Board Aid.blogspot.com

2008-05-08T13:32:00.000-07:00

Q of the Day!

During a pre-participation sports physical, Sara tells the Doctor that she has Mitral valve prolapse. What should the Doctor expect to hear?

A) Continuous murmur
B) Diastolic murmur
C) Holosystolic murmur
D) Early systolic murmur
E) Mid systolic murmur

scroll for answer...

Answer: E) Mid-systolic murmur. MVP is the most frequent valvular lesion, common to young women (especially on boards). Stretching of the mitral valve causes a midsystolic click. It can lead to mitral insufficiency and predisposes patients to infective endocarditis.

2008-04-30T08:14:00.001-07:00

Q of the Day!

A 48 year-old smoker complains of a “new cough.” During her history, she also notes that she has a lost 36 pounds in the last 2 years. A chest x-ray is obtained and shows a central mass. Her labs show that she also has hypercalcemia. What is most likely responsible for her hypercalcemia?

A) Small cell carcinoma
B) Parathyroid Hormone
C) Adenocarcinoma
D) PTH-like peptide
E) ACTH

scroll for answer

answer: D. PTH-like peptide

2008-04-21T17:53:00.001-07:00

Q of the Day!

You have a 46 year-old patient come into the office. He complains that he has noticed that his breasts are getting bigger. He currently is being treated for high blood pressure and GERD. Which of the patients’ medications could have caused his gynecomastia?

A) Minoxidil
B) Propranolol
C) Sucralfate
D) Chlorothiazide
E) Cimetidine

scroll for answer.....

Answer: E) Cimetidine. Cimetidine is an H2 Blocker used to treat GERD and peptic ulcers. Side effects of Cimetidine include gynecomastia (most common), headaches, vertigo, fatigue, and reduced sperm count. The other choices do not cause gynecomastia. Sucralfate is an anti-ulcer agent. Minoxidil, Propranolol, and Chlorothiazide are all drugs used to treat hypertension.

2008-04-20T11:29:00.001-07:00

Q of the Day!

An old man is found in the basement of his house. He was on the floor with rigor mortis setting in. What is the mechanism responsible for rigor mortis?

A) He overdosed on Baclofen
B) Increase in ATP production before he died
C) Myocyte death
D) Depletion of ATP
E) Myosin cross-bridge detachment

scroll for answer

D) depletion of ATP. ATP is required for Myocyte contraction. However, ATP is also required for the myosin cross-bridge to detach. During the moments of dying the muscles contract using the remaining ATP in the body. After some time there is no ATP in the body to detach the myosin cross-bridge.

2008-04-14T11:34:00.000-07:00

USMLE Step 1 Question of the Day!

There is a minor alteration of MHC-I antigens when a cell is invaded by a virus. The immune system will not recognize the infected cell without the help of alpha and beta interferon inducing increased class I antigen expression on the cell’s surface. Which of the following is the source of interferon-beta?

A) fibroblasts
B) T cells
C) B Cells
D) Macrophages
E) Natural killer cells

scroll for answer...

A) fibroblasts. Fibroblasts release interferon-beta and interleukin-6 in response to viral infection. IL-6 stimulates B cells to release interferon-alpha which also has antiviral activity. The increased expression of MHC-I antigens on infected cells surfaces helps the immune system recognize viral infected cells from healthy ones.

2008-04-08T07:54:00.000-07:00

Question of the Day!

A 5 year old female presents with multiple laryngeal squamous papillomas. Her mother tells you that they have removed similar lesions in the past and the diagnosis of juvenile papillomatosis was made. What virus is most commonly asscociated with this condition.

a)HSV
b)EBV
c)CMV
d)HPV
e)HIV

(scroll for answer)

d) HPV.

2008-04-07T07:59:00.000-07:00

Question of the Day!

Which of the following is most likely to produce a spinal cord lesion that destroys both bone and the disc cartilage?

a) Tuberculosis
b) multiple myeloma
c) metastatic carcinoma
d) Hodgkin's lymphoma
e) Non-Hodgkin's lymphoma

(scroll for answer)

answer: a) Tuberculosis- Pott's disease of the spine.

2008-04-05T20:06:00.001-07:00

Question of the Day!

Mr. K has just returned from a camping trip in North Carolina. He has spiked a fever with a headache, chills, and a rash. Mr. K states that his rash started on his left hand but now has spread up his shoulder and to his entire chest. Which of the following is most likely the cause of Mr. K’s symptoms?

A) Q fever
B) Poison ivy exposure
C) Coxiella burnetti
D) Trench fever
E) Rocky Mountain spotted fever

Answer: E) RMsf. RMsf is caused by a tick bite primarily in the Appalacian mountains. Rickettsia rickettsii is the obligate intracellular parasite responsible. Symptoms above lead to fulminant vasculitis, shock, thrombosis, and death (if untreated). Treatment is tetracycline. Q fever is caused by exposure to Coxiella burnetti and has no rash associated with it.

2008-03-30T20:17:00.001-07:00

Question of the Day!

A 3 year-old has always seemed tired but now has been having convulsions and noticeably sore joints. After a CBC and other lab tests, a CT scan demonstrates hepatomegaly and renomegaly. It is determined that the CT results were due to accumulations of glycogen. This patients’ condition is due to a defect of what enzyme?

A) alpha-glucosidase
B) glycogen phosphorylase
C) aldolase B
D) iduronate sulfatase
E) glucose-6-phosphatase

Answer: E) glucose-6-phosphatase. This patient has the glycogen storage disease- Type I Von Gierke. This disease if untreated will lead to failure to thrive, stunted growth, hepatomegaly, and renomegaly. A fasting hypoglycemia that leads to convulsions is also seen. Some patients even develop gout and skin xanthomas. A defect in glucose-6-phosphatase leads to accumulations of glycogen in the liver and kidneys.

2008-03-30T20:16:00.003-07:00

Question of the Day!

A man presents with fever, splenomegaly, anemia, and petechiae. After a full work-up he is diagnosed with subacute bacterial endocarditis caused by Streptococcus viridans. Which of the following is the most likely site to be the source of the organism?

A) colon
B) skin
C) urethra
D) oropharynx
E) liver

Answer: D) oropharynx. Subacute bacterial endocarditis has manifestations of fever, splenomegaly, petechiae, anemia, and hematuria. The cause of subacute BE is often Streptococcus viridans after oral or dental procedures. Prophylaxis antibiotics should be given prior to these procedures for people at risk.

2008-03-30T20:15:00.000-07:00

Question of the Day!

Coxsackievirus is an RNA virus that causes a variety of problems including myocarditis and herpangina, a febrile pharyngitis. All of the following are characteristics of coxsackievirus except:

A) single stranded
B) helical
C) hand, foot, and mouth disease
D) Picornavirus family
E) Positive polarity

Answer: B) helical. Coxsackievirus’ capsule is an icosahedral symmetry. It is a member of the Picornavirus family, has no envelope, single stranded, positive polarity, linear, and icosahedral capsid symmetry. It is the genesis of aseptic meningitis, herpangina, myocarditis, and hand, foot, and mouth disease.

2008-03-29T10:29:00.001-07:00

BuzzWord of the Day!

When you see "Hirano bodies" you should immediately think...

answer: alzheimer's disease

2008-03-25T07:04:00.001-07:00

Buzz Word of the Day!

When you see "Ghon complex" you should immediately think...

answer: Tuberculosis

2008-03-25T07:03:00.003-07:00

Question of the Day!

A new patient is complaining of recurrent diarrhea. On exam she presents with cutaneous flushing, asthmatic wheezing (with no hx of asthma), and a new tricuspid murmur. Urinalysis shows increased 5-HIAA. Your diagnosis most likely is?

A) Renal Osteodystrophy
B) Diabetes Insipidus
C) Crohn’s Disease
D) Carcinoid Syndrome
E) MEN type I

Answer: D) Carcinoid Syndrome. It is caused by tumor consisting of neuroendocrine cells, especially metastatic small bowel tumors. The tumors usually secrete large amounts of Serotonin which results in the symptoms in this patient. Use the ‘Rule of 1/3’: 1/3 metastasize, 1/3 present with 2nd malignancy, and 1/3 are multiple.

2008-03-25T07:03:00.001-07:00

Question of the Day!

Maple Syrup urine disease is due to a defective branched chain alpha-ketoacid dehydrogenase enzyme. A defect in this enzyme causes an inability to metabolize what amino acids?

A) leucine, isoleucine, methionine
B) methionine, valine
C) methionine
D) arginine, lysine, leucine
E) valine, isoleucine, leucine

Answer: E) valine, isoleucine, leucine. Maple Syrup Urine disease brings a variety of neurological symptoms and a high mortality. It gets its name from the thick, brown urine produced

2008-03-19T08:13:00.001-07:00

Question of the Day!

A 12 year-old girl stops mid-sentence and stares into space completely unaware of anything around her for a few moments. Her friends noticed that her lips were quivering during this time. What is most likely your diagnosis?

A) grand mal seizure
B) complex partial seizure
C) Attention deficit disorder
D) Attention deficit hyperactivity disorder
E) Absence seizure

Answer: E) absence seizue. Also known as petit mal seizure, an absence seizure in a child can be caused by genetic, infection, trauma, congenital, and metabolic reasons. Treatment involves finding the cause of the seizure.

Buzzword of the Day!

When you see "ferruginous bodies" you should think...

answer: asbestosis

2008-03-19T08:12:00.001-07:00

Buzzword of the day!

When you see "eburnation of bone" you should think...

answer: Osteoarthritis

D.O.C. of the day!

