Doctors in Training

USMLE

Step 1 Review Course.

Twenty new questions similar to the ones below will arrive every Monday and Thursday to your email address from now until May 14th. These questions encourage you to study for the USMLE now and help you learn the high-yield information in a more active manner.

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At this point in your USMLE study, I recommend that you spend about 10-12 hours a week reviewing and studying for the USMLE but do not neglect your present coursework. At the bare minimum, I recommend that you go through these twice-weekly questions. I also highly recommend finding a study partner to keep you on track and make your learning more active rather than simply reading to yourself. Quiz each other with these questions and “pimp” each other with new questions as you go through First Aid together. Additionally, you should try to go through First Aid at least once prior to the start of Part II of the Doctors In Training. om Step 1 Review in order to get the most out of the course. You can use our study schedules posted online to help make your study plan. If you have any questions. What are some of the distinctive clinical features of Williams syndrome? On which cells would you find CD3 molecules? On which cells would you find CD4 molecules? To what do CD4 molecules bind? On which cells would you find CD8 molecules?

To what do CD8 molecules bind? What causes the S1, S2, S3, and S4 heart sounds?  Name five or more drugs that inhibit acetylcholinesterase. What is the clinical application for each?  What are the main differences between nephritic syndrome and nephrotic syndrome? What are the acidic and basic amino acids? Where can you find high concentrations of basic amino acids? Why are these amino acids found in these areas? (FA p107) What bacteria are known for causing bloody diarrhea? What nerve injury would you suspect in a pt with the following motion deficits?

•  foot drop (loss of dorsiflexion)
• loss of plantar flexion
• loss of knee jerk
• loss of hip adduction

What are the leading causes of death in infants? What is the equation for determining a drug’s volume of distribution? What are the clinical features of hyperammonemia?  What changes in sleep patterns and sexual anatomy are seen in the elderly? Describe the probe and sample to which the probe binds in the following molecular biology techniques: Southern blot, Northern blot, and Western blot. What are the diagnostic criteria for a major depressive episode? What changes in sleep patterns are seen in pts with depression? What is the clinical definition of chronic bronchitis? Which neoplasm is most commonly responsible for the hormone paraneoplastic syndrome? (Cushing’s syndrome - PTH-related peptide (hypercalcemia - erythropoietin) polycythemia - ADH  SIADH What is the blood supply to the embryonic foregut, midgut, and hindgut? What adult structures arise from these primitive guts? Which tract of the spinal cord relays sensory information from the body?

Which track relays pain and temperature sensation? Which track relays motor sensation to the body? What is the most common tumor of the salivary gland? What is the most common malignant tumor of the salivary gland? What are the difference between a case-control study, a cohort study, and a clinical trial? Which studies use odds ratios, and which use relative risks? Three days ago you hospitalized a 40-year-old male for myocardial infarction. He has been given all of the usual medications. Today you notice that his platelet count is 30,000. What do you suspect is the cause of his low platelets? What are the different etiologies of Cushing’s syndrome? How is the level of ACTH different in each?  Which virus is responsible for the following disease?  - croup in children - common cold (2 viruses) - #1 cause of fatal diarrhea in children - bronchiolitis in infants (especially premature). How many half-lives does it take for a drug-infused at a constant rate to reach 94% of steady-state? What variables determine the half-life of a drug?

What structures of the inner ear are responsible for the sensation of linear and angular acceleration? What is the basic equation for cardiac output? What is the Fick principle? What factors affect stroke volume?  What are the two most common causes of chronic renal failure? What is the most common cause of Erb-Duchenne palsy? What are the characteristic findings of Erb-Duchenne palsy? What are the signs and symptoms of poliomyelitis? If you suspected polio in a pt with yours, where would you seek to obtain a viral sample from the pt? What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? What are Brunner’s glands? What are Peyer’s patches?  How can these structures help you identify the location from which a histological specimen was taken? What is the rate-limiting enzyme for ketone synthesis? for cholesterol synthesis? What is the classic triad of symptoms in multiple sclerosis? With what disorders do pts with multiple sclerosis commonly present?

