USMLE STEP 1 EVALUATION QUIZ
SOLUTION BANK FORESIGHT
ASSESSMENT PASS CONFIRMED
⫸ Common S/E of ACE-Inhib. Answer: cough, angioedema, inc K+
⫸ CCB (diphenhydropine) S/E. Answer: periph edema, dizziness/
lightheadedness
⫸ Beta Blocker S/E. Answer: bronchospasm, bradycardia, fatigue,
sexual dysfunction
⫸ HTN and at risk for Osteoporosis. Answer: THIAZIDES!
increased bone mineral density b/c increase in Ca2+ abs in DCT
⫸ Methylmalonyl-CoA mutase Def. Answer: -AR
-increased urine: methylmalonic acid and propionic acid
-hyperammonemia, ketotic hypoglycemia, and metab acidosis
-newborns present with lethargy, vomiting, and tachypnea
⫸ TCA Effect on Cardiac Na+ Channel. Answer: BLOCKS cardiac
fast Na+ channels= QT and QRS prolongation and arrhythmias
-treated with Sodium Bicarb
,⫸ MC Complication post Subarachnoid Hemorrhage. Answer: SAH
sx: thunderclap ha, confusion, fever, nuchal rigidity
MC Compl: VASOSPASM!
-vessels surrounding ruptured aneurysm
-cerebral ischemia and new onset confusion and/or focal neuro
deficits (paresthesia, weakness, etc) 4-12 days post SAH
-mech of vasospasm is related to impaired brain autoreg
-not seen on CT, need transcranial color doppler
-Nimodipine prescribed to prevent vasospasm post-SAH
⫸ Most Serious Compl of SAH. Answer: REBLEED!
-sudden dev of severe confusion, HA, N/V, decreased consciousness,
focal neuro deficits
-seen on CT
⫸ t(8;14). Answer: Burkitt lymphoma (c-myc activation)
-cmyc is an oncogene
-very aggressive, rapid proliferation of cell growth
⫸ t(9;22) aka Philadelphia chromosome. Answer: CML (BCR-ABL
hybrid), rarely ALL
-constitutive expression of tyrosine kinase
-poor prognosis when expressed in ALL
,⫸ t(11;14). Answer: Mantle cell lymphoma (cyclin D1 activation)
-cyclin D1 is a cell cycle regulator
-this translocation continuously allows cells to go on in cell cycle
without stopping/ apoptosis
⫸ t(14;18). Answer: Follicular lymphoma (BCL-2 activation)
[Diffuse Large B-Cell Lymphoma]
-bcl-2 inhibits apoptosis normally
-in this CA, there is constant anti-apoptotic activity
⫸ t(15;17). Answer: APL (M3 type of AML)
-translocation of retinoic acid rec (chr 15) onto chr 17, blocks
maturation and abnormal pro-myelocytes/ blasts increase which can
lead to an increase in DIC
⫸ t(12;21). Answer: Acute lymphoblastic leukemia/lymphoma
*better prog
⫸ Inc RBC, WBC and Platelets. Answer: polycythemia= increase
hematocrit
⫸ Decreased EPO. Answer: -Polycythemia Vera (neg feedback)
-Anemia of Chr Disease
-Chr Kidney Disease
, ⫸ Corticosteroids cause .... Answer: -Neutrophilia, despite causing
eosinopenia and lymphopenia
-Corticosteroids activation of neutrophil adhesion molecules,
impairing migration out of the vasculature to sites of in ammation
- BUT, sequester eosinophils in lymph nodes and cause apoptosis of
lymphocytes
⫸ Neutropenia. Answer: Sepsis/postinfection, drugs (including
chemotherapy), aplastic anemia, SLE, radiation
⫸ Lymphopenia. Answer: HIV, DiGeorge syndrome, SCID, SLE,
corticosteroids, radiation, sepsis, postoperative
⫸ Eosinopenia. Answer: Cushing syndrome, corticosteroids
⫸ MM. Answer: - Inc susceptibility to infection
- Primary amyloidosis (AL)
- Punched-out lytic bone lesions on x-ray = activated RANK-L
increased osteoclast activity
- M spike on serum protein electrophoresis
- Ig light chains in urine (Bence Jones protein)
- Activated IgG prod by plasma cells by IL-6, may lead to proteasome
inhib
- Rouleaux formation (RBCs stacked like poker chips in blood smear)
⫸ CO Poisoning. Answer: Normal PO2 (dissolved O2)
SOLUTION BANK FORESIGHT
ASSESSMENT PASS CONFIRMED
⫸ Common S/E of ACE-Inhib. Answer: cough, angioedema, inc K+
⫸ CCB (diphenhydropine) S/E. Answer: periph edema, dizziness/
lightheadedness
⫸ Beta Blocker S/E. Answer: bronchospasm, bradycardia, fatigue,
sexual dysfunction
⫸ HTN and at risk for Osteoporosis. Answer: THIAZIDES!
