Deck Step1 All Subjects

1. Proprotein Convertase Subtilisin/Kexin Type 9

aka PCSK9!
increases degradation of Hepatic LDL receptors –> Inc uptake of LDL into liver –> Decreased LDL serum
alirocumab, eva …?

2. C-Peptide Halflife?

35 mins

3. Iatrogenic Complication: Thyroid surgery

Hypocalcemia (hypoparathyroidism) –> Chovestek sign

4. ATP-Sensitive K Channel (k-ATP channel)

ATP binds to channel causing K influx –> release of Insulin

5. ADominant Hereditary Hypothalamic Diabetes Insipidus

Point Mutation in Neurophysin II

6. TRH stimulates the release of both:

TSH
PROLACTIN

7. DOPAMINE —(-)—> PROLACTIN

8. Osteoprotegrin: Decoy binder for RANK-Ligand

PTH reduces OPG –> Increased RANK-L –(+)–> RANK binding –> Activation of Osteoclasts –> Inc calcium resoprtion –> Inc serum Ca+

9. Teriparatide: PTH analogue

Intermittent use: Bone formation
Continued use: Bone resorption, osteoporosis

10. Site of PTH action?

PCT: PTH –(-)—> Na/PO4 cotransporter –> Excretes PO4
DCT: PTH –(+)—> Na/Ca Exchanger –> Reabsorpbs Ca

11. FGF-23: Released in Response to HyperPhosphatemia

Analogue of PTH
Reduces 1alphaHydroxylase –> decrease Calcitriol
produced by OSTEOCYTES
Earliast Marker of HyperPhosphatemia
Needtoverify: downregulation of NPT gene reduces PO4 absorption

12. Intermittent PTH/Analogue use?

Greater proportion of Osteoblastic activity vs Osteoclastic activity

13. PTH Action

PTH –> receptor on Osteoblasts –> Activation –> Inc production of RANK-L and Monocyte Colony Stimulating Factor
PTH: Inc RANK-L & Inc M-CSF & Dec OPG-decoy

14. Hepatic Gluconeogenesis Inhibited by?

Sepsis
Beta Blockers
Cytokines

15. Insulin Sensitivity is Decreased in CKD

due to high metabolites & UREA

16. Syndrome: Disorientation, sweating, palpitation

Hypoglycemia

17. Glut4

skeletal muscle
adipose tissue
excercise increases glut4 (AMP, Calcium Calmodulin Kinase Protein Modulator)
Insulin increases glut4 (dependent)

18. Prophylactic Erythromycin to Newborns

prevent Opthalmia neonatorum by N. Gonorrhea
else leads to blindness

19. Advanced Directive Types:

Living will
hospital proxy

20. Elizabeth Model for Grief: (stages)

Denial
Anger
Bargaining
Depression
Acceptance

Syndrome: Facial grimmacing, lip-smacking, Tongue movements and puckering

Tardive diskinesia
s/e: Typical antipsychotics
months to years after starting the drug
Rx: change (clozapine), venlabenzine, deutrabenazine

Learning Disorders

academic disorder, difficulty in – Learning – Reading – Writing

Boderline Personality Disorder

Unstable relationships
Mood instability
libaility

ATP7B Mutation?

Wilson
ARecessive
too much Ca

ATP7A Mutation?

defective Cu absorption
Too less Calcium

Deposits in Descemet membrane of Cornea?

Keyser-Fleischer Rings
Wilson

Global development Disorder

Engage in time-consuming, repetative behavior (mirror checking, excessive grooming) causing significant impairment in functioning:

Body dysmorphic disorder

Ziprasidone:

QT Interval
ECG Monitoring
SGA-Psych

Risperidone:

Prolactin Elevation – Hypogonadism – Osteoporosis – Galactorrhea – Amennorhea

FLAT EFFECT

Schizophrenia

Low Melatonin in CSF

Alzeimers disease

Reversible acute confusional state with reduced or fluctuating level of consciencess

DELIRIUM

Competitive Athletes, dancers fashion models

Functional Amenorrhea

SIADH: SSRIs!

Carbamazepine
Cyclophosphamide
SSRI

Decreased Cortisol:

Hypoglycemia
Normocytemic Anemia
Eosinophilia

Magnocellular neurons:

Suprooptic/paraventricular N of Hypothalamus
ADH/Oxytocin

Bradycardia and Hypo/Hypertension in Hypothyrodism?

HypErtension

Bilateral Fetal Hydronephrosis in Boys

Posterior Urethral valve defect

Principle: Oxygen-induced Hypercapnia in COPD

COPD patients given oxygen will become lethargic, seizures due to O2 induced hypovent.

