USMLE 24

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rere_girl4ever
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USMLE 24
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2015-03-11 01:48:01
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USMLE 24
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  1. What is the DOC for the prevention of venous thrombosis?
    • Heparin
    • DOC for the prevention of venous thrombosis especially in ppts undergoing hip and knee surgery.
  2. What is the MOA and use of Argatroban?
    • Inhibit thrombin directly
    • Use: Heparin-induced thrombocytopenia
  3. What is the MOA and use of Bivalirudin?
    • Inhibit thrombin directly
    • Use: Heparin-induced thrombocytopenia
  4. What is the MOA and use of Dabigatran?
    • Inhibit thrombin directly
    • Use: Heparin-induced thrombocytopenia
  5. What is the MOA and use of Lepiridin?
    • Inhibit thrombin directly
    • Use: Heparin-induced thrombocytopenia
  6. Which drugs are used in the treatment of Heparin induced thrombocytopenia?
    • Argatroban
    • Bivalirudin
    • Dabigatran
    • Lepiridin
    • Inhibit thrombin directly
  7. What is the MOA of Ticlopidine?
    Inhibit platelet aggregation by blocking ADP receptors, preventing the expression of glycoproteins IIb/IIIa on platelet surface.
  8. What is the MOA of Clopidogrel?
    Inhibit platelet aggregation by blocking ADP receptors, preventing the expression of glycoproteins IIb/IIIa on platelet surface.
  9. What causes a Paradoxical embolism?
    • Paradoxical embolism occurs when a thrombus from the venous system crosses into the arterial circulation via an abnormal connection between the right and left cardiac chambers e.g
    • Patent foramen ovale
    • Atrial septal defect
    • Ventricular septal defect
  10. Describe the presentation of a Paradoxical embolism.
    Patient with deep venous thrombosis, develops a stroke.
  11. Hyponatremia/ low serum sodium levels is most commonly associated with pneumonia caused by which microorganism?
    Legionella
  12. What is the most common lab abnormality of Legionella pneumophilia?
    Low serum sodium
  13. What is the pathology seen below?
    • Telangiectasia
    • -permanent dilatations of  superficial capillaries and venules.
    • - will BLANCH UNDER PRESSURE because the RBCs present are confined to the vasculature.
  14. What does the Haemophilus influenzae type b (Hib) vaccine consist of?
    PRPP (polyribose-ribitol-phosphate) coupled with diptheria or tetanus toxoid.
  15. The Hib vaccine consists of PRP capsular polysaccharide conjugated with either tetanus or diptheria toxoid. What is the importance of protein conjugation?
    • Increases immunogenicity
    • Protein conjugation causes a T-cell mediated immune response leading to immunoglobulin class switching and generation of memory B-lymphocytes.
    • The response would not occur with pure polysaccharide.
  16. Advanced maternal age is a risk factor for having a child with?
    Down syndrome
  17. As a mother, what is the risk factor associated with having a child with Down syndrome?
    Advanced maternal age >45 years
  18. What is the pathology seen below?
    • Nuchal fold thickening- Down syndrome
    • ⇧amount of fluid around the neck

  19. What is the pathology seen below? What is it lined with?
    • Pancreatic pseudocyst
    • Granulation tissue , fibrous
  20. What lines a pancreatic pseudocyst?
    Fibrous and granulation tissue
  21. Vasculitis 2o to IgA immune complex deposition is characteristic of?
    Henoch-Schonlein purpura
  22. Describe the symptoms of Henoch-Schonlein purpura.
    • Skin: palpable purpura on buttocks/ legs
    • Althralgias 
    • GI: abdominal pain
  23. What is the MOA and use of Propylthiouracil?
    • Block thyroid peroxidase
    • Inhibit the oxidation of iodide
    • ''         ''    organification (coupling) of iodide.
