USMLE 21

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rere_girl4ever
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USMLE 21
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2015-02-28 14:24:06
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USMLE 21
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  1. Describe the colonoscopy and biopsy findings of Kaposi's sarcoma.
    • Colonoscopy findings: Reddish/violet, flat maculopapular lesions or HEMORRAGIC POLYPOIDAL LESIONS/ NODULES.
    • Biopsy findings: Spindle shaped tumor cells with small vessel proliferation
  2. Colonic biopsy findings associated with this disease is described as spindle-shaped tumor cells with small vessel proliferation.
    Kaposi sarcoma
  3. What disease does Cryptosporidium cause?What are the biopsy findings?
    • Profuse, watery diarrhea 
    • Biopsy shows basophilic clustures on the surface of intestinal mucosal cells.
  4. Flask-shaped colonic ulcers are characterisitc of ?
    Entamoeba histolytica
  5. Trophozoites containing red blood cells are characteristic of?
    Entamoeba histolytica
  6. What causes a Pituitary apoplexy?
    Caused by sudden hemorrage of the pituitary gland, often in the presence of an existing pituitary adenoma
  7. Describe the presentation of a Pituitary atoplexy
    • Severe headache
    • Bitemporal hemianopsia
    • Visual disturbances
    • Decreased libido
    • Patients could die from cardiovascular collapse (hypotension) - due to ACTH deficiency
  8. What does it mean when a test is Reliable/ precise?
    A reliable test (precision) is reproducible in that it gives similar results on repeat measurements.
  9. A test which gives similar or very close results on repeat measurements is indicated as?
    A Reliable test (Precision)
  10. What is the associated between reliability and random error?
    Reliability is maximal when random error is minimal
  11. What does validity/ accuracy of a test mean?
    • Accuracy/ validity
    • Defined as a test's ability to measure what it is supposed to measure.
  12. A test's ability to measure what it is supposed to measure.
    Accuracy (validity)
  13. How can we evaluate the validity/ accuracy of a new test?
    By comparing its results to those obtained with the gold standard
  14. What combination of accuracy and precision exist below?
    • Accurate (valid)
    • Precise (reliable)
  15. What combination of accuracy and precision exist below?
    • Precise (reliable)
    • Not accurate (invalid)
  16. What combination of accuracy and precision exist below?
    • Accurate (valid)
    • Not precise (unreliable)
  17. What combination of accuracy and precision exist below?
    • Not accurate (invalid)
    • Not precise (unreliable)
  18. What does the vaccine for Neiseria meningitidis contain?
    Polysaccharide capsules
  19. The Bacille Calmette-Guerin vaccine is used for protection against which organism? What does it contain?
    • Mycobacterium tuberculosis
    • It contains live attenuated strains of M. 
    • bovis
  20. How can infection with Literia monocytogenes be acquired?
    Ingestion of unpasteurized dairy products and cold deli meats
  21. Tumbling motility is a unique feature of this microorganism.
    Listeria monocytogenes
  22. Label the heart murmurs which are best heard at each point.
  23. Right sided endocarditis involving the tricuspid valve is most often due to?
    • S.aureus
    • Commonly occurs in IV drug users
  24. Tricuspid valve endocarditis is associated with ?
    IV drug abuse
  25. At what location is the aortic heart sound best heard?
    Second right intercostal space at the right sternal boarder.
  26. This heart sound is best heard at the second right intercostal space at the right sternal boarder.
    Aortic valve
  27. At what location is the pulmonic valve best heard?
    Second left intercostal space at the left sternal boarder
  28. This heart valve is best heard at the second left intercostal space at the left sternal boarder
    Pulmonic valve
  29. At what location is the tricuspid valve best heard?
    Fourth left intercostal space at the lower left sternal boarder
  30. This heart valve is best heard at the fourth left intercostal space at the lower left sternal boarder.
    Tricuspid valve
  31. At what location is the mitral valve best heard?
    Fifth left intercostal space, medual to the mid-clavicular line
  32. This heart valve is best heard at the fifth left intercostal space, medial to the mid-clavicular line.
    Mitral valve.
  33. What is lipofuscin?
    A YELLOW-BROWN pigment "wear and tear" pigment associated with normal aging found in the heart, colon, liver, kidney, eye, ect. (especially in patients with malnutrition and cahexia)
  34. Yellowish-brownish intracytoplasmic granules in myocardial cells are diagnostic of?
    Lipofuscin
  35. What causes the formation of Lipofuscin?
    Lipid peroxidation and free radical injury.
