USMLE 28

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USMLE 28
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2015-03-09 19:40:35
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  1. Describe the pathology of Carbon tetrachloride poisoning.
    • Carbon tetrachloride ⇨oxidized by CY-P450 ⇨
    • forms free radical CCI4 ⇨ lipid peroxidation (lipid degradation and hydrogen peroxide formation) of cell membranes ⇨ LIVER NECROSIS (FATTY CHANGE)
  2. Describe the findings of Chronic graft rejection.
    Proliferation of vascular smooth muscle and parenchymal FIBROSIS
  3. Describe the translocation of follicular lymphoma.
    • f(14;18)
    • 14- heavy chain Ig
    • 18- Bcl2 (anti-apoptotic)
  4. What are the monoamine oxidase inhibitors and what is the MOA?
    • Tranylcypromine
    • Phenelzine
    • Isocarboxazid
    • Selegiline
    • MOA: ⇧levels of dopamine, serotonin and norepinephrine
  5. What can be used to treat atypical depression?
    • Monoamine oxidase inhibitors: Tranylcypromine, Phenelzine, Isocarboxazid, Selegiline
    • SSRI: Fluoxetine, Paroxetine, Setraline, Citalopram
  6. Which antiarrythmic drug causes the change below?
    • Class III antiarrythmics
    • Amiodarone
    • Ibutilide
    • Dofetilide
    • Sotalol
  7. Needle shaped, negatively birefringent crystals are characteristic of?
    Gout
  8. What is the MOA of Probenecid?
    • Inhibits reabsorption of uric acid in proximal convoluted tubule
    • Inhibits secretion of penicillin
  9. This drug inhibits reabsorption of uric acid in the PCT
    Probenecid
  10. This drug inhibits secretion of penicillin
    Probenecid
  11. What are the side effects of thiazide diuretics?
    • HyperGLUC
    • HyperGlycemia
    • HyperLipidemia
    • HyperUricemia
    • HyperCalcemia
    • HYPOKALEMIA METABOLIC ALKALOSIS
  12. How do we treat serotonin syndrome?
    Cyproheptadine - 5HT2 receptor antagonist
  13. What is the MOA and use of Cyproheptadine?
    • MOA: 5-HT2 receptor antagonist
    • USE: Serotonin syndrome
  14. How do we treat opoid toxicity?
    Naloxone or Naltrexone
  15. What is the use of Naloxone?
    • Opoid receptor antagonist
    • Opoid toxicity
  16. This drug is an opoid receptor antagonist.
    Naloxone/ Naltrexone
  17. How do we treat benzodiazepine overdose?
    Flumazenil- competitive antagonist at GABA receptor
  18. What is the use of Flumazenil?
    Antidote for Benzodiazepine overdose
  19. What does it mean for a drug to have a large arteriovenous concentration gradient?
    ⇧Arertiovenous concentration gradient = ⇧Tissue solubility

    High tissue solubility means that more anestheic is taken up from the arterial blood, which results in ⇩venous blood concentration.

