrinogen decarboxylase leading to accumulation of uroporphyrin in the urine - cutaneous blisters - liver involvement
164
Shape of crystals seen in a pt with Cystinuria
hexagonal crystals "6tinuria"
165
Enzyme deficient in PKU
phenylalanine hydroxylase leading to an accumulation of phenylalanine and phenylpyruvate
166
Clinical presentation of PKU
- fair skin - eczema - musty body odor or diaper
167
Caplan's syndrome is seen only in patients with these two diseases at the same time
rheumatoid arthritis and pneumoconiosis related to coal, asbestos, and silica exposure
168
Clinical presentation of lactose intolerance
abdominal pain, bloating, diarrhea, and a decreased stool pH
169
Diagnostic findings of Lactose Intolerance
1. Positive hydrogen breath test 2. Decreased stool pH: <5.5 normal ~6.0 3. Increased stool osmolarity 4. Intestinal biopsy will show that the pt has normal-appearing villi
170
Clinical features of chronic mesenteric ischemia
- postprandial abdominal pain | - food aversion which leads to weight loss
171
Defect seem with Xeroderma Pigmentosum
AR defect in nucleotide excision repair. UV light exposure damages DNA and leads to the presence of pyrimidine dimer; patients with xeroderma pigmentosum are unable to repair DNA pyrimidine dimers
172
Pathology and associated conditions of Chiari I malformation
Pathology: displacement of the cerebellar tonsils through the foramen magnum Associated: spinal cavitation such as syringomyelia
173
Pathology and associated conditions of Chiari II malformation
Pathology: herniation of cerebellar vermis and tonsils through the foramen magnum Associated: Lumbosacral myelomeningocele
174
Pathology and associated conditions of Dandy-Walker malformation
Pathology: agenesis of cerebellar vermis Associated: agenesis of the corpus callosum and occipital encephalocele
175
Empiric treatment of meningitis in newborns (0-6 months)
ceftriaxone and ampicillin
176
Empiric treatment of meningitis in pts 6-60 years old
Vancomycin + third gen cephalosporin (ceftriaxone or cefotaxime)
177
Empiric treatment of meningitis in pts >60 years old
Vancomycin + third gen cephalosporin (ceftriaxone or cefotaxime) + ampicillin
178
Name tumors associated with all 3 MEN syndromes
1: pituitary adenoma, parathyroid hyperplasia, pancreatic tumors 2A: Parathyroid hyperplasia, pheochromocytoma, medullary thyroid carcinoma 2B: pheochromocytoma, medullary thyroid carcinoma, mucosal neuromas
179
Common Peroneal Nerve Injury: vertebrae level, MOI, and Symptoms
Nerve: L4-S2 MOI: -fibular neck fracture -trauma or compression of the lateral leg Symptoms: -loss of dorsiflexion -loss of ankle eversion -decreased sensation on the dorsum of the foot
180
Femoral nerve injury: vertebrae level, MOI, and symptoms
nerve: L2-L4 MOI: pelvic fracture Symptoms: - decreased leg extension, patellar reflex, and sensation on the anterior and lateral thigh
181
Inferior Gluteal nerve injury: vertebrae level, MOI, and symptoms
Nerve: L5-S2 MOI: posterior hip dislocation Symptoms: -weakness climbing stairs or rising from a seated position -decreased hip extension
182
Obturator nerve injury: vertebrae level, MOI, and symptoms
Nerve: L2-L4 (just like femoral) MOI: Pelvic surgery (not pelvic fracture as seen with femoral) Symptoms: decreased thigh adduction and sensation on the medial thigh
183
Pudendal nerve injury: vertebrae level, MOI, symptoms
Nerve: S2-S4 MOI: stretch injury during childbirth symptoms: -decreased sensation in the perineum and genital area -fecal and/or urinary incontinence
184
Sciatic nerve injury: vertebrae level, MOI, symptoms
Nerve: L4-S3 MOI: -herniated disc -posterior hip location (same as inferior gluteal) symptoms: -pain and paresthesia along the posterior leg -decreased motor and sensory function in the ankle and foot
185
Tibial nerve injury: vertebrae level, MOI, symptoms
``` Nerve: L4-S3 MOI: -Baker cyst -knee trauma -tarsal tunnel syndrome symptoms: -decreased plantar flexion -inability to curl the toes -loss of ankle inversion (opposite of common peroneal nerve) -decreased sensation on the sole of the foot ```
186
What is the most common pituitary tumor in adults?
