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USMLE Step 1 from Goljan Notes


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What is the most common malaria?
Vivax (Viva! It's the MC)
What is the fever pattern for P. vivax?
48 hours (Viva the 48 hr party!!!)
Which malaria is the most lethal?
Falciparum (make one false step and you are dead)
Which malaria is associated with nephrotic syndrome?
P. malariae
What is the fever pattern for P. falsiparirum?
No pattern, it is so false that it doesn't have one
What is the fever pattern for P. malariae?
72 hours
What do you find in the lab work?
Blood smears with organisms inside RBC, falciparum ring form and gametocytes (banana shape)
Prophylaxis Tx for malaria?
What drug do you use for resistant falciparum?

ME FLOr resistant Falciparum
What is the Tx for all except falciparum?
Chloroquine plus primaquine
What is the specific Tx for falciparum?
IV quinidine or quinine plus doxycycline

Falciparum is the FALSE QUEEN (quinidine)
What leukemia has translocation t(15;17)
Acute Promyelocytic Leukemia (M3)
In which leukemia do you find DIC?
Acute Promyelocytic Leukemia (M3)
What leukemia has gum infiltration?
Acute Monocytic Leukemia (M5)
What leukemia has auer rods?
Acute Myelogenous Leukemia (M2/M3)
What are auer rods?
fused azurophilic granules on cytosol of blast cells
What leukemia is cured/reverse with Vitamin A (Retinol)?
Acute Promyelocytic Leukemia (M3)
What is the age distribution of all leukemias?
ALL (0-14) AML (15-39) AML (40-60) CML (40-60) CLL (>60 years old)
Which leukemia has translocation t9;22?
Chronic Myelogenous Leukemia (CML)
What is the frequency of acute leukemias ?
Acute Myelogenous Leukemia (M2) 30-40% Acute Promyelocytic (M3) 5-10%, Acute Monocytic (M5) 10%
What leukemia is associated with ABL protooncogene?
Chronic Myelogenous Leukemia (CML)
What is the translocation of ABL protooncogene?
What chromosome is CML found in? What is the name of the chromosome?
Chromosome 22; Philadelphia Chromosome
What is afected in chromosome 22 for CML?
bcr (break cluster region) bcr-ABL fusion gene
What is the most specific test for CML?
decrease LAP (Leukocyte Alkaline Phosphatase)
What are other positive tests for CML?
philadephia chromosome and bcr-ABL fusion gene
What is the most common cancer and leukemia in children?
What is the most common subtype?
pre-B (80%)
What is a positive marker for ALL?
Common ALL Antigen and TdT (terminal deoxynucleotidyl transferase)

You are Caller No. 10!!!
Where do B cells metastasize in ALL?
CNS and testicles

think B is for Brain and Balls!
Where do T cells metastasize in ALL?
Anterior Mediastinal mass or acute leukemia
Which ALL type has best prognosis?
Gout or Pseudogout?
How do you tell?
Positively Birefringement (Blue color) Pseudogout

Negatively Birefringement (Yellow color) Gout
What crystal is negatively birefringent?
Negative is Yellow in color so it's Monosodium Urate for Gout
What crystals are positively birefringent?
Positively Blue in color so it is Calcium Pyrophosphate Crystals (CPPC) for Pseudogout
Blue Crystals?
- Blue is Calcium pyrophosphate
Yellow Crystals?
Gout Monosodium urate
What joints are involved in Osteoarthritis?
What joints are involved in Rheumatoid Arthritis?
What are PIP joints inflamed called?
Bouchard Node

What is a Heberden Node?
Inflamation of DIP
What is rheumatoid factor? (RF)
IgM Ab against IgG
Where is rhematoid factor found?
In synovial fluid
What is the synovial tissue that grows over the articulate cartilage called?

