USMLE Step 1

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  1. Dysphagia
    Fe deficiency Anemia
  2. Symptom: Hourglass shaped stomach on barium swallow
    Sliding haital hernia
  3. Name common causes of:

    Subarachnoid hemorrhage
    Subdural hemorrhage
    Intraparenchymal hemorrhage:
    Basal Ganglia Hemorrhage
    • Subarachnoid hemorrhage: ruptured aneurysm
    • Subdural hemorrhage: rupture of bridging veins
    • Intraparenchymal hemmorrhage: emboli, metastatic disease, trauma, and hypertension
    • Basal ganglia hemorrhage: HTN
  4. Etiologies of Renal Papillary Necrosis
    • -Chronic analgesic use
    • -DM
    • -Sickle cell trait or disease (O2 in the papilla can get low enough that even sickle trait RBC begin to have Hgb polymerization)
    • -Severe acute pyelonephritis
  5. What Abs are associated with Celiac Sprue? What HLA type is associated with Celiac Sprue?
    • anti-endomysila
    • anti-tissue transglutaminase
    • anti-gliadin

    HLA-DQ2 and HLA-DQ8
  6. What malignancy is associated with Celiac Sprue
    T-cell lymphoma
  7. Ring enhancing lesion in AIDS patient?
    Toxoplasmosis (assc. w/ meat and cats)

    B-cell lymphoma (assc. w/ EBV and often involves the meninges)
  8. What virulence factor do the following bacteria use to avoid phagocytosis

    S. aureus
    Group A Strep
    Bordetella Pertussis
    • S. aureus - Protein A (Binds Fc portion of Igs)
    • SHiN - IgA protease  
    • Group A Strep - M protein
    • Bordetella Pertussis - Pertussis toxin (inhibits Gi --> increases cAMP)
  9. Adducted and internally rotated shoulder + Extended elbow + pronated forearm (aka loss of abduction, flexion and suppination)
    Erbs palsy: Damage to upper trunk (C5 and C6) of brachial plexus. Loss of input to Suprascapular n. , Musculocutaneous n. , Axillary n.  Associated with pulling baby out by arm during labor
  10. What is the most sensitive indicator of recent alcohol abuse?
    gamma-glutamyl transpeptidase is a liver enzyme that elevates after recent alcohol abuse before ALT, AST or alkaline phosphatase have been altered.
  11. Potbellied
    Puffy face
    Protuberant tongue
    Petite Stature (dwarfism)
    Cretinism is the syndrome produced by fetal hypothyroidism. Fetal Hypothyroidism etiologies include: maternal hypothyroid, iodine deficiency, thyroid aplasia, thyroid hormone synthesis defect (most often peroxidase)
  12. Renal stones + cystic bones spaces + constipation
    Stones Bones and Groans = Primary Hyperparathyroidism.

    Hypercalcemia, low phosphate, high alklaine phosphatase, increased cAMP in urine

    Contrast with secondary hyperparathyroidism, which will have low calcium and high phosphate.
  13. Complications of Down's
    • AML before age 5
    • ALL after age 5
    • ostium primum ASD
    • Alzheimer's disease
    • Duodenal atresia
    • Epilepsy
    • Visual problems
  14. What percentage of people fall into 1, 2 and 3 SDs
    68%, 95.5%, and 99.7%
  15. Patient presents w/ Tanner Stage 1 + weak lower extremity pulses + decreased T3/4. What are other signs and symptoms that are expected
    • This is a description of Turner's syndrome:
    • -short stature
    • -widely spaced nipples
    • -cystic hygroma (webbed neck)
    • -ovarian dysgenesis (infertility)
    • -hypothyroidism
    • -coarctation of the aorta (explain weak pulses)
    • -bicuscpid aortic valve
    • -Diabetes
  16. Nitroglycerin is not effective in relieving which type of angina
    Unstable / crescendo angina (due to incomplete occlusion by thrombosis and often assc with ST depression)
  17. Presentation: Chronic bronchiectasis + impaired sperm motility
    Kartageners; a defect in dynein motors, whcih are involved in ciliary movement and retrograde axonal movement
  18. Chronic alcohol use and cigarette smoking: does it induce or inhibit CYP450
  19. Compare and contrast Giant Cell Arteritis and Takaysu's Arteritis
    • Both are granulomatous disease of large vessels that are treated with corticosteroids.
    • Giant cell: Female > 50, flu-like symptoms, joint and muscle pain. temporal artery --> headache, opthalmic artery --> visual disturbance, and jaw claudication. High ESR.

