Usmle Step1

Front 1

CYP450 inducer

Back 1

Chronic alcohol use

St. john's wort

Phenytoin

Phenobarbital

Nevirapine

Rifampin

Griseofulvin

Carbamazepine

Front 2

CYP450 substrates

Back 2

Anti-epileptics

Theophylline

Warfarin

OCPs

Front 3

CYP450 inhibitor

Back 3

Acute alcohol abuse

Ritonavir

Amiodarone

Cimetidine

Ketoconazole

Sulfonamides

INH

Grapefruit juice

Quinidine

Macrolides(except azithromycin)

Front 4

Acute rejection

Back 4

usually<6months

exposures to donor antigen induces humoral/cellular activation of naive immune cells

lymphocytic interstitial infiltrate & endothelitis

Hint 4

Front 5

von Willebrand disease

Back 5

Autosomal dominant

• intrinsic pathway coagulation defect

→ functional factor VIII deficiency

→ prolonged BT/PTT

• Normal PT/platelet count

• defect in platelet-to-vWF adhesion

• Dx. ristocetin cofactor assay

• Tx. desmopressin

Front 6

HELLP syndrome

Back 6

Hemolysis

Elevated Liver enzymes

Low Platelets

• severe preeclampisa

• nausea, vomiting, RUQ pain

• blood smear : schistocytes

Tx. immediate delivery

Front 7

Osteogenesis inperfecta

Back 7

• Genetic bone disorder

• mutation of type I collagen

• macrocephaly with poor skull mineralization

• shortened extremities

• misshaped long bone

• multiple fracture during birth

• blue sclerae d/t translucency of the connective tissue

• conductive hearing loss

• dental imperfections d/t lack of dentin

Front 8

Osteogenesis imperfecta

Back 8

• Genetic bone disorder

• mutation of type I collagen

• macrocephaly with poor skull mineralization

• shortened extremities

• misshaped long bone

• multiple fracture during birth

• blue sclerae d/t translucency of the connective tissue

• conductive hearing loss

• dental imperfections d/t lack of dentin

Front 9

Chronic rejection

Back 9

• months to years

• CD 4+ T cells respond to recipient APCs presenting donor peptides, including allegeneic MHC

• proliferation of vascular smooth muscle and parenchymal fibrosis

• affects small airway → bronchiolitis obliterans

Front 10

Lipid lowering agent

Back 10

Back (Definition)

Front 11

Fibrates

Back 11

• gemfibrozil, clofibrate, bezafibrate, fenofibrat

• lowering TG > LDL

• activate PPAR-a → decreased hepatic VLDL, increase LPL activity → ↑ TG clearance

• S/E :

myopathy ( ↑ risk with statin)

cholesterol gallstone (↑ with cholestyramine)

Front 12

SLE

Back 12

• gradual symptom onset

• malar or discoid rash

• joint, renal, serosal &/or neurologic involvement

• anemia(spherocytosis, coomb test (+)), leukopenia, thrombocytopenia

• ANA(+), anti-dsDNA(+), anti-Sm(+)

• low C3 &C4

• increased immune complexes

Front 13

Sarcoidosis

Back 13

• Young adults, African Americans

• Constitutional symptoms

• cough, dyspnea & chest pain

• Extrapulmonary findings

- skin lesions

- anterior/posterior uveitis

- Lofgren syndrome

• bilateral hilar adenopathy

• pulmonary reticular infiltrates

• Hypercalcemia/hypercalciuria

(d/t 1a-hydroxylase mediated vitamin D activation in macrophage)

• elevated serum ACE level

• noncaseating granuloma

Front 14

cholinesterase inhibitor poisoning

Back 14

• organophosphates(irreversible cholinesterase inhibitor)

• insecticides, farmer Hx.

• activation muscarinic effect

Diarrhea

Urination

Miosis

Bronchospasm(wheezing)

Bradycardia

Excitation of skeletal m.&CNS

Lacrimation

Sweating

Salivation

Tx. atropine + pralidoxime

(atropine-competitive,

pralidoxime-regenerates AchE)

Front 15

Atropine poisoning

(Gardener's mydriasis)

Back 15

• Jimson Weed poisoning

Hot as a hare (temperature ↑)

Dry as a bobe (dry mouth)

Red as a beet (flushing)

Blind as a bat (mydriasis, acute angle-closure glaucoma)

Mad as a hatter (disorientation)

Tx. Physostigmine

Front 16

Atropine poisoning

(Gardener's mydriasis)

Back 16

• Jimson Weed poisoning

Hot as a hare (temperature ↑)

Dry as a bobe (dry mouth)

Red as a beet (flushing)

Blind as a bat (cycloplegia, mydriasis, acute angle-closure glaucoma)

Mad as a hatter (disorientation, hallucination, delirium)

Tx. Physostigmine

Front 17

Atropine poisoning

(Gardener's mydriasis)

Back 17

• Jimson Weed poisoning

Hot as a hare (temperature ↑)

Dry as a bobe (dry mouth)

Red as a beet (flushing)

Blind as a bat (cycloplegia, mydriasis, acute angle-closure glaucoma)

Mad as a hatter (disorientation, hallucination, delirium)

the bowel and bladder lose their tone, and the heart runs alone

Tx. Physostigmine

Front 18

Multiple Endocrine Neoplasia

Back 18

MEN 1(3P)