Not to be confused with Tophus that is found in Gout
Which on is symmetrical? Rheumatoid or Osteoarthritis?
What is it called when you get a patient with rheumatoid arthritis that expresses dry mouth and dry eyes?
Schoegrem Sx
Syndrome with rheumatoid arthritis with nodes in the lungs?
Kaplan Sx
What is the Tx of Rheumatoid Arthritis?
What are some effects of long teng methotrexate tx?
i.e. Arhtritis Tx
Macrocytic Anemia
Hypersegmented Neutrophils

Also causes:
Intersitial Fibrosis of the Lung
Tx for Gout?
What drug do you give for underexcretion of uric acid?
Overproducer of uric acid?
What is the mech. of Allopurinol?
Block Xanthine Oxidase
What is the mechanism of uric acid accumulation/gout in alcoholics?
Patients with alcoholism are under metabolic acidosis
-All the acids compete in the excrition of proximal tubule

Alcoholics contain b-hydroxybutiric acid, lactic acid so they compete with uric acid to be excreted
Dz with degenerative arthritis in vertebral columns, pee turns black?
cartilage is turns black
What is the inheritance of alkaptonuria?
autosomal recessive
What enzyme is absent and what accumulates?
Homgentisic Acid builds up

homogentisic oxidase
Patien w/ disuria, sterile piuria?
Non-specific urethritis chlamydia

No culture in urine
Same patient develops pain on Achilles Tendon? Conjunctivitis
Reiter's Sx

HLA-27 (+) patient
Chlamydia triggered HLA-B27?
Yes, it made Reiter become active

- Ulcerative colitis can also be an environmental factor
- psoriasis
- shigella
Patient with hot joint, pustule on palm aspirated and found gram neg. dipplococci?
Disseminated Gonococchemia
Tinosinovitis (hands)
Dermititis (pustules hand and feet)
What components do you need to kill Gonorrhea?
Septic arthritis?
MC gonorrhea (GC) Gonoccocus...
Any patient with bilateral bell-spalsy?
Lyme Dz until proven otherwise
MC cranial nerve involved with Lyme Dz?
VIIth nerve
Hemolytic Anemia? What do you see in this patient?
Babesia Micro
Ticks carry both dz?
Lyme and Babesia
What percent of lyme infected have babeiosis?
20% of patients have babeiosis
What is babesia microti?
intracellular erythrocytic parasite

similar to ring falciparum
Tx for chronic?
Tx for acute?
Mechanism of blue sclera?
Color of veins is blue
Seein the coroidal veins
that give the color to the sclera since there is very little collagen I
What is osteopetrosis?
Brittle bone Dz
Defect in osteoclasts
no marrow, severa anemia
Where are B cells located in lymph nodes?
Germinal Follicles; Peripheral areas of spleen (white pulp)
Where are T cells located?
ParacorTex; periarteriolar sheat in spleen
What are histiocytes and where are they located?
Part of the Lymphatic system in sinuses; skin (Langherhan's Cells); Red Pulp in Spleen
What is associated with Left Supraclavicular Nodes?
Abdominal and Pancreatic CA
What is associated with Right Supraclavicular Nodes?
Lung Mets and Esophageal CA; Hodgkin's lymphoma
What is the left supraclavicular node called?
Virchow's Node
What CA diseminates to para-aortic nodes?
Testicular CA and Burkitt's Lymphoma
What gene is associated with Follicular Lymphoma?
Translocation t14;18
overexpression of bcl-2

Follicular Think Fourteen
Fo Fo
What gene association is found in Burkitt's?
EBV translocation t8;14

African Jaw
What does the African variant involve? (Burkitt's)
What does the American variant involve? (Burkitt's)
GI, ovaries and retroperitoneum
What do you see in Burkitt's?
Starry Sky Apparence
What is the Starry Sky?
macrophages w/ phagocytosed apoptotic bodies
What are the characteristic cells in Hodgkin's Lymjphoma?
association w/ EBV; cutaneous anergy to common antigens
What are the cells of Hogkin's L. called?
Reed-Sternberg Cells
What are Reed-Sternberg Cells?
transformed germinal center B cells
What CD maker's do you use to detect RS cells?
CD15 and CD30; you got to be able to REED by 15 and 30
What does a classic RS cell look like?
two mirror image nuclei w/ eosinophilic nucleolus surrounded by a clear halo
What is elevated in vWF disease?
Elevated Bleeding Time (platelet adh. problem)
aPTT increased
What is elevated on hemophilia A?
VIII deficient
aPTT increased
(intrinsic pathway)
What is elevated in a person taking aspirin?
Bleeding Time elevated
What is elevated in Idiopathic Thrombocytogenic Purpura? Decreased?
Bleeding Time increased
platelets decreased
What are two other diseases that has Bleed Time increased and decreased platelets?
Thrombotic Thrombocytopenic Purpura
Hemolytic Uremic Syndrome
What factor involved in extrinsic pathway?
What factor involved in intrinsic pathway?
What is the best test for vWF diases?
ristocetin cofactor assay
What anti bodies does blood group O have?
anti A-IgM
anti B-IgM

anti AB- IgG
What anti bodies have blood A?
anti B
What does group B has?
anti A-IgM
What does group AB has?

