1: Step 1 Review

Front 1

10 mo old infant diagnosed with RSV infection. High fever, runny nose, loss of appetite, prematurity. What drug do you treat baby with?

Back 1

Treat RSV with palivizumab (monoclonal antibody against fusion protein of RSV, prevents infection of host cell)

Front 2

what is palivizumab and what does it treat?

Back 2

treats RSV infection
(monoclonal antibody against fusion protein of RSV, prevents infection of host cell)

Front 3

abatacept is used in what disease? how does it work?

Back 3

used in RA
it is selective costimulation modulator that inhibits T cell activation

Front 4

what is daclizumab used for?

Back 4

it is monoclonal antibody with high affinity for IL-2 receptor on activated T cells. Used to prevent tissue rejection in translplant patients

Front 5

how does prednisone work?

Back 5

it induces lipocortin, which inhibits phospholipase activity and subsequent prostaglandin synthesis. it can also inhibit transcription of many proinflammatory cytokines.

Front 6

What drug:
it induces lipocortin, which inhibits phospholipase activity and subsequent prostaglandin synthesis. it can also inhibit transcription of many proinflammatory cytokines.

Back 6

prednisone

Front 7

sirolimus drug works how?

Back 7

inhibits T cell proliferation by binding specirid serine-threoninne kinase that is needed for cell cycle progression

Front 8

burn patient with gram negative encapsulated oxidase positive aerobic rod in sputum. Agent?
how is it resistant?

Back 8

pseudomonas aeriginosa.
chromosomally mediated mutation to a porin protein.

Front 9

high pitched, holosystolic ejection murmur best heard at apex? what is it and what is going on in lungs?

Back 9

mitral regurgitation.
CHF, you will see heart failure cells (hemosiderin laden macrophages)

Front 10

describe the mumur of mitral regurg.
-pitch?
-where heard?
-when heard?

Back 10

high ptiched, holosystolic, best heard at apex

Front 11

consolidation in R upper lobe; thick, bloody sputum. alcoholic.
gram ?
oxidase?
shape?
name?

Back 11

klebsiella pneumoniae
gram (-) oxidase negative bacillus
"currant jelly sputum"

Front 12

gram (-) oxidase (-) bacillus
who gets it?

Back 12

klebsiella pneumo
alcoholics
currant jelly sputum

Front 13

gram (-) oxidase (+) bacillus

Back 13

pseudomonas aeriginosa
CF patients
bluegreen sputum with fruity odor

Front 14

blue green sputum with fruity odor

Back 14

pseudomonas aeriginosa
common in CF patients
gram (-) oxidase (+) bacillus

Front 15

gram (-) pleomorphous bacillus requiring factors X and V

Back 15

hemophilus influenzae

Front 16

most common cause of typical pneumonia in alcoholics?

Back 16

strep pneumo! It is most ocmmon in all adults, including alcoholics

Front 17

gram (+) catalase (-) coccus

Back 17

strep
strep pneumo has "rusty sputum"

Front 18

gram (+) catalase (+)

Back 18

staph
staph aureus most common type of staph that can cause of pneumonia.
seen in aspiration pneumonia in alcoholics

Front 19

rusty sputum? what organism?

Back 19

strep pneumo (gram +, catalase -)

Front 20

what artery and what branch of this artery supply blood to nasal mucosa?

Back 20

maxillary artery, sphenopalatine branch.

Front 21

facial artery branches from what artery and supplies what ?

Back 21

facial artery branches from external carotid and supplies superficial face.

Front 22

what are two terminal branches of external carotid artery?

Back 22

maxillary and superficial temporal

Front 23

what artery gives blood to parotid gland?

Back 23

transverse facial artery

Front 24

what artery supplies lip area, and what does this artery branch from

Back 24

the superior labial artery, branching from the facial artery.

Front 25

normal PCO2 in arterial blood?