Drug of choice for

Nocardia causing pneumonia

answer: Trimethoprim/sulfamethoxazole

2008-03-19T08:11:00.002-07:00

Buzzword of the Day!

When you see "Donovan bodies" you should think...

answer: Granuloma inguinale

D.O.C. of the Day!

Drug of choice for

Rickettsia causing spotted fever, end. typhus

answer: Tetracycline

2008-03-19T08:11:00.001-07:00

Buzzword of the Day!

When you see "erythema chronicum migrans" you should think...

answer: Lyme Disease

D.O.C. of the Day!

Drug of choice for

Tropheryma whippelii causing whipple’s disease

answer: Trimethoprim/sulfamethoxazole

2008-03-17T17:21:00.001-07:00

USMLE Step 1 Buzzword of the Day!

When you see "councilman bodies" you should immediately think...

answer: Hepatitis B (dying hepatocytes)

USMLE Step 1 D.O.C. of the day!

Drug of choice for

Campylobacter causing acute inflammatory diarrhea

answer: Ciprofloxacin

2008-03-17T17:20:00.001-07:00

Buzzword of the Day!

When you see "condyloma lata" you should immediately think...

answer: secondary syphilis

D.O.C. of the Day!

Drug of choice for

Mycobacterium leprae causing leprosy

answer: Dapsone and Rifampin

Most Common of the Day!

Most common cancer of the urinary collecting system?

answer: transitional cell CA

2008-03-16T10:30:00.001-07:00

Most Common of the Day!

Most common cause of secondary hypertension?

answer: Renal dz

D.O.C. of the Day!

Drug of choice for

Staphyloccous aureus causing a skin infection

answer: Dicloxacillin

2008-03-07T12:22:00.001-08:00

Buzz Word of the Day!

When you see "boot shaped heart" in a newborn you should immediately think...

answer: Tetralogy of Fallot

D.O.C. of the Day!

Drug of choice for

Candida causing vaginal candidiasis

answer: Miconazole

Most Common of the Day!

Most common aggressive Lung cancer...

answer: small cell / Oat cell

2008-03-07T12:21:00.001-08:00

Buzz Word of the Day!

When you see "arachnodactyly" you should immediately think...

answer: Marfan's

D.O.C. of the Day!

Drug of choice for

Staphylococcus aureus causing sepsis, osteomyelitis

answer:Oxacillin or Nafcillin

Most common of the Day!

Most common cause of bacterial meningitis in adults...

answer: Streptococcus pneumoniae

2008-03-07T12:20:00.001-08:00

USMLE Step 1 Buzz Word of the Day!

When you see "Bouchard's nodes" you should immediately think...

answer: Osteoarthritis

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Neisseria gonorrhea

Answer: Ceftriaxone

USMLE Step 1 Syndrome of the Day!

Wiskott-Aldrich Syndrome
- Immunodeficiency: combined B- &T-cell deficiency
- IgM w/  IgA
- Triad of thrombocytopenia, eczema, and recurrent otitis media infections

2008-03-07T12:19:00.001-08:00

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Bacillus Anthracis causing anthrax

(scroll for answer)

Ciprofloxacin or Tetracycline

USMLE Step 1 Fact of the Day!

Burkitt’s Lymphoma
- Small noncleaved cell lymphoma (EBV)
- 8:14 translocation
- Seen commonly in jaws, abdomen, retroperitoneal soft tissues
- Starry sky appearance

2008-03-07T12:18:00.002-08:00

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Trichomonas causing trichomoniasis

(scroll for answer)

answer: Metronidazole

USMLE Step 1 Most Common of the Day!

What is the most common cause of renal failure?

(scroll for answer)

answer: Acute tubular necrosis

USMLE Step 1 Buzz Word of the Day!

When you see "currant jelly sputum" you should immediately think...

(scroll for answer)

answer: Klebsiella

2008-03-07T12:18:00.001-08:00

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Bordetella pertussis causing whooping cough

(scroll for answer)

answer: Erythromycin

USMLE Step 1 Buzz Word of the Day!

When you see "erythema chronicum migrans" you should immediately think...

(scroll for answer)

answer: Lyme Disease

USMLE Step 1 Most Common of the Day!

The most common location of brain tumors in children is...

(scroll for answer)

answer: Infratentorial

2008-03-07T12:16:00.002-08:00

USMLE Step 1 Buzz Word of the Day!

When you see "starry-sky appearance" histologically, you should immediately think...

(scroll for answer)

answer: Burkitt's Lymphoma

USMLE Step 1 D.O.C. of the Day!

Drug that can be used in both

Ulcerative colitis and Crohn's disease

(hint:it is a combination of an antibacterial and an anti-inflammatory.)

(scroll for answer)

answer: Sulfasalazine

USMLE Step 1 Fact of the Day!

Bowen Disease
Males: single red plaque on the scrotum or shaft with ulceration and crusting
Females: single red-brown plaque on the vulva. May present as leukoplakia.
-cells appear neoplastic with increased nuclear to cytoplasmic ratio and increased mitotic activity.
-increased risk for invasive carcinoma for years.

2008-03-07T12:16:00.001-08:00

USMLE Step 1 D.O.C. of the Day!

Drug of choice of

Yersinia pestis causing plague

(scroll for answer)

answer: streptomycin

USMLE Step 1 Buzz Word of the Day!

When you see "lumpy bumpy" you should immediately think...

(scroll for answer)

answer: post-streptococcal glomerulonephritis

USMLE Step 1 Most Common of the Day!

The most common site of diverticula is...

(scroll for answer)

answer: sigmoid colon

2008-03-05T05:43:00.000-08:00

Step 1 Q of the day!

A 54 year old male with a history of alcoholism and chronic liver disease comes in complaining of weight loss and "increased abdominal fluid." A CT of the abdomen reveals a single mass in the right lobe of the liver. Blood work shows elevated alpha-fetoprotein. Which of the following is this man's diagnosis?

a)Metastatic colon CA
b)hepatoblastoma
c)hepatoma
d)cholangiocarcinoma
e)cirrhosis

(scroll for answer)

answer: c)hepatoma. Learning point: Hepatoma is also known as hepatocellular carcinoma

2008-03-04T08:30:00.000-08:00

Step 1 Q of the Day!

A 64 year old female smoker presents with increasing shortness of breath. A chest x-ray shows diffuse pulmonary infiltrate. At this time you decide to get a lung biopsy. Biopsy reveals alveolar wall fibrosis with sheets desquamated cells. At this point in time what therapy will help her most?

a)steroids
b)theophylline
c)isoniazid
d)treat symptoms only
e)azithromycin

(scroll for answer)

answer: a)steroids. Dx: desquamative interstitial pneumonitis- a subtype of interstitial pulmonary fibrosis.

2008-02-29T16:42:00.001-08:00

USMLE Step 1 Most Common of the Day!

The Most Common hereditary bleeding disorder is...

(scroll for answer)

answer: Von Willebrand's disease

USMLE Step 1 Buzz Word of the Day!

When you see "nitric gas emboli"

you should immediately think...

(scroll for answer)

answer: Caisson disease

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Treponema pallidum causing syphilis

(scroll for answer)

answer: Penicillin G

2008-02-29T16:20:00.000-08:00

Step 1 Q of the day!

A 65 year old patient is seen in the ER with a history polio. Which of the following statements is true concerning poliovirus infection?

a) oseltamivir is an effective preventive agent
b) replication occurs in the GI tract
c) congenital infection of the fetus is serious complication
d) skin testing is available to determine prior exposure
e) all of the above

(scroll for answer)

b) replication occurs in the GI tract

Syndrome of the Day!

"Hereditary nephritis with nerve deafness"

(scroll for answer)

answer: Alport's syndrome

Buzzword of the Day!

"aganglionic megacolon"

(scroll for answer)

answer: Hirschsprung's disease

2008-02-28T16:03:00.000-08:00

Step 1 Question of the Day!

A 4 year-old male is seen in the pediatric office for routine check up. The pediatrician tells you this boy suffers from peripheral neuropathy, vision problems and developmental delays. What autosomal recessive disease does this boy most likely have?

a) Hunter's syndrome
b) Fabry's Disease
c) Hurler's Syndrome
d) Krabbe's disease
e) Tay Sach's disease

(scroll for answer)

answer: d) Krabbe's disease.

D.O.C. of the Day!

What is the drug of choice for

urinary retention due to BPH?

(scroll for answer)

answer: Prazosin, Terazosin, or doxazosin

2008-02-27T14:01:00.000-08:00

Step I Q of the Day!

A 3 day old in PICU is found to have urine draining from his umbilicus. What is most likely his diagnosis?

a) urachal fistula
b) Meckel's cyst
c) Horseshoe kidney
d) Meckel's diverticulum
e) urachal cyst

(scroll for answer)

answer: a) urachal fistula

D.O.C. of the Day

What is the drug of choice for

absence seizures...

(scroll for answer)

answer:
ethosuximide

2008-02-25T18:58:00.001-08:00

USMLE Step 1 Buzz Word of the Day!

When you see "antiplatelet antibodies" you should immediately think...

(scroll for answer)

answer: Idiopathic thrombocytopenic purpura

USMLE Step 1 "Most Common" of the Day!

Most common bug in diarrhea?

(scroll for answer)

answer: campylobacter

USMLE Step 1 D.O.C. of the Day!

Drug of choice to

keep a patent ductus arteriosous open

and in what condition do you want to keep it open?

(scroll for answer)

answer:Prostaglandins and tetralogy of Fallot

2008-02-25T05:44:00.000-08:00

USMLE Step 1 Buzz Word of the Day!

When you see "chocolate cysts" you should immediately think...