just like new borns and old people
What blood group has greatest incidence of gastric carcinoma?
group A
What is associated w/ duodenal ulcer?
group O blood
Who is the universal donor?
Group O
Who is the universal acceptor?
AB no antibodies to attack those cells
What Protoconcogene (POC) is associated w/ osteogenic sarcoma?
What POC is associated w/ Leukemia?
What POC is associated w/ Breast CA?
What POC is associated w/ Astrocytoma?
What POC is associated w/ Neuroblastoma?
What POC is associated w/ lung CA?
What POC is associated w/ CML?
What POC is associated w/ Burkitt's Lymphoma?
What POC is associated w/ colon CA?
What POC is associated w/ MEN IIa/IIb Syndromes?
WhatPOC is associated w/ pancreatic CA?
What function does SIS have?
GF synthesis
(Growth Factor)
What fx does ERB-B2 has?
Receptor Synthesis
What fx does ABL has?
Non-receptor TK activity
WHat fx does RET have?
Receptor Synthesis
What fx does MYC have?
Nuclear Transcription
What fx does N-MYC have?
Nuclear transcription
WHat fx does RAS has?
GTP signal transduction
What two POC have the same function of Receptor Synthesis?
ERB-B2 and RET
What two POC have the same fx of nuclear transcription?
c-MYC and N-MYC
What does SIS activate?
What does ERB-B2 activate?
What does RET Activate?
Point Mutation
What does RAS activate?
Point Mutation
What does ABL activate?
What does MYC activate?
c-MYC translocation t(8;14)
What does N-MYC activate?
What two POC amplify?
ERB-B2 and N-MYC
What two POC activate point mutation?
What two POC activate translocation?
ABL and c-MYC
What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
What POC amplifies breasts??? imagine that...
Breast bigger two!
What are the inactivation of suppressor genes?
TP53, RB, APC and BRCA1/2
What suppressor gene (SG) is associated w/ lung, colon, breast and Li-Fraumeni syndrome?
What SG is assciated w/ breast, ovary and prostate CA?
What SG is associated w/ familial polyposis: color cancer?
What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
What is the function of TP53?
G1 to S phase inhibitor
What is the function of BRCA 1/2 gene?
Regulates DNA repair
What is the APC gene function?
Prevents nuclear transcription
- degrades catenin; an activator of nuclear transcription
What is the function of RB gene?
G1 to S phase inhibitor
What are the genes fo anti-apoptosis?
BCL-2 genes
What is the function of BCL-2 genes?
prevents the leakage of cytochrome c (signal for apoptosis)
What disease is associated with BCL-2?
b-cell lymphoma
B C L -2

Follicular Lymphoma t14;18
What is another disease that involves TP53?
Ataxia Telangiectasia
syceptibility to malignant lymphoma
What virus is associated w/ TP53?
HBV and

HTLV-1(T cell leukemia and lymphoma)

HPV 16,18 HPV16 inhibits TP53
RB inhibited by HPV 18
What CA is associated w/ hypercalcemia?
primary SCC of lung
Renal Adeconcarcinoma
PTH-like peptide
WHat CA is associated w/ myasthenia gravis?
Eaton-Lambert Sx
SCC of lung
What CA is associated w/ sudden appearance of seborrheic keratosis?
Stomach Adenocarcinoma
What CA is associated w/ hypertrophic osteoarthropathy?
Lung CA
What CA is associated w/ superficial migratory thrombophlebitis?
pancreatic carcinoma

Troussau sign (he had it himself, self-diagnosed)
What CA manifests Nonbacterial thrombotic endocarditis?
(Sterile Vegetations on Mitral Valve)
Mucous-secreting pancreatic and colorectal CA
WHat CA manifests w/ ADH increase? What do you find clinically?
SCC of lung

