1
USMLE Step 1 Pharmacology audio (self made)
Treonam
Treonam is a drug that is synergistic with aminoglycosides and
synergistic aminoglycosides. It works on a different binding site than
penicillin, so it doesn't cross-react with penicillin. Treonam has no
activity against gram positives or anaerobes.
Side Effects
Elevated LFTs
GI upset and skin rash
Seizures in renally insufficient patients
Disulfiram-like reaction with ethanol
Low vitamin K at high doses
Aminoglycoside nephrotoxicity and seizures at high plasma levels
Carbapenems, such as imipenem, are more likely to have seizures in
renally insufficient patients than treonam. The fourth side effect of
treonam is a disulfiram-like reaction with ethanol.
Aminoglycosides
Resistant bacteria need oxygen to uptake aminoglycosides, so they can't
be used against anaerobes. Also, resistant aminoglycosides are
gentamicin, neomycin, amikacin, tobramycin, and streptomycin.
Aminoglycosides cause mRNA misreading.
Resistance to aminoglycosides can happen via three mechanisms:
acetylation, phosphorylation, and adenylation. Acetylated and
phosphorylated are when you have an acetylation.
Clindamycin
Clindamycin inhibits translocation of the aminoacyl peptide during
protein synthesis of the 50s subunit translocation. It can also be used
to treat lung abscesses and aspiration pneumonia (above the diaphragm).
Macrolides
Macrolides are good for chlamydia, diphtheria, rocky mountain spotted
fever, and Lyme disease. They can also be used in renal failure patients.
Tetracyclines
Resistance to tetracyclines is caused by efflux or reduced influx.
Clindamycin blocks aminoacyl tRNA from binding to the ribosome.
Tacrolimus and sirolimus are macrolide side effects of macrolides.
Side Effects of Medications
Some medications can have serious side effects that should be taken into
account when considering treatment options.
Bactrim
Side effects of Bactrim include hemolytic anemia, kernicterus in
newborns, and Stevens-Johnson syndrome.
,Hemolytic anemia and granulocytopenia can be alleviated with folinic acid
supplementation and leukovorin.
Kernicterus in newborns may be caused by Bactrim or Trimethoprim
sulfamethoxazole.
Leukovorin can bypass side effects of Bactrim.
Tetracycline
Side effects of Tetracycline include photosensitivity and dizziness.
Other side effects include bone deformity in children and drug-induced
tubular obstruction.
Fluoroquinolones
Ciprofloxacin is often prescribed but can cause side effects including GI
upset, skin rash, headache, dizziness, tendonitis, tendon rupture,
phototoxicity, and seizures.
Other Medications
Allopurinol, acetazolamide, cephalosporin, methicillin, sulfonamides, and
trimethoprim are bactericidal. Sulfonamides alone are bacteriostatic.
Metronidazole can cause headaches, neurologic paresthesia, and dizziness.
Pregnancy Contraindications
There are 12 medications that are contraindicated during pregnancy,
including morphine and rifampin. Birth control drugs such as
aminoglycosides and warfarin also have side effects to be aware of.
Safety of Medications
While some medications may have serious side effects, many are safe to
use. Always consult with a healthcare professional before starting any
new medication.
2
USMLE Step 1 - Question Audiocast 1
Step 1 Audiocast
USMLE Step One Sample Test Questions
Block One, Items 1 through 46
A 25-year-old woman is brought to the emergency department one hour after
she fainted. She has had mild measurement and vaginal bleeding, sometimes
associated with lower abdominal pain, during the past 3 days. The most
common cause of secondary aim in areia is pregnancy to a 12-year-old girl
with the 1-year history of systemic lupus erythematosus.
A four-year-old boy has delayed motor development in correo athetosis. He
had normal development at birth. He chooses fingers and lips, which has
resulted in tissue loss.
A boy has arthritis. Serum and urine uric acid concentrations are
increased. Which of the following abnormalities is the most likely cause
of these findings? The most abnormalities are: (a) adenine phosphor
ribose all transference deficiency, (b) hypos anthing guanine phosphorus
,will transferase deficiency, (c) increased conversion of hypo santhi into
inosine monophosphate, or (d) phosphor i brussels cairo phosphate
synthetase deficiency? The answer is (b) hypo xanthine guansine guaninine
phosphorus.
A girl has delayed into inosine monophophophosate. The most likely cause
of this patient's condition is a small well-defined nodule in which of
the following locations? (a) Adrenal gland, (b) anterior pituitary gland,
(c) gall bladder, (d) kidney, (e) parathyroid gland, or (f) thymus? The
answer is (e). Functional parathyrorophyadoma can cause elevated
parathyoid hormone or PTH, which results in hypercalcemia and
hypophosphatemia.