(scroll for answer)

answer: Endometriosis

Bonus Buzz Word: Mallory bodies

(scroll for answer)

answer: Alcoholic Hepatitis

USMLE Step D.O.C. of the Day!

Drug of choice for

absence seizures

(scroll for answer)

answer: Ethosuximide

USMLE Step 1 "Most Common" of the day!

What is the most common Thyroid Cancer?

(scroll for answer)

answer: Papillary CA

2008-02-24T07:49:00.000-08:00

USMLE Step 1 Triad of the Day!

What syndrome?
urethritis, conjunctivitis, and arthritis?

(scroll for answer)

answer: Reiter's syndrome

USMLE Step 1 Drug of the Day!

What drug has the famous side effect of Red Man syndrome?

(scroll for answer)

answer: Vancomycin

USMLE Step 1 Fact of the Day!

Cytokines, Source, Function!
IL 1 Monocytes, macrophages Stimulates T cell proliferation & IL2 produciton
IL 2 Macrophages, T & NK cells Stim prolif of B, T & NK cell
IL 3 T cells GF of tissue mast cells & hematopoietic stem cells
IL 4 T cells inc growth of B & T cells/ inc HLA II Ags
IL 5 T cells Maturation of B into plasma cell
IL 6 T cells, monocytes Maturation of B & T cell/ (-) fibroblasts
IFN alpha B cells, macrophages Antiviral activity
IFN Beta Fibroblasts Antiviral activity
IFN gamma T & NK cells Antiviral activity, (+) macrophages, inc HLA II Ags
TNF alpha Macrophages, T & NK cells T cell prolif, IL 2 prod, cytotoxicity
TNF beta T cells T cell prolif, IL 2 prod, cytotoxicity

2008-02-23T06:49:00.001-08:00

USMLE Step Buzz Word of the Day!

When you see "strawberry tongue" you should immediately think...

(Scroll for answer)

answer: Scarlet fever

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

enterobius vermicularis

(scroll for answer)

Me'bend'azole/ pyrantel pamoate
('Bend' over to see the anal pruritus)

Board Aid Triad of the Day!

Lens dislocation, joint hyperflexibility, aortic dissection

(scroll for answer)

Marfan's syndrome

2008-02-22T17:54:00.001-08:00

USMLE Step 1 Buzz Word of the Day!

When you see "Reinke crystals" you should immediately think...

(scroll for answer)

answer: Leydig cell tumor

USMLE Step 1 D.O.C. of the Day!

Drugs of choice...

(now pay attention)

to diagnose myasthenia gravis and to treat myasthenia gravis? (2 Drugs)

(scroll for answer)

To dx: edrophonium

To tx: Neostigmine

USMLE Step 1 Triad of the Day!

Renal cell carcinoma, cavernous hemangiomas, adenomas

What disease?

von Hippel-Lindau disease

2008-02-22T08:50:00.001-08:00

USMLE Step 1 Buzz Word of the day!

When you see "homer-wright rosettes" you should immediately think...

(scroll for answer)

neuroblastoma

Board Aid D.O.C. of the Day!

Drug of choice for

Vibrio cholerae causing cholera

(scroll for answer)

Tetracycline

Board Aid Triad of the Day!

blood stasis, hypercoagulability, and endothelial damage

what triad? what condition?

Virchow's triad seen in pulmonary embolism.

2008-02-20T19:06:00.000-08:00

USMLE Step 1 Q of the Day!

A teenage male with a past medical history of sickle cell anemia presents to the ER with severe pain just below his anterior rib cage on the right side. The pain is colicky in nature. After diagnostic work-up, the patient is taken to the OR for cholecystectomy. Examination of the gall bladder reveals many dark black stones. These stones are made up of which one of the following substances?

a)carbon
b)bilirubin
c)urate
d)struvite
e)cholesterol

(scroll for answer)

answer: B) bilirubin.

What is the Drug of choice for

pregnancy induced hypertension

(scroll for answer)

answer: methyldopa

2008-02-10T18:04:00.000-08:00

Board Aid Step 1 Buzz word of the day!

When you see "Rouleaux formation" and "Russell bodies" you should immediately think...

(scroll for answer)

Answer: multiple myeloma

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Staphylococcus aureus causing sepsis, osteomyelitis

(scroll for answer)

Oxacillin or Nafcillin

USMLE Step 1 Fact of the Day!

Vitamin deficiencies and their problems Part 2:
Vitamin:
B12 (cobalamin) - macrocytic, megaloblastic anemia, neurologic symptoms, and glossitis
C (ascorbic acid) – scurvy: swollen gums, bruising, anemia, poor wound healing
D – Rickets in children, osteomalacia in adults, hypocalcemic tetany
E – increased fragility in erythrocytes
K – neonatal hemorrhage, inc PT and PTT but normal bleeding time

2008-02-10T18:03:00.001-08:00

USMLE Step 1 BuzzWord of the Day!

You will see this one on Boards!

When you see "Auer rods" (in myeloblasts) you should immediately think...

(scroll for answer)

Answer: Acute Myelogenous leukemia

Buzz Word Bonus:

Anti-IgG antibodies?

Rheumatoid arthritis (for more on RA see Dr. Shampton's Review of RA.)

USMLE Step 1 Fact of the Day!

Vitamin deficiencies and their problems Part 1:
Vitamin:
A - night blindness, dry skin, impaired immune response
B1 (thiamine) - Beriberi and Wernicke-korsakoff syndrome
B2 (riboflavin) - stomatitis, cheilosis
B3 (niacin) - Pellagra (dementia, diarrhea, dermatitis)
B5 (panthothenate) - dermatitis, enteritis, adrenal insufficiency
B6 (pyridoxine) - convulsions, hyperirritability
Biotin - dermatitis, enteritis
Folic Acid - macrocytic, megaloblastic anemia

2008-02-10T17:59:00.001-08:00

USMLE Step 1 Buzz Word of the DAY!

When you see "janeway lesions and osler's nodes" you should immediately think...

(scroll for answer)

Answer: Endocarditis

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

acute gout

(scroll for answer)

Indomethacin or any NSAIDs

2008-02-10T17:56:00.000-08:00

USMLE Step 1 Buzz Word of the Day

When you see "pink puffer" you should immediately think...

(scroll for answer)

emphysema

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

pneumocystis carinii pneumonia

(scroll for answer)

Trimethoprim-sulfamethoxazole

USMLE Step 1 Fact of the Day!

Immunoglobulin isotypes:

IgG - main antibody in secondary response
IgA - antibody against bacteria and viruses on mucous surfaces
IgM - primary response to antigen
IgE - allergy reaction (type I hypersensitivity)
IgD - function unknown

2008-02-10T17:53:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

A 12 year-old girl stops mid-sentence and stares into space completely unaware of anything around her for a few moments. Her friends noticed that her lips were quivering during this time. She had no recollection of any event. What is most likely your diagnosis?

A) grand mal seizure
B) complex partial seizure
C) Attention deficit disorder
D) Attention deficit hyperactivity disorder
E) Absence seizure

(scroll for answer)

Answer: E) absence seizue. Also known as petit mal seizure, an absence seizure in a child can be caused by genetic, infection, trauma, congenital, and metabolic reasons. Treatment involves finding the cause of the seizure.

USMLE Step 1 D.O.C. of the Day!

The drug Ribavirin is used to treat what 2 entities?

(scroll for answer)

Respiratory syncytial virus and Chronic hepatitis C

USMLE Step 1 Buzz Word of the Day!

when you see "Koplik spots" you should instantly think...

(scroll for answer)

Answer: Measles

2008-02-10T17:51:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

You have a 46 year-old patient come into the office. He complains that he has noticed that his breasts are getting bigger. He currently is being treated for high blood pressure and GERD. Which of the patients’ medications could have caused his gynecomastia?

A) Minoxidil
B) Propranolol
C) Sucralfate
D) Chlorothiazide
E) Cimetidine

(scroll for answer)

Answer: E) Cimetidine. Cimetidine is an H2 Blocker used to treat GERD and peptic ulcers. Side effects of Cimetidine include gynecomastia (most common), headaches, vertigo, fatigue, and reduced sperm count. The other choices do not cause gynecomastia. Sucralfate is an anti-ulcer agent. Minoxidil, Propranolol, and Chlorothiazide are all drugs used to treat hypertension.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Klebsiella causing pneumonia

(scroll for answer)

Any 3rd generation cephalosporin i.e. ceftriaxone, cefotaxime

Fact of the DAY!

Bug Profile: Giardia lamblia
- most common intestinal protozoa
- fecal-oral transmission of cysts- form trophozoites in duodenum
- cyst: 4 nuclei; trophozoite: 2 nuclei, 4 pairs of flagella (clown appearance)
- causes giardiasis- non-bloody, foul smelling diarrhea (don’t invade wall of duodenum)
- Dx by visualization of organism in stool or string test.
- Tx: metronidazole

2008-02-10T17:49:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A 64 year-old man has severe swelling of his lower extremities and difficulty breathing. On physical exam, breath sounds are absent at the base of both lungs.
All of the following are causes of Left-sided congestive heart failure except:

A) Cor pulmonale
B) Systemic Hypertension
C) Myocarditis
D) Cardiomyopathy
E) Congenital heart disease

(scroll for answer)

Answer: A) Cor pulmonale is an etiology of Right-sided CHF. Systemic HTN, myocarditis, cardiomyopathy can be causes of both Right and Left-sided CHF. Congenital heart disease is not an etiology of Right-Sided CHF, only Left-sided.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Mycoplasma pneumoniae causing atypical pneumonia

(scroll for answer)

Erythromycin

FACT of the DAY!

