USMLE World

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Topoisomerase I

Relieves (-) supercoiling via nicks

Topoisomerase II

Relieve (+) and (-) supercoiling via transient double stranded breaks followed by sealing.

Etoposide

Topoisomerase II inhibitor anti cancer drug. Testicular Cancer. Small Cell Lung Cancer.

Week 4

Neural Tube defects are the result of fusion fails of the anterior or posterior neural pore. When in development does this occur?

acetylcholine esterase
alpha fetoprotein

The presents of what in the amniotic fluid is indicative of a failure of fusion at the anterior or posterior neural pore (neural tube defect)?

anencephaly
anterior neural pore fusion

Total absense of brain and calvarium?
What failed?

Encephalocele
anterior neural pore fusion

Herniation of brain tissue?
What failed?

Hirschsprung Disease

Failure of neural crest cell MIGRATION into the intestinal wall. Result: Absense of myenteric and submucosal plexi in a segment of colonic wall.

Duodenal atresia

ABNORMAL APOPTOSIS. Duodenal lumen fails to recanalize. Presents: Intestinal obstruction in first days of life.

no

Can a failure of proliferation result in a neural tube defect?

no

Can a failure of maturation result in a neural tube defect?

IgG anti Exotoxin B subunit

What molecule provides immunity to disease caused by Cornebacterium diptheriae?

K antigen

What does Corynebacterium diptheriae expression on its membrane to resist IgA immunity at mucosal surfaces?

N acetylcysteine

mucolytic agent->x disulfide bridges->X glycoproteins

S4

Heart sound indicative of poor LV compliance

S3

Heart sound indicative of High LV End Diastolic Pressure

metoprolol

Selective Beta 1 blocker. Used to decrease contractility and rate at the myocardium.

Blastomyces
Coccidioides
Histoplasma
Paracoccidioides
Sporothrix

Clinically important dimorphic fungi

Dubin Johnson Syndrome

Autosomal Recessive. Mild conjugated hyperbilirubinemia.
Presents: mild icterus. No hepatosplenomegaly. Normal Liver Enzymes. Not Ill. Not Pruritic.

collagen

Elastin or Collagen?
Triple Helices via hydroxylation; glycosylation; S-S

both

Elastin or Collagen?
nonpolar amino acids

Elastin

Elastin or collagen?
Not hydroxylated (proline, lysine)

Increases systemic pressure
decreases Right to Left Shunt

What does squatting achieve in Tetralogy of Fallot?

atrial fibrillation
AV node refractory period

Absent P waves. Narrow QRS complex. Irregularly irregular R-R. What is the diagnosis? What determines the rate of ventricular contraction here?

Neural Crest Cell migration

Embryologically, what has failed in Tetralogy of fallot?

Neural Crest Cell migration

Embryologically, what has failed in Truncus Arteriosus?

Neural Crest cell migration

Embryologically, what has failed in Transposition of the great vessels?

beta1

What receptor mediates renin release from Juxtaglomerular cells?

O2 consumption/arteriovenous O2 difference

Cardiac Output as determined by the Fick equation is equal to what?

aorticopulmonary septation
bulbis cordis
truncus arteriosus

Neural crest cell migration failure is the cause of Tetralogy of Fallot, Truncus Arteriosus, and Transposition of the Great Vessels. What process does the this migration fail in? And which structures do they fail to migrate to?

Atrioventricular Septum
Late
Pulmonary Hypertension

Embryologically, Endocardial Cushion defects lead to congenital defects in what structure? Will this cause early or late cyanosis? What must develop for cyanosis to occur via a right to left shunt?

anterior cerebral artery

This artery supplies the medial portion of the hemispheres

Aorta Coarctation

Presentation: Blood pressure discrepancy between upper and lower extremities.
What is the diagnosis?

distal to left subclavian artery

In aorta coarctation, where does the compression occur usually?

microvessel dilation
adenosine
dipyridamole

"Coronary Steal" phenomenon refers to a redistribution of coronary blood flow away from ischemic areas. Anatomically what is this due to? Pharmacologically, what drugs can achieve this?

