usmle prep Flashcards


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1

Drug used in tumor lysis syndrome to break down uric acid

Rasburicase (convert uric acid to allantoin)

2

Drug that reduces uric acid formation

Allopurinol

Febuxostat

3

MAOB metabolizes dopamine, the enzyme can be inhibited by_____

Selegiline

4

MAOi (prevent tyramine metabolism) interact with ____________ to cause hypertension

cheese(tyramine)

5

Phenytoin anticonvulsant works by___________

Blocking Na influx/channels

6

What are the side effects of phenytoin?

Gingival hyperplasia

Hirsutism

Osteomalacia (interferes with vitD met)

Anemia (folic acid decr)

7

What is the mechanism of action of Valproic acid?

decrease GABA transaminases

block T type Ca2+ channels

block Na channels

8

What are the side effects of VALPROIC ACID?

''vALPRoATe''

Anemia

Liver toxicity

Pancreatitis

Allopecia

Teratogenic, tremors

9

Drugs that cause steven johnsons syndrome are_________

card image

10

What is the drug used to tx Malgnant hyperthermia and its MOA?

Dantrolene

It blocks ca2+ release from the sarcoplasmic reticulum

11

Mechanism of action of opioids ___________

At presynaptic: decrease ca2+ influx.

At post synaptic: increase k+ efflux

12

Organisms not covered by cephalosporins are_________

'' LAME''

Listeria monocytogens

Atypicals (chlamydia, mycoplasma)

MRSA

Enterococi

13

___________ is a drug always given with Imepenem to prevent renal toxicity from its metabolites.

Cilastatin

14

_______ is the drug of choice for treatment of lyme disease and rickettsia (both caused by ticks)

tetracycline

'' tets for ticks''

15

Which medication has the same intracellular target as trimethoprim (in bact cell) in its mechanism of action?

Methotraxate (In human cells)

Pyrimethamine (in protozoa)

16

_______is an Antifungal medication that inhibits cytochrome p450 enzymes.

Azoles

17

Empiric treatment of Entamoeba hystolytica requires a 2-phase approach:

Tissue agent (eg, metronidazole) is administered first to kill trophozoites.

Intraluminal agent (eg, paromomycin) is given to eliminate intraintestinal cysts to prevent reinfection.

18

Penicillin is given together with clavulanic acid to_______

decrease hydrolysis of the beta-lactam ring of penicillin (prevent cleavage of penicilin by bact cells)

19

Examples of beta lactamase inhibitors include___________

Clavulanic acid

Tazobactam

Sulbactam

20

What is the mechanism of resistance of aminoglycosides?

Antibiotic-modifying enzymes. These enzymes add chemical groups (eg, acetyl, adenyl, phosphate) to the antibiotic, which diminishes its ability to bind to the 16S ribosomal RNA within the 30s ribosomal subunit.

21

______________is a common adverse effect of trimethoprim-sulfamethoxazole due to the trimethoprim-induced blockade of the sodium channels in the collecting duct, which prevents sodium-potassium exchange and reduces renal excretion of potassium (similar to the action of amiloride).

Hyperkalemia

22

___________________is the most common benign liver tumor.

card image

Cavernous hemangioma

23

Damage to the anterior and posterior vagal trunks (of vagus) during fundoplication procedure causes _________

Delayed gastric emptying (gastroparesis) and gastric hypochlorhydria

24

_________ is derived from a zymogen produced by pancreatic acinar cells and activated by trypsin in the duodenum; levels correlate with pancreatic exocrine activity. ie low levels = pancreatic insufficiency.

Elastase (fecal elastase)

25

A drug that is non absorbabble antibiotic that is used to lower ammonia by modulating the bact that produces it in the GI tract

Rifaximin

26

Acute hemolysis following exposure to oxidative insults ie infection,oxidizing foods and meds (eg flouroquinolones) occurs in ________

Glucose 6 phosphste dehydrogenase deficiency

27

Patient without spleen have what kind of impairment?