Drug Profile: Tetracycline
Mechanism- bacteriostatic, reversibly bind to the 30s ribosomal subunit preventing the addition of new amino acids onto growing peptide chain
Effective against- gram (+) and gram (-), anaerobes, spirochetes, mycoplasma, rickettsiae, chlamydiae, and some protozoa
ADR’s- teeth discoloration, depression of skeletal growth, GI distress, hepatotoxicity, photosensitivity; contraindicated in pregnancy and children due to effects on teeth and bones

2008-02-10T17:47:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A 48 year-old smoker complains of a “new cough.” During her history, she also notes that she has a lost 36 pounds in the last 2 years. A chest x-ray is obtained and shows a central mass. Her labs show that she also has hypercalcemia. What is most likely responsible for her hypercalcemia?

A) Small cell carcinoma
B) Parathyroid Hormone
C) Adenocarcinoma
D) PTH-like peptide
E) ACTH

(scroll for answer)

Answer: D) PTH-like peptide. This case presents squamous cell carcinoma. There is an increased risk for smokers. It is also secretes PTH-like peptide (not PTH itself) which causes hypercalcemia. Don’t be surprised to see this trick question on your boards.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Candida causing vaginal candidiasis

(scroll for answer)

Miconazole

FACT of the DAY!

The Larynx
Muscles: ‘P’osterior cricoarytenoid= o’p’ens glottis
‘L’ateral cricoarytenoid= c’l’oses glottis
Thyroarytenoid= relaxes vocal cords
Cricothyroid= tightens vocal cords, innervated by sup. Laryngeal nerve
All 3 “arytenoids” are innervated by the recurrent laryngeal nerve
Sensory innervation:
‘Above’ glottis- ‘superior’ laryngeal nerve
Below glottis- Recurrent laryngeal nerve

2008-02-07T18:24:00.001-08:00

USMLE Step 1 Buzzword!

When you see "aschoff bodies" you should immediately think...

answer:
Rheumatic fever

USMLE Step 1 Most Common

Most common cause of a breast mass?

answer:
fibrocystic change

D.O.C. of the day!

Drug of choice for CNS toxoplasmosis?

answer:
Pyrimethamine and sulfadiazine (and add folinic acid)

2008-02-07T18:02:00.001-08:00

USMLE Step 1 Question of the Day!

A 43 year old man comes to the ER complaining of severe headache, fever, and neck pain. During his history you learn that he is HIV positive. You perform a lumbar puncture. What stain should you request given this man's symptoms and history?

A) Ziehl Neelsen
B) India ink
C) PAS
D) Giemsa
E) Congo Red

(scroll for answer)

answer: B) India ink. Given this man's immunocompromised state, you need to check for opportunistic infections such as cryptococcus. Cryptococcus stains with India ink.

Drug of Choice for

Enterobius vermicularis

(scroll for answer)

answer: Mebendazole

2008-02-02T20:16:00.001-08:00

USMLE Step 1 Q of the Day!

What is the most devastating long term sequelae of Schistosoma Hematobium?

A) Systemic hypertension
B) Pulmonary fibrosis
C) Portal hypertension
D) Uveitis
E) Bladder cancer

(scroll for answer)

answer: E) Bladder cancer. Infection with Schistosoma hematobium leads to bladder fibrosis and eventually bladder cancer. Infection with Schistosoma japonicum and Mansoni lead to portal HTN.

Drug of Choice for

Taenia solium causing Cysticercosis

(scroll for answer)

answer: Niclosamide

2008-02-02T19:38:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

During a pre-participation sports physical, Sara tells the Doctor that she has Mitral valve prolapse. What should the Doctor expect to hear?

A) Continuous murmur
B) Diastolic murmur
C) Holosystolic murmur
D) Early systolic murmur
E) Mid systolic murmur

(scroll for answer)

Answer: E) Mid-systolic murmur. MVP is the most frequent valvular lesion, common to young women (especially on boards). Stretching of the mitral valve causes a midsystolic click. It can lead to mitral insufficiency and predisposes patients to infective endocarditis.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Vibrio cholerae causing cholera

(scroll for answer)

Tetracycline

FACT of the DAY!

Defective enzymes Part II:
Pompe’s disease: alpha 1,4-glucosidase
Galactosemia: Galactose-1-phosphate uridyl transferase
Phenylketonuria: Phenylalanine hydroxylase
Maple Syrup Urine Disease: branched chain alpha-ketoacid dehydrogenase

2008-02-02T19:36:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

Maple Syrup urine disease is due to a defective branched chain alpha-ketoacid dehydrogenase enzyme. A defect in this enzyme causes an inability to metabolize what amino acids?

A) leucine, isoleucine, methionine
B) methionine, valine
C) methionine
D) arginine, lysine, leucine
E) valine, isoleucine, leucine

(scroll for answer)

Answer: E) valine, isoleucine, leucine. Maple Syrup Urine disease brings a variety of neurological symptoms and a high mortality. It gets its name from the thick, brown urine produced

USMLE Step D.O.C. of the Day!

Drug of choice for

Bacillus Anthracis causing anthrax

(scroll for answer)

Ciprofloxacin or Tetracycline

USMLE Step 1 Fact of the Day!

Defective enzymes Part I:

Gaucher’s disease: Glucocerebrosidase
Niemann-Pick disease: Sphingomyelinase
Von Gierke’s disease: Glucose-6-phosphatase
Cori’s disease: debranching enzyme

2008-02-02T19:35:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A 55 year-old man is treated with Propranolol for his hypertension. What side effects should the Doctor advise him of?

A) Headaches
B) Constipation
C) Sexual dysfunction
D) Exacerbation of GERD
E) Rebound hypertension

(scroll for answer)

Answer: C) Sexual dysfunction. Propranolol is a Beta Blocker. Its side effects include sexual dysfunction, arrhythmias if drug stopped abruptly, bronchoconstriction, and blocking hypoglycemic response in diabetics. Headaches are seen in alpha blockers and Ca channel blockers. Constipation and exacerbation of GERD are also ADR’s of Ca channel blockers. Rebound hypertension is seen when Clonidine is stopped abruptly.

USMLE Step 1 D.O.C. of the DAY

Drug of choice for

Salmonella Typhi causing Typhoid fever

(scroll for answer)

Trimethoprim/sulfamethoxazole

FACT of the DAY!

Mesothelioma
-malignant or benign tumor arising in the pleura. Malignant form is strongly associated with prolonged asbestos exposure.
-NO association between smoking and mesothelioma
-pathologic process: pleural exudative effusion accounts for its preferred spread pattern along the pleura. Metastases are common to the pericardium, mediastinum, and the contralateral pleura.

2008-02-02T19:34:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

Cystic Fibrosis is the most common lethal genetic disease in Caucasians. The autosomal recessive mutation occurs on:

A) chromosome 4
B) chromosome 7
C) chromosome 13
D) chromosome 18
E) chromosome 21

(scroll for answer)

Answer: B) chromosome 7. CF mutation occurs on chromosome 7, the cystic fibrosis transmembrane conductance regulator (CFTR) gene. Characteristics of CF include chronic pulmonary disease, pancreatic insufficiency, and meconium ileus in the newborn. Symptomatic tx and gene therapy are current therapies.
Board hint: mother kisses baby on cheek and sweat tastes salty.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Neisseria gonorrhea

(scroll for answer)

Ceftriaxone

FACT of the DAY!

Bowen Disease
Males: single red plaque on the scrotum or shaft with ulceration and crusting
Females: single red-brown plaque on the vulva. May present as leukoplakia.
-cells appear neoplastic with increased nuclear to cytoplasmic ratio and increased mitotic activity.
-increased risk for invasive carcinoma for years.

2008-02-02T19:32:00.001-08:00

USMLE Step 1 Question of the Day!

A new patient is complaining of recurrent diarrhea. On exam she presents with cutaneous flushing, asthmatic wheezing (with no hx of asthma), and a new tricuspid murmur. Urinalysis shows increased 5-HIAA. Your diagnosis most likely is?

A) Renal Osteodystrophy
B) Diabetes Insipidus
C) Crohn’s Disease
D) Carcinoid Syndrome
E) MEN type I

(scroll for answer)

Answer: D) Carcinoid Syndrome. It is caused by tumor consisting of neuroendocrine cells, especially metastatic small bowel tumors. The tumors usually secrete large amounts of Serotonin which results in the symptoms in this patient. Use the ‘Rule of 1/3’: 1/3 metastasize, 1/3 present with 2nd malignancy, and 1/3 are multiple.

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Trichomonas causing trichomoniasis

(scroll for answer)

Metronidazole

USMLE Step 1 Fact of the Day!

Infectious agents causing tumors part II:
Human Papillomavirus- cervical and vaginal cancer
Human Herpes Virus #8- Kaposi sarcoma
Human T-cell lymphotropic virus type 1- T-cell lymphoma or leukemia
Schistosoma haematobium- transitional cell carcinoma of the bladder

2008-02-02T17:14:00.001-08:00

USMLE Step 1 Question of the Day!

A 38 year-old woman presents to the emergency room after a car accident. She said she was driving down the road when all of a sudden she started having a seizure and could not control herself. She has been complaining of headaches and some memory troubles as of late. After a full workup, Doctors tell her she has a terrible brain tumor. CT scan shows that the tumor crosses over the corpus callosum. What primary brain tumor does she have?

A) Glioblastoma multiforme
B) Meningioma
C) Pituitary Adenoma
D) Medulloblastoma
E) Craniopharyngioma

(scroll for answer)

Answer: A) Glioblastoma multiforme or Grade IV astrocytoma. It is the most common primary brain tumor in adults. It carries with it a less than one year prognosis time. It is found in the cerebral hemispheres and often crosses the corpus callosum where it gets the nickname of “butterfly glioma.” On biopsy of the tumor, pseudopalisading tumor cells border central areas of necrosis and hemorrhage.