    • In order to achieve saturation of the blood, more anesthetic needs to be applied to replace the amount absorbed by peripheral tissue.
    • Blood saturation takes longer, brain saturation is delayed and onset of action is SLOWER.
  20. What does it mean for an anesthetic to have a small arteriovenous concentration gradient?
    • Anesthetic gases with low peripheral tissue solubility have smaller arteriovenous gradients as there is less peripheral tissue uptake. 
    • Less anesthetic is required to replace the amount absorbed by the peripheral tissue and so blood satruation occurs quickly, allowing concentrations in the brain to equilibriate faster.
  21. What is Recombination in viral genetics?
    Exchange of genes between 2 chromosomes by crossing over within homologous regions.
  22. Exchange of genes between 2 chromosomes by crossing over within homologous regions is characteristic of this viral genetics.
    Recombination
  23. This process occurs when viruses with segmented genomes exchange genetic material.
    Reassortment
  24. What is reassortment?
    • When viruses with SEGMENTED GENOMES exchange genetic material.
    • E.g. Influenza virus
  25. This term is described as the ability to take up naked DNA from environment.
    Transformation
  26. What is transformation is bacterial genetics?
    The ability to take up naked DNA from the environment
  27. How do we treat actinomyces infection?
    Penicillin
  28. Describe the rash of Rocky mountain spotted fever
    Rash starts at wrists and ankles and then spreads to trunk, palms and soles
  29. Describe the neurofibromas of Neurofibromatosis type 1
    • Skin colored/ pink nodules consisting of SCHWANN CELLS (neural crest derivative)
    • Rubbery texture
    • Button hole sign when pressure is applied to them
  30. This cutaneous pathology exhibits a "button-hole sign" when pressure is applied to them.
    Neurofibromas (Neurofibromatosis type 1)
  31. What are the skin tumors of neurofibromatosis type 1 derived from and composed of?
    • Neural crest cells
    • They are nodules which consist of schwann cells
  32. What is another way in which cafe-au-lait spots can be described?
    Hyperpigmented macules
  33. This embryonic derivative gives rise to the anal epithelium to the dentate line.
  34. This embryonic derivative gives rise to the anal canal below the pectinate line
  35. This embryonic derivative gives rise to the lens and cornea.
  36. This embryonic derivative gives rise to the retina.
  37. This embryonic derivative gives rise to the dermis.
  38. This embryonic derivative gives rise to the ependymal cells.
  39. This embryonic derivative gives rise to the astrocytes.
  40. Where are serotonin-releasing neurons in the CNS found?
    Raphe nuclei (located in the midbrain, pons and medulla).
  41. This embryonic derivative gives rise to the chorioid plexus
  42. Where is the raphe nuclei located? What is its function?
    • Midbrain, pons and medulla
    • Houses serotonin-releasing neurons
  43. Lesions to the raphe nuclei can cause?
    • Anxiety, insomnia, depression
    • Houses serotonin-releasing neurons
  44. Where is the nucleus cereleus located and what is its function?
    • Located in dorsal pons.
    • Houses norepinephrine-secreting neurons
  45. This structure houses norepinephrine-secreting neurons.
    Nucleus ceruleus / Locus ceruleus
  46. What is the function of the basal nucleus of Meynart?
    Houses acetylcholine-secreting neurons
  47. This structure houses acetylcholine-secreting neurons
    Basal nucleus of Meynart
  48. This type of hernia protrude through the Hesselbach triangle.
    Direct inguinal hernias.
  49. Describe the protrusion of Direct inguinal hernias.
    • Bulges through Hesselbach's triangle, which is formed by the inguinal ligament inferiorly, the inferior epigastric vessels laterally and the rectus abdominus muscle medially.
    • Goes through the external (superficial) inguinal ring only.
  50. What causes a direct inguinal hernia?
    Weakness of the transversalis fascia in the Hesselbach's triangle
  51. This type of hernia is caused by weakness in the transversalis fascia.
    Direct inguinal hernia
  52. This type of hernia is covered only by the external spermatic fascia.
    Direct inguinal hernia
  53. What are direct inguinal hernias covered by?
    Covered only by the external spermatic fascia
  54. What is Ethylene glycol?
    A substance found in automobile antifreeze, engine coolants and hydraulic brake fluids.
  55. What are the manifestations of Ethylene glycol poisoning?
    • Leads to acute renal failure due:
    • 1. Precipitation of calcium oxalate crystals (enveloped/ dumbbell-shaped)
    • 2. Balloning and vacuolar degeneration in PCT of kidney.
    • 3⇧Anion gap= METABOLIC ACIDOSIS

