Windsor USMLE Pearls - Phase - 1
  
 
Dear Students:
In the last few months, we were instrumental in developing the following things.
  1. Hundreds of USMLE review folders covering the entire basic medical sciences and the practice tests
  2. WIN TEST development on our local computer systems on campus in St. Kitts and Windsor USMLE center where 144 tests in USMLE format will be conducted for our Windsor students. This program will begin on May 9th.
  3. Development of specific teaching methods for USMLE. eg: teaching concepts on topics that have been tested frequently in USMLE like O2 Dissociation curve, Cardiac Cycle etc.
  4. Development of notes on Biostatistics, Medical Ethics and many other topics where student does not spend much time and will end up with scores between 70-74 and fail the exam.
  5. Compilation of most frequently asked CT scans, X-Rays, MRI, Ultrasound, EEG and EKG in USMLE exams
  6. Introduction of WINDSOR USMLE PEARLS. This is a special USMLE point wise review for our Windsor students. This was developed based on the 800 questions that will be asked in USMLE exams conducted by ECFMG. Windsor USMLE pearls will have 25, 000 points in the first phase which is ready and for use for our students. The first phase will cover USMLE-1 and USMLE-2. Please see the attached sample of Windsor USMLE pearls. Second Phase will have 25, 000 points which will cover USMLE-1 and USMLE-2. The third phase will have 50,000 points covering USMLE-2 and USMLE-3. We want all our students to review these Windsor USMLE pearls and we guarantee you that our Windsor USMLE pearls will cover all these 800 questions in USMLE-1 and 2 offered by ECFMG. We want our students to recognize easily all the 800 questions tested by ECFMG from our Windsor USMLE pearls and should be confident and must have seen those questions in our Windsor USMLE pearls. These pearls will be available to our students for use only in campus or at Windsor USMLE center in USA.
  7. Development of our Windsor USMLE center for our Windsor students only in USA. We want our students to take 12 weeks off during clinical rotations or after graduating and rent apartment near the center by sharing with other students. This center will be open 24 hours with reading rooms, Library, computer systems, Live lecture halls, snack and coffee facilities. Students who have difficulty in reading at home or who want to use our USMLE material and do combined group studies can come to our center with 12 weeks motivation and prepare at our center which is open 24 hours and take USMLE tests and pass successfully. These benefits are for our Windsor students at no cost to them. We recommend Kaplan course and add our review to the Kaplan which will help you pass the USMLE exam easily with high scores.
We are committed to see Windsor have high USMLE pass rates and that is our ultimate goal. We will do it at any cost.
Sample
( Phase-1 will have 25000 points for USMLE-1 and 2 covering all parts of Basic and Clinical Sciences. These are the compilation of most freequently asked questions on USMLE exams )
  1. Clonidin - reduces withdrawal symptoms of smoking
  2. Plasma homocysteine - independent factor for CAD (Coronary artery disease).
  3. Aspirin - useful for primary and secondary prevention of acute MI & stroke.
  4. CAGE screening test for alcohol abuse.
  5. Doc for mild to moderate pain is Aspirin.
  6. Brufen increases the serum lithium levels.
  7. Tramadol - has beoth opoid and non opoid effects.
  8. Side effect of Codeine - constipation
  9. A test with high specificity is useful to confirm a diagnosis.
  10. a) Immunisation - primary prevention b) Cervical pap smear - secondary prevention c) Partial mastectomy or radiation therapy for localized ca breast - tertiary prevention