Systemic bacteria clearance

28

Autosomal recessive disorder involving lack of homogentisic acid dioxygenase(metabolise tyrosine) leading to accumulation of homogentisic acid is called_______

Alkaptonuria

29

Clinical features of alkaptonuria are __________

Black urine when exposed to air

Blue black pigmentation on the face

Orchinosis (hyperpigmentaton in ear or eye sclera)

Arthritis in joint

30

What is the role of hCG therapy in a pt with PCOS receiving ovulation induction therapy with gonadotropins?

hCG mimic LH and act as ovulation trigger.

31

___________ is a fungalorganism that replicates within macrophages and spreads from lungs to the reticuloendothelial system through pulmonary lymphatics.

Histoplasma capsulatam

32

__________ IS A/W URIC ACID FORMATION IN POST KIDNEY TRANS??

Cyclosporin

33

What causes aplastic anemia?

autoimmune destruction of multipotent hematologic stem cells due to alterations in their surface antigen leading to cytotoxic Tcell responce and release of interferon gamma hence apoptosis.

34

Whats the commonest cause of type1 DM?

Autoimmune insulitis (islet leukocytic infiltration) with progressive beta cell loss.

35

Didanosine (ART used in HIV) causes_______________

Pancreatisis (''pancreaDIDis'')

36

Eg of encapsulated organism

Salmonella

H.influenza

E.coli

Strep. pneumoniae

37

C1 esterase inhibitor def

Angioedema, laryngospasm

38

Pseudocholinesterase def

Failure to breathe after fast acting anaesthesia eg succinylcholine or mivacurian are administered

39

Disruption of heme synthesis via inhibition of aminolevulinate dehydratase is caused by

Lead toxicity

40

Lead toxicity findings

Lead lines on gingivae

Encephalopathy, erythrocyte basophilic stippling

Abdominal colic , sideroblastic anemia

Drops- wrist and foot

41

Renal artery stenosis is commonly due to ________

Atherosclerosis

Fibromascular dysplasia

42

prolonged exposure to noise

damage to organ of corti

43

test to do before starting eternacept (tnf alpha inh)

tb

44

finasteride acts on what part of the prostate?

on epithlial cells and smooth muscle

45

Ethambutol (arabinosyl transfarase inhibition) causes__________

optic neuritis

46

What is the mechanism of action of Bisacodyl?

Activates enteric nerves in colonic myoplexus to stimulate peristalsis.

47

cause of gestational diabetes is due to

human placental lactogen

48

Examples of common immunosuppressants and mechanisms........

card image

49

During anaphylactic reaction what is likely to be elevated in the serum?

Histamine

Tryptase (specific marker of histamine)

NB:both result from mast cell and basophil degranulation

50

The immunoglobulin most abundant in the blood is ____________

IgG

51

Immunoglobulin found in tears, saliva and breast milk is__________

IgA

52

Which immunoglobulin is responsible of immediate response to antigen?

IgM

NB: IgG is a/w chronic response

53

Interferons α and β are produced by most human cells in response to viral infections. Their function is___________

Stop protein synthesis in infected cells

Promote apoptosis

54

What is the mechanism of vancomycin infusion reaction ?

Direct mast cell activation by the drug due to rapid infusion.

ie: Red man syndrome (not allergic rxn)

55

Hereditary angioedema is caused by deficiency of what enzyme?

C1 esterase inhibitor deficiency (leading to over activation of the complement system.)

56

What is serum sickness?

Immune complex–mediated type III hypersensitivity reaction that typically forms 5-14 days after exposure to foreign proteins in an antitoxin, antivenom, monoclonal antibody, or vaccine.

Patients typically develop fever, urticarial rash, and arthralgia that resolve spontaneously over days as the immune complexes are cleared by the mononuclear phagocyte system

57

The specific surface marker for monocyte-macrophage lineage cells is________

CD14

58

Whats the mechanism of action of glucocorticoids?

Reduces inflammation by binding to a cytosolic receptor, translocating into the nucleus, and inhibiting proinflammatory transcription factors eg nuclear factor-kappa-B (NF-κB).

59

Drug of choice in treatment of anaphylactic shock is _________________

Epinephrine

60

Disorders of innate immunity are____________

card image

61

What is mechanism of action of rituximab?

card image

Depletion of B cells (binds CD20 of B cells inducing cytotoxicity and phagocytosis)

62

The mediator released from macrophages and one of the most important during systemic inflammation in sepsis is___________

TNF alpha

others: IL1, IL6

63

Fluticasone MOA is__________

Promote apoptosis of eosinophils

NB: Glucocorticoids inhibit transcription of proinflammatory mediators and promote apoptosis of eosinophils, T cells, and monocytes.

