USMLE 15

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rere_girl4ever
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USMLE 15
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2015-03-06 20:35:58
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USMLE 15
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  1. Where and how does acetazolamide work?
    • PCT- Excretion of bicarbonate and sodium NaHCO3-)
  2. This drug works in the PCT.
    • Acetazolamide- carbonic anhydrase inhibitor
    • Excretion of sodium and bicarbonate  (NaHCO3-)
  3. This drug reabsorbs NaHCO3
    Acetazolamide- carbonic anhydrase inhibitor
  4. Where and how does mannitol work?
    • Descending limb of Henle's loop
    • Removes/ excrete H20
  5. This drug works in the descending limb of the loop of Henle.
    Mannitol- removes H20
  6. This drug excretes water.
    Mannitol - works in the descending limb of the loop of Henle
  7. What produces inhibin B and what is its function?
    • Sertoli cells
    • Inhibits FSH
  8. Describe the presentation of Fragile X syndrome.
    • Macroorchidism (enlarged testes)
    • Long face with a large jaw, large everted ears
    • Autism
    • MITRAL VALVE PROLAPSE
    • Double jointed thumbs
    • Single palmar crease
  9. Describe the presentation of the 47,XYY karyotype
    • Double Y males
    • Very tall, severe acne, learning disability, autism spectrum disorder
  10. Male presents with tall stature, severe acne and mild delays in both motor and language development.
    Double Y males - 47, XYY
  11. What is the MOA of Rifampin?
    Inhbit DNA-dependent RNA polymerase, thereby blocking transcription
  12. This antimicrobial drug inhibts DNA-dependent RNA polymerase.
    Rifampin
  13. How is Rifampin resistance aquired?
    Modification of rifampin binding site on the bacterial DNA dependent RNA polymerase
  14. What is the MOA of Isoniazid?
    • ↓synthesis to mycolic acids.
    • Bacterial catalase-peroxidase (encoded by KatG) needed to convert INH into active metabolite.
  15. Mutations leading to the underexpression of KatG is a mechanism of resistance to this drug.
    • Isoniazid
    • KatG encodes bacterial catalase-peroxidase needed to convert isoniazid into active metabolite.
  16. What are the 30S inhibitors?
    • Aminoglycosides
    • Tetracyclines
  17. What are the 50s inhibitors?
    • Chloramphenicol, Clindamycin
    • Erythromycin (MACROLIDES)
    • Linezolid
  18. Altered structure of enzymes involved in DNA winding-uwinding is a mechanism of resistance to this drug.
    • Fluroquinolones -floxacin
    • Mutation in DNA gyrase
  19. What are neurophysins?
    Carrier proteins involved in the posttranslational processing of oxytocin and vasopressin to the posterior pituitary/ neurohypophysis.
  20. Where is oxytocin produced?
    Paraventricular nuclei of the hypothalamus
  21. Where is vasopressin (ADH) produced?
    Supraoptic nuclei of the hypothalamus
  22. What are granulosa cell tumors?
    • Sex cord-stromal tumors
    • Yellow cut surface
    • Secrete estrogen and/ or progesterone
    • Presents with precocious sexual development, breast tenderness/ fibrocystic change, endometrial hyperplasia, abnormal uterine bleeding
    • Call-Exner bodies
  23. What are Call-Exner bodies and in which neoplasm is it usually found?
    • Granulosa cells arranged around collection of eosinophilic fluid, resembling primordial follicles.
    • Granulosa cell tumor
  24. Ovarian neoplasm which secretes estrogen and/or progesterone.
    Granulosa cell tumor
  25. Cancer Antigen-125 (CA-125) levels is used to monitor the progression of?
    Ovarian neoplasms
  26. The green discoloration of pus or sputum during a bacterial infection is due to?
    Release of myeloperoxidase from neutrophilic granules.
  27. What is myeloperoxidase?
    A blue-green heme-containing pigment that gives sputum its color.
  28. This is a blue-green heme containing pigment.
    Myeloperoxidase
  29. What is the pathology seen below?
    Infective endocarditis- valvular vegetations
  30. What are the predispostitions to the development of infective endocarditis?
    Valvular inflammation, damage and scarring
  31. Describe the formation of a valvular vegetation in infective endocarditis.
    Following bacterial binding, tissue factor expression results in PLATELET and FIBRIN depositon and the fomation of a valvular vegetation.
