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USMLE - Random
USMLE - questions I got wrong
| Question | Answer |
|---|---|
| first set of lymph nodes that drain testes | para-aortic |
| first set of lymph nodes that will show metastases for colon/rectal cancer if the cancer is below the pectineal line | inguinal - palpable |
| first set of lymph nodes that will show metastases for colon/rectal cancer if the cancer is above the pectineal line | iliac - inside the pelvis and not palpable |
| what does + leukocyte esterase test mean in urinalysis? | neutrophils in urine --> bacterial infection |
| What does Enterobacter do with nitrate? | nitrate ---> nitrite |
| reactivity for nitrite | enterobacter (includes klebsiella), eColi, P aeruginosa. Trite: Enter the eCommon Place Kleb. |
| UTI with no nitrite reactivity | enterococci (faecalis) |
| acute interstitial nephritis can be a hypersensitivity reaction to what drugs | NSAIDs and antibiotics |
| how does a patient with acute interstitial nephritis present? | acute renal failure, fever, maculopapular rash, periorbital edema and eosinophilia. Remember: 2 types of sxs: 1. renal failure --> periorbital edema because losing albumin, 2. systemic sx's (fever, rash, eosinophilia) |
| sphenopalatine artery arises from which artery? | maxillary |
| Duchenne Muscular dystrophy | lethal x-linked recessive disease, lacking the dystrophin protein in cardiac and skeletal muscle. Douchebag -- Douche = woman = X-linked. Bag = big calves, big heart. |
| 1/3 of Duchene Muscular Dystrophy arises from what genetic mechanism? | the gene has many series of aa's that are similar but not identical repeats --> misalignment of homologous chromosomes at meiotic synapsis --> frameshift mutations --> untranslatable mRNA |
| what drug maintains a patent ductus arteriosus? | prostaglandin, i.e. PGE1 analog - alprostadil |
| what do ibuprofen and indomethacin have in common? | inhibit formation of prostaglandins |
| patients on Li for bipolar disorder should get frequently tested for what? | TSH - Li causes decrease in thyroid hormones. Li sits on TSH. |
| how to treat hypothyroidism? | levothyroxine |
| phosphofructokinase-1. When is it elevated? | rate-limiting enzyme of glycolysis. would increase in anaerobic metabolism because glycolysis would be the only way to make ATP |
| phosphoenolpyruvate carboxykinase | gluconeogenesis regulating enzyme |
| name three enzymes that induce gluconeogenesis | cortisol, glucagon, epinephrine -- the stress enzymes |
| what does pyruvate dehydrogenase do? | turns pyruvate (from glycolysis) into Acetyl CoA (TCA cycle) |
| what are the 5 coenzymes of pyruvate dehydrogenase? | NAD, FAD, B1 (thiamine), lipoic acid, coenzyme A. What we're seeing in the codependent (cofactor) PD (pedi) visits: it's a FAD to put CoAn's (CoEnzyme A) LIPs (lipoic acid) between his thighs (thiamine) on his goNAD. |
| succinate dehydrogenase | makes FADH2 in the TCA cycle. Sucking him until he's dry (succinate dehydrogenase) is such a FAD. |
| transketolase | hexose monophosphate shunt, feeds GP3 and F6P into glycolysis |
| what is transketolase a marker of? | thiamin deficiency (it requires thiamin as a co-factor) and is markedly decreased in Wernicke Korsakoff Syndrome |
| what does the coombs test identify? | maternal anti-Rh antibodies bound to fetal RBC's or fetal autoimmune hemolytic anemia |
| what is the direct coombs test? | Baby's Rh+ cells already coated with maternal antibodies |
| what is the indirect coombs test? | mom's serum that has now developed the anti-Rh antibodies that would be bad for the fetus to get exposed to |
| how do babies with autoimmune hemolytic anemia present? | mild anemia, high post-natal hyperbilirubinemia |
| what are microspherocytes? | RBCs that have had antibody-coated portions clipped off by the spleen |
| what are reticulocytes? | immature RBCs |
| when do B thalassemia and sickle cell anemia present in babies? why? | 6 mos because that is when fetal Hb production ceases |
| what is congenital spherocytosis? | genetic defect in the cell membranes of RBC's --> smaller surface area and breaks open easily --> jaundice, enlarged spleen, shorter life span per RBC (RBC lifespan returns to nl after splenectomy) |
| heparin monitored by | APTT time |
| warfarin monitored by | PT time |
| child with massive painless rectal bleeding | think of peptic ulcer created by acid-secreting gastric mucosa next to Meckel's diverticulum in the ileum |
| UTI in renal pelvis | magnesium ammonium phosphate stone (most likely proteus infection) |
| when do you see calcium-containing kidney stones? | hypercalcinuria without hyperCa2+ |
| what are gall stones made of? | cholesterol |
| in whom do you see uric acid stones? | gout, leukemia, acidic urine |
| ameboid motility | Entamoeba, Naegleria, Acanthamoeba |
| corkscrew motility | trichomonas vaginalis |
| falling leaf motility | giardia lamblia |
| tumbling motility | listeria monocytogenes |
| swarming motility | proteus mirabilis |
| shaking in R hand, trouble starting movements, resting tremor which decreases with active movement, expressionless face, soft voice, soft shuffling gait | Parkinson's |
| selegiline | Parkinson's drug; inhibits MAO-B, which breaks down dopamine -- makes the levodopa last longer |
| MAO-A, MAO-B | MAO-A preferentially metabolizes NE and serotonin; MAO-B preferentially metabolizes dopamine |
| benztropine | antimuscarinic, improves Parkinson's tremor and rigidity |
| bromocriptine | dopamine receptor agonist; Parkinson's drug |
| levodopa | dopamine precursor -- increases circulating levels of dopamine; best drug for Parkinson's |
| pergolide | dopamine receptor agonist; Parkinson's drug |
| Kartagener Syndrome | autosomal recessive, abnormal dynein --> abnormal sperm motility, ciliary clearance, retrograde axonal transport |
| what proteins are responsible for anterograde and retrodrage axonal transport? | kinesin for anterograde, dynein for retrograde |
| what drug for schizoaffective disorder should you not give to patients with thrombocytopenia | valproic acid because it is already associated with thrombocytopenia |
| metformin is associated with which side effect? | lactic acidosis; more likely in renal-impaired pts or in pts taking nephrotoxic medication aminoglycosides or radio contrast dyes. |
| what is metformin used for? | non-insulin-dependent diabetes |
| aminoglycosides | binds to 30S ribosomal unit |
| glyburide | sulfonylurea antidiabetic agent used in adjunct to diet to lower blood glucose levels in non-insulin dependent diabetes |
| 5yo boy, awkward walking, frequent falls, hypertrophic calves (atrophy of myofibers and fibrofatty replacement of the interstitium), dilated cardiomyopathy | Duchenne muscular dystrophy |
| how to diagnose Duchenne Muscular Dystrophy? | immunohistochemistry showing absence of dystrophin in skeletal muscle biopsy |
| what is genetic anticipation? | phenomenon whereby a disease presents at an earlier age (with deeper penetrance) as it's passed down through generations; happens with trinucleotide repeat diseases |
| name three trinucleotide repeat diseases | Huntington's, Duchenne muscular dystrophy, fragile X |
Created by:
christinapham
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