  11. Best means of preventing many infectious disease immunization.
  12. Rx of hyper homocysteinemia - folate and B6 vitamins.
  13. Systolic blood pressure better predictor of morbidity than diastolic BP.
  14. Drug used for chemoprophylaxis of ca breast is tamoxifen.
  15. The most important preventable cause of cancer smoking.
  16. Aspirin and other NSAIDS reduce the risk of colon cancer.[2]
  17. AUDIT (Alcohol Use Disorder identification Test).
  18. Action of NSAIDS cyclo oxygenase I inhibitors.
  19. NSAIDS with cyclo oxygenase 2 inhibitor action - celecoxib (celebrex) and roxecoxib
  20. Acetamiophen is not a NSAID because it lacks peripheral anti inflammatory effects
  21. Misoprostol, synthetic PGL E1 analogae used in Rx of peptic ulcer.
  22. Opioids: a) Full opioid agonists - Morphince, codeine, methadone and fentanyl b) Partial agonist - Buprenorphine c) Mixed agonist and antagonist - Pentazocine, butorphenol, nalbuphine d) Rx of opioid addiction methadone e) Opioid with powerful cough suppressant action codeine f) Opioid in toxic doses predisposes to seizure meperidine g) Tramadol atypical analgesic with tricyclic antidepressant action h) Tramadol should not be given with MAO l i) DOC for breakthrough pain in chronic pain syndrome fentanyl lozenges j) Rx of adverse effects of opioid is naloxone
  23. Antiepileptics used for chronic neuropathic pain and post herpetic neuralgia gabapentine, carbamazepine and phenytoin
  24. Normal rectal (or) vaginal temperature 0.50 C higher than and normal axillary temperature 0.50 C lower than oral temperature.
  25. Rectal temperature more reliable than oral temperature
  26. Normal diurnal temperature variation 10 C
  27. a) Body temperature in IL 1 induced fever seldom exceeds 41.10 C b) In hyperthermia due to heart stroke temperature exceeds 41.10 C with no diurnal variation
  28. High temperature during 1st trimester of pregnancy may cause anencephaly
  29. Temperature over 410 C is a medical emergency
[3]
1. Post operatively
  • Epinephrine and nor epinephrine levels elevated for 1 - 2 days
  • Serum cortisol levels elevated for 1 - 3 days
  • Serum ADH levels elevated for 1 week
2. Preoperative ECG is must for
  • Men over 40 years age
  • women over 50 years age
3. Canadian cardiovascular society (CCS) angina class - used to assess the severity of anginal symptoms
4. Non invasive testing for myocardial ischaemia
  • Exercise treadmill testing
  • Dipyridamole thallium scintigraphy
  • Dobutaminie stress echo cardiography
5. Clinical criteria associated with cardiac complications in patients undergoing vascular surgery
  • H/O MI
  • Q waves in ECG
  • H/O angina
  • H/O ventricular arrhythmias
  • Diabetes mellitus
6. Incidence of perioperative myocardial infarction reduced by prophylactic betablockers in immediate preoperative period.
7. Surgery is to be delayed for 3-6 months for patient with a recent M.I.
8. Hb level below or 9g/dl is associated with significant more perioperative complication.
9. Hb levels below 10 g/dl in IHD patient associated with increased perioperative mortality rate.
[4]
10. Hyperglycemia in diabetic patients during surgery due to
  • Insulin resistance
  • Increased secretion of cortisol, epinephrine, glucagon and growth hormone.
11. Ideal blood glucose level during surgery is between 100-250mg/dl.
12. Indications for intraoperative insulin
  • Type I DM
  • Type II DM on insulin
  • Type II DM on oral agents undergoing major surgical procedures.
13. Methods of administration of intraoperative insulin
  • Subcutaneous insulin (most often used)
  • Continuous IV infusion in 5-10% dextrose
  • Separate IV insulin and dextrose infusions
[5]
1. Watson and Crick base pairing of nucleic acids in DNA
Purines - Adenine and Guanine
Pyramidines- cytosine and thymine
Adenine pairs with thymine
Guanine pairs with cytosine
(in RNA, thymine is replaced by uracil)
2. Unwindins of DNA is by Helicase enzyme defects in genes encoding helicase Eg. Werner's syndromes.
3. DNA
  1. Noncoding regions introns
  2. Coding regions Exons
4. Transcription-Syntheses of RNA and DNA
  1. Enzyme involved-RNA polymerase II
  2. Translation-Syntheses of proteins form mRNA
5. Initiating codons AUG, GUG, - code for methionine.
  1. Stop codons/nonsense codons - UAA, UAG, UGA.
6. DNA replication occurs by semiconservative method.
7. Stability of chromosomes conferred by Telomeres, (the ends of chromosomes).
8. Peroxisomal diseases Eg.
  1. 1. Zellweger's syndrome
  2. Rhizomelic dwarfism
9. Programmed cell death is called apoptosis.
10. Eosinophil specific chemotaxins - IL - 5, chemokines Rantes and Eotoxin.
11. Eosinophil peroxidase (EPO) and major basic protein (MBP) are specific to eosinophils.
[6]
12. IL - 8 is chemotactic specifically for neutrophils.
13. Tertiary lymphoid organs present in skin, mucosa of pulmonary, genitourinary and gastrointestinal tracts.
[7]
1. Geriatric unit-
  1. Acute confusion
  2. Urinary incontinence
  3. Immobility
  4. falls
2. Biswanger's disedase - Dementia in elders due to subcortical arteriosclerotic encephalopathy.
3. Earliest manifestation of dementia is forgetfulness.
4. Homeostenosis - human aging
5. Diagnostic "Law of parsimony" often does not apply in geriatric medicine.
6. Frontal release sings (snout, glabellal (or) palmomental reflexes) and absent ankle jerk and vibratory sense in elderly normally.
