USMLE Step 1 from Goljan Notes
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- Question
- Answer
- 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?
- Chloroquine
- What drug do you use for resistant falciparum?
-
Mefloquine
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?
- t9;22
- 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?
- ALL
- What is the most common subtype?
- pre-B (80%)
- What is a positive marker for ALL?
-
CALLA; CD10
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?
- t(12;21)
-
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?
-
Pseudublue
Pseudogout
- Blue is Calcium pyrophosphate - Yellow Crystals?
- Gout Monosodium urate
- What joints are involved in Osteoarthritis?
- DIP + PIP
- What joints are involved in Rheumatoid Arthritis?
- MCP + PIP
- What are PIP joints inflamed called?
-
Bouchard Node
Pouchard - 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?
-
Pannus
Not to be confused with Tophus that is found in Gout - Which on is symmetrical? Rheumatoid or Osteoarthritis?
- Rheumatoid
- 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?
- Methotrexate
-
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?
- Indomethacine
- What drug do you give for underexcretion of uric acid?
-
Probenecid
Sulfanpirizone - Overproducer of uric acid?
- Allopurinol
- 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 - Alkaptonuria
- 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
- STD?
-
Sinovitis
Tinosinovitis (hands)
Dermititis (pustules hand and feet) - What components do you need to kill Gonorrhea?
- C5-C9
- 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?
- Ceftriaxone
- Tx for acute?
- Tetracycline
- 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)
- Jaw
- 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?
- VII
- What factor involved in intrinsic pathway?
- XII, XI, IX, VIII
- 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?
-
nothing
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?
- SIS
- What POC is associated w/ Leukemia?
- RAS
- What POC is associated w/ Breast CA?
- ERB-B2
- What POC is associated w/ Astrocytoma?
- SIS
- What POC is associated w/ Neuroblastoma?
- N-MYC
- What POC is associated w/ lung CA?
- RAS
- What POC is associated w/ CML?
- ABL
- What POC is associated w/ Burkitt's Lymphoma?
-
c-MYC
MYC - What POC is associated w/ colon CA?
- RAS
- What POC is associated w/ MEN IIa/IIb Syndromes?
- RET
- WhatPOC is associated w/ pancreatic CA?
- RAS
- 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?
- Overexpression
- What does ERB-B2 activate?
- Amplification
- What does RET Activate?
- Point Mutation
- What does RAS activate?
- Point Mutation
- What does ABL activate?
-
translocation
t(9;22) - What does MYC activate?
- c-MYC translocation t(8;14)
- What does N-MYC activate?
- Amplification
- What two POC amplify?
- ERB-B2 and N-MYC
- What two POC activate point mutation?
- RET and RAS
- What two POC activate translocation?
- ABL and c-MYC
- What virus is associated w/ SIS POC and w/ Osteogenic Sarcoma?
- EBV
- What POC amplifies breasts??? imagine that...
-
ERB-B2
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?
- TP53
- What SG is assciated w/ breast, ovary and prostate CA?
-
BRCA 1
BRCA 2 - What SG is associated w/ familial polyposis: color cancer?
- APC
- What suppressor gene is asscoiated w/ retinoblastoma, osteogenic sarcoma and breast CA?
- RB
- 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?
-
"Sudden"
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
Hyponatremia - What CA manifests w/ ACTH increase? Clinical Symptoms?
-
SCC of lung
Medullary CA of Thyroid
Clin: Cushing Sx -
What CA manifests increase in erythropoietin?
Clinical? -
Renal AdenoCA
primary SCC of lung
Breast CA
hypercalcemia - What CA presents w/ inc. in B-hCG? Symp?
-
Choriocarcinoma (Testis)
gynecomastia - What CA presenst w/ Calcitonin increase? Symp.?
-
Medullary CA of Thyroid
hypocalcemia - 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?
- HBV
- 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?
- Myocarditis
- 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?
-
VSD
very small dudes :) - What is the MC congenital heart disease in adults?
- a is for ASD
- What are the three A's in ASD?
-
Adults
Alchohol Fetal Sx
ALL from Down Syndrome - What viral infection is involved w/ PDA?
- rubella
- What murmur is heard in PDA?
- machine like murmur during systole and diastole
- What keeps PDA open in fetus?
- PGE2
- What is the Tx for closure of PDA in newborn?
- indomethacin
- 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?
- Alcohol
- 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)
-
uranium
asbestos
chromium
nickel - What carcinogen is impilcated with pleural mesothelioma?
- Asbestos
- What carcinogen is impilcated with breast cancer and cervical cancer?
- Oral Contraceptives
- What carcinogen is impilcated with SCC of skin, lung CA, liver angiosacroma?
- Arsenic
- What carcinogen is impilcated with TCC of bladder? (2)
-
cyclophosphamide
b-naphthylamine (dye and rubber indus.) - What carcinogen is impilcated with acute leukemia?
- benzene
- 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?
- HHV-8
- What is the mos common risk factor for Nasopharyngela CA?
- EBV
- What is the mos common risk factor for larynx CA?
- polycyclic HOC (hydrocarbons)
- Jm
- Jn