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Streptococcus viridans causing endocarditis

(scroll for answer)

Penicillin + aminoglycoside

USMLE Step 1 Fact of the Day!

Infectious agents causing tumors part I:
Aspergillus- Hepatocellular carcinoma
Epstein Barr Virus- Burkitt’s lymphoma, nasopharyngeal carcinoma
Hepatitis B Virus- Hepatocellular carcinoma
Helicobacter pylori- gastric adenocarcinoma, gastric lymphoma

2008-02-01T13:25:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

Coxsackievirus is an RNA virus that causes a variety of problems including myocarditis and herpangina, a febrile pharyngitis. All of the following are characteristics of coxsackievirus except:

A) single stranded
B) helical
C) hand, foot, and mouth disease
D) Picornavirus family
E) Positive polarity

(scroll for answer)

Answer: B) helical. Coxsackievirus’ capsule is an icosahedral symmetry. It is a member of the Picornavirus family, has no envelope, single stranded, positive polarity, linear, and icosahedral capsid symmetry. It is the genesis of aseptic meningitis, herpangina, myocarditis, and hand, foot, and mouth disease.

USMLE Step 1 D.O.C. of the Day!

Drug of choice for

Yersinia Pestis causing plague

(scroll for answer)

Streptomycin

USMLE Step 1 Fact of the day!

Causes of edema:
- Increases hydrostatic pressure
- Reduced oncotic pressure
- Sodium retention
- Increased capillary permeability
- Lymphatic obstruction

2008-01-31T17:20:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

A man presents with fever, splenomegaly, anemia, and petechiae. After a full work-up he is diagnosed with subacute bacterial endocarditis caused by Streptococcus viridans. Which of the following is the most likely site to be the source of the organism?

A) colon
B) skin
C) urethra
D) oropharynx
E) liver

(scroll for answer)

Answer: D) oropharynx. Subacute bacterial endocarditis has manifestations of fever, splenomegaly, petechiae, anemia, and hematuria. The cause of subacute BE is often Streptococcus viridans after oral or dental procedures. Prophylaxis antibiotics should be given prior to these procedures for people at risk.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Bordetella pertussis causing whooping cough

(scroll for answer)

Erythromycin

USMLE Step 1 Fact of the Day!

Bug Profile:
Campylobacter jejuni
-gram (-), curved rods
-reservoirs cattle, chickens, dogs
-watery, foul smelling stools becoming bloody
-most common cause of diarrhea in US
-associated with Gullain-Barre
-may lead to Reiter’s syndrome

2008-01-29T16:06:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

There is a minor alteration of MHC-I antigens when a cell is invaded by a virus. The immune system will not recognize the infected cell without the help of alpha and beta interferon inducing increased class I antigen expression on the cell’s surface. Which of the following is the source of interferon-beta?

A) fibroblasts
B) T cells
C) B Cells
D) Macrophages
E) Natural killer cells

(scroll for answer)

Answer: A) fibroblasts. Fibroblasts release interferon-beta and interleukin-6 in response to viral infection. IL-6 stimulates B cells to release interferon-alpha which also has antiviral activity. The increased expression of MHC-I antigens on infected cells surfaces helps the immune system recognize viral infected cells from healthy ones.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Borrelia Burgdorferi causing Lyme disease

(scroll for answer)

Tetracycline

USMLE Step 1 Fact of the Day

Bug Profile:
Vibrio Cholera
-gram (-), comma-shaped
-produces choleragen
-rice water diarrhea: can be so voluminous can cause arrhythmia and rapid acute renal failure
-TX: tetracycline

2008-01-28T16:37:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

A 29 year-old male has noticed increasing amounts of bloody diarrhea. He also notes mild abdominal pain and multiple sore joints. Radiologically after barium, the rectum and descending colon demonstrate lead pipe colon. What is likely to be associated with this man’s disease?

A) positive string sign
B) skip lesions
C) HLA A3
D) HLA B27
E) Low risk of cancer

(scroll for answer)

Answer: D) HLA B27. This man has Ulcerative Colitis. UC is an inflammatory bowel disease that begins at the rectum and descending colon. Characteristics include crypt abscesses, pseudopolyps, lead pipe colon, and a high risk of colon cancer and toxic megacolon. Clinically there is a lot of blood (from ulcers) and only mild pain. There is an association between UC and human leukocyte antigen (HLA) B27. Answers A, B, & E are characteristics of Crohn’s disease, the other inflammatory bowel disease.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Legionella causing Legionnaire’s disease

(scroll for answer)

Erythromycin

USMLE Step 1 Fact of the Day!

Von Willebrand Disease
-deficiency of von Williebrand factor (VWF)
-VWF carries factor VIII (also a deficiency of factor VIII)
-Autosomal dominant
-Characteristics: easy bleeding or bruising
Increased menstrual bleeding
Increased PTT and bleeding time
TX: VWF or purified factor VIII

2008-01-27T14:20:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

Following his car accident, Mr. Meyer was told to get an MRI of his cervical spine. The MRI showed that Mr. Meyer had some damage to his left T1 spinal rami. Which of the following will most likely be affected?

A) triceps reflex
B) flexion of the 4th finger
C) thumb opposition
D) biceps reflex
E) supination

(scroll for answer)

USMLE Step 1 D.O.C. of the DAY!
Answer: B) flexion of the 4th finger and also the 5th finger. C8 and T1 form the lower trunk that eventually lead to the ulnar nerve. C5 and C6 form the upper trunk then contribute to the musculocutaneous nerve (answers D & E would be affected). C7 forms the middle trunk and then contributes to the axillary, radial, and median nerve (answer C would be affected by damage to C7 because of its median nerve contribution & answer A would be affected by damage to C7 because of its radial nerve contribution).

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Clostridium difficile causing pseudomembranous colitis

(scroll for answer)

Metronidazole

USMLE Step 1 Fact of the Day!

Lead Poisoning
-Heme and globin production enzymes are inhibited by lead
-High urine coproporphyrin III
-Serum Iron can be normal or mildly increased
-Serum Ferritin is increased
Findings on peripheral smear: RBC Basophilic stippling

2008-01-24T19:58:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

Bleomycin is used primarily for genitourinary cancers as well as lymphomas, and stands as one of the drugs of choice for testicular cancer. The major side effect associated with its use is:

A) Pulmonary fibrosis
B) Cardiotoxicity
C) Hemorrhagic cystitis
D) Peripheral neuropathy
E) Renal Toxicity

(scroll for answer)

Answer: A) Pulmonary fibrosis is the major side effect of Bleomycin. Other cancer drug side effects include Doxorubicin- cardiotoxicity, cyclophosphamide- hemorrhagic cystitis, vincristine- peripheral neuropathy, cisplatin- renal toxicity.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Treponema pallidum causing syphilis

(scroll for answer)

Penicillin G

USMLE Step 1 Fact of the DAY!

Drug Profile:
Chloroquine- general drug of choice for prophylaxis of malaria for general population (other drugs can be used)
- can be used to treat malaria (EXCEPT P.Falciparum)
Kills malaria 4 ways:
- inhibits plasmodia DNA synthesis
- transforms heme into a toxin so plasmodia are poisoned when they ingest it
- forms complexes that lyse the plasmodia and the RBC’s that it’s in
- alkalizes the plasmodia food vacuole- inhibiting organism’s growth
many ADR’s: including GI problems, tinnitus, nerve deafness, retinopathy

2008-01-20T18:50:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

2 months following her thyroidectomy, Mrs. Jones notices muscle tetany and numbness of the hands, feet, and lips. What are her laboratory tests most likely to show?

A) High serum calcium, Low serum phosphate, Low PTH
B) High serum calcium, Low serum phosphate, High PTH
C) Low serum calcium, High serum phosphate, Low PTH
D) Low serum calcium, High serum phosphate, High PTH
E) Low serum calcium, Low serum phosphate, Low PTH

(scroll for answer)

Answer: C) Low serum calcium, High serum phosphate, Low PTH. Mrs. Jones has developed hypoparathyroidism by accidental excision from her thyroid surgery. The muscle tetany and numbness is due to the severely low calcium. Serum phosphate accumulates from decreased renal excretion (no PTH).

USMLE Step 1 D.O.C. of the DAY!

Drugs of choice for

Mycobacterium tuberculosis causing tuberculosis
(4 of them)
(scroll for answer)

Pyrazinamide, Rifampin, Isoniazid, and Ethambutol

USMLE Step 1 FACT of the DAY!

Nephrotic Syndrome:
- Prolonged onset, prolonged increase in glomerular permeability to proteins, PROTEINURIA!, hypoalbuminemia leading to edema, hyperlipidemia
- Includes: membranous glomerulonephritis, minimal change disease, diabetic nephropathy, focal segmental glomerular sclerosis, SLE

2008-01-19T06:57:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A 12 year-old boy presents to the ER with his fifth fracture in 2 years. During the H+P you find the boy to be partially deaf and also with blue sclerae. This boys diagnosis is primarily:
A) Autosomal recessive
B) Autosomal dominant
C) X-linked recessive
D) X-linked dominant
E) Mitochondrial inheritance

(scroll for answer)

Answer: B) Autosomal Dominant. This boy has osteogenesis imperfecta. An autosomal dominant disorder caused by a variety of gene defects resulting in abnormal collagen synthesis. It is characterized by multiple fractures, blue sclerae, dental imperfections, and hearing loss.

USMLE Step 1 D.O.C. of the day!