Back 25

33-45 mmHg

Front 26

normal PO2 in arterial blood?

Back 26

75-105 mmHg

Front 27

produces lactose fermenting colonies on MacConkey's agar
oxidase (-)

Back 27

klebsiella pneumoniae

Front 28

most common gram (-) rod that infects infants as they come through birth canal?

Back 28

E.Coli

Front 29

what part of E.Coli causes neonatal disease?

Back 29

K1 capsule that prevents phagocytosis

Front 30

yeast with thin cell wall but no real capsule.
Ohio and Mississippi River valley
calcifications in lung
organism?

Back 30

Histoplasma capsulatum: small intracellular yeast

Front 31

yeast with broad slimy capsule, esp in immunosuppressed (AIDS or hematopoetic disorders

Back 31

cryptococcus

Front 32

yeast with multiple budding
south and central america

Back 32

paracoccidiodes

Front 33

nonbudding spherule filled with endospores
southwest and west US (San Joaquin valley fever)

Back 33

coccidiodes

Front 34

hyphae branching dichotomously at acute angles

Back 34

aspergillus: opportunistic fungus that can invade cavitary lesions and cause aspergilloma (fungus ball)

Front 35

curschmann spirals

Back 35

asthma

Front 36

increased reid index

Back 36

chronic bronchitis (reid index is the ratio of gland depth to total thickness of bronchial wall

Front 37

Lyme disease causes what condition in the heart?

Back 37

3rd degree heart block.

Front 38

3rd degree heart block can be caused by what transmissible disease?

Back 38

lyme disease

Front 39

early systolic ejection click

Back 39

aortic stenosis

Front 40

diastolic opening snap

Back 40

mitral stenosis

Front 41

crescendo-decrescendo murmur

Back 41

aortic stenosis

Front 42

holosystolic
harsh sounding
loudest at tricuspid area

Back 42

VSD

Front 43

describe murmur from VSD

Back 43

holosystolic
harsh sounding
loudest at tricuspid area

Front 44

aortic stenosis radiates where?

Back 44

carotids

Front 45

holosystoic high pitched blowing murmur

Back 45

tricuspid or mitral regurg
(mitral is loudest at apex, radiates to axilla)
both can be caused by rheumatic fever

Front 46

high pitched diastolic blowing murmur

Back 46

aortic regurg. Decrescendo murmur heard best over left sternal border

Front 47

continous machine like murmur. when is it loudest?

Back 47

PDA

loudest at S2

Front 48

mid systolic click

Back 48

mitral prolapse associated wtih marfans

Front 49

what murmur assoc. with marfans?

Back 49

mitral prolapse

Front 50

describe mitral prolapse murmur

Back 50

mid systolic click, crescendo murmur, loudest at S2, usually benign, associated wtih marfans

Front 51

cardiac muscle action potential has a plateau due to what?

Back 51

Ca++ influx

Front 52

What is cushings triad? when does it happen

Back 52

it is seen with increased ICP before herniation:
bradycardia
HTN
erratic respiration

Front 53

name 4 diseases assoc with subarachnoid hemorrhage

Back 53

marfans
ehlers danlos
APKD
berry aneurysms
(also, cocaine, sickle cell etc)

Front 54

what vessels are involved in subdural hematoma? what usually causes them? what patient population do you frequently see them in?

Back 54

bridging (emissary) veins

usually caused by trauma

common in alcoholics, elderly, shaken baby

Front 55

crescent shaped hematoma, crosses sutures but not midline?

Back 55

subdural hematoma

Front 56

subdural hematoma will look like what on CT?

Back 56

crescent shaped, will cross sutures but not midline

Front 57

trauma to middle meningial artery causes what kind of hematoma

Back 57

epidural, lens shaped
**lucid interval

Front 58

which hematoma has a lucid interval

Back 58

epidural

Front 59

herpes meningitis prefers what region of the brain?