- Primary hyperPTH (hyperCa)

- Pituitary tumor (prolactin, visual defects)

- Pancreatic tumors (gastrinomas)

MEN 2A (2P)

- MTC (calcitonin)

- Pheochromocytoma

- Parathyroid hyoerplasia

MEN 2B (1P)

- MTC (calcitonin)

- Pheochromocytoma

- Mucosal neuromas/marfanoid habitus

Front 19

lacunar infarct

Back 19

• pure motor hemiparesis - posterior limb of the internal capsule or basal pons

• pure sensory stroke - ventroposterolateral or ventroposteromedial thalamus

• ataxia-hemiplegia syndrome - posterior limb of the internal capsule or basal pons

• dysarthria-clumsy hand syndrome - genu of the internal capsule or basal pons

Front 20

RA

Back 20

• pain, swelling & morning stiffness in multiple joints

• small joints(PIP, MCP, MTP); spares DIP joints

• systemic symptoms (fever, wt. loss, anemia)

• Cervical spine involvement : subluxation, cord compression

• (+)RF, anti-CCP antibodies

• CRP & ESR correlate with disease activity

• x-ray: soft tissue swelling, joint space narrowing, bony erosions

Front 21

Digoxin toxicity

Back 21

• cardiac

: life- threatening arrhythmia

• Gi

: anorexia, N/V, abdominal pain

• Neurologic

: fatigue, confusion, weakness,

color vision alternation

predisposing factor

: renal failure, hypokalemia, verapamil, amiodarone, quinidine

Front 22

CREST syndrome

Back 22

Calcinosis

Raynaud's phenomenon

Esophageal dysmotility

Sclerodctyly

Telangiectasias

Anti-centromere antibodies

Anti-Scl-70 antibodies(anti-DNA topoisomerase I antibody)

Front 23

Chediak-Higashi syndrome

Back 23

• AR

• Defect in lysosomal trafficking regulator gene(LYST)

• Microtubule dysfunction in phagosome-lysosome fusion

• recurrent pyogenic infections bu staphylococci and streptococci, partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistocytosis

• Giant granules in granulocytes and platelets

• pancytopenia

• mild coagulation defects

Front 24

Oogenesis

Back 24

1st oocytes

• begin meiosis I during fetal life

• before menarche : arrested in meiosis I prophase I until ovulation.

2nd oocytes

• meiosis II is arrested in metaphase II until fertilization

Front 25

Tricyclic antidepressant(TCA)

Back 25

• Amitriptyline, nortriptyline, imipramine, desipramine, clomipramine, dexepin, amoxapine

Action/side effect

• Inhibiton of presynaptic neurotransmitter reuptake / tremor, insomnia

• blockade of cardiac fast sodium channel / conduction defect(cause of death), arrythmias, hypotension

•antagonism of centeal and peripheral muscarinic Ach receptor / hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, sinus tachycardia

• antagonism of peripheral a1 adrenergic receptor / peripheral vasodilation(orthostatic hypotension)

• antagonism of histamine(H1) receptor / sedation

Front 26

CSF flow

Back 26

ependymal cells of choroid plexus

→ lateral ventricle

→ foramina of Monro

→ 3rd ventricle

→ cerebral aqueduct of Sylvius

→ 4th ventricle

→ Foramen of Luschka/Magendie

→ subarachnoid space(arachnoid granulation)

→ dural venous sinus

Front 27

Calcium metabolism

Back 27

PTH

•↑ bone resorption

•↑ renal reabsorption of calcium & ↓ reabsorption of phosphate

•↑ conversion of 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D

Vitamin D

•↑ Intestinal absorption of calcium & phosphate

•↑ Renal reabsorption of calcium & phosphate

•↓ Parathyroid hormone secretion

•↑ Mineralization of bone

Calcitonin

•↓ Bone resorption

•↓ Renal calcium reabsorption

Front 28

High anion gap metaboic acidosis

Back 28

AG=Na-(Cl+HCO3) (N:8-12mEq/L)

MUDPILES

Methanol(formic acid)

Uremia

DKA

Propylene glycol

Iron tablet/Isoniazid

Lactic acidosis

Ethylene glycol(oxalic acid)

Salicylates(late)

Front 29

Amiodarone

Back 29

• class III antiarrhythmics

• potassium channel block(slowing phase 3)

• ↑ AP duration, ERP, QT interval

• lipophilic

• Toxicity ⭐️

- pulmonary fibrosis

- hepatotoxicitu(fatty change)

- hypo/hyperthyroidism

👉TSH check!!!!

- acts as hapten(corneal deposition, blue/gray skin deposits resulting in photosensitivity)

- neurologic effects

- constipation

- bradycardia, heart block, HF

• leas risk of torsades de pointes

Front 30

Gaucher disease

Back 30

most common

AR

Hepatosplenomegaly

Pancytopenia

Osteoporosis

Aseptic necrosis of femur

Bone crises

Gaucher cells(lipid laden macrophage resembling crumpled tissue paper)

Glucocerebrosidase deficiency

Front 31

Heroin(opioid) withdrawal

Back 31

sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nauea, stomach cramps, diarrhea(flu-like symptoms)

Tx.

- long term support

- methadone, buprenorphine