64

venous congestion causes expansion of which part iof the spleen?

red pulp

65

__________ is an enzyme that plays a crucial role in purine metabolism, to prevent accumulation of toxic metabolites(lymphocytotoxic).

__________inhibitors lead to destruction of the cell due to accumulation of metabolites.

Adenosine deaminase (ADA)

ADA inhbitors eg ( Medications that block ADA are used to treat lymphocyte-derived cancers )

66

Hyperacute rejection during transplant is due to recipient's preformed antibodies which are____________

Anti ABO blood group

Anti HLA antibodies

67

Hereditary angioedema is characterized by recurrent episodes of cutaneous and/or mucosal swelling due to__________ deficiency. C4 levels are low due to uninhibited cleavage of C4 by excess activated C1.

C1 inhibitor deficiency

68

What is the difference between pneumococcal conjugate and polysaccharide vaccine?

Pneumococcal conjugate vaccines are strongly immunogenic in infancy due to both B and T cell recruitment. They provide higher, longer-lasting antibody titers

The pneumococcal polysaccharide vaccine is poorly immunogenic in infants due to their relatively immature humoral antibody response. recommended for ages >65 and btn 2-65 with certain med condition eg DM

69

________________destroy parasite via antibody-dependent cell-mediated cytotoxicity with enzymes from their cytoplasmic granules. Another function is regulation of type I hypersensitivity reactions.

Eosinophils

70

_____________is the primary treatment for anaphylaxis as it decreases further mast cell release of inflammatory mediators and counteracts existing systemic inflammatory effects (eg, shock, bronchoconstriction).

Epinephrine

71

MECONIUM ILEUS IS ALMOST ALWAYS A/W _______

CF

72

DEEP INGUINAL RING AND SUPERFICIAL INGUINAL RING CAN BE DIFFERENTIATED BY ____________

INFERIOTR EPIGASTRIC VEIN

73

INCREASE P

OXANDROLONE

74

Many types of cancers evade immunodetection by increasing expression of _____________on their surface. Monoclonal antibodies against PD-1 upregulate the T-cell response and promote tumor cell apoptosis

PD-L1

75

_____________stimulates neutrophil migration to sites of inflammation. Other important chemotactic agents include 5-HETE (leukotriene precursor), C5a, and IL-8.

Leukotriene B4

76

Topical corticosteroids are the first-line therapy for atopic dermatitis. Their mechanism of action is __________

Decreasing tissue production of proinflammatory prostaglandins and leukotrienes through the inhibition of phospholipase A2

77

TESTESTERONE HAS EFFECT ON HB

INCREASES ERYTHROPOIETIC CAISING POLYCYTHEMIA

78

PERMETRIN

TO TX SCABIES

79

The only antibody that can cross the placenta______________

IgG

80

Chronic lung transplant rejection is due primarily to progressive scarring of the____________, leading to bronchiolitis obliterans. (months or years after transplantation and include obstructive lung disease (eg, reduced FEV1) with dyspnea and dry cough)

Small airways

81

The most important opsonins (coating proteins that enhance phagocytosis) are___________

IgG

C3b

82

metabolic syndr

olanzapine and second gen antipsychotics

83

Drug of choice foe panic attacks

SSRI

benzos foe immediate relief

84

long standing RA can lead to

vertebral sublaxation

85

nerve likely to be injured during cardiac catheter ablations

phrenic nerve

86

commoon infe in burn pt

pseudomonas aureginosa

87

Key Th2 cytokines that trigger acute inflammation in atopic dermatitis are _____

IL-4 and IL-13

88

____________is a type IV hypersensitivity reaction caused by drugs (eg, anticonvulsants, antibiotics) or their metabolites that typically occurs 5-21 days following drug initiation

card image

89

Pt with auto immune thyroiditis are at risk of developing which thyroid ca?