Back 59

temporal region

Front 60

: bleeding from ear; CSF leaking from nose or ear; battle sign (bruising of mastoid bone); raccoon eyes (bruising around eyes).

Back 60

basilar skull fracture

Front 61

1. Patient with history of being double-jointed complains of side-swiping cars.

Back 61

berry aneurysm

Front 62

2. Patient with HTN, difficulty walking on right side. PE: loss of strength on right side. Speech is normal. what artery is occluded?

Back 62

ACA

Front 63

3. Patient presents with headache, right leg weakness, difficulty walking on exam. PE: left eyelid seems closed, when you open it the pupil is small. Patient is clumsy with heel to shin exam.
what artery

Back 63

PICA, Wallenberg syndrome

Front 64

headache in young, overweight women. Diagnose: LP - increased ICP, but normal CSF findings.
what is it?

Back 64

pseudotumor cerebri

Front 65

associated with polymyalgia rheumatica (PMR); treat with corticosteroids; palpable temporal artery; diagnose with biopsy. More common in elderly women. ESR will be markedly elevated. Complications: blindness

Back 65

temporal arteritis

Front 66

increased metanephrins in urine (urinary VMA); treatmetn is alpha and beta blockers, surgery;

46 yo male nurse…recurring headaches…sudden onset of diffuse pressure-like headache…anxiety, palpitations, mild diaphoresis…BP 180/110…dilated pupils, warm, moist skin with tachycardia… values returned to normal after 45 min…6 similar episodes previously.

Back 66

pheochromocytoma
"10%" tumor:
kids, malignant, familial, calcified

Front 67

formula:
BP =

Back 67

CO x PTR

Front 68

after essential htn, what is SECOND most common cause of HTN?

Back 68

renal parenchymal disease

Front 69

As age increases ___ becomes a more important contributor to elevated blood pressure.

In younger patients _____ is a bigger contributor.

Back 69

Older = TPR

Younger = cardiac output

Front 70

8. All of the following are signs of end organ damage from HTN except:
a. Papilledema:
b. Proteinuria
c. LVH on EKG
d. Leg edema
e. Laterally displaced apical impulse

Back 70

Leg edema: a finding associated with end organ damage to heart

Front 71

15. The primary mechanism of action of Captopril is:
a. Blocks effect of angiotensin II on aldosterone
b. Competitively inhibits angiotensin II
c. Blocks production of angiotensin II
d. Competitively inhibits aldosterone

Back 71

C: Captopril blocks the production of angiotensin II

Front 72

how do ca++ channel blockers work?

Back 72

decrease conduction at AV node; relaxes smooth muscle, decreases contractility

Front 73

what drug category does this:
decrease conduction at AV node; relaxes smooth muscle, decreases contractility

Back 73

Ca++ channel blockers

Front 74

if pt has asthma and needs anti-hypertensive, what do you avoid?

Back 74

non-selsective B blocker (propanolol)

Front 75

what is difference?
atenolol
propanolol
labetolol

Back 75

atenolol = B1>B1
propanolol B1=B2
labetolol A1=B1=B2

Front 76

Ca++ channel blockers vs digoxin

Back 76

Ca++ blockers decrease chronotropic
digoxin inotropic effect

Front 77

side effect of metformin is metabolic _______

Back 77

acidosis

Front 78

side effect of what drug will cause depression, crying, can't get erection

Back 78

B blocker

Front 79

if you give pt an antihypertensive and they get racing heart, what did you give them?

Back 79

nifedipine. it has no effect on heart, but it decreases BP and causes REFLEX TACHYCARDIA

Front 80

peaked T waves due to?
what drugs cause this

Back 80

hyperkalemia
ACE inhibitors
ARBs

Front 81

intestinal ileus after surgery .
name 2 drugs you can give and 1 drug category to avoid

Back 81

avoid opiates

give metoclopromide or erythromycin

Front 82

crampy pain with distention

Back 82

obstruction of intestines

Front 83

sickle cell crysis has what effect on bilirubin?