Drug of choice for

Chlamydia pneumoniae causing pneumonia

(scroll for answer)

Tetracycline

USMLE Step 1 Fact of the Day!

Bug Profile: Mycoplasma pneumoniae
- causes atypical pneumonia
- no cell wall = no gram stain results
- only bacteria with cholesterol in cell membrane (mycoplasma)
- produces hydrogen peroxide which damages respiratory tract
- Dx by labs takes too long to be clinically useful
- DOC: Erythromycin but tetracycline is effective

2007-12-31T12:51:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

An 8 year-old boy is stung by a bee while playing in the park. Within minutes he goes into respiratory distress and unconsciousness. His reaction is mediated by:

A) complement
B) IgG antibody
C) IgM antibody
D) IgE antibody
E) Sensitized T cells

(scroll for answer)

Answer: D) IgE antibody. This child is allergic to bees. IgE antibody is the primary player responsible for an allergic reaction, Type I Hypersensitivity reaction.

USMLE Step 1 D.O.C. of the DAY!

drug of choice for

Klebsiella causing urinary tract infection

(scroll for answer)

Quinolones

USMLE Step 1 Fact of the DAY!

Rocky Mountain Spotted Fever
- caused by tick bites with intracellular obligate parasite- Rickettsia rickettsii
- organism invades capillaries causing vasculitis
- sudden fever, headache, chills, rash from extremities expanding to trunk
- leads to fulminant vasculitis, shock, thrombosis
- Dx by ELISA test
- Tx: Tetracycline

2007-12-23T14:37:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

A 23 year-old male presents to the emergency room after being picked up by the police. The Officer states the man was in the middle of a busy intersection directing traffic. After interviewing the man you find out that God has been talking to him through the traffic lights for the past 8 months. The man appears disheveled and rambles on about how he is the best traffic controller because God tells him what to do. The man denies any depression, mood disorders, or major stressors in his life. Which of the following is most likely this man’s diagnosis?

A) Major Depressive Disorder
B) Brief Psychotic Disorder
C) Delusional Disorder
D) Schizoaffective disorder
E) Schizophrenia

(scroll for answer)

Answer: E) Schizophrenia. Schizophrenia is a chronic disorder with major inability to function. Typically begins in early 20’s for men and later 20’s for women. Onset is preceded by at least 6 months of identifiable impairment. Positive symptoms include delusions, hallucinations, disorganized thinking & speech. Negative symptoms include withdrawal, alogia, flattening of affect, and avolition.

USMLE Step 1 D.O.C. of the DAY!

Streptococcus pyogenes causing pharyngitis

(scroll for answer)

Penicillin V or G

USMLE Step 1 Fact of the Day!

Drug Profile: Acyclovir
- antiviral: GTP analog that inhibits DNA polymerase
- requires viral thymidine kinase to be activated
- effective against Herpes simplex virus 1 and 2, Epstein Barr virus, Varicella zoster virus. All possess viral thymidine kinase.
- ADR’s: GI problems, renal problems, CNS, headache, tremor, rashes

2007-12-19T17:40:00.001-08:00

A 42 year-old woman presents to her doctor with lymphadenopathy of the supraclavicular node and a fever. Upon biopsy of the mass there is mixed cellular infiltrate of lymphocytes, eosinophils, lacunar cells, and Reed Sternberg cells are noted. Which of the following is most likely her diagnosis?

A) Invasive lobular carcinoma of the breast
B) Non-Hodgkin Lymphoma
C) Reactive lymphadenopathy
D) Hodgkin Lymphoma
E) Polycythemia vera

(scroll for answer)

Answer: D) Hodgkin lymphoma. It is mostly a male disease except for this case which is nodular sclerosing seen in women. Reed Sternberg cells are dead give away to Hodgkin Lymphoma.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Haemophilus influenza causing pneumonia, meningitis

(scroll for answer)

Any 3rd generation cephalosporin i.e. ceftriaxone, cefotaxime

USMLE Step 1 Fact of the DAY!

Pheochromocytoma
- most common tumor of the Adrenal medulla
- not a common adrenal tumor
- benign and well circumscribed
- composed of chromaffin cells producing epinephrine and norepinephrine
- unilateral alone or bilateral in MEN IIA & IIB
- Symptoms: Hypertension, palpitations, tachycardia, anxiety, and excessive sweating. Death from heart failure.
- Rule of 10’s: 10% bilateral, 10% extra-adrenal, 10% malignant, 10% children, 10% familial

2007-12-17T19:26:00.000-08:00

USMLE Step 1 QUESTION of the DAY!

All of the following lung conditions have a Forced expiratory volume per 1 second to forced vital capacity ratio (FEV1/FVC) less than 80% EXCEPT:

A) Sarcoidosis
B) Asthma
C) Bronchiectasis
D) Emphysema
E) Chronic bronchitis

(scroll for answer)

Answer: A) Sarcoidosis. Sarcoidosis is a restrictive lung disease. The others are obstructive lung diseases. Normal FEV1/FVC ratio is 80%. Restrictive lung diseases have a ratio above 80% with decreases in lung volumes. Obstructive lung diseases have a ratio less than 80% with increases in lung volumes.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Nocardia causing pneumonia

(scroll for answer)

Trimethoprim/sulfamethoxazole

USMLE Step 1 Fact of the Day!

Drug Profile: Metronidazole (FLAGYL)
- Effective against protozoa (not cysts) & anaerobic bacteria, undergoes nitroreduction
- Forms reactive intermediate (radical) that leads to damages DNA, DNA strand breaks
- Intestinal/systemic action: TID 7-10 days
- DOC for Clostridium difficile, mild-severe amebiasis, giardiasis, trichomoniasis, also bacterial vaginosis
- ADRs: GI problems/metallic taste, headache, paresthesias, ataxia, liver dysfunction Disulfiram rx (alcohol); Contraindicated in 1st/Trim. pregnancy

2007-12-15T20:01:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A husband and wife present with nausea, vomiting, and diarrhea 6 hours after sharing a Rice Burrito from their favorite Mexican restaurant. Which of the following organisms is most likely to be the cause?

A) Vibrio cholerae
B) Bacillus cereus
C) Enterotoxigenic E. coli
D) Salmonella typhi
E) Staphylococcus aureus

(scroll for answer)

Answer: B) Bacillus cereus. B. cereus is an aerobic, gram (+), spore-forming rod. It is found in grains. Its spores survive food preparation such as boiling. Treatment includes fluids and take care of symptoms.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Chlamydia trachomatis causing pelvic inflammatory disease

(scroll for answer)

Doxycycline

USMLE Step 1 Fact of the Day!

Tumor Markers:
Alpha-fetoprotein: Hepatocellular carcinoma, yolk sac tumor of ovary
Carcinoembryonic antigen: Colon adenocarcinoma, pancreatic carcinoma
Prostate-specific antigen: Prostate adenocarcinoma (present in small amounts in normal prostate)
Human chorionic gonadotropin: Choriocarcinoma
5’HIAA: carcinoid
CA 19-9: colon, pancreatic, and breast cancer
CA-125: Ovarian cancer
CD 25: hairy cell leukemia, adult T-cell leukemia
CD 30: Hodgkin’s disease
Neuron-specific enolase: small cell lung cancer, neuroblastoma
Acid phosphatase: prostate carcinoma
Alkaline phosphatase: Paget’s disease, biliary disease, metastases to bone

2007-12-13T17:39:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A 43 year-old female comes into the office complaining of a green vaginal discharge for 4 days. She states that it has been extremely itchy and is very concerned because her husband says, "it smells like a dead animal down there." What is the best drug to treat her condition?

A) Miconazole
B) Doxycycline
C) Ceftriaxone
D) Metronidazole
E) Penicillin G

(scroll for answer)

Answer: D Metronidazole. This woman has Trichomoniasis. Trichomoniasis vaginalis characteristics include yellow, green discharge, pH >4.5, putrid odor, severe pruritus, and excoriations from scratching. Treatment should also be started on sexual partners.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Rickettsia causing spotted fever, end. typhus

(scroll for answer)

Tetracycline

USMLE Step 1 Fact of the DAY!

Bug Profile:
Staphylococcus saprophyticus
- Gram (+) cocci in clusters
- Coagulase (-)
- novobiocin resistant (s. epidermidis is sensitive)
- causes community acquired UTI’s in young women
- TX: a Quinolone or trimethoprim-sulfamethoxazole

2007-12-09T18:25:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

A patient arrives via ambulance to the emergency department. He has been stabbed in the stomach nine times. During surgery, the Doctor finds that the superior mesenteric artery was completely severed. Which of the following is most likely to be affected?

A) Liver
B) Pancreas
C) Duodenum
D) Gallbladder
E) Lower 1/3 Esophagus

(scroll for answer)

Answer: C) Duodenum. The Superior mesenteric artery supplies the midgut. The midgut includes 2nd, 3rd, 4th parts of the Duodenum, jejunum, ileum, pancreas, and proximal two-thirds of the colon. The Liver, pancreas, gallbladder, and esophagus are all parts of the foregut (supplied by the celiac trunk).

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Tropheryma whippelii causing whipple’s disease

(scroll for answer)

Trimethoprim/sulfamethoxazole

USMLE Step 1 FACT of the DAY!

"The Hindgut"
- distal 1/3 of colon
- rectum

Artery: inferior mesenteric
nerves: lumbar splanchnic sympathetics
pelvic splanchnic (S2, S3, S4) parasympathetic

2007-12-07T16:06:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

Mr. D has a temperature of 100.8. He states that he was treated and getting over bronchopneumonia when he started having diarrhea and abdominal pain. He adds that he has noticed blood in his diarrhea. What drug is the best choice to treat his diarrhea?