Thyroid lymphoma

90

There is decreased responsiveness to __________ in old age making it hard to cope with critical illness eg sev burns

Adrenergic response

91

Mechanismof action of botulinum toxin

Blocks presynaptic exocytosis of Ach

92

Benzodiazepine withdrawal

Anxiety

Tremors

Insomnia

Sympathetic hyperactivity eg diaphoresis

Psychotic features eg hallucinations

93

Mitochondria DNA

In eukaryotic cells is in mitochondria

94

Sugar that is metabolized fast than others ?

Fructose 1 phosphate

95

The most common outcome of hep c infection without tx is_______

Life long infection

96

Methadone is an opioid agonist that prevents opioid withdrawal by its _______

Long half life

97

Damage to the pterion cause damage to which vessel?

Middle meningeal artery branch of maxillary artery

98

Spinal stenosis

Ligamentum flavin hypertrophy

99

Role of hcg(secreted by placental syncytiotrophoblast)in preg

Maintenance of corpus luteum(maintain pregnancy)

100

Drug of choice of listeria

Ampicillin

101

Posterior cerebral artery stroke

Contralateral hemianopia??

102

Peripheral acting mu opioid receptor antagonist for treating constipation (doesn't induce withdrawal symptoms; doesn't cross BBB)

Methylnaltrexone

103

Discolouration of skin due to station dermatitis (chronic venous insufficiency)

Hemosiderin deposit

104

Halogenated inhaled anesthesia can cause

Hepatocellular liver injury

(Have incr ast and prolonged PT)

105

Tx of priapism may involve penile injection with which medication?

Alpha adrenergic agonist (eg phenylephrin)

106

Breakdown of dipeptide and tripeptide to free amino acids takes place where in the GI

Intestinal mucosa

107

Needle shaped Crystal in gout are due to

Urate.

108

Diuretic drug that improve survival rate in heart failure with reduced EF_____

Spironolactone

109

Lithium interact with _______ to cause acute toxicity symptoms

NSAIDS

110

Renal cell carcinoma classic sings include______

Hematuria

And mass

Flank pain

Weight loss

111

Patients with cleft palate are at increased risk of ear infection due to dysfunction of

Ani palatini muscles

112

Best intial treatment of distal symmetrical polyneuropathy due to uncontrolled DM is

Amitriptyline

113

Function of golgi tendon is to _______

Maintains muscle tone

114

Opioid can generate pseudoallergic reaction by directly acting on ___________

Mast cells and cause degranulation

115

First line tx for trigeminal neuralgia is

Carbamazepine

116

Prolonged seizures,crush injuries can predispose to?

Rhabdomyolysis

117

Aldolase b deficiency

Sucrose or fructose should be avoided

118

Buzz words for PCP (Phencyclidine)

Agitation

Nystagmus

Ataxia

119
  • Mechanismof ace inhibitors post MI

Prevent remodeling and reduce LV dysfunction/dilatation

120

Tramadol can interact with ssri to cause ___

Serotonin syndrome

121

After 12 months of amenorrhea _______ confirms menopause in 50+ yr old women

Increased FSH

122

Patient with hyperuricemia have def of _______

Hypoxanthine guanine phosphoribotransferase

123

Treatment of malaria with primaquine is for _______

Treating exoerythrocytic parasite

NB chloroquine treats parasite circulating in blood but will not treat liver hypnozoites

124

Severe self limited watery diarrhea in immunocompromised pt is due to

Cryptosporidiosis

125

Atrophy of mammillary bodies is classically seen in ______

Wernicke Korsakoff syndrome

126

How does Phenytoin and antiepileptic drug cause decrease in VIT d ?

Inducing cyp24 which convert vit d to inactive form

127

Subacute thyroiditis usually follows viral infection and patient may show __________ on investigation

Low radioactive iodine uptake

128

Mesothelioma histologically shows__________

NB: asbestos exposure is the primary risk factor

Spindle cells positive for cytokeratin

129

Before fertilization oocyte is arrested at what stage ?