7. Modified Hachinski ischaemic score making clinical diagnosis of vascular dementia.
8. Acetyl cholinesterase inhibitors used in Rx of early stages of alzheimer's disease donepezil and tacrine.
9. Vitamin used in Rx of alzheimer's disease high dose vitamin E.
10. MC cause of stiffness in the elderly in osteoarthritis
11. Transient causes of geriatric incontinence "DIAPERS"
  • D - Deleriums
  • I - Infection
  • A - Atrophic urethritis/vaginitis
  • P - Pharmaceuticals and psychological
  • E - Excess urine output
  • R - Restricted mobility
  • S - Stool impaction
[8]
12. MC cause of established geriatric incontinence in detrusor over activity.
13. Second MC cause of established incontinence in
  • Older women is stress incontinence (rare in men)
  • Older men is urethral obstruction
14. Least common cause of incontinence is detrusor over activity.
15. Post voiding residual (PVR) volume > 450ml detrusor underactivity.
16. The corner stone of Rx of detrusor over activity incontinence is behavioral therapy.
17. Rx of choice for stress incontinence in surgery.
18. NSAID with highest risk of causing confusion and GI bleeding is indomethacin.
19. First choice of antihypertensive in older people is low dose thiazides.
20. DOC for isolated systolic hypertension in older patients is nitrendipine.
[9] 76
1. Macrophages -
  • Lungs - alveolar macrophages
  • Liver - Kupffer cells
  • Lymph - circulating macrophages
  • Brain - microglial cells
  • Kidney - mesangial cells
2. Natural killer cells - Antibody dependent cell mediated cytotoxicity.
3. Immunoglobulin -
  • IgG - crosses placenta
  • IM - primary Response
  • Jchain - igM and igA
  • ID - excessively found on surface of immature B cells.
4. Cytokines -
  • IL - 1AND TNF - alpha secreted by activated macrophages
  • IL2, 3,4,5,6 and IFN - r - by activated T cells.
  • IL - 4 - by Mast cells
  • IL - 8 is Neutrophilic chemotactic agent
5. Autoimmunity Theories
  1. Aberrant immunity eg. IDDM [by virus]
  2. Antigen recognition
  • - eg. sequestrated Ag - sperms -
  • sharing of Ag - Rhematic fever -
  • Auto Ab development - drugs - m- dopa.
6. IgM deficiency - susceptible to blood born infections
  • Eg. Meningococi.
  • IgA deficiency - GIT and RT infection common
  • IgA deficiency caused by phenytoin and penicillamine.
7. Quinke's disease/Angioedema - C1 inhibition deficiency Rx - Danazol or EACA
[10]
