USMLE2

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rere_girl4ever
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292913
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USMLE2
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2015-01-15 12:00:06
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USMLE2
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  1. Differentiate between the findings in Chronic HBV with high infectivity vs Chronic HBV with low infectivity
    • High infectivity: HBsAg + HBeAg  + Anti-HBc IgG
    • Low infectivity: HBsAg + Anti-HBe  + Anti-HBc IgG
  2. Which serologic markers are found in hepatitis B immunization?
    Anti-HBs (Antibody to HBsAg)
  3. Which serologic markers are found in recovery of HBV infection?
    • Anti-HBs
    • Anti-HBe
    • Anti-HBc IgG    *Note: IgG=prior exposure/ chronic infection
  4. Which serologic markers are found in Acute HBV?
    • HBsAg
    • HBeAg
    • Anti-HBc IgM   *Note: IgM= acute/recent infection
  5. What serological markers are present in the window period of HBV?
    • Anti-HBe
    • Anti-HBc IgM
  6. What does Anti-HBc IgM indicate?
    • HBcAg- antigen associated with core of HBV
    • IgM- acute/recent infection
  7. What does Anti-HBc IgG indicate?
    • HBcAg- antigen associated with core of HBV
    • IgG- prior exposure/ chronic infection
  8. Acute poststreptococcal glomerulonephritis
  9. Decreased serum C3 levels are diagnostic of which glomerular disease?
    Acute poststreptococcal glomerulonephritis
    • Goodpasture syndrome
    • Crescent formation
  10. PR3-Antineutrophil cytoplasmic antibody (PR3-ANCA) is diagnostic of?
    • Granulomatosis with polyangiitis (Wegener)
    • c-ANCA, PR3-ANCA
  11. Cytoplasmic antineutrophil cytoplasmic antibody is diagnostic of?
    • c-ANCA, PR3-ANCA
    • Granulomatosis with polyangiitis (Wegener)
  12. Perinuclear antineutrophil cytoplasmic antibody is diagnostic of?
    • p-ANCA, MPO-ANCA
    • Microscopic polyangitis
  13. Myeloperoxidase antineutrophil cytoplasmic antibody is diagnostic of?
    • p-ANCA, MPO-ANCA
    • Microscopic polyangitis
  14. High circulating eosinophils are characteristic of which glomerular disease?
    • Interstitial nephritis
    • Fever, rash, hematuria, costovertebral angle tenderness
  15. What is a beta (type II) error?
    • Stating that there is not an effect or difference when one exists (null hypothesis is not rejected when it it in fact false).
    • Also known as a False negative error.
  16. What is an alpha (type I) error?
    • Stating that there is not an effect or difference when one exists (null hypothesis incorrectly rejected in favor of alternative hypothesis).
    • Also known as a false positive.

  17. What are the causes of Homosyctinuria (high levels of homocysteine)?
    • 1. Cystathionine synthase deficiency
    • 2. Decreased affinity for cystathionine synthase for pyridoxal phosphate (B6) and Serine
    • 3. Homocysteine methyltransferase (methionine synthase) deficiency
    • 4. B12 deficiency

  18. What role does B6 play in the metabolism of  homocysteine?
  19. What role does B12 play in the metabolism of  homocysteine?
  20. Which amino acid is used in the metabolism of  homocysteine? What role does it play?
  21. What role does homocysteine methyltransferase play in the metabolism of  homocysteine?
  22. What role does methionine synthase play in the metabolism of  homocysteine?
    It is also called homocysteine methyltransferase

  23. What role does cystathionine synthase play in the metabolism of  homocysteine?
  24. What are the findings in Homocystinuria?
    • Increased homocysteine in urine
    • Intellectual disability
    • Osteoporosis
    • Tall stature
    • Kyphosis
    • Lens subluxation (downward and inward)
    • Thrombosis
    • Atherosclerosis (stroke and MI).
  25. Lens subluxation (downward and inward) is found in which disease?
    • Homocystinuria
  26. Lens subluxation (upward and temporally) is found in which disease?
    • Marfan syndrome
  27. Describe the lens subluxation in Homocystinuria.
    • Lens subluxation (downward and inward)
  28. Describe the lens subluxation in Marfan syndrome.
    • Lens subluxation (upward and temporally).
  29. Descibe the metabolism of methionine to homocysteine.
  30. How does homocysteine go back to form methionine?
    • Homocysteine can be converted to methionine by combining with N-5-methyl-tetrahydrofolate in a reaction requiring B12 (cobalamin).
    • In this reaction, a methyl group is transferred from a methylated THF to homocysteine, forming methionine and THF.
  31. What do monozygotic twins arise from?
    • 1 fertilized egg (1 egg + 1 sperm) that splits into 2 zygotes in early pregnancy
    • Same sex, genetically identical, similar in appearance.
  32. What do dizygotic twins arise from?
    • 2 eggs that are separately fertilized by 2 different sperm
    • Different sex, genetically different
  33. What type of  placentation is found in dizygotic twinning?
    Dichorionic diamniotic
  34. Where is hypocretin (orexin) produced and what is its function?
    • Lateral hypothalamus
    • Promote wakefullness and inhibit REM sleep
    • Decreased in narcolepsy
  35. Describe the presentation of Narcolepsy
    • Excessive daytime sleepiness.
    • ƒHypnagogic (just before sleep) or hypnopompic (just before awakening) hallucinations.ƒ
    • Nocturnal and narcoleptic sleep episodes that start off with REM sleep.ƒ
    • Cataplexy (loss of all muscle tone following a strong emotional stimulus, such as laughter) in some patients.
  36. What are hypnagoic hallucinations?
    • Hallucinations which occur just before sleep.
    • Hypnagoic- going to sleep
  37. What are hypnopompic hallucinations?
    Hallucinations which occur just before awakening.
  38. What is 5-hydroxyindoleacetic acid?
    • 5-HIAA 
    • Found in Carcinoid syndrome
    • Breakdown of serotonin
  39. Elevated amounts of 14-3-3 proteins are helpful in diagnosing?
    Creutzfeldt-Jakob disease
  40. Describe the protrusion of a femoral hernia.
    • Protrudes below inguinal ligament through femoral canal  *Note: direct and indirect inguinal hernias are above.
    • Lateral to pubic tubercule.
    • Medial to femoral vein and artery.
  41. What complications can arise from femoral hernias?
    • If a segment of bowel is present in the hernia sac, incaceration  can cause bowel obstruction (nausea, vomiting, abdominal pain)
    • Impaired blood flow to contents causes strangulation. 
    • Ischemia and necrosis occur (fever).
  42. This type of hernia protrudes below inguinal ligament.
    Femoral hernia
  43. Liver mass plus increased levels of AFP is suggestive of?
    Hepatocellular carcinoma
  44. How does HBV trigger neoplastic changes in hepatocellular carcinoma?
    Integrates viral DNA into cellular genome of host.
  45. Serum marker for hepatocellular carcincoma?
    Increased Alpha-fetoprotein.
  46. What does a promoter mutation results in?
    Decreased level of gene TRANSCRIPTION
  47. What occurs at the promoter region?
    RNA polymerase II and multiple other transcription factors bind to DNA upstream from locus (TATA and CAAT boxes)
  48. What is the function of small nuclear ribonucleoproteins?
    Remove introns from hnRNA/ pre-MRNA

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