    Takayasu's: Asian female < 50. weak pulses in upper extremities. Visual and neurological symptoms.
  20. Alcoholic + Hematemsis then vomiting 


    Alcoholic + Vomiting then hematemesis
    Alcoholic + Hematemsis then vomiting = Esophageal varices (due to portal hypertension, which is often secondary to alcoholism) 

    Alcoholic + Vomiting then hematemesis = Mallory Weiss Syndrome (hematemesis from tears in esophagus due to vomiting, which is often secondary to drinking too much). The tears can go through the whole wall (Boerhaaves syndrome)
  21. How does B12/folate deficiency affect HbA1c reading?
    B12/folate deficiency --> low RBC turnover

    Therefore more old RBCs --> higher HbA1c 
  22. Which chromosomes are these tumor suppressors located on?

    DCC and DPC
    DCC and DPC: 18q - assc/ colon and pancreatic cancers, respectively

    • BRCA-1 and NF-1: 17q
    • NF-2: 22q
    • p53: 17p  
  23. Restrictive endocarditis w/ eosinophils
    • Loeffler's endocarditis. More common in tropical climates.
    • Fibrosis due to eosinophil granules. Can be idiopathic or can assc. with parasites.
  24. (1) Catalase (+) and Novobicin sensitive

    (2) Catalase (+) and Coagulase (+)

    (3) Alpha hemolytic + optichin resistant

    (4) Alpha hemolyic + optichin sensitive
    (1) Catalase (+) and Novobicin sensitive = staph epidermis

    (2) Catalase (+) and Coagulase (+) = staph. aureus

    (3) Alpha hemolytic + optichin resistant = strep viridans

    (4) Alpha hemolyic + optichin sensitive = strep pneumo
  25. Name the Autoantibodies that would be associated with these presenstations: 

    (1) Dental caries
    (2) Raynauds and difficult swallowing
    (3) Rash, renal disease, hemolytic anemia, and neurological distrubances
    (4) Thyroiditis
    (5) Non-granulomatous vasculitis of small vessels  of lung and kidneys
    (6) Granulomatous inflammation of small vessels of lung and heart w/ eosinophils. Assc with Asthma.
    (7) Granulomatous vasculitis of nasopharynx, lungs and kidneys
    • (1) Sjogren's: SS-A (Lo) and SS-B(La)
    • (2) CREST: anti-centromere
    • (3) SLE: anti-dsDNA
    • (4) Hashimoto's: anti-mitochondrial
    • (5) Microscopic Polyangitis : pANCA
    •  Churg-Strauss: pANCA
    • (7) Wegener's : cANCA
  26. Craniopharyngioma resembles what tumor histologically
    Ameloblastoma (tumor of the dental epithelium)
  27. Progressive onset of CHF over many years
    Chronic ischemic heart disease. Results in patchy areas of fibrosis
  28. 46 y/o woman + Deformed hands and wrist + amyloid deposition in glomerulus.

    Identify the amyloid
    AA from SAA which is produced in liver in response to chronic inflammation. 

    AA Amyloidosis is often seen in kidney's heart and GI  
  29. Clawing of 4th adn 5th fingers. What carpal bone is associated with nerve damage that results in this sign.
    Ulnar claw.  Long standing ulnar damage removes innervation of medial lumbricals --> can't extend 4th and 5th fingers.

    Often due to broken hamate

    Also results in wasting of the dorsal interosseus muscles
  30. Aspiration pneumonia: Anaerobes or Aerobes?And what would you use to treat such a pneumonia?
    A mix of aerobes (e.g. pneumococcus) and oral anaerobes (BacteriodesPrevotellaFusobacteriumPeptosteptococcus)!

    Use clindamycin since it has good coverage of anaerobes as well as aerobic gram (+) bacteria
  31. Describes presentation of the following: 

    (1) Indirect inguinal hernia
    (2) Direct inguinal hernia
    (3) Femoral Hernia
    (1) Indirect inguinal - Male infants. Hernia enters internal inguinal ring lateral to inferior epigastric vessel. Caused by persistent processus vaginalis & failure of internal inguinal ring to close

    • (2) Direct inguinal - Older male. Bulge through Hesselbach's triangle (medial to inferior epigastric vessels) to reach external inguinal ring. Caused by weakness of transversalis fascia

    (3) Femoral - Women. Through femoral ring (medial to femoral vessels and inferior to inguinal ligament)
  32. What are the two major sources of alkaline phosphotase? If alkaline phosphatase is high, what is the best enzyme should be used to differentiate between the source of high alkaline phosphatase?
    • Bone and Liver
    • Gamma-glutamyl transpeptidase is predominately liver made.
  33. Gardenerella - how do you perform the whiff test? What is the characteristic histology? What is the tx?
    • (1) Gardernerella Vaginosis has a fishy odor that is made more prominent by adding KOH (whiff test).
    • (2) Garderneralla produce Clue Cells
    • (3) Tx with oral Metronidazole. MOA is to react with ferrodoxin to form reactive species that damage cellular components and interfere with DNA
  34. Image Upload
    Describe the channels for each phase of the AP
    Before stimulus: resting potential of a nerve is about -70 mV. Maintained by high K+ efflux (non-gated K+ channels) and low Na+ permeability. 