  32. Myxomatous degeneration is common in which diseases and can lead to the development of?
    • Mitral valve prolapse
    • Common in connective tissue disease such as Marfan or Ehlers-Danlos syndrome
  33. This fetal abnormality is associated with Maternal type I diabetes.
    Anencephaly
  34. What is polyhydramnios and which fetal anomalities is it associated with?
    • Polyhydramnios refers to excessive accumulation of amniotic fluid.
    • GI obstruction due to duodenal, esophagal or intestinal atresia and anencephaly.
  35. What are the complications of a posterior urethral valve?
    Decreased fetal urine output and oligohydramnios
  36. What conditions are associated with increased fetal urination?
    • High cardiac output due to anemia
    • Twin to twin transfusion syndrome
    • Maternal diabetes type I
  37. Describe the urea cycle.
    • Orange Colored Cats Always Ask For Awesome Umbrellas
    • 1. CO2 + NH3 is converted by Carbamoyl phosphate synthetase I to Carbamoyl phosphate with N-acetylglutamate as a cofactor.
    • 2. Carbamoyl phoshphate then combines with Ornithine to form Citrulline in a reaction catalyzed by ornithine transcarbamoylase in the mitochondrial matrix.
    • 3. Citrulline then enters the cytosol and is converted to Argininosuccinate, which is then converted to Arginine, giving off Fumarate
    • 4. The conversion of arginine to ornithine by the cytosolic enzyme arginase completes the urea cycle by releasing a urea molecule.
  38. What is Ornithine transcarbamylase deficiency?
    • Inability to convert Carbamoyl phosphatate and Ornithine to Citrulline.
    • Excess carbamoyl phosphate is converted to orotic acid (⇑OROTIC ACID + HYPERAMONNEMIA)
  39. What is the function of NADPH oxidase?
    • Catalyzes the reduction of O2 to O2- (superoxide) within phagolysosomes, facilitating the intracellular killing of organisms ingested by phagocytes.
  40. What are the diagnostic tests for Chronic Granulomatous Disease?
    • 1. Nitroblue tetrazolium testing: Adding nitroblue tetrazolium to a sample of the patients neutrophils. Properly functioning neutrophils produce a reactive oxygen species that can reduce the yellow nitroblue tetrazolium to dark blue formazan.
    • 2. Dihydrorhodamine flow cytometry: assesses the production of superoxide radicals by measuring the conversion of dihydrorhodamine to rhodamine, a fluorescent green compound that can be detected by flow cytometry machines, Cells with deficient NADPH oxidase activity will exhibit decreased flourescence.
  41. What is the Nitroblue tetrazolium test and what is it used for?
    Nitroblue tetrazolium testing: Adding nitroblue tetrazolium to a sample of the patients neutrophils. Properly functioning neutrophils produce a reactive oxygen species that can reduce the yellow nitroblue tetrazolium to dark blue formazan.
  42. What is the Dihydrorhodamine flow cytometry and what is it used for?
    Dihydrorhodamine flow cytometry: assesses the production og superoxide radicals by measuring the conversion of dihydrorhodamine to rhodamine, a fluorescent green compound that can be detected by flow cytometry machines, Cells with deficient NADPH oxidase activity will exhibit decreased flourescence.
  43. What is the function of Myeloperoxidase?
    Catalyzes the production of hypochlorite (bleach) from hydrogen peroxide and chlorine.
  44. Where is the tubular fluid concentration of para-aminohippuric acid the lowest?
    in the Bowman's capsule
  45. How is para-amminohippuric acid secreted in to the nephron?
    by the Proximal convoluted tubule.
  46. In ehich part of the nephron is para-aminohippuric acid reabsorbed?
    • PAH is not reabsorbed in any portion of the nephron. 
    • 100% excreted
  47. What disease is pure red cell aplasia associated with?
    • Thymomma
    • Parvovirus B19 
  48. Which diseases are associated with thymomma?
    • Myasthenia gravis
    • Pure red cell aplasia
  49. Prolonged exposure to loud noises causes hearing loss due to damage to?
    Stereociliated hair cells of the organ of Corti
  50. Sudden, extremely loud noises can produce hearing loss due to?
    Tympanic membrane rupture.
  51. What is pure red cell aplasia?
    • Inhibition of erythrocyte precursors
    • ↓erythrocyte count
    • ↓Hb
    • ↓reticulocytes 
    • NORMAL WBC, Platelets, Iron, B12, Folate
  52. What is transference? Give an example.
    • Transference: Unconscious shifting of emotions or desires associated with one person to another.
