USMLE Step 1 immuno - exam test Questions and well researched answers
Heterophile ab NEGATIVE Mono-like syndromes - (answer)*CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - (answer)-word salad: well-articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
Congenital Deficiency of Propionyl CoA Carboxylase - (answer)-prevents conversion of propionyl CoA to
methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA, cholesterol side chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap acidosis
Down Synd Comorbidities - (answer)Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability
MCC of Hypoglycemia in EtOH-ics - (answer)Thiamine def= suppression of GNG (pyruvate DH) and TCA
cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - (answer)impaired clearance of insulin
,USMLE Step 1 immuno - exam test Questions and well researched answers
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - (answer)Nitrates decrease preload, which will
increase the LV outflow tract... BUT since the ventricle is abnormally shaped, there is an outflow
obstruction
Mets through BM - (answer)Clonal proliferation of cells can invade/ metastasize*
1. malignant cells to lose their cell-to-cell adhesion molecules (cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the basement membrane and to release
metalloproteinases (e.g., collagenases, stromelysins, gelatinases) to degrade the basement membrane
and other enzymes to degrade the interstitial connective tissue- tissue inhibitors of metalloproteinases
neutralize these tumor-produced enzymes and limit the degree of invasion
3. cell receptors to attach to bronectin and other proteins in the extracellular matrix (ECM) and to break
it down
4. malignant cells to produce cytokines that stimulate locomotion, so that they can move through
basement membranes and the intracellular and extracellular matrices
Bicuspid Aortic Valve - (answer)Commonly presents in young, asymptomatic patient with soft systolic
ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - (answer)1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
Drug causes of SIADH - (answer)-Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - (answer)-Ant Talofibular Lig dmg
,USMLE Step 1 immuno - exam test Questions and well researched answers
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - (answer)- Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - (answer)-failure of septum primum and septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - (answer)-MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
Coronary Blood Flow Peak - (answer)-at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
Right Dom Heart - (answer)majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - (answer)-PDA comes off of LCX
- SA and AV node supplied by LCX
Increased Pulse Pressure - (answer)hyperthyroidism, aortic regurgitation, aortic stiffening (isolated
systolic hypertension in elderly), obstructive sleep apnea ( sympathetic tone), exercise (transient)
Decreased Pulse Pressure - (answer)aortic stenosis, cardiogenic shock, cardiac tamponade, advanced
heart failure (HF)
, USMLE Step 1 immuno - exam test Questions and well researched answers
Causes of Spontaneous Depol causing Tachyarrhythmias - (answer)Hypokalemia, Hypermagnesemia, or
prolonged QT interval
= all cause spontaneous depol of ventricles in phase 3 or 4 and it will cause an extra AP in heart
Direct alpha 1 agonist mediated effects - (answer)- vasc smooth muscle contraction= increased afterload
and venous return= increased DBP + SBP causes reflexive increase in vagal tone= dec HR and slowed AV
conduction
- mydriasis
- increased internal urethral sphincter tone and prostate contraction
Direct alpha 2 agonist mediated effects - (answer)- CNS med decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - (answer)- coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - (answer)-nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - (answer)- decreased left ventricular chamber size
- shortened base- to- apex dimension
- ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV outflow tract
- atrophy of myocardium causes increased interstitial connective tissue, often with concomitant
extracellular amyloid deposition
Heterophile ab NEGATIVE Mono-like syndromes - (answer)*CMV
HHV-6
HIV
Toxoplasmosis
Wernicke's Aphasia - (answer)-word salad: well-articulated, nonsensical speech paired with lack of lang
comprehension
-aud association cortex: post part of sup temporal gyrus
- supplied by MCA
Congenital Deficiency of Propionyl CoA Carboxylase - (answer)-prevents conversion of propionyl CoA to
methylmalonyl CoA
-propionyl CoA derived from= val, ile, met, thr, odd # FA, cholesterol side chains