Back 83

Vaso-occlusion → hemolysis → increased unconjugated bilirubin overwhelming hepato-bili system

Front 84

colicky pain 48 yo female; clay colored stools, dark urine; increased total bilirubin. what is dx?

Back 84

cholilithiasis
decreased bile acids relative to cholesterol causes cholesterol to precipitate out of gallbladder fluid. form obstructio of common bile duct, unable to excrete --> increases conjugated bilirubin. increased conj bili in urine makes it dark, absence of urobilinogen in stool makes it clay colored

tx - ursodeoxycholic acid +/- surgery

Front 85

crigler Najjar I is defect of what enzyme? what builds up?

Back 85

build up of UNconjugated bili due to no UDP=glucuronyl transferase.

Front 86

dubin johnson? type of bili?

Back 86

cojugated bili can't get out of liver (defect in liver excretion)

Front 87

gilberts? type of bili?

Back 87

bili can't enter liver; unconjugated bili build up
decreased UDP glucuronyl transferase
increased hemolysis with STRESS

Front 88

what test do you do for pancreatitis?

Back 88

secretin stimulation test; normally secritin increases bicarb released from the pancreas, but with pancreatic deficiency, it will not increase

Front 89

norovirus does what to GI tract?

Back 89

attaches to epithelium in GI tract, blunted villi, shortened microvilli, loss of brush border enzymes causes decreased absorption of fats/carbs

Front 90

chocolate cyst, think of....

Back 90

endometriosis

Front 91

Tx for BPH?

Back 91

bethanechol (parasympathomimetci) to trigger micturition
prazosin (alpha blocker)

Front 92

cauda equina syndrome will cuase what sx?

Back 92

low back pain,
weakness in legs
sensory numbness
anuria (bladder/bowel dysfxn)
SADDLE ANESTHESIA

Front 93

saddle anesthesia... what syndrome causes this?

Back 93

cauda equina syndrome

Front 94

Remember: in DM, be cautious with B-blockers because they can mask tachycardia – a normal response to hypoglycemia

Back 94

yup

Front 95

gastric vs duodenal ulcer

Back 95

gastric = rough edge lesion; NSAID assoc; worse with food

duodenal = punched out lesion; improves with food; assoc with H Pylori; referred pain to shoulder

Front 96

cushings ulcer vs curlings ulcer

Back 96

Cushing’s ulcer: patient on hi dose steroids develops ulcer (e.g. ICU pt). FA: brain injury & ICP.
Curling’s ulcer: burn patient who develops ulcer

Front 97

virchow node vs sister mary joseph node

Back 97

i. Virchow’s node: L supraclavicular
ii. Sister Mary Joseph node: periumbilical node

Front 98

what is amylase level when you have an ischemic colon?

Back 98

INCREASED

Front 99

DKA vs hyperosmolar coma? how are they differeint :
Diabetes type?
level of hyperglycemia?
serum ketones?
pH?
serum osm?

Back 99

DKA = DM 1; started by a trigger; hyperglycemia (300-600)
↑ SERUM ketones, FFA
metabolic acidosis (pH <7.3)
serum osm <350

hyperosmolar: DM2
hyperglycemia (>800)
volume depletion
pH >7.3
serum osm >350

Front 100

Young patient with sweat smelling breath; polyuria; polydypsia; ketouria; glycosuria; deep & rapid breathing (Kussmaul)

Back 100

DKA

Front 101

Middle aged to elderly patient with mental status changes; neuro findings; glycosuria; osmotic diuresis, hypokalemia

Back 101

hyperosmolar coma

Front 102

serum osmolarity formula?

Back 102

= 2Na + glu/18 + BUN/2.8

Front 103

DKA or hyperosmolar?

- focal neuro findings and seizure.

