USMLE 24

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rere_girl4ever
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294259
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USMLE 24
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2015-01-30 16:04:42
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USMLE 24
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  1. Describe the structure of cilia.
    • Cilia is composed of 2 central microtubules, surrounded by 9 microtubule doublets.
    • Each microtuble doublet is connected to the adjacent doublet by dyenin arms.
    • Dyenin arms contain the dyenin ATPase that generates energy for the dyenin arms to slide past each other, producing ciliary movement.
  2. What complications can arise from Kartagener syndrome?
    • Male and female infertility- immotile sperm and dysfunctional fallopian tube cilia
    • ↑risk of ectopic pregnancy

    • Bronchiectasis- enlargement of lung airways
    • Recurrent sinusitis
    • Situs inversus (e.g dextrocardia)- Cardiac point of maximal impulse is on the RIGHT
  3. What causes Hyper IgM syndrome?
    Defective CD40L/ CD154 on CD4+  T cell → B cell cant undergo class switching from IgM
  4. What causes a persistent truncus arteriosus?
    Caused by the abnormal neural crest cell migration through the truncus arteriosus and bulbus cordis to separate the aorta and pulmonary artery.
  5. What causes Transposition of the great vessels?
    Failure of the aorticopulmonary septum to spiral due to abnormal migration of neural crest cells.
  6. What causes Tetraology of Fallot?
    • Abnormal migration of neural crest cells through the truncus arteriosus and bulbus cordis to separate the aorta and pulmonary artery.
    • Results in anterior displacement of the infundibular septum. 
  7. Which heart defects are caused by the abnormal migration of neural crest cells?
    • Tetralogy of Fallot
    • Transposition of the great vessels
    • Truncus arteriosus

  8. What does an endocardial cushion defect results in?
    • Failure of the atria and ventricles to separate.
    • Defect in atrioventricular septum.
  9. Where are thyroid hormone receptors located?
    Inside the nucleus
  10. Describe the splitting of an Atrial Septal Defect.
    • Wide, fixed spliiting of S2.
    • ASD creates a left to right shunt (because of higher pressure in the left atrium). 
    • This results in increased blood flow through the pulmonary artery, delaying pulmonary closure.
  11. What causes Eisenmenger syndrome?
    Uncorrected left-to-right shunt (VDS, ASD, PDA) causes such ↑ pulmonary blood flow through the pulmonary atery, which results in pathologic remodeling of the vasculature (pulmonary sclerosis).

    • The hypertrophied Right ventricle occurs to compensate and the shunt becomes right-to-left.
    • Causes late cyanosis, clubbing and polycythemia.
  12. Describe the symptoms of heroin withdrawal.
    • Dilated pupils
    • Piloerection
    • Yawning
    • Lacrimation
    • Hyperactive bowel sounds/ stomach cramps
  13. Describe the clinical presentation of myasthenia gravis.
    • Ptosis- drooping of eyelid
    • Diplopia
    • Eye weakness- tired eyes
    • Muscle weakness worsens during course of the day
    • Decreased force of muscle contraction with repetitive stimulation
    • Associated with thymomma or thymic hyperplasia- presents as ANTERIOR MEDIASTINAL MASS
  14. Where does lymph from the head drain into?
    Cervical lymph node
  15. Where does lymph from the esophagus drain into?
    Cervical lymph node
  16. Where does lymph from the lungs drain to?
    Hiliar lymph node
  17. Where does lymph from the trachea drain into?
    Mediastinal lymph node
  18. Where does lymph from the esophagus drain to?
    Mediastinal lymph node
  19. Where does lymph from the testes drain into?
    Para-aortic lymph node
  20. Where does lymph from the ovaries drain into?
    Para-aortic lymph node
  21. Where does lymph from the kidneys drain into?
    Para-aortic lymph node
  22. Where does lymph from the uterus drain into?
    Para-aortic lymph node
  23. Wher does the popliteal lymph node drain?
    • Dorsolateral foot
    • Posterior calf
  24. Where does the axillary lymph node drain?
    • Upper limb, breast, skin above umbilicus
  25. Where does the celiac lymph node drain?
    • Liver, stomach, spleen, pancreas, upper duodenum
  26. What does the superior mesenteric lymph node drain?
    • Lower duodenum, jejunum, ileum, colon to splenic flexure
  27. Where does the inferior mesenteric lymph node drain?
    • Colon from splenic flexure to upper rectum
  28. Where does the internal iliac lymph node drain?
  29. Where does the superficial inguinal lymph node drain?
    • Anal canal (below pectinate line)
    • Skin below umbilicus (except popliteal territory)
    • Scrotum
  30. Where does lymph from the scrotum drain into?
    Superficial inguinal lymph node
  31. Where does lymph from the bladder drain into?
    Internal iliac
  32. Where does lymph from the prostate drain into?
    Internal iliac
  33. Where does lymph from the anal canal (above the pectinate line drain into?
    Internal iliac
  34. Where does lymph from the anal canal (below the pectinate line) drain into?
    Superficial inguinal
  35. Label the image below
    • A- I band
    • B- A band
    • C- H band
    • D- I band
    • E- Z line
    • F- M line
    • G- Z line
  36. At this region of the sacomere, myosin filaments are bound to structural proteins.
    • E: M-line
    •  
  37. At this region of the sacomere, actin filaments are bound to structural proteins.
    D&F: Z line
  38. At this region of the sacomere, actin does not overlap with myosin.
    A: I band 
  39. At this region of the sacomere, myosin does not overlap with actin
    C- H band
  40. Which bands decrease in size during contraction?
    I-band and H-band
  41. This band extends over the entire region of the thick myosin filaments.
    B- A band
  42. This band does not change size during contraction.
    B- A band
  43. What is sampling bias?
    • Non-random sampling of a population
    • A common example is that severely ill patients are the most likely to enroll in cancer trials, leading to results that are not applicable to patients with less advanced cancers.
  44. What is Allocation bias?
    • Can result from the way treatment control groups are assembled. 
    • It may occur if subjects are assigned to the study groups of a clinical trial in a non-random fashion. 
    • For instance, in a study comparing oral NSAIDs and corticosteroid injects for the tx of osteoarthritis, obese patients may be preferentially assigned to corticosteroid group.
  45. What is detection bias?
    • Refers to the fact that a risk factor itself may lead to extensive diagnostic investigation and increase the probability that a disease is identified.
    • For instance patients who smoke may undergo increased imaging surveillance, due to their smoking status, which would detect more cases of cancer in general.
  46. What is Referral (admission rate) bias?
    • Occurs when the case and control populations differ due to admission or referral practices.
    • For instance, a study involving cancer risk factors performed at a hospital specializing in cancer research may enroll cases referred from all over the nation. However, hospitalized control subjects without cancer may come from only the local area.

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