Ataxia Telangiectasia
DNA repair
Combined Immune Deficiency
Hematologic Malignancy

Presentation: "Superficial blanching nests of distended capillaries"; Recurrent upper and lower respiratory infections; cerebellar ataxia.

What is the diagnosis?
What is defective?
What are the secondary diseases to this defect?

Vitamin A

A 10X overdose of what vitamin causes cirrhosis?

Viridans streptococci

This organism does the following reaction:
sucrose->dextroxe.
Dextrose=adherence to fibrin.
Thus, the organism lives at sites of trauma.

Purine Catabolism

What is Lesch Nyhan syndrome essentially a failure of?

Pb2+
hypochromic anemia

What toxicology inhibits Mitochondrial Fe2+ transport? How does this manifest?

Bare Lymphocyte Syndrome

A failure of HLA Class II expression on APCs

Sphingolipid catabolism
Sphingomyelinase
Monocytes

Niemann Pick disease is essentially a failure of what? What is the defective enzyme? Where does the metabolite build up?

Niemann Pick Disease

Hepatosplenomegaly. Anemia. Motor neuropathy. Cherry red macular spot. Early childhood death.

Acute Intermittent Porphyria
UP I Synthase/PB deaminase

Acute attacks of abdominal pain. Psychosis. Urine turns dark upon light exposure.
BUT NO PHOTOSENSITIVITY.
What is the diagnosis?
What is the defective enzyme?

Porphyria Cutanea Tarda
Uroporphyrinogen Decarboxylase

Uroporphyrinogen in urine. Mild photosensitivity.
What is the diagnosis?
What is the defective enzyme?

ALA dehydratase
Ferrochelatase
ALA
Protoporphyrin IX

In the Heme Synthesis pathway, which enzymes are inhibited by Pb2+? What will build up?

ALA synthase
glucose heme

What is the rate limiting enzyme in Heme synthesis? What inhibits this enzyme?

Vitamin B6 pyridoxine

Regarding Heme synthesis, what is the cofactor for ALA synthase?

Alcohol
Barbiturate
Hypoxia

Regarding Heme synthesis, what activates the rate limiting enzyme ALA synthase?

ALA dehydratase

Regarding Heme synthesis, which enzyme contains zinc?

neural tube defects

Teratogenicity of Valproate

Ebstein anomaly

Teratigenicity of lithium

Ebstein anomaly
Lithium

"Atrialized" right ventricle due to downward tricuspid valve displacement.
What defect?
What cause?

ACE inhibitor
Thiazide diuretic

1st dose hypotension occurs as a result of the vasodilative effect of the administered drug with the background hypovolemia from another drug. What is the administered drug? What is the background drug?

Down Syndrome

Duodenal atresia. What congenital disease?

Duodenal Atresia

On the 1st day of life a baby has bilious vomiting with NO ABDOMINAL DISTENTION. What is the diagnosis?

Bicuspid Aortic Valve
Turner Syndrome

What are the congenital associations with Aorta Coarctation?

Lead Time Bias

Study error: Patients seem to live longer only because disease is detected earlier by test method than by conventional method.

Lead Time Bias

Artificial increase in survival time among tested patients who actually have an unchanged prognosis.

Killed Vaccine

What type of vaccine is the Rabies vaccine?

Measurement Bias
Observer Bias

Study Error: Misclassification via mislabeling populations, etc

Valproate

Inhibits intestinal folate absorption. Neural Tube defects.

Idiopathic Membranous Nephropathy
podocyte

IgG4 anti PLA2R (m type).
What disease?
Regarding disease, which cells express this receptor?

IgG anti PLA2R

Idiopathic Membranous Nephropathy is the result of what auto antibody?

minimal change disease

Abnormal T cell production of a glomerular permeability factor causes foot process fusion.

Berger Disease IgA Nephropathy

Painless hematuria in a child/young adult 2-3 DAYS after an upper respiratory infection?

Post Streptococcal GlomeruloNephritis

Painless hematuria in a child/young adult 2-3 WEEKS after an upper respiratory infection?