    • Blocks 5' deiodinase → ⇩peripheral conversion of T4 to T3
    • USE: Hyperthyroidism, used in Pregnancy
  24. This drug blocks 5' deiodinase.
    • Propylthiouracil
    • Blocks 5' deiodinase which converts T4 to T3
    • NOTE: This is unique only to Propylthiouracil
  25. This drug decreases the peripheral conversion of T4 to T3.
    • Propylthiouracil
    • Blocks 5' deiodinase which converts T4 to T3
    • NOTE: This is unique only to Propylthiouracil
  26. These drugs are used in the treatment of hyperthyroidism?
    • Methimazole
    • Propylthiouracil
  27. Which drug is used in the treatment of hyperthyroidism in pregnancy?
    Propylthiouracil
  28. This drug cannot be used in the treatment of hyperthyroidism during pregnancy because it it teratogenic .
    Methimazole- causes aplasia cutis
  29. What is the difference between Propylthiouracil and Methimazole in terms of their MOA?
    • Methimazole + Propylthiouracil:
    • Block thyroid peroxidase
    • Inhibit the oxidation of iodide
    • ''         ''    organification (coupling) of iodide.
    • Propylthiouracil:
    • Blocks 5' deiodinase → ⇩peripheral conversion of T4 to T3
  30. Patient who has hyperthyroidism undergoes medical therapy on antithyroid medications later present with fever and throat pain. What is the most likely diagnosis and what is the best next step in management of this patient?
    • Agranulocytosis - Neutrophils<500mL
    • WBC count with differential

  31. Why is Methimazole contrainidicated in the treatment of hyperthyroidism in pregnant women?
    It is a teratogen- causes Aplasia cutis
  32. This antithyroid medication is known to cause hepatotoxicity.
    Propylthiouracil
  33. When should the first dose of the diptheria-pertussis-tetanus vaccine be administered to infants?
    • 2 months of age.
    • In areas of endemic disease, this vaccine can be given as early as 4-6 weeks of age, but not earlier.
  34. How does the lingual nerve innervate the tongue?
    The lingual nerve, a branch of the mandibular division of the trigeminal nerve (CN V3) provides sensation (pain, touch, temperature, pressure) to the anterior 2/3 of the tongue.
  35. This nerve provides sensation (pain, touch, temperature, pressure) to the anterior 2/3 of the tongue.
    Lingual/ mandibular branch of the trigeminal nerve (CNV3)
  36. What innervates the palatoglossus muscle of the tongue?
    Vagus nerve CN 10
  37. What is the action of glitazones?
    ⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
  38. What is the action of Pioglitazone?
    ⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
  39. What is the action of Rosiglitazone?
    ⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
  40. What is the action of Thiazolinediones?
    ⇧insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma)
  41. These drugs increase insulin sensitivity by binding to peroxisome proliferator activated receptor gamma (PPAR-gamma).
    • Glitazones/ Thiazolinediones
    • Pioglitazone
    • Rosiglitazone
  42. What are the side effects of Glitazones?
    • Weight gain, edema
    • Hepatotoxicity
    • Heart failure
    • ⇧risk of fractures
  43. Fluid retention, with resultant weight gain and edema, is common side effect of which diabetes drug?
    Glitazones- weight gain and edema
  44. Lactic acidosis is a common complication of which diabetes drug?
    Metformin
  45. What cellular receptor does the cytomegalovirus bind to?
    Cellular intergrins
  46. Which cellular receptors does the Epstein-Barr virus bind to upon infection?
    CD2/ CD21- B cells
  47. Which cellular receptors does the Rabies virus bind to upon infection?
    Nicotinic acetylcholine receptor
  48. What cellular receptor does the Rhinovirus bind to upon infection?
    ICAM1 (CD54)
  49. Label the diagram below.
    • 1. Mital valve opens
    • 2. Ventricular filling
    • 3. Mitral valve closes
    • 4. Isovolumetric contraction
    • 5. Aortic valve opens
    • 6. Ventricular ejection
    • 7. Aortic valve closes
    • 8. Isovolumetric relaxation
    • 9. Stroke volume
  50. What does a change in the dashed line below mean? What can cause such a change?
    • ⇧ ventricular PRELOAD.
    • The rightward shift of the ventricular filling indicates a larger than normal volume is being placed into the ventricule during diastole. 