A) Trimethorprim/sulfamethoxazole
B) Ceftriaxone
C) Tetracycline
D) Metronidazole
E) Penicillin G

(scroll for answer)

Answer: D) Metronidazole. Mr. D was treated with a broad spectrum antibiotic for his bronchopneumonia. He developed pseudomembranous colitis from the antibiotic use. Pseudomembranous colitis is caused by an overgrowth of clostridium difficile. It is characterized by fever, bloody diarrhea, and abdominal pain. The drug of choice for clostridium difficile is metronidazole.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Staphyloccous aureus causing a skin infection

(scroll for answer)

Dicloxacillin

USMLE Step 1 FACT of the DAY!

Type I Hypersensitivity Reaction: IgE
- Mediators: mast cells and basophils (secreting histamine)
- Signs & Symptoms: Urticaria, erythema, bronchiole constriction, laryngeal edema, shock, death
- Examples: eczema, asthma, anaphylaxis, hay fever

2007-11-11T17:27:00.001-08:00

USMLE Step 1 QUESTION of the DAY!

Hemophilia A is the most common type of hemophilia. Which of the following is a characteristic of Hemophilia A?

A) autosomal dominant
B) autosomal recessive
C) factor IX deficiency
D) bleeding time prolonged
E) aPTT prolonged

(scroll for answer)

Answer: E) aPTT prolonged. Hemophilia A is an x-linked recessive bleeding disorder. aPTT is the only screening test that is abnormal. There is a primary deficiency of Factor VIII.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Mycobacterium leprae causing leprosy

(scroll for answer)

Dapsone and Rifampin

USMLE Step 1 FACT of the DAY!

Parkinson’s Disease:
- onset after age 50
- decrease in Dopamine due to loss of dopaminergic substantia nigra neurons (causes depigmentation of substantia nigra)
- Lewy bodies found in damaged cells
- resting tremors, masked facies, shuffling gait, muscular rigidity
- Tx includes either increasing dopamine or decreasing acetylcholine via pharmacotherapy

2007-10-29T17:51:00.001-07:00

USMLE Step 1 QUESTION of the DAY!

An 8 month-old boy is brought to your office for yet another ear infection. The patient has had a history of thrombocytopenia and eczema. This boy most likely has what?

A) Wiskott-Aldrich syndrome
B) DiGeorge syndrome
C) Severe combined immunodeficiency
D) Job’s syndrome
E) A plasma cell abnormality

(scroll for answer)

Answer: A) Wiskott-Aldrich syndrome is an X-linked recessive disease. It is a congenital combined T- and B-cell deficiency characterized by recurrent infections, thrombocytopenia, and eczema. C) SCID is also a combined T- and B-cell deficiency, DiGeorge syndrome is a T-cell deficiency, and Job’s syndrome is a phagocyte disorder which also is associated with eczema.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Campylobacter causing acute inflammatory diarrhea

(scroll for answer)

Ciprofloxacin

FACT of the DAY!

Bacterial cystitis:
- dysuria (painful and burning urination), urgency, frequency
- more common in females due to short urethra
- affects males >70 due to prostatitis, very young male = congenital anomaly
- Bacteria count > 100,000 + infection but lower if pregnant or young child
- Also + nitrate reduction test w/ pyuria w/ + esterase study (PMN’s); Coliform bacilli most common invaders
- Brunn’s nests-tiny invaginations that expand w/ cystitis called goblet cell metaplasia- “cystitis glandularis” or when extreme “cystitis cystica”
- Mucosa is slightly elevated w/ scattered inflammatory cells- sometimes so intense lymphoid follicles develop

2007-10-27T13:51:00.001-07:00

USMLE Step 1 QUESTION of the DAY!

A new patient tells you he has an autosomal recessive disorder that caused his liver disease. He is now complaining that he has had tremors and muscle spasticity. He also notes that his vision is getting worse and worse. Which of the following would you most likely expect to find?

A) bronze diabetes
B) kayser-fleischer rings
C) nutmeg liver
D) increased ceruloplasmin
E) emphysema

(scroll for answer)

Answer: B) Kayser-Fleischer rings. This man most likely has Wilson’s disease, an autosomal recessive disorder of copper metabolism. There is an accumulation of copper (but a decrease in serum ceruloplasmin) which deposits in the liver, basal ganglia, kidney, and cornea (kayser-fleischer rings). Bronze diabetes is seen in hemochromatosis; Nutmeg liver usually manifests in congestive heart failure (most often right sided); emphysema is noted in alpha-1 Antitrypsin deficiency.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Shigella causing dysentery

(scroll for answer)

Trimethoprim/sulfamethoxazole

FACT of the DAY!

Reye’s Syndrome
-this is why you don’t give children aspirin for viral infections or any reason for that matter
-characterized by fulminant hepatitis and cerebral edema
-use acetaminophen instead

2007-10-22T09:09:00.000-07:00

USMLE Step 1 QUESTION of the DAY!

A 43 year-old woman has been HIV positive for 18 years. Recently her sister has noticed that she has been slow responding to questions and also somewhat uncoordinated in her movements. A full workup is done including a CT of her brain. The CT demonstrates ring enhancing lesions. Which of the following would be her best treatment choice?

A) Pyrimethamine-sulfadiazine
B) Metronidazole
C) Chloroquine
D) Trimethoprim-sulfamethoxazole
E) Clarithromycin and ethambutol

(scroll for answer)

Answer: A) Pyrimethamine-sulfadiazine. This patient is experiencing Toxoplasma encephalitis caused by toxoplasma gondii. It is a common dementia in full blown AIDS. Drug of choice for toxoplasma is Pyrimethamine-sulfadiazine. Answer D is the D.O.C. for Pneumocystis carinii. Answer E is the D.O.C. for M. avium complex.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Neisseria Meningitis causing meningitis

(scroll for answer)

Penicillin G

FACT of the DAY!

Congenital Heart Defects:
Cyanotic (represents R to L shunt)
-Tetralogy of Fallot
-Transposition of great vessels
-Persistent truncus arteriosus
-Eisenmenger’s complex (board favorite)

Acyanotic (represents L to R shunt)
-Ventricular septal defects
-atrial septal defects
-patent ductus arteriosus

Obstructive
-coarctation of aorta (infants-preductal; adults-postductal)
-pulmonary stenosis or atresia
-aortic stenosis or atresia

2007-10-18T13:38:00.000-07:00

USMLE Step 1 QUESTION of the DAY!

An old man is found in the basement of his house. He was on the floor with rigor mortis setting in. What is the mechanism responsible for rigor mortis?

A) He overdosed on Baclofen
B) Increase in ATP production before he died
C) Myocyte death
D) Depletion of ATP
E) Myosin cross-bridge detachment

(scroll for answer)

Answer: D) depletion of ATP. ATP is required for Myocyte contraction. However, ATP is also required for the myosin cross-bridge to detach. During the moments of dying the muscles contract using the remaining ATP in the body. After some time there is no ATP in the body to detach the myosin cross-bridge.

USMLE Step 1 D.O.C. of the DAY!

Drug of choice for

Proteus causing urinary tract infection

(scroll for answer)

Quinolones

FACT of the DAY!

Touch receptors:
Pacinian corpuscle- vibration, most rapid adapting, travel in dorsal column
Meissner’s corpuscle- touch, fast adapting, travel in dorsal column
Merkel’s discs- pressure, slow adapting, travel in dorsal column
Pain and temperature- fibers travel in spinothalamic tract and are mostly free nerve endings

USMLE Step 1

2007-06-29T14:23:00.000-07:00

A husband and wife present with nausea, vomiting, and diarrhea 6 hours after sharing a Rice Burrito from their favorite Mexican restaurant. Which of the following organisms is most likely to be the cause?

A) Vibrio cholerae
B) Bacillus cereus
C) Enterotoxigenic E. coli
D) Salmonella typhi
E) Staphylococcus aureus

(scroll for answer)

Answer: B) Bacillus cereus. B. cereus is an aerobic, gram (+), spore-forming rod. It is found in grains. Its spores survive food preparation such as boiling. Treatment includes fluids and take care of symptoms.

USMLE Step 1

2007-06-29T14:20:00.000-07:00

A 43 year-old female comes into the office complaining of a green vaginal discharge for 4 days. She states that it has been extremely itchy and is very concerned because her husband says, "it smells like a dead animal down there." What is the best drug to treat her condition?

A) Miconazole
B) Doxycycline
C) Ceftriaxone
D) Metronidazole
E) Penicillin G

(scroll for answer)

Answer: D Metronidazole. This woman has Trichomoniasis. Trichomoniasis vaginalis characteristics include yellow, green discharge, pH >4.5, putrid odor, severe pruritus, and excoriations from scratching. Treatment should also be started on sexual partners.

USMLE Step 1

2007-05-30T19:14:00.000-07:00

During a pre-participation sports physical, Sara tells the Doctor that she has Mitral valve prolapse. What should the Doctor expect to hear?

A) Continuous murmur
B) Diastolic murmur
C) Holosystolic murmur
D) Early systolic murmur
E) Mid systolic murmur

Answer: E) Mid-systolic murmur. MVP is the most frequent valvular lesion, common to young women (especially on boards). Stretching of the mitral valve causes a midsystolic click. It can lead to mitral insufficiency and predisposes patients to infective endocarditis.

check back later for your answer.

yesterday's answer:
Answer: D) PTH-like peptide. This case presents squamous cell carcinoma. There is an increased risk for smokers. It is also secretes PTH-like peptide (not PTH itself) which causes hypercalcemia. Don’t be surprised to see this trick question on your boards.

