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The Uniformed Services University of the Health Sciences
United States Medical Licensing Examination Step 1
The Uniformed Services University of the Health Sciences
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What ages are the WISC intelligence test used for?
6 and 16
Below what IQ is mental retardation?
What is negative reinforcement?
you want the action ; and the reinforcement is taking away a negative stimulus
What are the three freudian structures?
Id (subconcious> urges), Ego (mediator) , Superego (conscious; morals; self blame)
A man who wants another woman thinks his wife is cheating on him (defense?)
What kind of defense mechanism is seen in a child under stress exhibitting bed wetting?
What are the 4 mature defense mechanisms?
Sublimation, altruism, Supression (not thinking about something to avoid it); Humor
What are the 4 W's of infant deprivation?
Weak, Wordless, Wanting, Wary
What part of the brain is decreased in ADHD?
frontal lobe volume
What are the 3 different treatments available for ADHD?
methylphenidate, amphetamine, amoxetine (SNRI)
What can conduct disorder eventually turn into?
What other syndrome is Tourrettes closely related to?
Treatment of Tourettes and tics?
haloperidol and clonidine
A child is 5 years old and for the past year SHE has been regressing in development, she now has mental retardation, loss of verbal abilities, ataxia, and sterotyped hand-wringing?
X-linked Retts (males die in utero)
What is childhood disintegrative disorder?
similar to Retts but more common in boys and much more milder
What are the 3 types of orientation and the order they are normally lost in?
time, place, person
What is dissociative amnesia?
inability to recall personal information due to stress/trauma
What is pseudodementia?
depression that presents like dementia
Which has an abnormal EEG (delirium or depression)?
Which two diseases is tactile hallucinations common in?
alcohol withdrawal and cocaine abuse
What are the different categories of schizophrenia?
brief psychotic disorder (< 1 month); Schizophreniform (1-6 months); Schizoaffective (2 weeks of stable mood with psychotic symptoms….spychotic symptoms don’t happen with mood symptoms)
Schizophrenia presents earlier in (men or women)?
Persisten feelings of detachment or estrangement from oneself?
What are the acute treatment of manic episode?
lithium, valproate, carbamazepine, olanzapine
Difference between bipolar 1 and 2?
1 is manic; 2 is hypomanic
What kind of sleep changes are seen in major depressive disorder?
increased REM; decreased delta; decreased latency
What are some symptoms of atypical depression?
hypersomnia, overeating and mood reactivity (the ability to experience improved mood after positive events); SENSITIVITy to rejection
Treatment of atypical depression?
Adverse effect of ECT?
treatment for social phobia?
What is the difference between OCD and OCD personality?
OCD is ego dystonic (the person is aware of the problem and can't stop it)
Treatment for OCD?
SSRI and clomipramine
Timeframe for PTSD vs Acute Stress Disorder?
Treatment for GAD?
Difference between conversion disorder and adustment disorder?
conversion involves somatoform symptoms (both caused by acute stress)
Munchausen's syndrome by proxy?
illness in a child is caused by the cargiver so the caregiver can gain attention
Complaints for somatization disorder?
4 pain, 2 GI, 1 sexual, 1 pseudoneurological
In personality disorder, are people aware of the problem?
3 clusters of personality disorders?
weird (A - schizoid, schizotypal, paranoid) Wild (B - antisocial, histrionic, borderline, narcissitic) Worried (C - dependant, avoidant, OCD)
What is the major defense mechanism in paranoid personality disorder? Borderline?
Content with social isolation (avoidant vs schizoid)?
Gender identity disorder?
cross-gender identification (discomfort with one's sex)
difference between contemplation and precontemplation in overcoming substance addiction?
precontemplation = no problem; contemplation = knowing there is a problem not ready to change
Withdrawal from what drug is associated with flu-like symptoms (rhinorrhea, diarrhea) ?
heroin (+ piloerection and mydriasis)
Treatment for nicotine ?
2 most immediate symptoms of marijuana use?
tachycardia and conjunctival injection
Best treatment for anorexia/bulemia?
SSRI (no buproprion - may decrease seizure threshold)
What is buspirone?
5HT1 agonist (used in GAD); also D2 antagonist > can cause increased prolactin + possible parkinsonian symptoms
a2-antagonist; 5-HT2 antagonist and 5-HT3 antagonist (sedation and increased apetite + anticholinergic activity)
Drug for migraine and cluster headaches acts at what receptor?
5HT1b and d (sumitriptan)
ondansetron (all setrons)
Migraine medication associated with retroperitoneal fibrosis + serotonin atagonist?
Methylsergide (sumitriptan also a serotonin inhibitor)
treatment of depression with insomnia?
mirtazapine (a2 blocker + serotonin blocker)
Antipsychotics (traditional) high potnecy and low potency?
Hal Flu 3 High (haloperidol; fluphenazine; trifluoperazine); Low Close Thighs (Chlorpromazine; thioridazine)
What is increased in the cell by typical antipsychotics?
cAMP (block D2…MAD2s)
Treatment of neuroleptic malignant syndrome?
dantrolene and bromocriptine
Deposits in the eye in chlorpromazine and thioridazine?
chlorpormazine = corneal; thioridazine = retinal
What serotonin receptor is primarily blocked by atypical antipsychotics?