Prolactinoma
187
Name the 4 tumors associated with psammoma bodies
* concentric spherules with dystrophic calcifications - meningiomas - papillary thyroid carcinoma - serous epithelial ovarian carcinoma - mesothelioma
188
Foster Kennedy Syndrome: most common cause and symptoms
Cause: meningiomas arising from the olfactory groove Symptoms: -anosmia -ipsilateral anopia -contralateral papilledema
189
Describe subclavian steal syndrome and the vessels involved
blood flow through the subclavian artery to the ipsilateral upper limb is diminished: perfusion to the affected extremity is maintained through the ipsilateral vertebral artery. This occurs through the basilar artery
190
Brugada syndrome: What is it, who does it affect, and what will you see on EKG?
- AD mutation that affects sodium channels within the heart. This pts are at risk of developing ventricular tachyarrhythmias that can result in cardiogenic syncope and sudden cardiac death - most commonly affects Asian males - pseudo-right bundle branch block and ST-segment elevations in leads V1-V3
191
What medical condition is a contraindication for using mannitol?
Congestive Heart Failure. The drug causes water to move into the extracellular space leading to pulmonary edema. A pt with CHF is already experiencing this and could not handle the exacerbation
192
Name 4 hormones that have nuclear receptors that contain DNA-binding domains
- aldosterone - cortisol - estradiol - thyroxine
193
Does prolactin have a plasma membrane or nuclear receptor?
plasma membrane receptor
194
Pathology behind why older people can't see up close
age-related hardening of the lens and loss of accommodative ability (aka presbyopia). It can no longer relax and curve to see object up close. Corrected with positive power lenses
195
What is the role of IkB in the NF-kB signal transduction pathway from IL-1 binding to IL-6 induction?
Releases NF-kB after undergoing phosphorylation
196
Adverse effects of Metformin
nausea, abdominal discomfort, diarrhea, and lactic acidosis
197
Remodeling of a scar is primarily mediated by what enzyme?
matrix metalloproteinases
198
How to distinguish parietal cells on histo
parietal cells can be identified by their large size, central, round, nucleus, and intensely acidophilic cytoplasm
199
What is the vector for Yersinia pestis?
Most often transmitted by infected fleas, and the direct handling of animals infected with those fleas
200
What is self-selection sampling technique? | What type of bias is seen with this?
Self-selection occurs when individuals select for themselves to participate in a study. Self-selection bias
201
What diseases will show an M-protein spike (M-spike)?
B cell malignancies including Waldenstrom macroglobulinemia, plasma cell leukemia, smoldering myeloma, amyloidosis, or plasmacytoma
202
How is multiple myeloma diagnosed?
Confirmed by bone marrow biopsy where there are at least 10% clonal plasma cells. Disease is only suspected when an M-spike is seen
203
Lack of input from which neural pathway would lead to priapism?
sympathetic fibers from the prostatic plexus. Cavernous and pudendal nerves carry sympathetic fibers that release NE to stop erection Parasympathetic=Erection Sympathetic=no erection
204
Vitamin E deficiency can have a similar presentation to deficiency of what other vitamin?
Vitamin B12. Pts will not have megaloblastic anemia, hyper segmented neutrophils, or increased serum methylmalonic acid concentrations
205
Tissue biopsy of a pt with Kaposi sarcoma (HHV-8) will show what?
Proliferating spindle cells forming slit-like spaces filled with blood
206
If a new drug prevents polymerization of actin filaments, what leukocyte function will most likely be inhibited?
Phagocytosis actin provides a mechanical superstructure for the phagocyte to maintain shape, shuttles enzymes and their substrates together to augment signaling, aids in the endocytosis of large particles
207
What age related change causes older people to not be able to concentrate urine as well as a younger pt?
Decreased renal tubule responsiveness to ADH (vasopressin)
208
If the MCA ruptures on the dominant side of the brain what symptoms will be seen?
Global aphasia as a result of the involvement of Broca and Wernicke areas, along with the arcuate fasciculus Also presents with paralysis and sensory loss of the contralateral face and arm
209
What is Pierre Robin syndrome and what pharyngeal arch is altered?
Pierre Robin: small lower jaw, downward displacement or retraction of the tongue, and cleft palate First pharyngeal arch: maxilla, mandible, masseter, pterygoids, and mylohyoid, CN V2 and V3
210
What is a critical component of Extracellular matrix found in human renal mesangial cells?
Fibronectin
211
What is the location of the lymph nodes which first drain the ovaries on their way to the para-aortic lymph nodes?
along the ovarian vessels. Most lymph vessels follow the arterial supply
212
What PE findings are suggestive of a pleural effusion?
unilateral decreased breath sounds, dullness to percussion, and decreased tactile fremitus are most suggestive of a pleural effusion
213
How is Cryptosporidium parvum characterized?