The answer is (f). Salmonella and trinities. While Staph aureus is the
most common cause of hematogenous osteomyelitis and children, Salmonella
is the most frequent cause for patients with sickle cell anemia. This is
a favorite test question for USMLE.
A three-year-old boy is brought to the physician because of fever,
headache, and sores on his back and left shoulder for one day. His
temperature is 37.8 degrees Celsius or 100 degrees Fahrenheit. Treatment
with aspirin is contraindicated in this patient.
The most common diagnosis is aspirin. The diagnosis of this condition is
not to be given to this patient with aspirin. The diagnosis of this
condition is not as often as aspirin. It's not as frequently as the
diagnosis of a reye's syndrome is the reason why children do not receive
aspirin, except of course to treat Kawasaki's disease. Reye's syndrome is
characterized by vomiting, followed by liver damage, including hepatic
steatosis and hepatomegaly, and encephalopathy, beginning with
irritability and aggressive behavior and potentially progressing to coma.
The answer is (a). Decreased osteoblast activity. The effect of the
bisphosphonate drug is most likely due to the expected but beneficial
effect of this drug is the opposite of how estrogen therapy works. The
result of the drug is (a) decrease insulinlike growth factor1
concentration, (b) decreased osteo protein production, (c) increased 125
dihydroxy cholecalciferol concentration, (d) increased osteo protein
production, (e) increased osteoblast activity, or (f) increased bone
resorption. Choice (f) increased the rank l production.
The most likely diagnosis of acute renal failure is dehydration. The
symptoms began shortly after he started taking a nasal decongestant
orally for cold symptoms began to increase urinating symptoms began after
he began to urinate again. The symptoms of a man with the.
Alpha agonist decongestants and antihypertensive drugs
Alpha agonist decongestants can cause rebound congestion called rhinitis,
and are physically addictive. Antihypertensive drugs can cause
hypertension and worsened prostate problems by causing prostatic smooth
muscle constriction by causing prostate problems.
Exam tips: Nasal spray and p-values
Nasal spray and an oral medication often show up on exams. A lower p-
value means a lower acceptable likelihood of obtaining the same results
by chance, and thus significant results can be reported more confidently.
A higher p-value means a 1% false positive rate instead of a 5% false
positive rate, and the study will have more power. There is an increased
likelihood of statistically significant findings, and a lower likelihood
of a false positive rate or a type 1 error.
, Neisseria gonorrhea and immune response
Neisseria gonorrhea can change its pilis responsible for adhesion to host
cells and is the main antigen to which the host mounted immune response
responds. Prior infection does not confer long-lasting immunity for this
reason.
Clozapine vs haloperidol
The symptoms would be more likely to improve if this patient were treated
with clozapine rather than with haloperidol, as it is effective with
african flattening and adonia evolution in a fascia.
Medial medullary syndrome and tumor suppressor
The answer is a crossed finding that means a brainstem lesion left or
it's a lateral tongue right-sided or contralateral weakness. The exiting
left hypoglossal nerve has been affected within the left medulla, and the
patient's disease is the quintessential tumor suppressor as it activates
apoptosis.
HPV and antibodies
Carcinogenesis of HPV is caused by insertion of the virus into the host
DNA and production of a protein that binds with an essential p53
substrate functionally inactivating the p53.
Measles virus and antibodies
After infection with measles virus, a six-year-old boy produces
antibodies to all eight viral proteins. The antibodies to surface
antigens like Hemagglutinin are protective, and antibodies to receiving
the antibodies to researches are responsible for clumping RBC's in vitro.
Patient with Bicuspid Aortic Valve and Swollen, Painful Knee
A patient with a bicuspid aortic valve comes to the physician because of
a one week history of a swollen painful left knee. The patient has a
peptic ulcer, which we know is caused predominantly by h pylori
infection.
The answer is:
Deposition of antigen-antibody complexes post-streptococcal
glomerulonephritis is caused by the deposition of circulating immune
complexes.
The result is a type 3 hypersensitivity and a test favorite.
Progressive Epigastric Heartburn and Weight Loss
A 45-year-old man has had a three-week history of progressive epigastric
heartburn and a 4.5 kg or 10-pound weight loss. The doctor predicts
hyperacidity and gastric ulcer development. The physician also predicts
that a collaboration of proteases and urease with local tissue
destruction will cause hyperacidity and ulcers.