TCA (also doexepine)
Major function of TCA?
blocks reuptake of NE and SERT
Which tricyclic is least sedating
Treatment of fibromyalgia?
What are the 3 Cs of toxicity in TCA?
convulsions, Coma, Cardiotoxicity (arrythmia) - treat with NaBicarbonate (alkalinize)
paroxetine, fluoxetine, sertraline, citalopram (parrots flying searching for cities)
What SNRI is indicated for diabetic peripheral neuropathy?
What anti-depressant cant be taken with meperidine (opioid analgesic)?
MAO-I (trancypramine, selegeline, phenelzine, isocarboxasid)
MOA of buproprion?
NoE and Dopamine reuptake inhibitor
MOA od trazadone?
serotonin reuptake inhibitor (used for insomnia; can give priapism)
Which kidney has a longer renal vein and is taken preferentially in a living donor transplant?
What two structures does the ureter pass under?
uterine artery + ductus deferans (water under the bridge)
What is a good measure of total body water?
D2O and tritiated water
What fluid compartment is measured by inulin? Radiolabeled albumin (or evans blue)?
ECF; plasma volume
Calculation of clearance of a substance from plasma?
urine concentration * urine flow rate / plasma concentration
Best estimate for RPF?
PAH (freely filtered and secreted, clearance is > then GFR)
What is used in the filtration fraction equation (RBF or RPF)?
RPF, don’t need hematocrit (if they ask for RBF then u need HCT)
How do you convert effective renal plasma flow to renal plasma flow?
divide by .9
Do prostaglandins change filtration fraction?
NO (dilate both efferent and afferent); Angiotensin 2 only dilate efferent so will increase FF)
Which will decrease the filtration fraction (NSAIDS or ACE-I)?
ACE-I (only act on the efferent arteriole)
Calculate free water clearance?
urine - water (occupied); water(O) = U(O) * V/ Plasma(O)
How does aldosterone contribute to reabsorbing Na+?
inserts Na+ channels in the collecting ducts (increased sodium pushes K+ out)
What solutes have a Tubular fluid/plasma ratio of nearly 1 along the entire length of the tubule?
Na+ and K+
An (increase or decrease) in sodium delivery will stimulate the macula densa cells?
Which cells in the kidney make a-1 hydroxylase?
proximal tubule cells
What mechanism is V2 receptor (IP3 or cAMP)?
cAMP (on medullary collecting duct)
ANP causes an (increase or decrease) in GFR?
increase GFR (but diuresis)
6 causes of hyperkalemia (shiting of potassium out of the cell)?
insulin deficiency; B-blocker (impair Na+/K+ pump); hyperosmolarity (water pulls it out); acidosis; digitalis; cell lysis
Why does B-blocker and insulin deficiency cause hyperkalemia?
impaired Na+/ K+ pump
Which type of RTA is associated with increased risk of calcium stones (inability to excrete H+ in the collecting duct and HIGH urine pH)?
Type 1 (distal)
Which type of RTA is associated with inability of proximal tubule to reabsorb HCO3
Which atypical antipsychotic is a partial agonist at the D2 site?
Decreased tactile fremitus?
asthma and emphysema (absent in atelectasis)
Permanent knobby appearing knees and painful swelling of the tibial tuberosity?
Hypercellular glomeruli; "lumpy bumpy"; subepithelial?
Which nephritic syndrome is associated with celiacs disease/ dermatitis herpetiformis?
Berger's disease (IgA)
hyperlipidemia is associated with (nephritic or nephrotic) syndrome?
How is nephrotic syndrome associated with thromboembolism and increase risk of infection?
loss of antithrombin 3; loss of immunoglobulins
GBM thickening, subepithelial deposits; nephrotic?
nephrotic syndrome in children that responds to corticosteroids?
GBM splitting is associated with which two diseases?
Alport and MPGN 1 (MPGN2 is dense deposit within the membrane)
What nephrotic syndrome is associatedw ith C3 nephritic factor?
type 2 MPGN
Struvite stones are associated with what?
Proteus (ammonium magnesium)
(increased or decreased) pH worsens struvite stones?
Which kidney stone is radiolucent?
Risk factors for renal cell carcinoma?
smoking, obesity, cadmium, VHL (3)
Chromosome for WT1?
a-galactosidase a deficiency; accumulation of what?
ceramide trihexoside (X-linked; hypohydrosis, angiokeratome, renal insufficiency)
4 causes of renal papillary necrosis?
diabetes mellitus, acute pyelonephritis, chronic phenacetin (analgesic nephropathy is also a precursor for transitional cell carcinoma), sickle cell anemia
two drugs known to cause Fanconis syndrome?
expired tetracycline, cisplatin
What kind of kidney stones is associtaed with dialysis?
What 2 diuretics are used in gluacoma?
mannitol and acetazolamide
What diuretic can cause pulmonary edema?
Which diuretic is used for altitude sickness?
Which diuretic abolishes the medullary hypertonicity ?
Which of these is a sulfa drug (furosemide or ethacrynic acid)?
furosemide (allergy); use the other one for sulfa allergy
Which diuretic should not be used with aminoglycosides due to ototoxicity?
Which diuretics cannot be used in GOUT patietns?
furosemide and thiazides
Which diuretic is associated with elevated lipid levels and high glucose?
What diuretic can be used to treat hirsutism?
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