Important points for STEP 1

##GENERAL PRINCIPLES##
1. From which structure does the thymus arise (defective in DiGeorge syndrome)?
a. THIRD branchial pouch (Thymus = Third, and not the fourth pouch)
2. Which causes of meningitis should be considered in a child <6 month-old?
a. B group Streptococcus
b. E. coli
c. Listerina
3. All laryngeal muscles have the same embryological origin, except one. What is its
origin?
a. Branchial arch 4 (cricothyroid muscle innervated by superior laryngeal
nerve)
i. Other intrinsic laryngeal muscles originated from Branchial arch 6
(recurrent laryngeal nerve innervation)
4. What is the content of the gold standard medium to culture B. pertussis?
a. Bordet-Gengou agar = blood + potato + glycerol + cephalexin/nicotinamide
i. Regan-Lowe medium (blood + charcoal + ATB) has replaced it???
5. Which bacterial gene process is known by DNA transfer directly from one
bacterium to another?
a. CONJUGATION (conjuges contato intimo um com outro transfere)
6. What is the consequence of Giardia colonization of the duodenum?
a. Small bowel INFLAMMATION + Villous ATROPHY = malabsorption syndrome
i. Point: they do not invade the lining
7. Which two tests can be used to detect the F508 mutation of cystic fibrosis?
a. Southern blot
b. Polymerase chain reaction sequencing
8. What are the 3 types of cell able to provide the two signals necessary for Tlymphocyte activation?
a. Dendritic cells, macrophages and B-lymphocytes (all three are APCs)
i. 2 signals required: MHC-peptide recognition + CD28-B7 interaction
9. What is the structure that prevents IV dopamine from getting to the CNS?
a. Tight junctions (from astrocytes) only allows transcellular passage of
substances (wich must be LIPID soluble)

##MICROBIOLOGY##
1. What tissue is most affected by Ganciclovir side-effects?
a. Hematological pancytopenia, leukopenia, neutropenia + hemolytic
anemia!!
2. What is the treatment for 2-cm liver cyst from Echinococcus?
a. Albendazole
3. What is the major virulence factor of S. pyogenes?
a. M-protein
4. What is the major virulence factor of S. pneumonia
a. Protein A
5. What is the common unit between S. pyogenes and S. pneumonia that is S.
aureus?
a. Presence of capsule in Streptococcus (absent in S. aureus!!)

##BEHAVIOR##
6. When does sampling bias occur?
a. It occurs if factors unrelated to the aim of the study distinguish the subjects
form the rest of population so that the study cannot be generalized.
7. A child is climbing starts with alternating steps, copying circle and self-feeding.
What is the age?
a. 3 years old (and they cause use 3-word phrases)
8.

##CARDIOLOGY##
1. Polyarteritis nodosa (PAN) does not have LUNG lesions it is associated with
HbsAg
a. Differently from PAM (microscopic polyangiitis) p-ANCA
2. Which substance is responsible for the dry cough experienced by patients taking
ACEi?
a. Bradykinin elevated (up to 15% of patients)
3.

##ENDOCRINE##
1. Hyperkalemia, hypoglycemia and hyperpigmented spots should make us think on
which disease?
a. Addisons disease
2. How 17-hydroxyprogesterone level is expected to be in 21-hydroxylase deficiency?
a. Elevated
3.

##GASTROINTESTINAL##
1. Which type of diarrhea is related to pseudomembranous colitis?
a. Usually watery but small amounts of blood may be present
2. How is TIBC affected in Hemochromatosis?
a. TIBC (indirect measurement of transferrin) since there is transferrin in
states of IRON OVERLOAD (need for iron absorption in the body)
3. AST/ALT >1.5 with normal alkaline phosphatase is suggestive of what?
a. Alcoholic hepatitis

##HEMATO/ONCOLOGY##
1. How CML may possibly present with DIC over years?
a. DIC is often a prequel to Blast crisis (converts to AML M3 DIC risk)
2. How does INDIRECT coombs differ from direct coombs?
a. Indirect detects free antibodies by first adding the Antigen then the
antibody

3. What is the MOA of the drug used to prevent neutropenic fever?

a. It binds a transmembrane receptor (G-CSF = GH glycoprotein growth
factor)

##MUSCULOSKELETAL##
1. What rotator cuff muscle is responsible for lateral rotation?
a. Infraspinatus
2.

##NEUROLOGY##
1. What is the effect of activation of subthalamic nucleus in healthy brain?
a. Excitation of the globus pallidus internus
i. It is the ONLY stimulatory nuclei of the basal ganglia
2. What physiologic change is expected in a 63-yo man with hearing problems?
a. Degeneration of the proximal hair cells of the organ of corti
i. Proximal cells = thin membrane high-pitched sounds (presbycusis)
3. How does phenytoin cause megaloblastic anemia?
a. Absorption of FOLATE and increases its utilization by the body = total
folate
4. Watch out for differences between dementia vs. normal aging
a. Normal aging does not have problems paying bills, taking medication or
navigating these are all initial signs of Alzheimer disease.
5. Which tracts are affected by Subacute Combined Degeneration (by B12
deficiency)?
a. Spinocerebellar tracts
b. Corticospinal (lateral)
c. Dorsal colums
6. How do you expect to be the verbal fluency of a patient with Wernickes (left
superior and medial temporal lobe damage)?
a. Speak extremely fluently with no information (Well, this is my sister is
always here work out here to get shes looking, the three neighbors are
looking in other part)
b. https://www.youtube.com/watch?v=3oef68YabD0
7. Chorea + dementia + depression in the 3-4th decade of life, what is the diagnosis?
a. Huntigtons disease
8. Low frequency sensorineural loss + vertigo + tinnitus in 30-60 year-old patient,
diagnosis?
a. Mnire disease (endolymphatic system)
9. In severely immunocompromised patients acute altered mental status + ataxia +
visual changes should make us consider which diagnosis?
a. PML (JC virus)

##PSYCHIATRY##
1. Fluphenazine is a HIGH-POTENCY anti-psychotic association to EPS
a. Try to Fly High (Tryofluperazine, Fluphenazine, Haloperidol)
2. Sertraline + St. Johns wort may lead to Serotonin syndrome

##RENAL##
1. Goodpasture syndrome and other RPGN will have symptoms of
glomerulonephritis!!
a. We do not expect proteinuria >3.5g or other nephortic signs in these
diseases.
2.

##REPRODUCTIVE##
1. Uterine size larger than expected for age and -HCG + vaginal bleeding should
make us think about what condition?
a. Hydatiform moles
2. Disruption of which process is responsible for the development of cervical cancer?
a. Cell cycle regulation loss of p53 and Rb genes (two tumor supressors)
3. Smooth philtrum and small head is typical of which teratogen?
a. Alcohol use
4. What are the major risk factors for placenta accrete?
a. Multiple pregnancies, previous C-section and age >35 yo.
5. Symptoms of preeclampsia with <20 weeks of gestation. Diagnosis?
a. Molar pregnancy

##RESPIRATORY##
1. Which drug can cause Mast Cell stabilization and is suitable for asthma
prophylaxis?
a. Cromolyn sodium (it prevents degranulation)
2. Which pneumoconiosis can present with same histological findings of Sarcoidosis?
a. Beryliosis it has noncaseating granulomas on Biopsy.

##MISCELANEOUS##
1.