The diagnosis is not acute pilo nor cancer. The patient's symptoms are
not acute or cancer. It is a symptom of a disease that is not an acute
pilosia or cancer. The disease is not a disease. The diagnosis was not an
USMLE Step 1 Pharmacology audio (self made)
Treonam
Treonam is a drug that is synergistic with aminoglycosides and
synergistic aminoglycosides. It works on a different binding site than
penicillin, so it doesn't cross-react with penicillin. Treonam has no
activity against gram positives or anaerobes.
Side Effects
Elevated LFTs
GI upset and skin rash
Seizures in renally insufficient patients
Disulfiram-like reaction with ethanol
Low vitamin K at high doses
Aminoglycoside nephrotoxicity and seizures at high plasma levels
Carbapenems, such as imipenem, are more likely to have seizures in
renally insufficient patients than treonam. The fourth side effect of
treonam is a disulfiram-like reaction with ethanol.
Aminoglycosides
Resistant bacteria need oxygen to uptake aminoglycosides, so they can't
be used against anaerobes. Also, resistant aminoglycosides are
gentamicin, neomycin, amikacin, tobramycin, and streptomycin.
Aminoglycosides cause mRNA misreading.
Resistance to aminoglycosides can happen via three mechanisms:
acetylation, phosphorylation, and adenylation. Acetylated and
phosphorylated are when you have an acetylation.
Clindamycin
Clindamycin inhibits translocation of the aminoacyl peptide during
protein synthesis of the 50s subunit translocation. It can also be used
to treat lung abscesses and aspiration pneumonia (above the diaphragm).
Macrolides
Macrolides are good for chlamydia, diphtheria, rocky mountain spotted
fever, and Lyme disease. They can also be used in renal failure patients.
Tetracyclines
Resistance to tetracyclines is caused by efflux or reduced influx.
Clindamycin blocks aminoacyl tRNA from binding to the ribosome.
Tacrolimus and sirolimus are macrolide side effects of macrolides.
Side Effects of Medications
Some medications can have serious side effects that should be taken into
account when considering treatment options.
Bactrim
Side effects of Bactrim include hemolytic anemia, kernicterus in
newborns, and Stevens-Johnson syndrome.
,Hemolytic anemia and granulocytopenia can be alleviated with folinic acid
supplementation and leukovorin.
Kernicterus in newborns may be caused by Bactrim or Trimethoprim
sulfamethoxazole.
Leukovorin can bypass side effects of Bactrim.
Tetracycline
Side effects of Tetracycline include photosensitivity and dizziness.
Other side effects include bone deformity in children and drug-induced
tubular obstruction.
Fluoroquinolones
Ciprofloxacin is often prescribed but can cause side effects including GI
upset, skin rash, headache, dizziness, tendonitis, tendon rupture,
phototoxicity, and seizures.
Other Medications
Allopurinol, acetazolamide, cephalosporin, methicillin, sulfonamides, and
trimethoprim are bactericidal. Sulfonamides alone are bacteriostatic.
Metronidazole can cause headaches, neurologic paresthesia, and dizziness.
Pregnancy Contraindications
There are 12 medications that are contraindicated during pregnancy,
including morphine and rifampin. Birth control drugs such as
aminoglycosides and warfarin also have side effects to be aware of.
Safety of Medications
While some medications may have serious side effects, many are safe to
use. Always consult with a healthcare professional before starting any
new medication.
2
USMLE Step 1 - Question Audiocast 1
Step 1 Audiocast
USMLE Step One Sample Test Questions
Block One, Items 1 through 46
A 25-year-old woman is brought to the emergency department one hour after
she fainted. She has had mild measurement and vaginal bleeding, sometimes
associated with lower abdominal pain, during the past 3 days. The most
common cause of secondary aim in areia is pregnancy to a 12-year-old girl
with the 1-year history of systemic lupus erythematosus.
A four-year-old boy has delayed motor development in correo athetosis. He
had normal development at birth. He chooses fingers and lips, which has
resulted in tissue loss.
A boy has arthritis. Serum and urine uric acid concentrations are
increased. Which of the following abnormalities is the most likely cause
of these findings? The most abnormalities are: (a) adenine phosphor
ribose all transference deficiency, (b) hypos anthing guanine phosphorus
,will transferase deficiency, (c) increased conversion of hypo santhi into
inosine monophosphate, or (d) phosphor i brussels cairo phosphate
synthetase deficiency? The answer is (b) hypo xanthine guansine guaninine
phosphorus.
A girl has delayed into inosine monophophophosate. The most likely cause
of this patient's condition is a small well-defined nodule in which of
the following locations? (a) Adrenal gland, (b) anterior pituitary gland,
(c) gall bladder, (d) kidney, (e) parathyroid gland, or (f) thymus? The
answer is (e). Functional parathyrorophyadoma can cause elevated
parathyoid hormone or PTH, which results in hypercalcemia and
hypophosphatemia.
