USMLE 26

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rere_girl4ever
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297736
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USMLE 26
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2015-03-10 12:44:42
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USMLE 26
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USMLE 26
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  1. What is the most effective agents for the treatment of hypertriglyceridemia?
    • Fibrates:
    • Gemfibrozil
    • Clofibrate
    • Bezafibrate
    • Fenofibrate
  2. Which lipid lowering agents are the most useful in lowering triglyceride levels?
    • Fibrates:
    • Gemfibrozil
    • Clofibrate
    • Bezafibrate
    • Fenofibrate
  3. How do fish oil supplements acts as a lipid lowering agent?
    Fish oil supplements contain omega-3 fatty acids which are used in the treatment of hypertriglyceridemia
  4. What are the effects of Fibrates- Gemifibrozil, Clofibrate, Bezafibrate, Fenofibrate on each of the following:
    LDL
    HDL
    Triglycerides
    • LDL:⇩
    • HDL: ⇧
    • Triglycerides: ⇩⇩⇩
  5. What are the effects of Niacin on each of the following:
    LDL
    HDL
    Triglycerides
    • LDL:⇩⇩
    • HDL: ⇧⇧
    • Triglycerides: ⇩
  6. What are the effects of Ezetimibe on each of the following:
    LDL
    HDL
    Triglycerides
    • LDL:⇩⇩
    • HDL:  ↔
    • Triglycerides: ↔
  7. What are the effects of Bile acid resins - Cholestyramine, Colestipol, Colesevelam) on each of the following:
    LDL
    HDL
    Triglycerides
    • LDL:⇩⇩
    • HDL:  Slightly ⇧
    • Triglycerides: Slightly ⇧
  8. What are the effects of HMG-CoA reductase inhibits - STATINS on each of the following:
    LDL
    HDL
    Triglycerides
    • LDL:⇩⇩⇩
    • HDL:  ⇧
    • Triglycerides:  ⇧
  9. What is the MOA and use of Tadafil?
    • Inhibit phosphodiesterase-5 → ⇧cGMP, smooth muscle relaxation in the corpus cavernosum, blood flow, penile erection.
    • Use: Erectile dysfunction
  10. How do Class IC antiarrythmics exhibit strong use dependence?
    They inhibit phase 0 depolarization which prolongs ventricular depolarization - ⇧ QRS duration to a greater extent at HIGHER heart rates (e.g in cardiac stress testing).
  11. How does Acetyl-CoA activate gluconeogenesis?
    Activates pyruvate carboxylase which converts Pyruvate ⇨ Oxaloacetate
  12. What increases the activity of pyruvate carboxylase?
    • Acetyl CoA
    • BIOTIN
    • ATP
  13. Biotin is required in which part of gluconeognesis?
    • Pyruvate carboxylase
    • Pyruvate ⇨ Oxaloacetate
  14. What are the effects of alanine in gluconeogenesis/ glycolysis?
    It inhibits glycolysis by inhibiting Pyruvate kinase which converts Phosphoenolpyruvate to Pyruvate.
  15. What role does citrate play in gluconeogenesis?
    • Stimulates Fructose-1,6-bisphosphatase 
    • Converts Fructose-1,6-bisphosphate to Fructose 6 phosphate
    • NOTE- Think fruits (citrate and fructose are fruity)