USMLE Step 1

2007-05-27T16:45:00.000-07:00

A 48 year-old smoker complains of a “new cough.” During her history, she also notes that she has a lost 36 pounds in the last 2 years. A chest x-ray is obtained and shows a central mass. Her labs show that she also has hypercalcemia. What is most likely responsible for her hypercalcemia?

A) Small cell carcinoma
B) Parathyroid Hormone
C) Adenocarcinoma
D) PTH-like peptide
E) ACTH

check back later for your answer.

yesterday's answer:
Answer: A) Cor pulmonale is an etiology of Right-sided CHF. Systemic HTN, myocarditis, cardiomyopathy can be causes of both Right and Left-sided CHF. Congenital heart disease is not an etiology of Right-Sided CHF, only Left-sided.

USMLE Step 1

2007-05-24T20:12:00.000-07:00

A 64 year-old man has severe swelling of his lower extremities and difficulty breathing. On physical exam, breath sounds are absent at the base of both lungs.
All of the following are causes of Left-sided congestive heart failure except:

A) Cor pulmonale
B) Systemic Hypertension
C) Myocarditis
D) Cardiomyopathy
E) Congenital heart disease

check back tomorrow for your answer.

Yesterday's answer:
Answer: E) Cimetidine. Cimetidine is an H2 Blocker used to treat GERD and peptic ulcers. Side effects of Cimetidine include gynecomastia (most common), headaches, vertigo, fatigue, and reduced sperm count. The other choices do not cause gynecomastia. Sucralfate is an anti-ulcer agent. Minoxidil, Propranolol, and Chlorothiazide are all drugs used to treat hypertension.

USMLE Step 1

2007-05-23T19:18:00.000-07:00

You have a 46 year-old patient come into the office. He complains that he has noticed that his breasts are getting bigger. He currently is being treated for high blood pressure and GERD. Which of the patients’ medications could have caused his gynecomastia?

A) Minoxidil
B) Propranolol
C) Sucralfate
D) Chlorothiazide
E) Cimetidine

check back tomorrow for your answer.

Yesterday's Answer:
D) depletion of ATP. ATP is required for Myocyte contraction. However, ATP is also required for the myosin cross-bridge to detach. During the moments of dying the muscles contract using the remaining ATP in the body. After some time there is no ATP in the body to detach the myosin cross-bridge.

USMLE Step 1

2007-05-22T18:40:00.000-07:00

An old man is found in the basement of his house. He was on the floor with rigor mortis setting in. What is the mechanism responsible for rigor mortis?

A) He overdosed on Baclofen
B) Increase in ATP production before he died
C) Myocyte death
D) Depletion of ATP
E) Myosin cross-bridge detachment

check back tomorrow for your answer.

Yesterday's Answer:
A) Pyrimethamine-sulfadiazine. This patient is experiencing Toxoplasma encephalitis caused by toxoplasma gondii. It is a common dementia in full blown AIDS. Drug of choice for toxoplasma is Pyrimethamine-sulfadiazine. Answer D is the D.O.C. for Pneumocystis carinii. Answer E is the D.O.C. for M. avium complex.

USMLE Step 1

2007-05-18T18:10:00.001-07:00

A 43 year-old woman has been HIV positive for 18 years. Recently her sister has noticed that she has been slow responding to questions and also somewhat uncoordinated in her movements. A full workup is done including a CT of her brain. The CT demonstrates ring enhancing lesions. Which of the following would be her best treatment choice?

A) Pyrimethamine-sulfadiazine
B) Metronidazole
C) Chloroquine
D) Trimethoprim-sulfamethoxazole
E) Clarithromycin and ethambutol

check back tomorrow for your answer.

Yesterday's Answer:
B) Kayser-Fleischer rings. This man most likely has Wilson’s disease, an autosomal recessive disorder of copper metabolism. There is an accumulation of copper (but a decrease in serum ceruloplasmin) which deposits in the liver, basal ganglia, kidney, and cornea (kayser-fleischer rings). Bronze diabetes is seen in hemochromatosis; Nutmeg liver usually manifests in congestive heart failure (most often right sided); emphysema is noted in alpha-1 Antitrypsin deficiency.

USMLE Step 1

2007-05-18T18:07:00.001-07:00

A new patient tells you he has an autosomal recessive disorder that caused his liver disease. He is now complaining that he has had tremors and muscle spasticity. He also notes that his vision is getting worse and worse. Which of the following would you most likely expect to find?

A) bronze diabetes
B) kayser-fleischer rings
C) nutmeg liver
D) increased ceruloplasmin
E) emphysema

check back tomorrow for your answer.

Yesterday's Answer:
A) Wiskott-Aldrich syndrome is an X-linked recessive disease. It is a congenital combined T- and B-cell deficiency characterized by recurrent infections, thrombocytopenia, and eczema. C) SCID is also a combined T- and B-cell deficiency, DiGeorge syndrome is a T-cell deficiency, and Job’s syndrome is a phagocyte disorder which also is associated with eczema.

USMLE Step 1

2007-05-18T18:03:00.000-07:00

An 8 month-old boy is brought to your office for yet another ear infection. The patient has had a history of thrombocytopenia and eczema. This boy most likely has what?

A) Wiskott-Aldrich syndrome
B) DiGeorge syndrome
C) Severe combined immunodeficiency
D) Job’s syndrome
E) A plasma cell abnormality

check back tomorrow for your answer.

Yesterday's Answer:
E) aPTT prolonged. Hemophilia A is an x-linked recessive bleeding disorder. aPTT is the only screening test that is abnormal. There is a primary deficiency of Factor VIII.

USMLE Step 1

2007-05-15T16:31:00.000-07:00

Hemophilia A is the most common type of hemophilia. Which of the following is a characteristic of Hemophilia A?

A) autosomal dominant
B) autosomal recessive
C) factor IX deficiency
D) bleeding time prolonged
E) aPTT prolonged

check back tomorrow for your answer.

Yesterday's Answer:
D) Metronidazole. Mr. D was treated with a broad spectrum antibiotic for his bronchopneumonia. He developed pseudomembranous colitis from the antibiotic use. Pseudomembranous colitis is caused by an overgrowth of clostridium difficile. It is characterized by fever, bloody diarrhea, and abdominal pain. The drug of choice for clostridium difficile is metronidazole.

USMLE Step 1

2007-05-13T18:41:00.001-07:00

Mr. D has a temperature of 100.8. He states that he was treated and getting over bronchopneumonia when he started having diarrhea and abdominal pain. He adds that he has noticed blood in his diarrhea. What drug is the best choice to treat his diarrhea?

A) Trimethorprim/sulfamethoxazole
B) Ceftriaxone
C) Tetracycline
D) Metronidazole
E) Penicillin G

check back tomorrow for the answer.

Yesterday's Answer:
C) Duodenum. The Superior mesenteric artery supplies the midgut. The midgut includes 2nd,3rd,4th parts of the Duodenum, jejunum, ileum, pancreas, and proximal two-thirds of the colon. The Liver, pancreas, gallbladder, and esophagus are all parts of the foregut (supplied by the celiac trunk).

USMLE Step 1

2007-05-13T18:39:00.000-07:00

Question of the Day!
A patient arrives via ambulance to the emergency department. He has been stabbed in the stomach nine times. During surgery, the Doctor finds that the superior mesenteric artery was completely severed. Which of the following is most likely to be affected?

A) Liver
B) Pancreas
C) Duodenum
D) Gallbladder
E) Lower 1/3 Esophagus

Check back tomorrow to see if you got it right!

Yesterday's answer:
D) HLA B27. This man has Ulcerative Colitis. UC is an inflammatory bowel disease that begins at the rectum and descending colon. Characteristics include crypt abscesses, pseudopolyps, lead pipe colon, and a high risk of colon cancer and toxic megacolon. Clinically there is a lot of blood (from ulcers) and only mild pain. There is an association between UC and human leukocyte antigen (HLA) B27. Answers A, B, & E are characteristics of Crohn’s disease, the other inflammatory bowel disease.

USMLE Step 1

2007-05-11T19:12:00.000-07:00

Question of the Day!
A 29 year-old male has noticed increasing amounts of bloody diarrhea. He also notes mild abdominal pain and multiple sore joints. Radiologically after barium, the rectum and descending colon demonstrate lead pipe colon. What is likely to be associated with this man’s disease?

A) positive string sign
B) skip lesions
C) HLA A3
D) HLA B27
E) Low risk of cancer

Check back tomorrow to see if you got it right!

Yesterday's answer:
A) fibroblasts. Fibroblasts release interferon-beta and interleukin-6 in response to viral infection. IL-6 stimulates B cells to release interferon-alpha which also has antiviral activity. The increased expression of MHC-I antigens on infected cells surfaces helps the immune system recognize viral infected cells from healthy ones.

USMLE Step 1

2007-05-11T19:08:00.000-07:00

USMLE Step 1

2007-04-23T17:11:00.000-07:00

Buzz Word of the Day!

When you see "RBC's stacked like poker chips" you should think...

answer: Multiple myeloma (Rouleaux formation)

USMLE Step 1

2007-04-23T17:08:00.000-07:00

Buzz Word of the Day!

When you see "Reinke crystals" you should think...

answer: Leydig cell tumor

USMLE Step 1

2007-04-23T17:04:00.000-07:00

Buzz Word of the Day!

When you see "psammoma bodies" you should think...

Can you name all four conditions?

answers:
Papillary adenocarcinoma of the thyroid
Serous papillary cystadenocarcinoma of the ovary
Meningioma
Mesothelioma

USMLE Step 1

2007-04-23T17:02:00.000-07:00

Buzz Word of the Day!

When you see "port wine stain" you should think...

answer: hemangioma