Metaphase of meiosis ii

130

Tx of ADHD

card image

Ovarian torsion usually involve

131

Ovarian torsion usually involves

Twisting if infundibulopelvic ligament

132

Hepatocellular carcinoma can be caused by viruses _______

Hep B and hep C

133

Mitochondrial damage leading to impaired fatty acid metabolism is seen in ________

Reye syndrome

134

Neonatal respiratory distress syndrome

card image

Diffuse atelectasis is seen on x-ray as ground glass opacities and air brinchogram

135

Epiglottis

Inspiratory stridor

136

Hypercalcemia In_________&__&& is caused by PTH independent VIT d activation by macrophages

Sarcoidosis

137

Drugs that are given rectally avoid _______

First pass metabolism by going directly into the circulation

138

Agammaglobulinemia is characterized by _________

Low or absent circulating mature Bcell CD19,CD20

139

Vocal cord nodule in immunocompromised is usually a resiult of_______

HPV

140

Hypersplenism is associated with __________

Pancytopenia

141

Formation of non caseating granuloma due to type IV hypersensitivity reaction to an unknown antigen is seen in_________

Sarcoidosis

142

Malignant hyperthermia is caused by genetic defect in____________

Ryanodine receptor

nb symptoms occur when pt is exposed to inhaled anaesthetics

143

Neomycin mechanism of action?

kills gut flora hence reducing ammonia production

144

How do you differentiate between kaposis sarcoma and bacillary angiomatosis (Bartonella spp)?

Biopsy: Kaposi's sarcoma will show lymphocytic infiltrates in the sample while angiomatosis will show neutrophilic infiltrates.

145

Medulla of the adrenal gland is stimulated by

Acetylcholine

146

Drugs that don't require dose adjustment in hepatic or renal conditions

Monoclonal antibodies

147

Drug used for bulimia nervosa________

Fluoxetine(ssri)

148

Drug of choice for ADHD is___________

Methylphenidate (A drug that increase availability of norepinephrine and dopamine)

149

_________Is a polypeptide hormones that binds to transmembrane receptor along plasma membrane

Prolactin

NB:other hormones are intracellular

150

Proliferating spindle cells forming slit like spaces filled with blood is seen in ________

Kaposi sarcoma

151

Cytokine involved in class switching of immunoglobulin

Il4

Il13

152

Angiodysplasia of ascending colon is common disorder in old age and usually present with ________

Bleeding

153

First line treatment for claudication ?

Cilostazol

154

In hypersensitive type I mast cell secrete histamine in immediate phase and then secret ______ in late phase.

Prostaglandins

155

Circulation in lungs

Bronchial circulation

Pulmonary circulation

156

Rituximab moa

Lymphocytes mediated release of cytokines

157

Maple syrup disease is caused by ____________

Branched chain alpha keto acid dehydrogenase

158

Phenylketonuria (PKU) is an autosomal recessive disease caused by mutation of the gene that codes for____________________

Phenylalanine hydroxylase

159

Earliest response to bleeding injury is caused by_________

Secretion of Endothelin

160

What hormone increase during pre prandial period and declines after a meal ?

Ghrelin

161

Impaired binding of testosterone to it's receptors can be caused by __________

Spironolactone (cause gynecomastia)

162

Role of dextrose in ORS is_________

To enhance sodium absorption

163

The IV drug that causes arterial vasodilation and improve renal perfusion __________

Fenoldepam

164

What cells can't use ketones as a form of energy

Erythrocytes

Liver cells

165

Increased TGF-β activity is responsible for ___________________

Hypertrophic/keloid scar

(Also fibrosis of the lung, liver, and kidney that occur with chronic inflammation)

166

Following ischemic to cardiac muscle after how long does contractility stop when ATP starts to decline?

Within 60 seconds after ATP starts to decline

167

Side effects of succinylcholine _____________?

Malignant hyperthermia

Severe hyperkalemia

Bradycardia

168

What's the mechanism of HUS due to shiga toxin?

Microthrombi in small blood vessels formation

169

Effect of UV light on the skin ?

Endonuclease nicking of the damaged DNA strand

170

Which component of cardiovascular system is more susceptible to nitrates

Large veins

171

H influenza protection/ vaccination MOA?