  36. What are the effects of thiazide diuretics on Ca2+?
    Increases reabsorption of calcium → ⇧serum Ca2+
  37. What is the cause and findings of Familial hypocalciuric hypercalcemia?
    • Cause: defective Ca2+ sensing by parathyroid and renal tubule cells
    • Findings
    • ⇧Serum Ca2+
    • Normal to ⇧PTH
    • ⇩Ca2+ excretion (hypocalciuria) due to impaired renal calcium sensing
  38. How does Acyclovir work?
    • Acyclovir is converted to acyclovir monophosphate by thymidine kinase
    • Cellular enzymes then convert acyclovir monophosphate to acyclovir triphosphate.
    • When viral DNA polymerase incorporates acyclovir triphosphate into the viral DNA chain, viral DNA synthesis is terminated.
  39. Where do Carcinoid tumors arise from?
    Enterochromaffin (endocrine) cells of the intestinal mucosa.
  40. What causes a ppt to develop the clinical manifestations of Carcinoid syndrome?
    If intestinal carcinoids metastasize to the liver, their secretory products are not degraded (5-hydroxyindoleacetic acid), and they enter the systemic circulation.
  41. Describe the symptoms of Cardinoid syndrome.
    • Cutaneous flushing, dizziness
    • Diarrhea, crampy abdominal pain
    • Dyspnea and wheezing
    • Right-sided (pulmonary, tricuspid) valvular heart disease.
  42. What is the mechanism of Nitroprusside?
    Venous and arterial vasodilator that decreases both preload and afterload by ⇧cGMP by direct release of nitric oxide.
  43. What is responsible for Aldesleukin (Il-2's) anticancer effect?
    Increased activity of T cells and NK cells
  44. What is the use of Aldesleukin (IL-2)?
    • Metastatic melanoma 
    • Renal cell carcinoma
  45. What is the target and use of Alemtuzumab?
    • Target: CD52
    • Use: Chronic lymphocytic leukemia
  46. Monoclonal antibody used in the treatment of chronic lymphocytic leukemia
    Alemtuzumab
  47. This monoclonal body targets CD52.
    • Alemtuzumab
    • Chronic lymphocytic leukemia
  48. Name the Class 1A antiarrythmics.
    • Double Quarter Pounder
    • Dysopyramide
    • Quinidine
    • Procainamide
  49. Name the Class 1B antiarrythmics.
    • Lettuce Tomato Mayo
    • Lidocaine
    • Tocainide
    • Mexiletine
  50. Name the Class 1C antiarrythmics.
    • More Fries Please
    • Moricizine
    • Flecainide
    • Propafenone
  51. Which antiarrythmic drugs produces the change seen in the red curve in the action potential of a ventricular muscle cell?
    • Class 1A antiarrythmics
    • Double Quarter Pounder
    • Disopyramide
    • Quinidine
    • Procainamide
  52. Which antiarrythmic drugs produce the change seen in the red curve of the action potential of a ventricular muscle cell?
    • Class 1B
    • Tomato Lettuce Mayo
    • Tocainide
    • Lidocaine
    • Mexiletine
  53. Which antiarrythmic drugs produce the change seen in the red curve of the action potential of a ventricular muscle cell?
    • Class 1C antiarrythmics
    • More Fries Please
    • Moricizine
    • Flecainide 
    • Propafenone
  54. This drug prolongs phase 3 repolarization of the ventricular myocyte.
    • Shortens the AP
    • Class 1A
    • Double Quarter Pounder
    • Dysopyramide
    • Quinidine
    • Procainamide
  55. This drug shortens phase 3 repolarization of the ventricular myocye.
    • Shortens the AP
    • Class 1B
    • Lettuce Tomato Mayo
    • Lidocaine
    • Tocainide
    • Mexiletine
  56. This drug slows phase 0 of the ventricular myocyte action potential.
    • Class 1C
    • More Fries Please
    • Moricizine
    • Flecainide
    • Propafenone
  57. Label the circle of Willis below.
    • 1- Basilar artery
    • 2- Anterior cerebral artery 
    • 3- Anterior cerebral artery
    • 4- Middle cerebral artery
    • 5-Internal carotid artery
  58. Label the circle of Willis below.
  59. Occlusion of the Anterior cerebral artery would result in?
    • Loss of motor and sensory function in the CONTRALATERAL LEG AND FOOT.
    • **Note** Contralateral face and arm is spared.