    • This can occur during any state of fluid overload: 
    • Renal failure
    • Congestive heart failure
    • Infusion of intravenous fluids- e.g. normal saline infusion
  51. What does a change in the dashed line below mean? What can cause such a change?
    • Increased contractility
    • e.g. Dobutamine infusion
    • Higher pressures would be reached during the ventricular ejection phase and a greater volume of blood would be ejected during contraction.
  52. What does a change in the dashed line below mean? What can cause such a change?
    • Increased afterload
    • E.g Clamping of aorta
  53. Where are astrocytes derived from?
    Neurectoderm
  54. Where are microglia derived from?
    Monocytes in the bone marrow
  55. Where are oligodendrocytes derived from?
    Neurectoderm
  56. Small elongated nuclei, many short branching processes are characteristic of which neuroglia?
    Microglia
  57. Small round dark nuclei surrounded by pale halo are characteristic of which neuroglia?
    Oligodendrocytes
  58. Person undergoes neuronal shrinkage and intense cytoplasmic eosinophilia. If the person survives, what would the area demonstrate?
    Glial hyperplasia- proliferation of astrocytes in an area of neuron degeneration is called gliosis.
  59. What are the side effects of Spironolactone?
    • Hyperkalemia
    • Gynecomastia
    • Decreased libido
    • Impotence
  60. What are the side effects of Triamterene?
    • Hyperkalemia
    • Nausea, vomiting, dizziness
    • Leg cramps
  61. What is the role of platelets in the pathogenesis of Atherosclerosis?
    • Platelet-derived growth factor (PDGF) is released by locally adherent platelets, dysfuncitonal endothelial cells and macrophages to promote migration of SMOOTH MUSCLE CELLS.
    • Platelets also release TGF-B which is chemotactic for smooth mucle cells and induces collagen production
  62. In the pathogenesis of atherosclerosis, what causes migration of smooth muscle cells from the media into the intima?
    • PDGF
    • FGF
  63. Infection with this microorganism occurs via the inhalation of spores that commonly contaminate animal hides.
    Coxiella burnetti- Q fever
  64. What are the actions and use of Dobutamine?
    • β12, α
    • ⇧Cardiac output (Inotropic > Chronotropic)
    • USE: Heart failure, cardiac stress testing
  65. What is the action and use of Norepinephrine?
    • α121
    • Use: Hypotension (but ⇩renal perfusion)
  66. What is the DOC for the treatment of anaphylaxis?
    Epinephrine
  67. Consecutive readings of a patients blood pressure are 75, 110, 80, 90, 75 and 110 mmHg. Calculate the median.
    • Step 1: Arrange in order: 75 75 80 90 110 110
    • Step 2: Cancel off one at each end until you get to the middle: 75 75 80 90 110 110
    • Step 3: Average off the middle variables: (80+90)/2 = 85mmHg MEDIAN
  68. What causes Beta thalassemia?
    • POINT MUTATIONS in:
    • Splice sitesabberent splicing of pre-mRNA
    • Promotor sequences- premature chain termination during mRNA translation
  69. This is the most common thalassemia in patients of Meditteranean descent.
    Beta-thalassemia
  70. What does immunizaton with diptheria toxoid induce?
    Production of circulating IgG against the exotoxin B subunit, effectively preventing the disease.
  71. What is status epilepticus?
    • Recurrent/ continuous generalized tonic-clonic seizures that last more than 30 minutes, without a return to consciousness.
    • Violent shaking
  72. What are the first-line drugs for management of status epilepticus?
    • Benzodiazepines (Lorazepam, Diazepam)
    • *more rapid onset of action
  73. How do we treat Status epilepticus?
    • 1st step: Benzodiazepines (Diazepam, lorazepam)
    • 2nd step: Simultaneously load with Phenytoin (to prevent recurrence of seizures.
    • If still seizing- start phenobarbital.
    • Still seizing- intubate and give general anesthesia.
  74. This epilepsy drug blocks outgoing K+ current on multiple levels.
    Valproic acid
  75. This epilepsy drug blocks NMDA receptors.
    Valproic acid

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