USMLE 18

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USMLE 18
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2015-02-25 01:17:44
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  1. What is the pinworm?
    Enterobius vermicularis
  2. Describe the presentation and diagnosis of infection with Enterobius vermicularis.
    • Perianal pruritis (itching)
    • DIagnosis is made by the scotch tape test- presence of oval, flattened, eggs with a bean shaped appearance
  3. How do we treat Enterobius vermicularis (pinworm) infection?
    • Bendazoles
    • Pyrantel pamoate- pregnant patients
  4. Diethylcarbamazine is indicated for the treatment of?
    • Loa loa - swelling in skin, worm in conjunctiva
    • Wuchereria bancrofti- elephantitis 
  5. Ivermectin is used to treat infections caused by?
    • Strongyloides stercoralis
    • Onchocerca volvulus
  6. Nifurtimox is used to treat diseases caused by?
    Trypanosoma cruzi- Chagas
  7. Praziquantel is used in the treatment of?
    • Schistosoma
    • Clonorchis sinensis
    • Taenia solium
    • Diphyllobothrium latum 
    • Paragonimus westermani
  8. Which drugs target vascular endothelial growth factor and what is it used for?
    • Ranibizumab
    • Bevacizumab 
    • Pegaptanib
    • Neovascular age-related macular degeneration
  9. What is the target and use of Ranibizumab?
    • Target: Vascular endothelial growth factor
    • Use: Neovascular age-related macular degeneration
  10. What is the target and use of Bevacizumab?
    • Target: Vascular endothelial growth factor
    • Use: Neovascular age-related macular degeneration
  11. What is the target and use of Pegaptanib?
    • Target: Vascular endothelial growth factor
    • Use: Neovascular age-related macular degeneration
  12. What is neovasculat age-related macular degeneration and what can be used to treat it?
    • The leading cause of blindness in industrialized countries. 
    • It involves degeneration of the central retina and presents as difficulty with driving, reading, watching TV ect.
    • Anti-vascular endothelial growth factor: Ranibizumab, Bevacizumab, Pegaptanib
  13. Where is the thymus derived from?
    Ventral wings of the 3rd pharyngeal pouch
  14. Which structures are derived from the third pharyngeal pouch?
    • Ventral wings- Thymus
    • Dorsal wings- INFERIOR parathyroid glands
  15. Where is the inferior parathyroid gland derived from?
    Dorsal wings of the 3rd pharyngeal pouch
  16. This structure is derived from the ventral wings of the 3rd pharyngeal pouch.
    Thymus
  17. This structure is derived from the dorsal wings of the 3rd pharyngeal pouch.
    Inferior parathyroid glands
  18. Where is the superior parathyroid glands derived from?
    Dorsal wings of the 4th pharyngeal pouch
  19. This structure is derived from the dorsal wings of the 4th pharyngeal pouch
    • Superior parathyroid glands
    • ULTIMOBRANCHIAL BODY

  20. Where are the epithelial lining of the PALANTINE TONSILS derived from?
    2nd pharyngeal pouch
  21. Which structures are derived from the 2nd pharyngeal pouch?
    Epithelial lining of the PALANTINE TONSILS
  22. What is the MOA and use of Raloxifen?
    • Selective estrogen receptor modulator
    • Estrogen antagonist at BREAST and UTERUS
    • Estrogen agonist at BONE
    • Primarily used to treat osteoporosis
  23. This drug is an estrogen antagonist at breast and uterus, but an estrogen agonist at bone.
    • Raloxifene
    • Selective estrogen receptor modulator
  24. What is the MOA and use of Alendronate?
    • Bisphosphonate
    • Pyrophosphate analog; bind hydroxyapatite in bone, inhibiting osteoclastic activity (inhibits bone resorption)
  25. What is splitting? Give an example.
    • The unconscious belief that people are wither wholly good or wholly bad.
    • Patient thinks that all other nurses are horrible and mean which she identifies a medical student as the only person who understands her
  26. What is intellectualization? Give an example.
    • Suppressing one's feelings by thinking about the problem.
    • E.g. A surgeon who avoids his feeling of failure after a patient dies by thinking about every step of the surgery in meticulous detail.
  27. What is sublimation? Give an example.
    • Channeling an unacceptable impulse into an acceptable from of behavior
    • E.g. A patient with sexually explicit thoughts becoming a sex therapist.
  28. What  is the MOA and use of Ribavirin?
    • Inhibits iosine monophosphate dehydrogenase which converts IMP to AMP and GMP (purine production)
    • USE: RSV and Hepatitis C
  29. What is the MOA and use of Oseltamivir?
    Sialic acid analogue inhibitor of neuraminidase  ↓release of progeny virus