  60. What causes ataxia in Ataxia-telangiectasia?
    Cerebellar atrophy
  61. In this disease, the DNA of ppts are hypersensitive to Ionizing radiation.
    Ataxia telangiectasia
  62. What causes Fanconi anemia?
    • Defect in DNA-repair enzymes
    • Caused by hypersensitivity of DNA to cross-linking agents
  63. Which disorders are characterized by deficient DNA-repair enzymes?
    • 1. Ataxia telangiectasia
    • 2. Xeroderma pigmentosum
    • 3. Fanconi anemia
    • 4. Hereditary nonpolyposis colorectal cancer
  64. What complication can Fanconi anemia lead to?
    • Aplastic anemia- failure or destruction of myeloid stem cells
    • Fanconi anemia- DNA repair defect.
  65. Neurofibrillary tangles in the neocortex are seen in?
    Alzheimers disease
  66. Loss of neurons in the substantia nigra is characteristic of?
    Parkinson disease
  67. Atrophy of the caudate nucleus is seen in?
    Huntington disease
  68. Posterior column involvement is seen in?
    B12 deficiency and Syphillis
  69. The presence of Lewy bodies is characteristic of?
    Parkinsonism
  70. How do we calculate the half life of a drug?
    t 1/2 =( Vd x 0.7)/ CL
  71. How do we calculate the maintenance dose of a drug?
    • Maintenance dose= (Cp x CL) / Bioavailability fraction
    • For meds administered intravenously, bioavailability=1
  72. How do we calculate the loading dose of a drug?
    Loading dose = (Vd x Cp)/ Bioavailability fraction
  73. This antibiotic has a volume of distribution of 70L and a clearance of 0.5L/min. How much should be administered every six hours to maintain a therapeutic steady-state plasma concentration of 4mg/L?
    • Maintenance dose= (Cp x CL)/ Bioavailability fraction
    • = 4 mg/L x 0.5 L/min
    • = 2 mg/min
    • However, when administered at 6-hour intervals: 
    • =2 mg/min x 60 min/hour x 6 hours
    • =720 mg
  74. This microorganism grows on charcoal yeast extract agar buffered with cysteine and iron.
    Legionella
  75. What does Legionella grow on?
    Charcoal yeast extract agar buffered with cysteine and iron
  76. Which organisms grow on silver stain?
    • Fungi (e.g. Pneumocystis jirvoreci)
    • H.pylori
    • Legionella
  77. How is infection with Legionella pneumophilia transmitted?
    Inhalation of contaminated water in air conditioning systems, hot water tanks.
  78. What are the enteroviruses and what do they cause?
    • Poliovirus
    • Echovirus
    • Coxsackievirus
    • Hepatitis A virus
    • Can cause aseptic (viral) meningitis except Hepatitis A Virus
  79. What are the most common causes of viral aseptic meningitis? How does it spread?
    • Enteroviruses- Coxackievirus, Echoviruses, polioviruses
    • Spreads fecal-oral
  80. What causes Kallmann syndrome?
    Failure of the GnRH-secreting neurons to migrate from their origin in the olfactory placode to their normal anatomical location in the hypothalamus.
  81. Describe the lab values of each in Kallman's syndrome: GnRH, FSH, LH, testosterone
    ALL IS DECREASED
  82. Describe the presentation of Kallman syndrome.
    • Anosmia
    • Poorly developed secondary characteristics
    • Infertility (low sperm count)
    • Amenorrhea (in females)
  83. What are the angiotensin II receptor blockers?
    • Losartan
    • Candesartan
    • Valsartan
  84. What is the MOA of Losartan?
    Blocks binding of angiotensin II to AT1 receptors
  85. What are the effects with the use of angitensin II receptor blockers on: Renin, Angiotensin I, Angiotensin II, Aldosterone, Bradykinin
    • Renin: ⇧
    • Angiotensin I: ⇧
    • Angiotensin II: ⇧
    • Aldosterone: ⇩
    • Bradykinin: No change
  86. These drugs blocks binding of angiotensin II to AT1 receptors
    • Losartan
    • Candesartan
    • Valsartan
  87. What is the use of Primaquine?
    It is added to the treatment of infections with P.vivax and P.ovale to completely eradicate infections and PREVENT RELAPSE.
  88. How do we prevent malarial relapse in infections with P.ovale/vivax?
    Add Primaquine
  89. Macrovesicular fatty change is most commonly caused by?
    Chronic ethanol consumption - Hepatic steatosis
  90. How does chronic ethanol consumption affect the liver?
    Causes a macrovesicular fatty change- Hepatic steatosis

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