increased bone mineral density b/c increase in Ca2+ abs in DCT
⫸ Methylmalonyl-CoA mutase Def. Answer: -AR
-increased urine: methylmalonic acid and propionic acid
-hyperammonemia, ketotic hypoglycemia, and metab acidosis
-newborns present with lethargy, vomiting, and tachypnea
⫸ TCA Effect on Cardiac Na+ Channel. Answer: BLOCKS cardiac
fast Na+ channels= QT and QRS prolongation and arrhythmias
-treated with Sodium Bicarb
,⫸ MC Complication post Subarachnoid Hemorrhage. Answer: SAH
sx: thunderclap ha, confusion, fever, nuchal rigidity
MC Compl: VASOSPASM!
-vessels surrounding ruptured aneurysm
-cerebral ischemia and new onset confusion and/or focal neuro
deficits (paresthesia, weakness, etc) 4-12 days post SAH
-mech of vasospasm is related to impaired brain autoreg
-not seen on CT, need transcranial color doppler
-Nimodipine prescribed to prevent vasospasm post-SAH
⫸ Most Serious Compl of SAH. Answer: REBLEED!
-sudden dev of severe confusion, HA, N/V, decreased consciousness,
focal neuro deficits
-seen on CT
⫸ t(8;14). Answer: Burkitt lymphoma (c-myc activation)
-cmyc is an oncogene
-very aggressive, rapid proliferation of cell growth
⫸ t(9;22) aka Philadelphia chromosome. Answer: CML (BCR-ABL
hybrid), rarely ALL
-constitutive expression of tyrosine kinase
-poor prognosis when expressed in ALL
,⫸ t(11;14). Answer: Mantle cell lymphoma (cyclin D1 activation)
-cyclin D1 is a cell cycle regulator
-this translocation continuously allows cells to go on in cell cycle
without stopping/ apoptosis
⫸ t(14;18). Answer: Follicular lymphoma (BCL-2 activation)
[Diffuse Large B-Cell Lymphoma]
-bcl-2 inhibits apoptosis normally
-in this CA, there is constant anti-apoptotic activity
⫸ t(15;17). Answer: APL (M3 type of AML)
-translocation of retinoic acid rec (chr 15) onto chr 17, blocks
maturation and abnormal pro-myelocytes/ blasts increase which can
lead to an increase in DIC
⫸ t(12;21). Answer: Acute lymphoblastic leukemia/lymphoma
*better prog
⫸ Inc RBC, WBC and Platelets. Answer: polycythemia= increase
hematocrit
⫸ Decreased EPO. Answer: -Polycythemia Vera (neg feedback)
-Anemia of Chr Disease
-Chr Kidney Disease
, ⫸ Corticosteroids cause .... Answer: -Neutrophilia, despite causing
eosinopenia and lymphopenia
-Corticosteroids activation of neutrophil adhesion molecules,
impairing migration out of the vasculature to sites of in ammation
- BUT, sequester eosinophils in lymph nodes and cause apoptosis of
lymphocytes
⫸ Neutropenia. Answer: Sepsis/postinfection, drugs (including
chemotherapy), aplastic anemia, SLE, radiation
⫸ Lymphopenia. Answer: HIV, DiGeorge syndrome, SCID, SLE,
corticosteroids, radiation, sepsis, postoperative
⫸ Eosinopenia. Answer: Cushing syndrome, corticosteroids
⫸ MM. Answer: - Inc susceptibility to infection
- Primary amyloidosis (AL)
- Punched-out lytic bone lesions on x-ray = activated RANK-L
increased osteoclast activity
- M spike on serum protein electrophoresis
- Ig light chains in urine (Bence Jones protein)
- Activated IgG prod by plasma cells by IL-6, may lead to proteasome
inhib
- Rouleaux formation (RBCs stacked like poker chips in blood smear)
⫸ CO Poisoning. Answer: Normal PO2 (dissolved O2)