  16. The nitrogen atoms in the urea molecule are derived from?
    NH3 and Aspartate
  17. What causes the formation of a granuloma?
    • Macrophages secrete IL-12 which induce differentiation to TH1 helper cells
    • TH1 cells produce IFN-Y to stimulate macrophages
  18. What is the function of the TH2 cell?
    • Recruits eosinophils for parasitic defense
    • Promotes IgE production by B cells
  19. What stimulates isotype switching to IgE?
    TH2- IL-4
  20. What cytokine promotes T helper differentiation into the TH2 subset?
    IL-4
  21. What stimulates isotype switching to IgA?
    IL-5
  22. What cytokine stimulates growth and differentiation of eosinophils?
    IL-5
  23. What is the function of IL-5?
    • Promotes growth and differentiation of eosinophils
    • Enhances class switching to IgA
  24. Mucicarmine stain is used to detect?
    Polysaccharide capsule of cryptococcus neoformans
  25. What type of hypersensitivity plats an important role in the host defense against M.tuberculosis?
    Delayes Type hypersensitivity- Type IV
  26. What disease does the Calcivirus cause?
    Norovirus/ Norovirus- viral gastroenteritis
  27. What viral family does the Norovirus belong to and what disease does it cause?
    • Calciviruses
    • Viral gastroenteritis
  28. What viral family does Rubella belong to?
    Togaviruses
  29. What viral family does Western equine encephalitis belong to?
    Togaviruses
  30. What viral family does Eastern equine encephalitis belong to?
    Togaviruses
  31. What causes gene mutations in HIV?
    Highly active ANTIRETROVIRAL therapy causes drug resistance and a high mutation rate of the HIV genome
  32. What does the pol gene of HIV code for?
    • Reverse transcriptase
    • Aspartate protease
    • Integrase
  33. Patient being treated for tuberculosis experiences optic neuropathy (red-green colored blindness). What drug causes this adverse effect?
    Ethambutol
  34. What side effects are associated with the use of Ethambutol?
    • Optic neuropathy 
    • Red-green color blindness
  35. What are the side effects of Aminoglycosides?
    • Nephrotoxicity
    • Ototoxicity- vertigo, deafness, tinnitus
    • Flaccid paralysis due to neuromuscular blockade
    • Teratogen
  36. What are the side effects of Chloramphenicol?
    • Anemia/ Aplastic anemia
    • Grey baby syndrome
  37. What are the side effects of Dapsone therapy?
    Agranulocytosis
  38. What are the side effects of Trimethoprim therapy?
    • Megaloblastic anemia
    • Leukopenia
    • Granulocytopenia
  39. What is the function of endothelin?
    Vasoconstrictor
  40. What causes familial Pulmonary arterial hypertension?
    Due to mutation in bone morphogenic protein receptor type 2 (BMPR2)
  41. On cardiac auscultaion, this murmur is characterized by a snap followed by a rumbling diastolic murmur.
    Mitral stenosis
  42. What is the pathology seen below in the lung?
    • Sarcoidosis
    • Non caseating granuloma
  43. Alcoholic insists he can be a controlled drinker is using which defense mechanism?
    Denial
  44. What is fantasy defense mechanism? Give an example
    • Fantasy- Substituting imaginary scenarios
    • e.g. Son has osteosarcoma, underwent amputation, prognosis is poor. Mother says she is not worried about prognosis and says someday he will fulfill his dream of playing in the major league.
  45. Patient presents with breathing difficulty secondary to pain with inspiration. The pain is carried by which nerve?
    Phrenic nerve
  46. Tumors located in the lung apex are called?
    Pancoast tumors
  47. Tumors located in the superior sulcus are called?
    Pancoast tumors
  48. Where are Pancoast tumors located?
    In the apex/ superior sulcus of the lung
  49. Describe the symptoms of a Pancost tumor.
    • 1. Severe pain in the shoulder region that radiates toward the axilla and scapula.
    • 2. Horner's syndrome- due to the involvement of the cervical sympathetic ganglia. Symptoms include ipsilateral ptsosis, miosis and anhydrosis.
    • 3. Compression of the subclavian vessels may cause edema of the upper extremity.
    • 4. Extension of the tumor into the intervertebral foramino may lead to spinal cord compression and paraplegia
  50. Compared to the control medication, how many patients need to be treated with Superstatin to prevent one additional myocardial infarction?
    • Number needed to treat- represents the number of patients that need to be treated with a medication in order to prevent an additional negative outcome.
    • NNT= 1/ ARR
    • ARR= Event rate control- Event rate treatment
    • ARR= (10/1000= 0.01 or 1%)- (25/1000= 0.25 or 2.5%)
    • ARR=2.5%- 1%
    • ARR= 1.5%
    • NNT=1/0.015
    • NNT= 66.6
    • 67 patients need to be treated with Superstatin to prevent an additional myocardial infarction.