The answer is (f). Salmonella and trinities. While Staph aureus is the
most common cause of hematogenous osteomyelitis and children, Salmonella
is the most frequent cause for patients with sickle cell anemia. This is
a favorite test question for USMLE.
A three-year-old boy is brought to the physician because of fever,
headache, and sores on his back and left shoulder for one day. His
temperature is 37.8 degrees Celsius or 100 degrees Fahrenheit. Treatment
with aspirin is contraindicated in this patient.
The most common diagnosis is aspirin. The diagnosis of this condition is
not to be given to this patient with aspirin. The diagnosis of this
condition is not as often as aspirin. It's not as frequently as the
diagnosis of a reye's syndrome is the reason why children do not receive
aspirin, except of course to treat Kawasaki's disease. Reye's syndrome is
characterized by vomiting, followed by liver damage, including hepatic
steatosis and hepatomegaly, and encephalopathy, beginning with
irritability and aggressive behavior and potentially progressing to coma.
The answer is (a). Decreased osteoblast activity. The effect of the
bisphosphonate drug is most likely due to the expected but beneficial
effect of this drug is the opposite of how estrogen therapy works. The
result of the drug is (a) decrease insulinlike growth factor1
concentration, (b) decreased osteo protein production, (c) increased 125
dihydroxy cholecalciferol concentration, (d) increased osteo protein
production, (e) increased osteoblast activity, or (f) increased bone
resorption. Choice (f) increased the rank l production.
The most likely diagnosis of acute renal failure is dehydration. The
symptoms began shortly after he started taking a nasal decongestant
orally for cold symptoms began to increase urinating symptoms began after
he began to urinate again. The symptoms of a man with the.
Alpha agonist decongestants and antihypertensive drugs
Alpha agonist decongestants can cause rebound congestion called rhinitis,
and are physically addictive. Antihypertensive drugs can cause
hypertension and worsened prostate problems by causing prostatic smooth
muscle constriction by causing prostate problems.
Exam tips: Nasal spray and p-values
Nasal spray and an oral medication often show up on exams. A lower p-
value means a lower acceptable likelihood of obtaining the same results
by chance, and thus significant results can be reported more confidently.
A higher p-value means a 1% false positive rate instead of a 5% false
positive rate, and the study will have more power. There is an increased
likelihood of statistically significant findings, and a lower likelihood
of a false positive rate or a type 1 error.
, Neisseria gonorrhea and immune response
Neisseria gonorrhea can change its pilis responsible for adhesion to host
cells and is the main antigen to which the host mounted immune response
responds. Prior infection does not confer long-lasting immunity for this
reason.
Clozapine vs haloperidol
The symptoms would be more likely to improve if this patient were treated
with clozapine rather than with haloperidol, as it is effective with
african flattening and adonia evolution in a fascia.
Medial medullary syndrome and tumor suppressor
The answer is a crossed finding that means a brainstem lesion left or
it's a lateral tongue right-sided or contralateral weakness. The exiting
left hypoglossal nerve has been affected within the left medulla, and the
patient's disease is the quintessential tumor suppressor as it activates
apoptosis.
HPV and antibodies
Carcinogenesis of HPV is caused by insertion of the virus into the host
DNA and production of a protein that binds with an essential p53
substrate functionally inactivating the p53.
Measles virus and antibodies
After infection with measles virus, a six-year-old boy produces
antibodies to all eight viral proteins. The antibodies to surface
antigens like Hemagglutinin are protective, and antibodies to receiving
the antibodies to researches are responsible for clumping RBC's in vitro.
Patient with Bicuspid Aortic Valve and Swollen, Painful Knee
A patient with a bicuspid aortic valve comes to the physician because of
a one week history of a swollen painful left knee. The patient has a
peptic ulcer, which we know is caused predominantly by h pylori
infection.
The answer is:
Deposition of antigen-antibody complexes post-streptococcal
glomerulonephritis is caused by the deposition of circulating immune
complexes.
The result is a type 3 hypersensitivity and a test favorite.
Progressive Epigastric Heartburn and Weight Loss
A 45-year-old man has had a three-week history of progressive epigastric
heartburn and a 4.5 kg or 10-pound weight loss. The doctor predicts
hyperacidity and gastric ulcer development. The physician also predicts
that a collaboration of proteases and urease with local tissue
destruction will cause hyperacidity and ulcers.
The diagnosis is not acute pilo nor cancer. The patient's symptoms are
not acute or cancer. It is a symptom of a disease that is not an acute
pilosia or cancer. The disease is not a disease. The diagnosis was not an