    Depolarization: After a stimulus causes nerve to hit threshold, VG-Na+ channels open causing Na+ influx 

    Repolarization: VG-Na+ channels have closed and VG-K+ channels open

    Hyperpolarization: VG K+ channels causehyperpolarization but slowly close, bringing the nerve back to resting state
  35. What is the MOA of the following toxins: 

    • Tetrodoxin (pufferfish) and Saxitoxin (dinoglagellates) - Prevent VG-Na+ channels from opening, thus preventing AP
    • Ciguatoxin (Moray eel) and Batrachotoxin (South American frogs) - keep VG-Na+ channel open causing persistent depolarization of nerve
  36. Describe the process of heme breakdown
    • Heme ---- (Heme Oxygenase) --> Biliveridin *this happens in soft tissue like a bruise or in the spleen for normal RBC breakdown* 
    • Biliveridin ----> Bilirubin (UB)
    • UB than is transported in blood to liver by albumin
    • UB --(UDP-gluconryl transferase)--> CB
    • CB is secreted w/ bile where it is converted to urobiligen by bacteria. Urobiligen is excreted and cycled back to liver. Urobiligen gives stool its brown color and urine its yellow color
  37. Explain the difference in activity of Acyclovir for HSV/VZV and EBV/CMV?
    • Acyclovir (along with Valacyclovir, Famciclovir, and Gancicyclovir) must first be monophosphorylated by viral thymidine kinase - this is the rate limiting step.
    • HSV/VZV thymidine kinase have higher activity for acyclovir than EBV/CMV thymidine kinase.
    • After monophosphorylation, the nucleotide analog is di- and tri-phosphorylated by cellular kinases. After this step it can be incorporated in viral DNA. 

    ZidovudineCytarabineVidarabine do not need this viral kinase step.
  38. What antibiotic causes brown-staining teeth?
  39. Does rectal administration have first-pass effect?
  40. What intestinal protozoa are acid-fast? How do you treat them?
    • Isospora and Cyclospora
    • Tx with TMP-SMX
  41. Protozoa assc. w/ raspberries?
  42. What protozoan causes bloody diarrhea? How do you treat it?
    • Entamoeba hystalytica 
    • Tx w/ metronidazole
  43. What is the major side-effects of metronidazole?
    • Disulfram-like reaction ("No drinking on the metro!")
    • Metallic taste in mouth
  44. What two intestinal protozoa affect mostly immunecompromized people?
    • Cryptosporidium (generally tx with nitazoxanide in immunecompotent pts, but for immunecompromised try to get immune system back up rather than use antimicrobial) 
    • Isospora (tx w/ TMP-SMX)
  45. Compare and contrast (1) Naegleria, (2) Acanthaemoeba, (3) Balamuthia mandrillaris
    • (1) will cause ACUTE meningoencephalitis in swimmers and will show NO CYSTS (only trophozoites) in CSF
    • (2) and (3) cause CHRONIC meningioencphalitis with CYSTS and trophozoites. 

    (2) affects immunecompromised pts mostly and can cause corneal infections

    (3) affects immunecompotent pts and can cause granulomatous skin lesions.
  46. Describe toxoplasmosis infection in (1) AIDS patients and (2) fetus?
    Patient 1 will have ring-enhancing lesions in the brain + white-fluffy patches on retina. Results in neurological symptoms and visual defects. 

    Patient 2 will be a fetus w/ chorioretinitis or blindness, seizures, metnal retardation, microcephaly. OR can be born normal and have reactivation of disease in adolescence leading chorioretinitis and possible blindness
  47. Tx for toxoplasmosis
    Sulfadiazine + pyrimethamine
  48. Tx for PCP
    TMP/SMX or pentamide
  49. Under what CD4 count are people susceptible to toxo and PCP
Card Set:
USMLE Step 1
2013-06-03 16:30:47

USMLE Step 1 - no particular subject
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