  51. How do we calculate number needed to treat?
    NNT= 1/ARR (Absolute risk reduction)
  52. What should be removed from a patient's diet with aldolase B deficiency?
    Fructose and sucrose
  53. What makes up sucrose?
    Fructose and glucose
  54. What makes up maltose?
    Glucose + Glucose
  55. What makes up lactose?
    Galactose + Glucose
  56. The conversion of pro-carcinogens to carcinogens/ active metabolites depends on the activity of which enzyme?
    Cytochrome P450 MONOOXYGENASE
  57. What is the pathology below?
    Ecthyma gangrenosum- Pseudomonas aeruginosa
  58. What is the pathology below?
    Ecthyma gangrenosum- Pseudomonas aeruginosa
  59. What is ecthyma gangrenosum? What causes it and which patients are commonly affected?
    • A cutaneous nectrotic disease associated with Pseudomonas aeruginosa infection.
    • Common in neutropenic patients, hospitalized patients, patients with burns and chronic indwelling catheters.
  60. What is the action of Enfuvirtide?
    • Binds to the heptad repeat 1 (HR1) of gp41 and prevents fusion of viral membrane with the target cellular membrane.
    • As a result, the HIV genome entry is denied into uninfected CD4+ T cells.
  61. This drug binds gp41, inhibitng viral entry of HIV.
    Enfuvirtide
  62. HIV DNA synthesis from the RNA template is impaired by?
    Reverse transcriptase inhibitors
  63. HIV polyprotein cleavage is prevented by which medication?
    Protease inhibitors- navir
  64. HIV DNA integration into the host genome is catalyzed by?
    HIV viral integrase
  65. What is the MOA of Raltegravir?
    Inhibits HIV integrase, thereby preventing HIV genome integration into host cell chromosome
  66. This drug inhibits HIV viral integrase.
    Raltegravir
  67. CD4 is a cell surface marker for?
    CD8+ cytotoxic T cells
  68. CD15 is a cell surface marker for?
    • Reed-Sternberg cells (CD15 and CD30)
    • Hodgkin lymphoma
  69. What cell surface markers are on Reed-Sternberg cells?
    CD15 + CD30
  70. The best treatment of chronic dry cough caused by an ACE inhibitor is replacement of this drug with?
    Angiotensin receptor blocker - e.g Losartan
  71. What can be used to close the PDA?
    • Indomethacin, NSAIDS
    • Inhibit PGE1 synthesis
  72. What is the effect of indomethacin on the PDA?
    Closes the PD by inhibiting PGE1 synthesis
  73. What can be used to maintain a PDA?
    Prostaglandins (PGE1)
  74. What are the effects of prostaglandins on the PDA?
    Closes the PDA
  75. What is the agent of choice for prevention and treatment of post-myocardial infarction arrythmias?
    Lidocaine- affect ischemic/ depolarized tissue
  76. Which drug has the highest selectivity for ischemic myocardium compared to normal cardiac tissue?
    Lidocaine- class IB
  77. What complication can arise from the use of Ticlopidine?
    • Neutropenia- ⇩WBCs 
    • Presents as fever with mouth blisters
  78. How can we treat von Willebrand disease?
    Desmopressin- releases vWF stored in endothelium
  79. This drug releases vWF stored as endothelium.
    Desmopressin
  80. What is enuresis and how do we treat?
    • Involuntary urination (bed wetting)
    • Tx: oral desmopressin acetate (DDAVP) which mimics ADH
  81. mRNA is stored in this structure for future translation.
    P bodies
  82. What is the function of P bodies?
    • 1. Stores mRNA for future translation
    • 2. Contain exonucleases, mRNA decapping enzymes and micro-RNA induced mRNA silencing
  83. Injury to this nerve often results from a fracture of the neck of the fibula.
    Common peroneal nerve

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