Which penicillin fits the following description? Often the drug of choice against Enterococcus sp. - effective against Pseudomonas sp. - good for otitis media because it covers. What is the definition of a first-degree heart block? What is the classic presentation of a patient with gonococcal arthritis? What is the difference between malingering and factitious disorder?  What are the rate-limiting enzymes for the following metabolic processes?

• glycogen synthesis
• glycogen breakdown
• fatty acid synthesis
• fatty acid oxidation

Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in pts with benign prostatic hyperplasia. What are the risk factors for colon cancer? What is the difference between prevalence and incidence? What physiology accounts for the automaticity of the AV and SA nodes? How does the emphysema caused by smoking differ from the emphysema caused by alpha-1-antitrypsin deficiency? What is the difference between Meissner’s corpuscle and a Pacinian corpuscle? What syndrome causes the triad of sterility, bronchiectasis, and recurrent sinusitis? What is the primary defect in this syndrome? In which glomerular disease would you expect to see the following changes?

• foot process effacement (electron microscope)
• wire-loop appearance (light microscope)
• mesangial deposits of IgA (electron microscope)
• crescent-moon shaped lesion (light microscope)
• segmental sclerosis and hyalinosis (light microscope)

What clinical scenario is most commonly seen in Reye’s syndrome? What are the characteristics of Reye’s syndrome? What would you expect to find in the synovial fluid of a pt with gout? with pseudogout? What effects do prostaglandins and thromboxane have on platelet aggregation? When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? Distinguish the following types of organ transplant rejection. MechanismTime Frame hyperacute rejection acute rejection chronic rejection What is Zollinger-Ellison syndrome? What type of collagen is abnormal in patients with Alport’s syndrome?  In which order elimination is the rate of elimination proportional to the drug concentration? What is the most common tumor of the adrenal medulla in adults? in children?  What lab abnormalities would you expect to see in a pt with SIADH?

What drugs are used in the treatment of Parkinson’s disease? What are the common side effects of beta-blockers? Which pt populations should use caution when taking beta-blockers? What are the signs of right-sided heart failure? What are the signs of left-sided heart failure? What asthma medication fits the following statement.

• inhaled treatment of choice for chronic asthma
• inhaled treatment of choice for acute exacerbations
• narrow therapeutic index, the drug of last resort blocks conversion of arachidonic acid to leukotriene
• inhibits mast cell release of mediators, used for prophylaxis only
• inhaled treatment that blocks muscarinic receptors
• inhaled long-acting beta-2 agonist
• blocks leukotriene receptors

What bacterium causes leprosy? What part of the body is infected? What animal is a reservoir in the US? What are the symptoms of Kluver-Bucy syndrome? What area of the brain is damaged in this syndrome? Why should a “Hot T-bone steak” come to mind when someone asks you about interleukins? Compare the leading causes of death in ages 1-14 to those in ages 15-24? What are the side effects of neuroleptic toxicity? What is the composition of a nucleosome? Which histone ties nucleosomes together? What types of preventive services are needed in the following pts? Diabetic - drug abuser - alcoholic - high-risk sexual behavior What are the causes of normocytic, normochromic anemia? What 5 classes of medications are used to treat glaucoma? What infections are caused by Chlamydiae? What is the treatment for most Chlamydia infections? What are the characteristics of thoracic outlet syndrome? What abnormal lab values would lead you to suspect alcoholic hepatitis?  What are the most common locations for atherosclerosis? What vitamin deficiencies would you expect to see in a pt with a malabsorption syndrome such as cystic fibrosis or celiac sprue? What types of pancreatic tumors are often seen in MEN type I? What nerves innervate the tongue? What is the classic presenting symptom in a pt with Lyme disease?

