HIGH YIELD-Recent material from recent test-taker:

Discussion in 'USMLE STEP 1' started by Guest, Nov 4, 2006.

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    Guest Guest

    Recent material from recent test-taker:

    1. Drawing of urea cycle. Point to area where NH4 enters the cycle.
    2. What causes RBCs to form aggregates in Sickle Cell Disease?
    3. A gene product is thought to produce tRNA. What characteristic tells you that it is tRNA?
    1. presence of many modified bases
    2. 7 methyl guanine cap
    3. polyA tail

    4. Drawing of glycolytic, gluconeogenic, glycogen synthesis pathways. Point to the part of the drawing which is influenced by insulin.
    5. G proteins and second messengers
    6. Nitric oxide works thru which second messenger?
    - cGMP
    7. How would you distinguish the gene product translated from cDNA from that translated from ordinary DNA?

    Some questions on glycogen storage diseases, lysosomal diseases. They were pretty straightforward. Study the pathways well.

    Post-translational modifications, like capping and N-linked phosphorylation
    Study also about lac operon, transcription, translation.

    PHARMACOLOGY

    This section is pretty ok except for those tracings. Antibiotics, the questions still tend to focus on the action of the drug at the molecular level. So For example, how does tetracycline work? Ans: by inhibiting attachment of tRNA to the ribosome. Something like that. Study also the AIDS drugs. As usual, what action of drug at the molecular level.
    I didn't get a lot of anti-cancer drugs. Study adverse effects. Same with all drugs, study the common adverse effects. Drug for methotrexate
    1. What drug is usually given as pre-treatment for leukemia chemotherapy?
    - allopurinol
    2. Drawing of nephron. Where does this diuretic act?
    3. Which of the following anti-diuretics works by inhibiting the Na/K/2Cl transporter?
    - furosemide

    PATHOLOGY

    1. Px with signs and symptoms of Goodpasture's Disease. What would LM show of a kidney biopsy?
    -crescents
    2. Photomicrograph of a heart muscle form a patient who died of MI. Date the infarct
    3. Photomicrograph of plasma cells. Patient with lytic lesions in the vertebrae. What is the disease?
    -multiple myeloma
    4. Mechanism of I cell Disease
    5. Px who is HIV positive with CD4 count less than 200. Px presents with bloody diarrhea. Colonoscopy showed reddish lesions with crypt abscesses. What is the associated pathology?
    1. adenoCA
    2. Kaposi's sarcoma
    (I couldn't decide between these two )
    6. 2 y.o. premature infarct dies after 2 days. Picture of blood clot in lateral ventricles. Cause?
    1. SAH
    2. Berry aneurysm
    3. Intracranial bleed
    7. 57 y.o. female with back pain. Xray showed lytic lesions. What is the underlying malignancy?
    1. breast CA
    2. thyroid CA
    8. Px with Grave's disease. What is the visual field defect?
    9. 16 y.o. girl with amenorrhea, shield-like chest. What is the karyotype?
    -45 XO
    10. Px with weakness, irritability, paresthesias. Photomicrograph showing basophilic stippling. To what was he exposed?
    -lead
    11. Photomicrograph of hypersegmented neutrophils, what is the deficiency?
    - Vit B12 or folic acid

    In general, pathology is OK. Classic presentations. It would be good to be an expert in patho to recover for hateful biochem. I got several photomicrographs of RBCs in Pxs with spherocytosis, sickle cell. Picture of WBCs, lymphocytes. Familiarize yourself with monocytes, basophils, you know

    MICROBIOLOGY

    1. 25 y.o male who went hiking in the woods 2 wks ago. He was treated with a penicillin drug for throat infection. PE shows linear erythematous rashes over arms, legs, hands. What is the cause?
    - photosensitivity
    - Varicella-Zoster
    - Hypersensitivity
    (I answered photosensitivity)
    2. Px with inguinal lymphadenopathy, painless penile ulcer. What is the method of diagnosis?
    -dark field microscopy
    3. Px with annular erythematous rashes, migratory arthritis. Ab against which organism will be elevated in the Px's serum?
    - Borrelia burgdorferi
    4. Px who went on a trip to Brazil developed cardiomyopathy. What is the etiologic agent?
    - Trypanosoma cruzi
    - Leishmania braziliensis
    5. ss (+) RNA, non-encapsulated virus that causes meningoencephalitis. To what group does it belong?
    - Picornavirus
    - Coronavirus
    - Reovirus
    - Etc
    7. Px with greenish ear discharge, with a fruity smell. What is the antibiotic of choice?

    As with the other sections, micro is fine except that you have to jog your memory fast coz you're under time pressure. viruses are tricky but luckily I just got one. Know the difference between gram (+) and G (-) bugs, virulence factors of bugs esp. cholera, pertussis bugs that act thru G proteins.

    ANATOMY

    1. Px with inattention, loss of drive. Point to the lesion. (Drawing of brain)
    2. Px with injury to the knee. Point to the structure in the MRI that prevents excessive sliding of the tibia anteriorly.

    3. Hypothenar atrophy and impaired adduction of fingers. What nerve is affected?
    4. Px with difficulty doing push ups, doing wrist flexion, extension of fingers. What nerve is affected?

    Study neuroanatomy well.

    BEHAVIORAL SCIENCE

    Lots of computations on odds ratio, relative risk, Hardy-Weinberg, values for sensitivity and specificity of two studies and you will be asked to compare. May questions also about biases. The study will be described and you have to determine what is the bias of study. Questions on alpha and beta errors. Same thing as before, the study will be described and you'll be asked what error is it. Questions on what is the best thing to say to a patient given a particular situation. For this you have to study ethics. Kaplan is OK

    PHYSIOLOGY

    Most of the questions on physiology involve charts, graphs then interpret it. Acid base balance in graph. You will also be given values of lung volumes and you'll be asked what disease the px has. Obstructive vs restrictive or both obstructive and restrictive? Values of pressures and oxygen content of each heart chamber, then you'll be asked what the pathology is - ASD, VSD, TOF etc.
    Study also GI hormones, that's high yield. Graph on renal part of Kaplan that shows reabsorption curves in nephron. ( Na K Cl glucose PAH etc). They will point to a line and ask what substance that is. In my exam, high-yield are respiratory physio, renal, GI. Cardio: a lot of questions. Study the action potential of nerves and cardiac muscles well. Like ryanodine receptors

    1.What structure removes Ca from cytoplasm after contraction?
    - ryanodine receptors??
    - microtubules
    2.What is responsible for depolarization in SA node?
    - influx of Ca

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