8. T ½ of injected gamma globulins - 4 weeks.
9. Cyclosporin A - direct suppressive effect of B and T helper cells.
10. BRCA 1 gene associated with Ca. Breast and ovaries, BRCA 2 gene associated with Ca. Male Breast.
11. Lifraumeni syndrome - mutation of p53 tumor suppressor gene.
12. Anticancer drug used commonly in GIT malignancies - 5 fluorourail.
13. High fat diet associated with increased risk of Ca. Breast, colon, prostate and lung.
14. Procarbazine - anticancer drug with disulfiram like effect.
15. Cisplatinum causes sever nausea and vomiting and Nephrotoxicity.
16. Mitomycin causes - hemolytic uremic syndrome.
17. Hydroxy urea causes - hyperpigmentation.
18. Allopurinol causes - steven Johnson syndrome and enhances toxicity of 6 mercaptapurine.
19. Duxorubicin - cardiomyopathy.
20. Rx. of hypercalcaemia - 1. hydration 2. Biphosphonates 3. Calcitones.
21. Stiffman syndrome - associated with Ca. Breast.
22. Most common cancer associated with paraneoplastic syndrome is small cell Ca of lung.
23. Nepelometry - quantitative determination of serum immunoglobulins. (IgG, IdgA and IgM)
24. RAST - for IgE.
25. Multicolony stimulating factor - IL - 3
  • Mast cell growth factor - IL - 4
  • B-cell growth factor - IL - 5
  • B-cell differentiation factor - IL - 6
[11]
Very early B cell and T cell growth factor - IL -7, Chemotactic factor for neutrophils - IL - 8
26. MC primary immunodeficiency disorder - selective IgA deficiency.
27. Immunodeficiency in sarcoidosis
  1. Partial deficit in T cell function
  2. Intact or increase B-cell function
28. SLE-
  • Sensitive test - Antinuclear Antibody (ANA)
  • Specific test - Anti - Smith Ab and Anti - ds DNA
29. Recipients for Liver transplantation are selected on basis of
  1. ABO matching
  2. Organ size.
30. Tacrolimus (FK506) - 100 times more patent immunosuppressant drug than cyclosporine.
31. HLA and associated diseases.
  1. Ankylosing spondylytis B27, Reiter's disease B27, Salmonella arthritis B27
  2. Psoriasis vulgaris - CW6
  3. Grave's disease - DW3, DW12
  4. Diabetes mellitus - DR3, DR4
  5. ALL - A2 6. SLE - DR4
  6. Narcolepsy - DR2
32. Drug causing hypersensitivity pneumonitis - Minocycline.
33. Most effective Rx. of any allergic conditions is Avoidance.
34. Major Histocompatibility complex (MHC) chromosome 6
  1. Class I - HLA - A, B and C Class II - HLA D
35. Hypersensitivity reactions:
  1. Type I/Anaphylaxis - IgE mediated Eg. Urticaria, atopy
  2. Type II/cytotoxic - IgG/IgM mediated Eg. ITP, Myasthenia, Autoimmune hemolytic anaemia.
  3. Type III/Immune complex - IgG/IgM mediated Eg. Extrinsic allergic alveolitis, Arthus reactions, serum sickness
  4. 4. Type IV / cel mediated - T cell mediated Eg. contact hypersensitivity, Tuberculin test.
36. Transplantation
  1. Autograft - one part of the body to the other.
  2. Isograft - among twins.
  3. Allograft - same species
  4. Xenogaft - different species
37. Transplant rejection
  1. Hyperacute - immediately after revascularization
  2. Acute - within days and weeks
  3. Chronic - with in months and years.
38. Pseudo allergic reaction
  1. Not mediated by allergen - IgE reaction
  2. Direct mast cell activation occurs
  3. c) Eg: i) Redman syndrome in rapid infusion of vancomycin ii) Radiocontrast media reactions.
[13] 114
6 - Cancer
1. Serum tumour Markers:
  1. HCG - Testicular (Germ cells) carcinoma, choriocarcinoma
  2. Alphafetoprotein - Hepatocellular CA, Testicular Ca.
  3. CEA - Colorectal Ca.
  4. Neuron specific enolase ? Neuroblastoma, Ca.lung
  5. CA -125 -Ca. ovary ,CA -19-9 -Ca. colon. pancreas, CA -15-3 -Ca. Breast.
2. Erythropoeitin secreting tumors
  1. Uterine fibromyoma
  2. Cerebellar hemangioblastoma.
  3. Branchogenic ca
  4. Hepatocellur ca
  5. Renal cell ca
3. Hypercalcaemia - squamous cell type of Bronchogenic Ca.
4. Prolactin secretion (Galactorrhoea) - by Hypernephroma.
5. Acanthosis migricans by Ca.stomach, thyrotoxicosis.
6. 60 Cobalt machines, Linear accelerators - used in Teletherapy.
7. Examples of brachytherapy Caesium 137 in Ca.cervix
8. Radiomimetic drugs - nitrogen mustards
9. Spindle, poisons - plant alkaloids
10. MC side effect of cancer chemotherapy is vomiting.
51effect of alcohol excess on the anion gap (AG) increases the AG [This is due to an increase in the production of lactate (see above) and l3-hydroxybutyrate (13-*HB). Acetyl CoA, the end-product of alcohol metabolism, is in- creased in the blood and is converted in the liver into ketone bodies (AcAc and 13-*HB). Excess amounts of NADH (see above) favor the conversion of AcAc into 13-*HB. *wing to the increase in lactate and 13-*HB anions, there is an increased AG metabolic acidosis in alcoholics. See Table 6-2.]
