USMLE 14

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  1. How do we calculate negative predictive value?
    • = TN/ (TN+ FN)
    • = 180/ (180 + 140)
  2. What forms the Allantois?
    Yolk sac forms the allantois, which extends into the urogenital sinus.
  3. What does the allantois become?
    Urachus, a duct between the fetal bladder and yolk sac.
  4. What is the urachus? What forms it?
    • Uracus is a duct between the fetal bladder and yolk sac.
    • It is formed by the Allantois.
  5. What is a patent urachus? What does it present with?
    • Connects the umbilicus and the bladder.
    • Presents with urine discharge from the umbilicus.
  6. Urine discharge from the umbilicus is characteristic of?
    Patent urachus
  7. What is a Vesicourachal diverticulum? What does it present as?
    • Failure to close the part of urachus adjacent to the bladder
    • → Outpouching of bladder


  8. Outpouching of the apex of the bladder is due to?
    Vesicourachal diverticulum
  9. What is a urachal sinus? What does it present as?
    • Failure to close the distal part of the urachus (adjacent to the umbilicus).
    • It presents with periumbilical tenderness and a purulent discharge from the umbilicus due to the persistent and recurent infections.
  10. What is a urachal cyst? What can it lead to?
    • Failue of central portion of urachus to obliterate. Leads to formation of a urachal cyst, a fluid-filled cavity lined with uroepithelium, between umbilicus and bladder.
    • Can lead to infection, adenocarcinoma
  11. What is Omphalocele?
    Incomplete closure of anterior abdominal wall causes persistence of herniation of abdominal contents into umbilical cord, covered by peritoneum.
  12. What is the pathology seen below?
    Omphalocele
  13. What is Gastrochisis?
    • Due to inadequate enlargement of the peritoneal cavity.
    • Extrusion of abdominal contents through abdominal folds, not covered by peritoneum.
  14. What is the pathology seen below?
    • Gastrochisis
  15. Where does Acetazolamide work? How does it work?
    • c- Proximal convoluted tubule
    • It inhibits Carbonic anhydrase which effectively blocks reabsorption of NaHCO3- → urinary alkalinization
  16. Glaucoma drug which causes a highly alkaline urine?
    • Acetazolamide
    • Carbonic anhydrase inhibitor- blocks reabsorption of NaHCO3-
  17. Describe the presentation  and findings of a transient ischemic attack.
    • Sudden onset of transient numbness and tingling of left arm which lasts less than 15 mins
    • Normal MRI - e.g echo
  18. Patient experiences sudden onset of transient numbness and tingling of the left arm. MRI shows no abnormalities. What is the pathology?
    Transient ischemic attack
  19. Increased gastrointestinal blood loss is the most common side effect of?
    Aspirin
  20. Describe the mutation of sickle cell anemia.
    Valine replaces glutamate at position 6 of the beta chain
  21. What promotes sickling of RBCs?
    • Low oxygen / oxygen unloading
    • High altitude
    • Increased acidity
    • Low blood volume (dehydration)
  22. Which complement deficiencies are associated with increased susceptibility to Neisseria?
    C5-C9
  23. Which complement deficiencies are associated with lupus-like syndrome?
    C1, C3, C4
  24. What are some of the long term symptoms of hydrocephalus?
    • Lower extremity spasticity.
    • Spasticity results from loss of inhibition of motor neurons, causing excessive muscle contraction. 
    • →Hyperreflexia & hypertonicity.
    • Results from upper motor neuron damage caused by stretching of the periventricular pyramidal tracts.
  25. Lower extremity hyporeflexia would result from?
    • Damage to the lower motor neurons of the lower extremities
    • Can occur in Poliomyelitis or Werding-Hoffman disease
  26. What is the composition of the 3' end of the tRNA molecule?
    CCA
  27. What does the D arm of the tRNA contain?
    Dihydrouracil residues necessary for tRNA recognition byt the correct aminoacyl-tRNA synthetase.
  28. Dihydrouracil residues are contained in this part of the tRNA.
    D arm
  29. What does the anticodon arm contain?
    Contains sequences which are complementary to the mRNA codon and is read in the 3'-5' direction.
  30. This part of the tRNA contains sequences which are complementaty to the mRNA codon.
    Anicodon arm
  31. What does the T arm contain?
    Contains the TψC sequence (thiamine, pseudouracil, cytosine) sequence necessary for binding of tRNA to ribosomes.
  32. This part of the tRNA contains the thiamine, pseudouracil, cytosine sequence.
    T arm
  33. Label the diagram below.
  34. Polyadenylation occurs at which end ?
    3' end
  35. The 7-methylguanosine cap is added at which end?
    5' end
  36. The cell type below is diagnostic of?
    • Cytomegalovirus
    • Owl eye inclusions
  37. The image below indicated infection with?
    • Cytomegalovirus
    • Owl eye inclusion
  38. Explain the pathology seen below.
    • Left Avascular necrosis/ Osteonecrosis
    • Note how the femoral neck is markedly shortened compared to the right side.