Already chronic C02 retainers –> “compensated” Respiratory Acidosis! Alterations in V/Q balance in lungs can increase deadspace ventilation and further rise in PaCO2

At baseline: – Pulmonary vasoconstriction: diverted to well ventilated areas of the lung – Chronic Hypoxic state: High Hgb affinity for CO2 – Peripheral chemoreceptor stimulation
After O2 administration – Vasodilation diverts blood away from well ventilated regions – Decrease Hgb affinity for CO2 (Haldane effect) – Decreased chemoreceptor stimulation
Effect – Increase Physiologic dead space (V/Q mismatch) – Increase Blood PCO2 – Decrease Minute Ventilation

Ranke Complex

Fibrosed Ghon complex
lower lobe infection
ipsilateral lymph node

PO2 Content

Mixed with pulmonary shunt blood

ENOLASE

GLycolysis
2Phosphoglycerate —[enolase]–> PEP

Poison Ivy, oac, sumac

Urshiol induced dermatitis
contact dermatitis

Problems in Proteosomes:

More viral infections!
intracellular viral degradation initiation
Ubiquitin tags proteins to be degradaded

Valsalva Maneuver –> Decrease Venous return

Bearing down, forceful exhalation

Valsalva –> Loud Murmer in ?

Loud in HOCM
Decreasing LVFilling –> Increase LV Outflow tract Obstruction (worsens) –> Murmer loud!

Valsalva –> Softer Murmur in ?

Soft in AS
Decrease LV Filling –> Decrease LVEDP –> less gradient, softer murmer

HOCM Murmur

Anything that reduces Preload –> Increase Murmur intensity
Anything that increases Afterload –> Decrease Murmur intensity

POST MI, continued High CK

Reperfusion injury –> O2 radical damage to cell wall by neutrophils –> CK release from BRAIN/HEART/Muscle

Bone morphogenetic protein receptor type II or BMPR2 is a serine/threonine receptor kinase

BMPR2
Connective tissue disease, HIV infection

AR, MR, VSD murmurs increase when __load increases?

Afterload increases
handgrip, squatting

Exercise induced fatigue, pain parasthesias or dizziness and vertigo:

SUBCLAVIAN STEAL SYNDROME
severe stenosis of proximal subclavian artery –> reversal in blood flow from contralateral vertebral artery to ipsilateral verterbral artery
ARM ISCHEMIA in affected EXTREMITY

EF Formula:?

Ef = SV / EDV

SV = EDV - ESV 

Ef = EDV - ESV / EDV 

Normal > 50%

54. Meds for Chronic Heart Failure with reduced EF (CHFrEF)

Mortality benefit: – ACE – ARB – Nephrilisin INhib (CI with ACE == angioedema) – Beta blocker : metaprolol – Spironolactone (specially for Pulmonary Edema)
No Mortality Benefit: – Diuretics – Digoxin reduces hospitalization

55. features of HF with Preserved EF

In Diastolic Dysfunction: EF could be preserved over >50
56. Formation of Atheroma:

Endothelial dysfunction
Cholesterol, HDL, LDL goes into the intima –> monocytes migrate (Macs) –> phaogcytoze LDL become foam cells –> produce growth factors –> collage synthesis in intima, smooth muscle proliferation, extracellular necrotic debri

57. Internal carotid artery derived from which arch?

Pharyngeal arch 3: Common Carotid and Proximal-ICA

58. Eccentric Ventricular Enlargement, CO is high/low/normal?

CO is maintained.
LV systolic dysfunction –> LV vent enlargement –> FRANKSTARLING –> SV Maintained –> [YEARS LATER: CHRONIC] –> Cardiac remodelling –> Sarcomeres added in Series to accomodate Inc LV Volume –> Eccentric Hypertrophy –> SV Still maintained –> [DECADE LATER] –> cannot compensate anymore incoming fluid –> Contractile Dysfunction –> Decompensated Heart Failure
CO eventually falls

59. Breast Milk does not contained Vitamin ….. and ……?

K and D

60. B12 absorbed from? and how?

b12 is absorbed in ILium, its got to survive the stomach acidity!
Helped by R-protein and IF
b12-protein complex in stomach, R-binder from salivary gland also in stomach –> Stomach acdity separates b12 from protein and binds R-binder –> goes into Duodenum –> Pancreatic Protease splits R from b12 –> IntrinsicFactor (IF) binds b12 –> b12-IF complex absorbed form ILIUM

61. INDIA INK?

Basically detects GELATINOUS capsule
ENCAPSULATED budding yeast
Cryptococcus Neophhh???