- cerebral edema

Back 103

neuro findings, seizure = hyperosolar

cerebral edema = DKA

Front 104

ii. ACE inhibitors: good for HTN, CHF (decrease afterload), diabetic renal disease. (Use ARB if side effects bad). Always give ACE inhibitor to pts with HTN + DM, unless contraindicated.

Back 104

yup.

Front 105

pt with CHF, HTN, DM2

what four medication classes do you avoid?

Back 105

i. Glitazones: . Not good for CHF patients - CV toxicity, edema (increases intravascular vol), weight gain, hepatotoxicity
ii. Metformin: can cause lactic acidosis. When tissues aren’t well perfused (as in CHF), then you can develop lactic acidosis; metformin will compound.
iii. B-blockers: mask sympathetic response to hypoglycemia
iv. Thiazides: hyperglycemia is side effect

Front 106

how does acarbose work?

Back 106

slows sugar hydrolysis

Front 107

how does metformin work?

Back 107

decrease gluconeogeneis
increase glyclolysis
decrease serum glucose
sensitize to insulin

Front 108

how do glyburide and sulfonylureas work

Back 108

trigger insulin release from B cells

Front 109

what disease has adrenals are atrophied or destroyed, can’t make glucocorticoids, aldosterone, androgens (cortex); epinephrine & norepi (medulla). Very high ACTH levels, as pituitary tries to increase production of adrenal hormones.

Back 109

adrenal insufficiency
Addisons disease

Front 110

when do you see hyperpigmentation? what is mech?

Back 110

increased POMC, breadkdown procuctu stimulates MSH, melanoscytes are increased.
seen in adrenal insufficiency (addisons)

Front 111

what is side effect of ACE inhibitor on potassium levels

Back 111

causes elevated K+

Front 112

Fe deficiency vs anemia of chronic disease. what is TIBC in each?

Back 112

Fe deficiency will have inc. TIBC (no Fe in macrophabes of bone marrow)

anemia of CD will have decreased TIBC (will see Fe stored in macrophaves)

Front 113

alpha thal is what ethnic group?
beta thal is ?

Back 113

alpha thal is blacks and asians

beta thal is blacks and mediteranien

Front 114

what is fabry's disease

Back 114

lysosomal storage disease. deficiency in alpha galactosidase A. causes build up of GB3 glycolipid in vessels and organs.
causes anhidrosis, fatigue, angeiokeratomas, renal failure

sex linked recessive

Front 115

what is hartnup disease

Back 115

defective gene prevents reabsorption of neutral amino acids (TRYPTOPHAN) in intestines and renal tubules.

remember tryptophan is needed to make serotonin, melanin and niacin. NIACIN is used to make nicatinamide, part of NAD. So if you don't have enough tryptophan, you cant make niacin, and you therefore have

presents with PELLAGRA (4 D's) death, dementia, diarrhea, dermatitis.

Front 116

pellagra is what and can be caused by what 2 diseases (just as an example?

Back 116

pellagra = lack of niacin
4 Ds" diarrhea, dermattiis, dementia, death.

1. can be caused by hartnup disease (decreased tryptophan means decreased Niacin)
or
2. can be cuased by carcinoid syndrome (increased serotonin pulls trypt. away from making niacin)

Front 117

child infected with parvovirus has what hematologic problem

Back 117

aplastic anemia

Front 118

what is DiGeorge syndrome? what is calcium level?

Back 118

failure of 3rd and 4th pharyngeal pouches, no thymus, HYPOCALCEMIA

Front 119

winged scapula is paralysis of what nerve?