52 effect of alcohol on uric acid levels hyperuricemia [The increase in lactate and 13- *HB anions leads to hyperuricemia, since all acids compete for secretion in the same loca- tion in the proximal renal tubules. Hyperuri- cemia may precipitate acute gouty arthritis.]
53 effect of alcohol on TG levels hypertriglyceridemia [The metabolic products of alcohol (NADH, acetate, acetyl CoA) are used by the liver to synthesize TG. The TG is packaged into VLDL (cause of a fatty liver) and released into the blood (type IV hyperli- poproteinemia).]
54 effect of cigarette smoking on ABGs . chronic respiratory acidosis, . hypoxemia; an increase in Paco2 always causes a decrease in Pao2' . increase in the A-a gradient: refers to the oxygen gradient between the alveoli and arterial blood [Smoking also increases C* levels in the blood. See Table 6-2.]
55 effect of cigarette smoking on the WBC and REC count increases total neutrophil and RBG count [The neutrophil count is increased owing to the release of catecholamines, which interfere with the synthesis of adhesion molecules. This causes the marginating pool (normally 5*% of the peripheral blood neutrophils) to enter the circulating pool of neutrophils. RECs increase owing to a hypoxemic stimu- lus for erythropoietin release, which pro- duces a secondary polycythemia.]
56 effect of volume depletion on serum BUN and albumin, Hb and Hct, and urine specific gravity . serum BUN, Hb, Hct, and albumin are all increased: due to hemoconcentration of blood from a reduction in plasma volume, . urine specific gravity is increased: ADH is released in response to volume depletion, leading to the reabsorption of free water in the collect- ing tubule and concentration of urine
57 cause of an FP syphilis serology presence of anti-cardiolipin antibodies [The test antigen in the RPR and VDRL is beef cardiolipin to which non-treponemal anti- bodies normally react in the test. Anti-cardio- lipin antibodies in patients with SLE and other disorders cross-react with the cardio- lipin in the test system, leading to an FP syphilis serology. The FTA-ABS is negative, since it measures specific treponemal anti- bodies.]
58 cause of neutropenia in African Americans normal increase in the marginating neutro- phil pool [Normally, the circulating and mar-ginating (adherent to the endothelium) pool of neutrophils is equally distributed. An in- crease in the marginating pool in African Americans is a normal variation and does not hinder neutrophil response to infection.]
59 lab test alterations in children that differ from those in adults
increased serum alkaline phosphatase: 3-5 times higher in children than in adults and due to increased osteoblast activity from ac- tive bone growth, . increased serum phos- phate: phosphate is the driving force for de- positing calcium in bone, . lower Hb: 11-12 g/dL
60 ab test results in women that significantly differ from those in men lower serum levels: * serum iron, * percent transferrin saturation, * ferritin [The above differences are secondary to menses (- 3 5-4* mL of blood loss per period), lower serum mL of blood loss per period), lower serum
61 lab test alterations in pregnancy that differ from those in non-pregnant women . two times greater increase in plasma volume than RBG mass: this results in * decrease in Hb and Hct-dilutional effect, * increase in creatinine clearance-increased plasma vol- ume, * low serum BUN-increased urine clearance, * low serum uric acid-increased urine clearance, * low serum creatinine- increased urine clearance, . increased serum alkaline phosphatase: * placental origin, * heat stable, . respiratory alkalosis: progester- one overstimulates the central respiratory center, . increased total T4 and cortisol: estro- gen increases synthesis of their binding pro- teins without altering the free hormone lev- els, . mild glucose intolerance: anti-insulin effect of hPL, . glucosuria: * lower renal threshold for glucose, * normal blood glucose
62 lab test alterations in the elderly decreased creatinine clearance: due to a * decrease in the GFR, * decrease in renal excretion of drugs (potential for nephrotoxic- ity), * decreased ability to concentrate urine, . lower Hb concentration in men: * drop in testosterone reduces erythropoiesis, * elderly men and women have the same Hb concentra- tion, . increase in serum autoantibodies: de- crease in CD8. T suppressor cells allows CD4 T helper cells to stimulate antibody produc- tion, . decreased response to skin testing with common antigens: * diminished DRH re- sponse, * cellular immunity slightly im- paired, . slight elevation in serum glucose: due to down-regulation of insulin receptors as adipose increases, . "obstructive" type of PFTs: * lower Paoz, * increased TLC and RV, * lower VC, TV, and FEVlsec, . slight increase in serum alkaline phosphatase: due to osteo- phyte formation in osteoarthritis
 
 
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