62. VHL tumors in renal, adrenal medulla and ..?

Cerebellar & Retinal hemangioblastomas

63. How big are lacunar infarts?

< 15 mm cavity infarcts

64. Microbes causing COPD exacerbation?

Dyspnea and/or cough, Changes in Sputum color Physical: PURSED LIPS with prolonged expiration

Viral – Rhinovirus – Influenza – Parainfluenza
Bacteria – H. Infl, Moraxella catarrhalis, Strep Pneumonia
Airpoultion, embolism

65. IPP becomes equal/greater/less than Airway pressure in Emphysema?

Greater than airways

66. Bleomycin sideeffect: causes due to ?

Pulmonary fibrosis due to Free radical formation

67. Phthirus Pubis… LICE!

68. Superior Messenteric artery is usually at ……. angle?

45; pathologic if less < 20
compresses 3rd part of duodenum if < 20 degrees

69. Fetal Hb begins production ….

By 8 weeks

70. Extremely high affinity for O2?

4 gamma chains in Hb
Hb Barts

71. Leading cause of Foodborne gastroenteritis?

Campylobacter jejuni (which is also implicated in Guillain barre syndrome)

72. Sudain III Stain identifies what in Stool?

Fat!

73. Most severly affected nutrient in malasoprtion: FAT!

74. Generalized Malabsorption causing conditions:

Defective pancreatic secretiosn
muscosal disorders - Celiac, IBD (crohn, UC)
Bacterial overgrowth (gi surgery, motility)
parisitic: giardia

75. Clinical Disinfectants

Alcohol cell membranes, __P__roteins not-sporicidal
Chlorhexidin cell membranes,__C__ytoplasm not-sporicidal
H202 destructivefreeradicals sporicidal
Iodine Halogenation sporicidal

76. Gout causing drugs:

URIC ACID secretion reducers:

Diuretics - loop, thiazide
Salicylates - low dose
ACEI
Cyclosporin

77. Sjogren syndrome: which cellular infiltration?

Lymphocytic INfiltration around germinal centers
also normal serous acini
Salivary gland:

78. OCCULOMOTOR NERVE what fibers in and out?

OUTER: Parasympathetic N: —– Aneurysmal Compression —– EARLY: Dilated pupil —– LATE: Ptosis, Opthalmoplegia (Down and Out)
INNER: Deep Extraocular Muscle efferents —– Diabetic (Infarcts first in the deep fibers): Diabetic Opthalmoplegia —– EARLY: Down and Out —– Normal reactive Pupil!

79. common microbes in CF:

Pseudomonas
S. Aureus

80. Excocrine Insufficency progressive:

81. M.Tb pathogenesis:

tb enters lungs –> alveolar sacs –> Macs eat them –> There is inhibition of Phagosomes and lysosomes –> unchecked growth –> migrate to Lymphnodes –> Macs present antigens (APC) to naive Th0 cells –> Th0 differentiats to Th1 –> Th1 migrates to the site in th elungs –> Th1 secrets INF-gamma and IL2 –> Intracullar killing and granuloma formation

82. Anti-PD1 antibodies / mechanism?

If the tumor cell expresses PD-L1 and B7, it avoids T Cell destruction

CancerCell–(b7)==(CD28)–TCell
CancerCell–(MHC)==(TCR)–TCell
CancerCell–(PDL1)==(PD1)–TCELL
CancerCell–(B7)==(CTLA-4)–TCell

83. Plasma Cell neoplasm:

Eccentric Nuclei prominent nucleoli
Clock face chromatin

84. Drug reactions with CHELATING agents

Tetracyclin
Fluoroquinolones

85. Blood nipple discharge, diagnosis?

Intraductal papilloma

86. Osteonecrosis of JAW is a s/e of?

Bisphosphonates!
commonly used high doses for cancer or oral surgeries

87. Abdomen CT

88. Cold is intra or extra vascular hemolysis?

INTRAvascular hemolysis
Infection: Mycoplasma, Hematological Malignancies, IgM
EAR PINNA

89. WARM Agglutination exampels:

SLE
CLL
Medications/Penicillin? (combs+)
IgG

90. Calculating Clearance === GFR ?; === RBF?

INULIN == GFR (freely filtered, no absorption or secretion) – Amount Excreted == Amount Filtered
PAH == RPF (freely filtered, some Secretion from tubule – Amount Excreted > Amount Filtered

Estrogen increases or decreases T4?

Increases T4
Estrogen Increase –> Inc TBG, Inc Bound-T4 –> Decrease FreeT4 –+> Hypothalamus (TRH) –+> TSH –+> Thyroid T3,T4 –> Increase T4 free level (restored)

Needle shaped cholesterol clefts on micrsocopy?

AtheroEMBOLIZATION
clefts are surrounded by multi nucleated giants cells

tags: step1 - usmle - deck