Back 119

long thoracic

Front 120

what is parinauds syndrome

Back 120

upward gaze, nystagmus, sometimes pseud-argyll robetrson pupils...
associated with damage to dorsal midbrain (specifically superior colliculus due to CN III or edinger westphal)

associated with these conditions:
- PINEALOMA (pineal gland tumor) (also called intracranial germinoma)

- women with MS in 20s and 30s
-stroke affecting midbrain

also assoc with hydrocephalus (eg. pinealoma causes it) AV malformation, trauma and brain stem toxoplasmosis infection,

Front 121

what is another name for pinealoma?
what are some symptoms

Back 121

intracranial germinoma

parinauds syndrome (upward gaze), hydrocephalus, nystagmus etc

Front 122

asthma affects what part of resp. tree?

Back 122

terminal bronchioles (so does CF and chronic bronchitis)

Front 123

CF affects waht part of resp tree?

Back 123

terminal bronchioles

Front 124

trendelenbergs sign?

Back 124

weak ABductor muscles of hip.

(+) when pt stands on one leg and the hip drops on the side opposite the stance leg. this indecates weakenss on the side of the stance leg because normally the stance leg could support the extra weight.

due to paralysis of superiro gluteal nerve which innervates gluteus minimus and gluteus medius

Front 125

what is colle's fracture

Back 125

fracutre of distal radius due to falling on wrists that are extended.

The fracture is most commonly caused by people falling backward onto a hard surface and breaking their fall with extended outstretched hands - falling with wrists flexed would lead to a Smith's fracture. It can also be caused by overuse. It usually occurs about an inch or two proximal to the radio-carpal joint with posterior and lateral displacement of the distal fragment resulting in the characteristic dinner fork like deformity.

Front 126

what is smith fracture?

Back 126

reverse colles' fracture

fracutre of distal radius due to falling on flexed wrists.

Front 127

streak ovaries are found in waht disease

Back 127

turners syndrome 45 xo
increased LH and FSH
short stature, webbed neck, lymphedema in neonate, coarctation of aorta

Front 128

if you see lymphedema in a neonate, what disease do you susopect?

Back 128

turners

Front 129

coarctation of aorta, increased LH and FSH is what disease?

Back 129

turners

Front 130

noise induced hearing loss affects what part of the ear/

Back 130

hair cells on organ of corti.
high freq sounds lost first

Front 131

what does the cupula do?

Back 131

senses rotation

Front 132

huntingtons disease involves atrophy of what part of the brain?

Back 132

atrophy of caudate:
decreased striatum activity and the striatum is made of the caudate plus the putamen

Front 133

how do class 3 anti-arrithmetics work?

Back 133

block potassium efflux and prolong phase 3 of the action potential

Front 134

what disease:
muscle fibers replaced by fat and CT; x linked recessive

Back 134

duchenne muscular dystrophy

Front 135

late onset food poisoning due to spores; toxin mediated; also causes gas gangrene

Back 135

c perfringens

Front 136

leptospira interrogans can lead to what disease?

Back 136

weil's disease: hepatic dysfxn conjugated hyperbilirubiemnia, renal dysfucntion, bleeding

Front 137

GH stimulates what to cause growth?

Back 137

GH stimulates IGF-1 from liver; defectivr GH receptors casue dwarfism (high GH, low IGF-1)

Front 138

affect of thiazide diuretics on:
LDL?
K+?
Na+?
Ca++?
BP?
uric acid?
glucose?

Back 138

thiazides will INCREASE:
Ca, LDL, uric acid, glucose

DECREASE:
K, Na, BP

Front 139

chromosome translocation 14:18 will cause what disease and what oncogene mutation

Back 139

overexpression of BCL2
follicular lympohoma (non hodgkins)

Front 140

overexpression of BCL 2 is associated with what chromosmal tranlocation?

Back 140

14:18

Front 141

what prevents risk of ovarian cancer

Back 141

OCPs
multiparity
breast feeding

Front 142

which has highest mortality:
ovarian ca
cervical ca
endometrial ca

Back 142

ovarian ca bc there is no screening for it

Front 143

what is only GLUT receptor that responds to insulin levels? what tissues is it found in?

Back 143

GLUT-4
found in muscle and adipocytes