Antibodies against hemagglutinin

172

Lesions in syphilis

Primary - chancre

Secondary - condylomata lata

Tertiary - gummas

173

Mechanism of vit D in treatment of psoriasis

Inhibit T-cell and keratinocyte proliferation and stimulate keratinocyte differentiation

174

A topical drug that acts like a toll like receptor to increase antiviral cytokine production and upregulate NFkB is called ______________

Imiquimod

175

Neck /head of femur is supplied by

Medial circumflex arteries

176

Antilipid drug that impairs excretion of statins

Fibrates

177

External branch of superior laryngeal nerve can be injured in thyroidectomy. The nerve supplies which muscle?

Cricothyroid muscle

178

Conversion of norepinephrine to epinephrine is facilitated by the_________

card image

PNMT

179

___________ is found in adipose tissue, where it functions to drive the breakdown of stored triglycerides into free fatty acids and glycerol. During times of starvation, this enzyme provides substrates for hepatic gluconeogenesis and ketone body formation.

Hormone-sensitive lipase

180

Patients with turners syndr can be treated with growth hormone that stimulates the __________

JAC-STAT pathway

(this induce prod of IGF-1)

181

Whats the function of cholecytokinin (CCK)?

Causes contraction of the gallbladder to release bile

182

Side effects of tamoxifen (that are not caused by Raloxifene)

Endometrial hyperplasia

Endometrial carcinoma

Uterine sarcoma

183

1o hyperparathyroidism causes hypercalcemia which causes constipation by __________________

Inhibit nerve depolarization leading to reduced colonic motility and impaired smooth muscle contraction.

184

PT with crohn disease are prone to get kidney stones due to _______

Reduced intestinal calcium oxalate formation

185

Vitamin necessary fo RBC membrane integrity ______

Vit E

(Def causes acanthocytes and hemolysis)

186

A carrier protein that transport both T4 and vit A is called

Transthyretin

187

Coadministration of levothyroxine with other medications can impair its absorption, these include

Iron

Calcium

Antiacids

(Also foods like soy products)

188

Treatment of generalized anxiety disorder is

Ssri/snri (Citalopram )

189

An oral macrolide antibiotic that inhibits the sigma subunit of RNA polymerase is _______

Fidaxomicin

(TX of c defficile)

190

Fracture of the 12th rib is likely to cause injury to which structure?

Kidney

191

The precursor for serotonin synthesis is ________

Tryptophan

192

Non stimulant drugs for ADHD __________

Atomoxetine

Alpha 2 adrenergic agonists

193

___________should be monitored in tx with olanzapine and other 2nd gen antipsychotics

Fasting glucose and lipid panel

194

Common side effects of SSRI is _______

Sexual dysfunction

195

Drug induced parkinsonism is treated with

Benztropine

196

Generalized anxiety disorder treatment with no risk of dependence

Buspirone

197

Turner syndrome is associated with what cardiovascular abnormality?

Bicuspid aorta

198

The vessel with highest O2 saturation in a fetus is

Umbilical vein that drains directly into IVC

199

Cancer cells usually have increased __________ activity that prevent chromosomal shortening

Telomerase

200

For maximum tensile strength collagen requires hydroxylation of proline and lysine this occurs in ________

Rough endoplasmic reticulum

NB: vit C is used as a cofactor in the reaction

201

Enzyme that removes short RNA fragment(RNA primers) that are base paired to DNA template

DNA polymerase l

202

Crohn's dse affects commonly the terminal ileum impairing bile reabsorption causing _______

Gall stones

203

Duodenal atresia is due to ____________ while intestinal atresia of midgut (jejunum, ileum, prox colon) is due to _______________

Failure of lumen to recanalize

Vascular occlusion

204

P falciparum ability to be more infectious/achieve higher parasitemia is because ______

Can infect erythrocytes of all ages

205

Cells that increase in COPD

Neutrophils

Macrophages

  • CD8 T lymphocytes

206

CD8 t lymphocytes present antigen to MHC I which comprises of ________

Heavy chain and B2 microglobulin

207

Slow abnormal rise of Bhcg is seen in _________

Ectopic pregnancy

208

__________ targets tumor cells and virally infected cells that lack MHC I expression.

Natural Killer cells

209

Severe nodulocystic acne is treated with_____________

Oral Isotretinoin

210

Chronic use of glucocorticoids (glucocorticoids induced osteoporosis) predisposes to fractures of ________

Vertebral

usually asymptomatic