    USE: Influenza A and B
  30. This drug is used in the treatment of respiratory syncytical virus.
    Ribavirin
  31. This drug is used in the treatment of influenza A and B.
    Oseltamavir- neuraminidase inhibitor, decreases release of progeny virus
  32. This drug inhibits viral neuraminidase.
    • Oseltamavir- decreases release of progeny virus
    • USE: Influenza A and B
  33. What is the MOA and use of Lamivudine?
    • Nucleoside reverse transcriptase inhibitor (NRTI)- Competitively inhibit nucleotide binding to reverse transcriptase and terminate the DNA chain.
    • Tx: HIV infection
  34. What is the use of Amantadine?
    • Parkinson disease↑dopamine release, ↓dopamine reuptake
    • Influenza A
    • Rubella
  35. What are the toxicities associated with the use of Amantadine?
    • Ataxia
    • Livedo reticularis
  36. Which pathway of apoptosis is the FasL binding to Fas CD95 part of?
    Extrinsic pathway
  37. What is negative selection?
    T cells expressing TCRs with high affinity for self antigens undergo apoptosis
  38. What is positive selection?
    T cells expressing TCRs capable of binding surface self MHC molecules survive
  39. How do the Fas receptors initiate the extrinsic pathway of apoptosis?
    • 1. Fas ligand (FasL) binds Fas (CD95
    • 2. The receptors trimerize, forming an adapter protein called Fas-associated death domain (FADD).
    • 3. Receptor-bound FADD then stimulates the activation of initiator caspases 8 & 10 which then activates executioner caspases 3 & 6.
  40. What is CD95?
    Fas- extrinsic pathway of apoptosis
  41. What role does the Fas/FasL play in T lymphocytes?
    • During initial clonal expansion, activated T lymphocytes are resistant to Fas-induced apoptosis.
    • However, they become more sensitive with progressive stimulation.
    • T cells that are highly stimulated by self antigens/ with high affinity for self antigens will undergo apoptosis.
  42. Mutations involving Fas or Fas L result in?
    • Failure of apoptosis of T cells with high affinity to self antigens. → excessive accumulation of autoreactive T cells
    • Development of autoimmune diseases such as SLE.
  43. What is affinity maturation
    B cells that exhibit a stronger affinity for the antigen are more able to proliferate more than cells with lower affinity,
  44. Which cytokines induce the formation of Th1 cells?
    IFN-γ and IL-12
  45. Whiich cytokines induce the formation of Th2 cells?
    IL-4
  46. What complication can rise from total parenteral nutrition after bowel resection? Why?
    • Total parenteral nutrition can induce gallstone formation due to:
    • 1. Absent enteral stimulation due to decreased cholecystokinin release. → Biliary stasis