    • E.g. Patient who is seeing therapist for depression makes progress in sessions and gained insight into how his father was never there for him. Physician had to cancel next session for an emergency. At the next session, the patient refuses to talk saying that the therapist can't make him a priority.
  53. What is acting out? Give an example.
    • Expressing unacceptable thoughts and feelings through actions.
    • E.g. Patient breaks items at psychiatrist office due to rage.
  54. What is displacement? Give an example.
    • Transfering avoided ideas or feelings to a neutral person or object.
    • E.g. Resident doctor being belittled by an attending on rounds nd then later angrily berating a medical student.
  55. What is projection? Give an example.
    • Misattributing one's own unacceptable thoughts and feelings to another person.
    • E.g. Patient accusing his psychiatrist of being angry with him, when in fact the patient is angry with the psychiatrist and is unable to acknowledge it.
  56. What is regression? Give an example.
    •  Individuals return to an earlier level of functioning to alleviate psychological distress.
    • E.g Patient sulking and refusing to speak rather than discussing his feelings.
  57. Null hypothesis is not rejected when it is in fact false.
    • Type II error (β)
    • There is not an effect or difference when one truly exists.
  58. Null hypothesis is incorrectly rejected in favor of alternative hypothesis.
    • Type I error (alpha)
    • Stating that there is an effect or difference when none exists.
  59. Null hypothesis is not rejected.
    • Correct result
    • Stating that there is not an effect or difference when none exists.
  60. Null hypothesis rejected in favor of alternative hypothesis.
    • Correct result
    • There is an effect or difference when one exists.
  61. What is a Type II (beta) error also known as?
    False-negative error.
  62. What is a type I (alpha) error also known as?
    False-positive error
  63. ST segment elevation in the inferior leads is diagnostic of? It is commonly due to?
    • Inferior MI
    • Often due to blockade of the right coronary artery, the artery usually responsible SA and AV node perfusion. ⇒BRADYCARDIA
  64. What is the MOA and use of Scopolamine?
    • Muscarinic antagonist
    • Motion sickness
  65. What are the causes of defects in the middle ear ossicles?
    • Osteogenesis Imperfecta
    • Otosclerosis- abnormal bone remodeling in the middle ear.
  66. What is the function of fructokinase?
    Converts Fructose to Fructose-1-Phosphate, trapping fructose in the cell.
  67. In this disease, there is a defect in fructokinase. What are the clinical and lab and findings?
    • Essential fructosuria
    • Fructose appears in blood and urine
    • Positive for reducing sugar, negative for glucose
  68. What is the function of Aldolase B?
    Converts Fructose-1-Phosphate to Dihydroxyacetone and Glyceraldehyde
  69. Label the immunoglobulin molecule as to the site of attachment to antigen, site for complement attactment, site for attachment to phagocytic cells.
  70. What are the effects of the vagus nerve on the airways of the lungs?
    When the vagus nerve is stimulated, acetylcholine is release. Acetylcholine produces bronchoconstriction by acting on muscarinic receptors.
  71. What is the mechanism of action and use of ipratropium?
    • Blocks muscarinic receptors, preventing bronchoconstriction.
    • COPD
  72. What is the mechanism of action and use of Tiotropium?
    • Blocks muscarinic receptors, preventing bronchoconstriction.
    • COPD
  73. This drug prevents bronchoconstriction.
    Muscarinic antagonists- Ipratropium and Tiotropium
  74. First line treatment of acute bronchial asthma.
    Albuterol- Beta2 agonist
  75. What is the MOA and use of Albuterol?
    • Beta-2 agonist. Bronchodilator
    • First line treatment of acute bronchial asthma.
  76. What are the Methylxanthines? What is their MOA?
    • Theophylline and Aminophylline
    • Causes BRONCHODILATION by inhibiting phosphodiesterae→ ↑cAMP levels. Blocks action of adenosine.
  77. What is the MOA of Theophylline?
    Causes bronchodilation by inhibiting phosphodiesterase → ↑cAMP. Blocks action of adenosine.
  78. This drug causes bronchodilation by inhibiting phosphodiesterase → ↑cAMP
    Theophylline, Aminophylline
  79. What is the action of Adenosine on the lungs?
    Causes BRONCHOCONSTRICTION
  80. This drug blocks the action of adenosine.
    Theophylline- bronchodilator
  81. What is the mechanism of action of Zileuton?
    • 5-lipoxygenase pathway inhibitor
    • Blocks conversion of arachadonic acid to leukotreines.
  82. This drug is a 5-lipoxygenase pathway inhibitor.
    Zileuton

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