Fever, watery diarrhea, and cramping abdominal pain. Light microscopy shows intraluminal oocysts on acid-fast stain
214
What component of Myco Tb can be directly cytotoxic to macrophages?
cord factor: prevents fusion of the vesicles containing MTB with the lysosome The acid-fast guy is using his whip in the sketchy video. That is what is used to show Cord Factor
215
How will S. Aureus and S. pyogenes appear on culture?
S. aureus: clusters | S. pyogenes: chains
216
What is the immune reaction seen with an Acute allograft rejection?
Host CD8+ T lymphocytes recognize class 1 MHC molecules on renal allograft cells Type 4 hypersensitivity
217
What PE finding would there be with an occlusion of the posterior cerebral artery (PCA)?
Infarction of the ipsilateral occipital lobe and a contralateral homonymous hemianopsia with macular sparing
218
Why are premature neonates with hyaline membrane disease given O2 at a saturation between 92% and 95%?
Prevent retinopathy of prematurity by maintaining the chemical gradient of VEGF. High O2 saturation would eliminate this and blood vessel growth which isn't complete would stop, leading to ROP
219
MOA of topical erythromycin used on newborns. What is it used to prevent?
MOA: inhibits bacterial protein synthesis by binding to bacterial ribosomal 50s subunits
220
If pt presents with abdominal pain, vomiting, and presence of large white worms in the stool what is the most likely organism?
Ascaris lumbricoides
221
Which enzyme is needed to convert trypsinogen to trypsin?
Enteropeptidase Results in the inability to convert numerous digestive proenzymes into their active forms
222
Clinical presentation of scabies
intensely pruritic erythematous papules of the sides or webs of the fingers, wrist, axillae, areolae, or genitalia, and burrows may be visible
223
When embolizing a leiomyomata what is the route of the catheter when entering through the femoral artery?
external iliac --> internal iliac artery --> uterine artery
224
What type of lung tumor will lead to the production of PTHrP?
squamous cell carcinoma
225
What are the primary inflammatory mediators that promote vasodilation in the initial innate immune response?
Histamine, Prostaglandin-E2, and bradykinin Prostaglandin-E2 and bradykinin also sensitize nociceptive nerve endings
226
Which nerves located near the posterior aspect of the prostate , when damaged, could lead to erectile dysfunction?
Pelvic splanchnic ``` Parasympathetic= erection sympathetic= no erection ```
227
Which two organs participate in gluconeogenesis?
liver and kidney
228
What causes roseola and clinical presentation of the disease?
HHV-6 several days of high fevers followed by a macular eruption that starts on the neck and trunk which then spreads outward to the face and extremities
229
Which tumor causes precocious puberty or virilization?
Ovarian sertoli-leydig cell tumor
230
Side effects of Beta 2 adrenergic agonists
tremor, hypokalemia, hyperglycemia, tachycardia, hypertension, and headache
231
Which spinal tract is responsible for temperature and pain?
lateral spinothalamic tract. Crosses the body two levels up so contralateral side is affected
232
What is the dysfunction in Leukocyte Adhesion Deficiency (LAD) and what would this cause to be wrong in the leukocyte?
LFA-1 (CD18) which would inhibit migration of the cell
233
Describe esophageal peristalsis and lower esophageal sphincter tone in a pt with CREST syndrome
esophageal peristalsis: decreased | lower esophageal sphincter tone: decreased
234
What does CREST syndrome stand for?
``` calcinosis cutis Raynaud phenomenon esophageal dysmotility sclerosis telangiectasias ```
235
Function of cytochrome c
released from mitochondria as the intrinsic and extrinsic apoptotic pathways converge. Cytochrome c then activates caspases that potentiate apoptosis. This leads to cell shrinkage, nuclear, pyknosis, karyorrhexis, and blebbing of the cellular membrane
236
MOA of fluroquinolones
Inhibit DNA gyrase, which disrupts DNA synthesis
237
Glipizide: Class and MOA
second-generation sulfonylurea | inhibits potassium pump, depolarizing the insulin cells, leading to calcium induced exocytosis of insulin into the blood
238
Best way to decrease the number of sudden cardiac deaths
placement of external automatic defibrillators in public spaces
239
Which cells contain high-affinity glutamate transporters?
astrocytes
240
Relationship between mean and median according to the skew of a chart
right skew: mean > median left skew: mean < median
241
Lab findings seen with von Willebrand disease
increased bleeding time decreased factor VIII activity suppressed ristocetin cofactor activity

USMLE Step 1 Facts (1 decks)

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