    2. Disturbance of bile circulation
  47. What are the effects of Bupropion on sexual function?
    NO SEXUAL SIDE EFFECTS
  48. What are the side effects of Buproprion?
    • Stimulant effects e.g. Tachycardia, insomnia, agitation
    • Headache
    • Seizures in anorexic/ bulimic patients.
  49. What is the mechanism of Bupropion?
    ↑ NE and dopamine via an unknown mechanism
  50. What are the SSRIs and what are their effects on sexual function?
    • Floxetine, Paroxetine, Setraline, Citalopram
    • Sexual dysfunction (anorgasmia, ↓libido)
  51. What are the effects of Trazodone on sexual function?
    Priaprism- persistant, painful erection of the penis
  52. Describe the presentation of Carcinoid syndrome.
    • Wheezing
    • Facial flushing
    • Right sided valvular disease
    • Tumor of GI e.g appendix
  53. How can we treat carcinoid syndrome?
    • Surgical resection of the tumor
    • Somatostatin analog e.g Ocreotide
  54. What is the MOA and use of Ondansetron?
    • 5-HT3 antagonist
    • Controls vomiting postop and in patients undergoing cancer chemotherapy
  55. What is the MOA and use of Flutamide?
    • Nonsteroidal competitive inhibitor at androgen receptors.
    • Used for prostate carcinoma.
  56. This drug is used as an antiemetic in patients undergoing chemotherapy.
    Ondansetron
  57. What does Anti-HAV IgG indicate?
    Prior HAV infection and/ or prior vaccination
  58. What is anicteric?
    No jaundice
  59. Which sensory pathways reaches the cortex without relay nuclei in the thalami?
    Smell
  60. Motor innervation (movement) of the tongue is provided by which cranial nerve?
    • Hypoglossal nerve (CN 12)
    • Palatoglossus muscle is innervated by the vagus nerve (CN 10)
  61. What is the function of CN 12?
    Hypoglossal- tongue movement
  62. Which nerve provides general sensation to the anterior 2/3 of the tongue?
    Mandibular branch of the trigeminal nerve (CN V3)
  63. What innervation does CN V3 provide to the tongue?
    • General sensation to the anterior 2/3 of the tongue
    • Mandibular branch of the trigeminal nerve
  64. Which nerve provides general sensation to the posterior 1/3 of the tongue?
    Glossopharyngeal (CN 9)
  65. What role does the CN 9 play in tongue innervation?
    General sensation to the posterior 1/3 of the tongue.
  66. Which nerve provides general sensation to the posterior area of the tongue root?
    Vagus nerve (CN 10)
  67. Which nerve provides taste to the anterior 2/3 of the tongue?
    Chorda tympani branch of facial nerve
  68. What role does the vagus nerve play in tongue innervation?
    Provides taste. gustatory innervation to anterior 2/3 of tongue
  69. Which nerve provides taste to the posterior 1/3 of the tongue?
    Glosspharyngeal CN 9
  70. Label the terminal sulcus and foramen cecum.
  71. What are the anti-inflammatory cytokines?
    TGF-β and IL-10
  72. This organism does not produce hydrogen sulfide (H2S) on triple sugar iron (TSI) agar.
    Shigella
  73. These organisms produce hydrogen sulfide (H2S) on triple sugar iron (TSI) agar.
    • Salmonella
    • Proteus
    • Yersinia
  74. Gram negative rod, oxidase positive
    Pseudomonas aeruginosa
  75. Gram negative rod, oxidase negative
    • Produces hydrogen sulfide (H2S)
    • Salmonella
    • Proteus
    • Yersinia

    • Does not produce hydrogen sulfide (H2S)
    • Shigella
  76. What is the pathogenic mechanism for shigella infection?
    Invasion of GI mucosa by entering M cells in Peyer's patches
  77. What causes Alkaptonuria?
    • Deficiency of homogentisate oxidase (which converts Homogentisic acid/ ALKAPTON to Maleylacetoacetic acid) in the degradative pathway of tyrosine to fumarate.
    • Accumulated homogentisic acid causes pigment deposits in connective tissues throughout the body.
  78. What is the function of homogentisic acid oxidase?
    Converts homogentisic acid/ Alkapton to Maleylacetoacetic acid in the degradative pathway of tyrosine to fumarate.
  79. What is the function of dopamine hydroxylase?
    Converts dopamine to norepinephrine.
  80. This enzyme plays an important role in the degradation of tyrosine to fumarate.
    Homogentisic acid oxidase
  81. This enzyme converts dopamine to norepinephrine.
    Dopamine hydroxylase
  82. What is the function of Tyrosinase?
    • Converts tyrosine to melanin
    • Deficient in Albinism
  83. Pancreatic islet amyloid deposition is characteristic of?
    Type 2 diabetes mellitus
  84. What role may Amylin play in diabetes?
    • Amylin is stored in insulin secretory granules and is co-secreted with insulin from the pancreatic beta cells.
    • Deposits of amylin are seen in the pancreatic islets of patients with type 2 DM
  85. Which HLA subtypes are the most important determinants of type 1 DM?
    HLA-DR3 and DR4

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