Henoch Schonlein purpura

IgA Nephropathy in the context of extrarenal symptoms involving the skin and gi

Multiple Myeloma

renal disease b/c light chain deposition->cast nephropathy. Not amyloidosis.
What disease?

Mixed Cryoglobulinemia
IgM Glomerular Deposition

Hep C patient develops renal disease marked by:
-basement membrane thickening
-cell proliferation

What disease? How is it mediated?

CREST
anti centromere

Dysphagia and Sclerodactyly.
What disease?
How is it mediated?

Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia

CREST is due to anti centromere antibodies.
What does CREST stand for?

Rheumatic Fever

IgM anti M protein
crossreacts with:
-Heart glycoprotein
-Joint glycoprotein

Rheumatic Fever

Joint paint + heart murmur.
What disease?

Acute Tubular Necrosis
Vasoconstriction

Cyclosporine; Tacrolimus nephrotoxicity manifests as what? This is secondary to what?

ganciclovir
zidovudine

AIDS patient being treated for CMV Retinitis develops severe neutropenia. What drug? What drug if already administered, would exclude prescription of this CMV drug (on account of being bone marrow suppressive)?

Foscarnet

Pyrophosphate analog CMV Retinitis drug

Foscarnet

AIDS patient being treated for CMV Retinitis develops seizures. What drug?

Foscarnet

chelates Ca2+ (side effect)->Hypocalcemia
renal wasting (side effect)->hypomagnesemia
Low Ca2+ + Low Mg2+ = SEIZURE

What drug?

Acyclovir

antiviral drug. Patient develops delerium and tremor.
What drug?

Acyclovir

antiviral drug. Crystal nephropathy. Neurotoxic.

Protease Inhibitor

AIDS drugs. Fat redistribuition and insulin resistance.

K+ sparing diuretic
CS CCD

Triamterene is of what drug class? Where, anatomically, does it act?

Pulmonary Edema

What is the major danger of aggressive osmotic diuretic therapy?

efferent

Afferent arteriole or Efferent arteriol:
Preferential action by AT2 (vasoconstriction)

uric acid

Needle shaped. Negative birefringence w polarized light.

no

Procainamide can induce SLE-like syndrome. Will this involve the kidney?

amphotericin b

Drug of choice for mucormycosis

amphotericin b

A patient is taking an antifungal and develops normocytic normochromic anemia. What drug?

Ethacrynic Acid

What loop diuretic has the greatest ototoxicity? Loop diuretic ototoxicity is believe to by due to the presence of Na+K+2Cl- symporter in the ear. Usually ototoxicity occurs when used in conjunction with an aminoglycoside (someone with a UTI and Pulmonary Edema).

carbonic anhydrase

Enzyme needed for the production of aqueous humor

hydration

Acyclovir is nephrotoxic. It crystalizes when its concentration>solubility. What is the best pretreatment to prevent this from happening?

allopurinol

Pre-treatment in lymphoma and leukemia to prevent tumor lysis syndrome

prednisone

Pre-treatment for Radiocontrast imaging studies. Decreases allergic reaction to radiocontrast.

hypocalcemia
hypokalemia
hypomagnesemia

What are the most COMMON side effects of loop diuretics?

proximal tubule

Where is carbonic anhydrase located in the kidney?

CNS
eye
GI
Pancreas
Proximal tubule
RBC

Where in the body is carbonic anhydrase located?

CD7

Multi chain complex T cell marker

CD14 TLR4 coreceptor

Monocyte; Macrophage marker

corpus callosum

A patient cannot retrieve an object with his right hand that he is palpating with his left hand. Where is the lesion?

X factor hematin
V factor NAD+
S. aureus

Haemophilus influenzae is a blood loving organism. It cannot be grown on sheeps agar however, unless it is in the presence of another organism. This organism is hemolytic. What nutrient does H. influenzae attain through the hemolysis of RBCs by this organism? What nutrient does H. influenzae attain directly from this organism? What is the organism?

cystic fibrosis

del F508=phenylalanine deletion at 508.

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