What are the stages of dying according to Kubler-Ross? Explain the development of the thyroid gland. Which IV anesthetic fits the following description? 

•  a/w hallucinations and bad dreams
• a most common drug used for endoscopy
• used for rapid anesthesia induction
• decreases cerebral blood flow (important in brain surgery)

What is the mechanism of action and clinical use for methylphenidate? What is the most common urea cycle disorder? What are the findings with this disorder? What change is seen in Barrett’s esophagus? What is the equation for determining a drug’s clearance? What substance activates the classic complement pathway? What substance activates the alternative complement pathway?  In a normal Gaussian curve, what percentage of the sample population falls 1 standard deviation, 2 standard deviations, and 3 standard deviations?  What is seen in Budd-Chiari syndrome? What conditions are a/w Budd-Chiari syndrome? What tests can be used to help detect the presence of an MI? What is the equation for calculating the glomerular filtration rate?

How long does it normally take for an antidepressant to start working? What is the mechanism of action of cyclosporin? In which glomerular disease would you expect to see the following changes?

• anti-GBM antibodies (immunofluorescence)
• Kimmelstiel-Wilson lesions (light microscope)
• “spike and dome” appearance (electron microscope)
• “tram track” of subendothelial humps (electron microscope)
• subepithelial humps (electron microscope)

The most common cause of osteomyelitis in all patients is Staph. aureus. What organism would you also suspect in a sickle cell pt with osteomyelitis? What about a drug addict with osteomyelitis? What amino acids are necessary for purine synthesis? What is the rate-limiting enzyme for pyrimidine synthesis? for purine synthesis?  What are the common causes of dilated cardiomyopathy? What hormone is detected in a positive urine pregnancy test? How long after conception will this hormone first appear in the urine? What structures give rise to the glomerular filtration barrier? Which disease results from a loss of the negative charge glomerular filtration barrier? What are the three symptoms of pellagra? What are the causes of pellagra? What factors are considered when determining the loading dose and maintenance dose of medication? What are the two types of diabetes insipidus? What is the cause of each?  What is the cause of cystinuria?

What is the treatment for cystinuria? What is the WAGR complex? What two drugs are given to those with organophosphate poisoning? What are some of the common causes of eosinophilia? What antibiotics have the following mechanisms of action? Compare the leading causes of death in ages 25-64 to those in ages 65+? What are the risk factors for a fat embolus? What are the risk factors for a pulmonary embolus? What structures arise from the Mesonephric ducts? What other name is given to the Mesonephric ducts? Which lysosomal storage disease fits the following description?

• cherry-red spot on the retina
• corneal clouding + mental retardation
• no corneal clouding + mental retardation
• the demyelinating disease affects peripheral nerves
• crinkled paper cytoplasm
• sphingomyelin buildup
• treatment is dialysis
• accumulation of galactocerebroside in the brain
• accumulation of glucocerebroside in the brain What are the Jones criteria for the diagnosis of acute rheumatic fever?

What are some of the extrapulmonary causes of restrictive lung disease?  What drug can be used to treat carcinoid syndrome? What is the difference between conscious, preconscious, and unconscious in Freudian psychoanalysis? Conscious- preconscious- unconscious- What muscles compose the rotator cuff muscles?  What is the difference between Wernicke’s aphasia, Broca’s aphasia, and conduction aphasia? How do nicotinic acetylcholine receptors differ from muscarinic acetylcholine receptors in their mechanisms of action? What structures are injured in an unhappy triad knee injury? Which fungal infection fits the following description? Causes diaper rash - opportunistic mold with septate hyphae that branch at a 45-degree angle - opportunistic mold with irregular non-septate hyphae that branch at wide angles  - dimorphic fungi common to SW US (San Joaquin Valley fever) - causes thrush in immunocompromised pts and vulvovaginitis in women - dimorphic fungi with broad-based budding yeast - known for causing pneumonia in AIDS pts to start Bactrim prophylaxis when CD4.

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