    • Are common in elderly patients with osteoporosis who have sustained a fall.
    • The medial femoral circumflex artery is vulnerable to damage from femoral neck fractures.
  39. Injury to this vessel can cause avascular necrosis of the femoral head.
    Medial circumflex femoral artery
  40. What is the function of the ductus arteiosus?
    • Deoxygenated blood from the SVC passes through the RA → RV → pulmonary artery →
    • patent ductus arteriosus → descending aorta 
    • DEOXYGENATED BLOOD BYPASSES THE LUNGS
  41. The ductus arteriosus is an embryonic derivative of?
    The 6th aortic arch
  42. The ductus arteriosus closes shortly after birth secondary to?
    • Decreased prostaglandin E2 (PGE2) levels
    • Increased oxygen concentration
  43. Describe the murmur of a patent ductus arterisosus.
    Continuous machinery-like murmur
  44. What are the effects of Indomethacin on the patent ducuts arteriosus?
    • Closes the PDA 
    • Inibitor of PGE2 synthesis
  45. What does the bulbus cordis form?
    The smooth part (outflow tract) of the left and right ventricles
  46. The embryonic structure forms the smooth part (outflow tract) of the left and right ventricles.
    Bulbus cordis
  47. What does the primitive atrium form?
    Rough/ trabeculated part of the left and right atrium
  48. This embryonic structure forms the rough/ trabeculated part of the left and right atrium.
    Primitive atrium
  49. What does the right horn of the sinus venosus form?
    Smooth part of right atrium (sinus venarum)
  50. This embryonic structure forms the sinus venarum.
    Right horn of sinus venosus - Smooth part of right atrium
  51. This embryonic structure forms the smooth part of the right atrium
    • Right horn of sinus venosus -
    • Sinus venarum
  52. How does leuprolide work?
    GnRH analog with agonist properties when used in a pulsatile fashion and antagonist properties when used in continuous fashion.
  53. What is the mechanism of Finasteride?
    A 5α-reductase inhibitor (↓conversion of testosterone to DHT)
  54. What is the mechanism and use of Cladribine?
    • Purine analog which is resistant to degradation by adenosine deaminase, inhibits DNA polymerse, DNA strand breaks
    • DOC for hairy cell leukemia
  55. This drug is resistant to degradation by adenosine deaminase.
    Cladribine- purine analog
  56. What is the DOC for hairt cell leukemia?
    • Cladribine 
    • Pentostatin
  57. What is the most common cause of nephrotic syndrome in adults?
    Membranous glomerulopathy
  58. Spike and dome appearance on methenamine silver stain is characteristic of this glomerular nephropathy?
    Membranous glomerulopathy
  59. Incomplete gallbladder emptying/ gallbladder hypomotility resutls in?
    Bile precipitation and formation of BILIARY SLUDGE
  60. Black pigment stones result from?
    Intravascular hemolysis
  61. Brown pigment stones result from?
    Biliary tract infection
  62. Loss of infectivity after ether exposure is a characteristic feature of?
    • Enveloped viruses
    • Ether and other organic solvents dissolve the lipid bilayer that makes up the outer viral envelope.
  63. How is the Hepatitis A virus transmitted?
    • Fecal-oral
    • Often via ingestion of oysters, shellfish
    • * At restaurants, overcrowded areas
  64. What is the use of Inulin clearance?
    Inulin clearance can be used to calculare GFR because it is freely filtered and is neither reabdorbed nor secreted.
  65. What can be used to estimate GFR?
    • Inulin clearance
    • Creatinine clearance
  66. Paraaminohippuric acid is used to calculate?
    Renal plasma flow
  67. Where is Coccidioides immitis endemic to?
    • Southern & central California
    • Arizona
    • New Mexico
    • Western Texas
    • Northern mexico
  68. Rupture of apical blebs or cysts is the most common cause of?
    Primary spontaneous pneumothorax- tall thin, males
  69. What causes a primary spontaneous pneumothorax? Who does it frequently occur in?
    • Rupture of apical blebs or cysts
    • Occurs most frequently in tall, thin, young males
  70. Tall, thin male presents with sudden-onset unilateral chest pain with hyperresonance and absent breath sounds on physical examinaton? What is the most likely diagnosis?
    Primary spontaneous pneumothorax- due to rupture of apical blebs or cysts
  71. Describe the presentation of a pneumothorax.
    • Unilateral chest pain
    • Unilateral chest expansion
    • Hyperresonance
    • Absent breath sounds
    • ↓tactile fremitus
  72. Describe the metabolism of Nitroprusside.
    Nitroprusside is initally metabolized to cyanide, with subsequent conversion to thiocyanate by liver rhodanase.
  73. How can we treat cyanide toxicity?
    Nitrates followed by sodium thiosulfate (donates SULFUR to liver rhodanase to enhance conversion of cyanide to thiocyanate.

Card Set Information

Author:
 rere_girl4ever
ID:
 295526
Filename:
 USMLE 14
Updated:
2015-02-12 00:03:53
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USMLE 14
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USMLE 14
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