  56. These urine crystals are enveloped or dumbbell shaped.
    Calcium oxalate
  57. What type of kidney stones does Ethylene glycol poisoning cause?
    Calcium oxalate - enveloped/ dumb bell shaped
  58. Woman being treated for bipolar disorder experiences excessive thirst and frequent urination. What is the pathology?
    Nephrogenic DI 2o to lithium
  59. α2δ2 describes the structure of?
    • Hemoglobin A2 
    • ⇧HbA2 in β-thalassemia minor
  60. α2γ2 describes the structure of?
    Hemoglobin F
  61. ζ2ε2  describes the structure of?
    • Hemoglobin Gower
    • Zeta2, epsilion2
    • earliest Hb i fetus (synthesied in yolk sac)
  62. γ4 describes the structure of?
    • Hemoglobin Bart 
    • α-thalassemia (4 allele deletion)
  63. Liver biopsy below is characteristic of infection with?
    • Hepatitis B
    • "Ground glass appearance" due to fine, granular eosinphilic appearance as a result of hepatocyte being filled with spheres and tubules of HBsAg
  64. In this type of infection, hepatocyes take on a finely granular, eosinphilic appearance, more commonly described as "ground glass."
    Hepatitis B infection
  65. Describe the movement of electrolytes in tx with Spironolactone.
    • Excretion of Na+ and H20
    • Reabsorption of K+ and H+
  66. Describe the findings of each in a patient with emphysema.
    FEV1/FVC
    TLC
    Diffusing capacity
    • FEV1/FVC: ⇩
    • TLC: ⇧
    • Diffusing capacity: ⇩
  67. What is the function of α1- antitrypsin?
    • Inhibits protease released by macrophages and neutrophils.
    • Protease contains elastases, cathepsins, matrix metalloproteinases.
  68. What are the side effects of Viblastine toxicity?
    Bone marrow suppression
  69. What are the side effects of Vincristine toxicity?
    • Neurotoxicity:
    • Arreflexia
    • Peripheral neuritis- numbness and tingling
  70. What is the MOA of Vincristine/ Vinblastine?
    Vinca alkaloids that bind β-tubulin and inhibit its polymerization into microtubules ⇨ prevent mitotic spindle formation
  71. This drug binds β-tubulin and inhibit its polymerization into microtubules.
    • Vincristine/ Vinblastine
    • Vinca alkaloids that bind β-tubulin and inhibit its polymerization into microtubules ⇨ prevent mitotic spindle formation
  72. This drug prevents mitotic spindle formation.
    • Vincristine/ Vinblastine
    • Vinca alkaloids that bind β-tubulin and inhibit its polymerization into microtubules ⇨ prevent mitotic spindle formation
  73. Which drugs cause hemorragic cystitis?
    • Cyclophosphamide 
    • Ifofosfamide
  74. What is the pathology seen below?
    • Metastatic liver disease
    • Hypodense mases in liver
  75. How do we treat infections caused by Chlamydia trachomatis?
    • AZITHROMYCIN ***
    • DOXYCYCLINE *
  76. What are the adverse effects of the use of Sotalol?
    • Soltalol is a beta-blocker with a class III (K+ blocking) antiarrrythmic properties
    • Torsades de pointes
    • Excessive β blockade
  77. What is the MOA of Sotalol?
    Beta blocker with class 3 (K+ channel blcoking) antiarrythmic properties
  78. Patients with sickle cell anemia become fully asplenic. They are at risk for infection by?
    Encapsulated organisms
  79. Which organisms are the MCC of osteomyelitis with sickle cell disease?
    • 1. Salmonella
    • 2. S.aureus
    • 3. E.coli
  80. Down syndrome incidence increases with?
    Maternal age
  81. What is the submucosal nerve plexus also called?
    Meissner
  82. Where is the Meissner plexus located?
    • In the submucosa
    • Submucosal nerve plexus
  83. Where is the Auerbach plexus located?
    • In the muscularis externa
    • Myenteric nerve plexus
  84. The myenteric nerve plexus is also known as? Where is it located?
    • Auerbach nerve plexus
    • Located in the muscularis externa
  85. Which disorders cause a megaloblastic anemia?
    • Folate deficiency
    • B12 deficiency
    • Orotic aciduria

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