What CA manifests w/ ACTH increase? Clinical Symptoms?
SCC of lung
Medullary CA of Thyroid

Clin: Cushing Sx
What CA manifests increase in erythropoietin?
Renal AdenoCA
primary SCC of lung
Breast CA

What CA presents w/ inc. in B-hCG? Symp?
Choriocarcinoma (Testis)

What CA presenst w/ Calcitonin increase? Symp.?
Medullary CA of Thyroid

What region of the face does BCC and SCC occur?
BCC top of the face upper lips
SCC below lower lips
WHat RNA virus is associated with TP53 suppressor?
HTLV-1 T cell leukemia and lymphoma virus!
What DNA virus is associated w/ TP53 suppersor gene?
HBV and HPV 16,18 E6 inhibits it
What two genes are knocked out by HPV 16, 18?
E6 and E7 produced by HPV

E6 inhibits TP53
E7 inhibits RB suppressor gene
What CA does EBV is associated with?
Burkitt's lymphoma
CNS lymphoma in AIDS
Mixed Cellularity Hodgkin's
Nasopharyngeal CA
What virus is associated w/ hepatocelluar CA?
What RNA virus causes hepatocellular CA?
HCV not HBV!!!

HBV is DNA virus
What deffect has opening snap during diastole?
Mitral Stenosis

Snap Stenosis
What MCC of death in rheumatic fever?
What type of Hypersensitivity is Rheumatic Fever?
Type II
What organism is involved in Rheumatic Fever?
group A Strepto

Step. pyogenes
What do the antibodies react to in Group A Steptococcus?
Ab react to M proteins
What are two common findings in myocarditis?
aschoff bodies
Anitschkow Cells

the two Russians
WHat are Aschoff Bodies?
central fibrinoid necrosis surrounded by reactive histiocytes
How long after a group A step. pharyngitis does Rheumatic Fever occur?
1-5 weeks after episode
What are five signs of Rheumatic fever?
1) Carditis
2) Migratory polyarthritis
3) Subcutaneous Nodules
4) Erythema Marginatum
5) Sydenham's Chorea
What valve is affected with a pansystolic (holosytolic) murmur?
Mitral Regurgitation
What valve is involved in a mid-systolic click?
Mitral Valve Prolapse

it clicks half way since the chordae restrain it
What two diseases have Mitral Valve Prolapse?
Marfan's Sx
Ehlers Danlos
What pathology is associated with coarctation of the aorta?
Turner Sx
What is the MC congenital heart disease in children?
very small dudes :)
What is the MC congenital heart disease in adults?
a is for ASD
What are the three A's in ASD?
Alchohol Fetal Sx
ALL from Down Syndrome
What viral infection is involved w/ PDA?
What murmur is heard in PDA?
machine like murmur during systole and diastole
What keeps PDA open in fetus?
What is the Tx for closure of PDA in newborn?
Where is the murmur best heard for PDA?
between the shoulder blades
What carcinogen is impilcated with pancreatic adenocarcinoma, SCC of oropharynx and upper/mid esophagus?
What carcinogen is impilcated with stomach AdenoCA?
nitrosamines and nitrosamides
What carcinogen is impilcated with colorectal cancer?
Lithocholic acid
secondary bile acid
What carcinogen is impilcated with Lung CA? (4)
What carcinogen is impilcated with pleural mesothelioma?
What carcinogen is impilcated with breast cancer and cervical cancer?
Oral Contraceptives
What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
What carcinogen is impilcated with TCC of bladder? (2)
b-naphthylamine (dye and rubber indus.)
What carcinogen is impilcated with acute leukemia?
What carcinogen is impilcated with SCC of penis?
Smegma in uncircumcised male
What carcinogen is impilcated with SCC of scrotum?
tar, soot, oil (chimney sweeper)
What carcinogen is impilcated with malignant lymphoma?
Alkylating agents
What is the mos common risk factor for BCC, SCC, melanoma?
UVB light
What is the mos common risk factor for Kaposi's Sacroma?
What is the mos common risk factor for Nasopharyngela CA?
What is the mos common risk factor for larynx CA?
polycyclic HOC (hydrocarbons)

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