-Propionic Acidemia: poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap acidosis
Down Synd Comorbidities - (answer)Neuro: MR, early onset Alzheimer's
Cardio: complete AV septal defect, VSD, ASD
GI: duodenal atresia, hirschprung disease
Endo: hypothyroid, DM1, obesity
Heme: ALL (> 5 yo) and AML (<5 yo)
Rheumatology: atlantoaxial stability
MCC of Hypoglycemia in EtOH-ics - (answer)Thiamine def= suppression of GNG (pyruvate DH) and TCA
cyle (alpha-KG DH)
MCC of Hypoglycemia in advanced renal insuff - (answer)impaired clearance of insulin
,USMLE Step 1 immuno - exam test Questions and well researched answers
Avoid Nitrates in Hypertrophic Cardiomyopathy bc... - (answer)Nitrates decrease preload, which will
increase the LV outflow tract... BUT since the ventricle is abnormally shaped, there is an outflow
obstruction
Mets through BM - (answer)Clonal proliferation of cells can invade/ metastasize*
1. malignant cells to lose their cell-to-cell adhesion molecules (cadherins)
2. cell receptors to attach to laminin (a glycoprotein) in the basement membrane and to release
metalloproteinases (e.g., collagenases, stromelysins, gelatinases) to degrade the basement membrane
and other enzymes to degrade the interstitial connective tissue- tissue inhibitors of metalloproteinases
neutralize these tumor-produced enzymes and limit the degree of invasion
3. cell receptors to attach to bronectin and other proteins in the extracellular matrix (ECM) and to break
it down
4. malignant cells to produce cytokines that stimulate locomotion, so that they can move through
basement membranes and the intracellular and extracellular matrices
Bicuspid Aortic Valve - (answer)Commonly presents in young, asymptomatic patient with soft systolic
ejection at right 2nd ICS
-can cause aortic regurg
MCC of Vaginal Candidiasis - (answer)1. Abx use= reduces lactobacilli pop
2. High estrogen levels- preg
3. System corticosteroid therapy
4. Uncontrolled DM
5. Immunosuppression, including HIV
Drug causes of SIADH - (answer)-Carbamazepine
-Cyclophosphamide
-SSRI
MC Ankle Sprain due to inversion of plantar-flexed foot - (answer)-Ant Talofibular Lig dmg
,USMLE Step 1 immuno - exam test Questions and well researched answers
-ecchymosis at the ant-lat aspect of the ankle
Upper Brachial Plexus Injury - (answer)- Musculocutaneous and Suprascapular N.
- dystocia mc in neonates; severe trauma mc in adults
- should adduction, elbow extension, and forearm pronation
Patent foramen ovale - (answer)-failure of septum primum and septum secundum to fuse after birth
-can lead to paradoxical emboli
Ventricular Septal Defect - (answer)-MC occurs in membranous septum
-Acyanotic at birth bc of L to R shunt
Coronary Blood Flow Peak - (answer)-at Early Diastole
-coronary perfusion driven by diastolic pressure
-tachycardia will decrease coronary perfusion
Right Dom Heart - (answer)majority of people
-PDA comes off RCA
-SA and AV nodes supplied by RCA
Left Dom Heart - (answer)-PDA comes off of LCX
- SA and AV node supplied by LCX
Increased Pulse Pressure - (answer)hyperthyroidism, aortic regurgitation, aortic stiffening (isolated
systolic hypertension in elderly), obstructive sleep apnea ( sympathetic tone), exercise (transient)
Decreased Pulse Pressure - (answer)aortic stenosis, cardiogenic shock, cardiac tamponade, advanced
heart failure (HF)
, USMLE Step 1 immuno - exam test Questions and well researched answers
Causes of Spontaneous Depol causing Tachyarrhythmias - (answer)Hypokalemia, Hypermagnesemia, or
prolonged QT interval
= all cause spontaneous depol of ventricles in phase 3 or 4 and it will cause an extra AP in heart
Direct alpha 1 agonist mediated effects - (answer)- vasc smooth muscle contraction= increased afterload
and venous return= increased DBP + SBP causes reflexive increase in vagal tone= dec HR and slowed AV
conduction
- mydriasis
- increased internal urethral sphincter tone and prostate contraction
Direct alpha 2 agonist mediated effects - (answer)- CNS med decrease in BP
- decreased intraocular pressure
- decreased lipolysis
- decreased presyn NE release
- increased platelet aggregation
S. epidermidis - (answer)- coag neg
-novobiocin sens
- infective endocarditis and infective arthritis in prosthetic pts
Asymptomatic heart defect in turner's synd - (answer)-nonstenotic bicuspid aortic valve
-early systolic , high frequency click over right second IC space
Cardiac Changes w/ Normal Aging - (answer)- decreased left ventricular chamber size
- shortened base- to- apex dimension
- ventricular septum becomes sigmoid and shape, with basilar portion bulging into LV outflow tract
- atrophy of myocardium causes increased interstitial connective tissue, often with concomitant
extracellular amyloid deposition
