1001-1200 Flashcards
What court case upheld the parents’ decision to forgo potentially lifesaving surgery for their infant with Down syndrome and tracheoesophageal fistula (known as the “letting nature take its course” case)?
The Infant Doe case
What are the three surrogate criteria?
- What did the patient want, 2. What would the patient say, 3. What is in the patient’s best interests
What are the four most common defense mechanisms used by obsessive-compulsive persons?
Isolation of affect, Undoing, Reaction formation, Intellectualization
What defense mechanism shifts an emotion or drive from one idea or object to another?
Displacement
What defense mechanism involves the separation of oneself from one’s experiences?
Dissociation
What mature defense mechanism substitutes socially acceptable intentions for those that are unacceptable, allowing instincts to be refocused rather than blocked?
Sublimation
The indirect expression of hostility is known as what?
Passive-aggressive behavior
What defense mechanism consists of an emotional or behavioral outburst to cover up an underlying feeling or idea?
Acting out
What is the defense methanism in which the person uses a self-serving explanation for a belief or behavior in order to avoid the stress of admitting his or her true motivation?
Rationalization
What defense mechanism involves the separation of ideas from the feelings origiinally associated with them?
Isolation
What type of smile appears at 8 weeks of age in reaction to faces?
Exogenous smile
What defense mechanism involves excessive thinking to avoid affective expression?
Intellectualization
In what stages of sleep, known as “deep sleep,” are delta waves seen on EEG?
Stages 3 and 4
In what stage of sleep, comprising 25% of total sleep time, are saw-tooth waves seen on EEG?
REM stage
What type of smile occurs when a 14-month-old baby smiles at her mother?
Preferential smile
What are the three characteristics of attention deficit hyperactive disorder (ADHD)?
- Short attention span 2. Impulsivity 3. Hyperactivity
What is the drug of choice for treating ADHD?
Methylphenidate (Ritalin)
Describe the normal bereavement period?
The person identifies with the deceased. The person has low suicidal tendencies. The period lasts for less than 6 months.
What percentage of stage 4, REM, and total sleep time is “made up” after sleep deprivation?
Stage 4-80% REM-50% Total sleep-33%
Name the reaction that appears in babies when they are temporarily deprived of their usual caretaker. (This reaction usually begins around 6 months of age, peaks around 8 months, and decreases at 12 months.)?
Separation anxiety
What are the characteristics of pathologic grief (depression)?
Greater than I year in duration, Abnormal identification with the deceased, Suicidal tendencies
What is the term used to describe ejaculation before or just after beginning a sexual encounter?
Premature ejaculation
Name the disorder: occurs during stages 3 and 4 of sleep; can’t be diagnosed until 5 years of age; occurs more often in boys; occurs at least 2x a week for at least 3 consecutive months; and causes distress or impairment in social functioning?
Enuresis (bedwetting)
In what lobe of the cerebral cortex is the visual center located?
Occipital lobe
What disorder seen in late adolescence is characterized by normal weight, cavities, calluses on the back of hands, enlarged parotid glands, esophageal scars, and electrolyte imbalances?
Bulimia
Name the level of retardation in which the person has an IQ of 35 to 49 and is considered “trainable”?
Moderate
What is the level of retardation of a person with an IQ of less than 20 who requires total care?
Profound
What are the pharmacologic effects seen sexually with: alpha-Blockers?
Impaired ejaculation
What are the pharmacologic effects seen sexually with: Serotonin?
Inhibited orgasm
What are the pharmacologic effects seen sexually with: beta-Blockers?
Impotence
What are the pharmacologic effects seen sexually with: Trazodone?
Priapism
What are the pharmacologic effects seen sexually with: Dopamine agonists?
Increased erection and libido
What are the pharmacologic effects seen sexually with: Neuroleptics?
Erectile dysfunction
What is the level of retardation of a person with an IQ of 50 to 70 who is self-supportive with help (This category includes approximately 85% of all mentally retarded persons.)?
Mild
What is the diagnosis of a child who is oblivious to the external world; has delayed language development and pronoun reversal; participates in head-banging; inflicts self-injury; and has no separation anxiety?
Autism
What is the probable diagnosis of a person who has a depressed mood and hypomania for more than 2 years (not caused by substance abuse)?
Cyclothymic (non-psychotic bipolar) disorder
What four factors are indicators of a good prognosis for a person with schizophrenia?
- Late onset 2. Acute onset 3. Presence of positive symptoms 4. Paranoid type
What form of schizophrenia has no prominent psychotic symptoms at evaluation?
Residual or treated
What disorder that carries a high mortality rate is most often associated with girls in their mid-teens who weigh less than 85% of ideal body weight, have primary or secondary amenorrhea and presence of lanugo?
Anorexia nervosa
What is the disorder associated with an abnormally and persistently elevated, expansive, or irritable mood (manic episode) that alternates with depression?
Bipolar disorder
What lobe of the cerebral cortex is responsible for emotion, memory, and language?
Temporal lobe
What neurotransmitter plays a significant role in Alzheimer’s disease and memory function, and is also responsible for erections in men?
Acetylcholine (ACh)
What lobe of the cerebral cortex is responsible for speech, personality, memory, abstract thoughts, and high-order functions?
Frontal lobe
What is the term for bilateral occlusion of the posterior cerebral arteries resulting in cortical blindness, where the patient denies he or she is blind?
Anton’s syndrome (Visual hallucinations are common in relation to occipital epileptic foci.)
What lobe of the cerebral cortex is associated with motivation, memory, emotion, violent behaviors, and social-sexual behaviors?
Limbic lobe
What hemisphere is used for language and (for most people) is the dominant hemisphere?
Left hemisphere (Left
What lobe is responsible for intellectual processing of sensory information for visual-spatial tasks?
The nondominant parietal lobe (usually the right)
What is the name of a report made from the outcome of a single clinical subject?
Case report
What is the main inhibitory neurotransmitter of the brain that is associated with anxiety?
Gamma-aminobutyric acid (GABA)
Movement disorders are associated with what dopamine pathway (what part of the brain)?
Nigrostriatal pathways (basal ganglia)
What neurotransmitter is low in depression and high in mania, is found in the locus ceruleus, and is the neurotransmitter of the sympathetic nervous system?
Norepinephrine (NE)
In which syndrome does a person present with intentionally produced physical ailments with the intent to assume the “sick role”?
Munchausen’s syndrome (factitious disorder)
What dopamine pathway is associated with the “positive” symptoms of psychosis?
Mesolimbic-cortical pathway
The tuberoinfundibular system is associated with what two hormones?
- Dopamine (prolactin inhibitory protein [PIP])-inhibits release of prolactin 2. Prolactin
In medical screening, what is the term for the proportion of truly disease-free individuals who are correctly identified as not having the disease?
Specificity
Of the number of people who are tested as being negative, the percentage that is truly negative is known as what?
Negative predictive value
What type of study looks forward in time (the subjects are followed into the future) and takes a long time to complete?
Prospective study
What type of study examines the relationship between diseases and other variables at one particular time, but not causality?
Cross-sectional study
What study reports on the outcome of a group of clinical subjects?
Case series reports
What type of study looks back in time to provide some indication of past circumstances?
Retrospective study
Of the people who tested positive, what is the term for the percentage that is actually positive for the disease?
Positive predictive value
What test is used when you have one interval data, one set of nominal data, and only two groups?
T-test
In a classic gaussian curve, what percentage of the curve is between: ± 3 standard deviations (SDs)?
99.70%
In a classic gaussian curve, what percentage of the curve is between: The mean and ± 1 SD?
34%
In a classic gaussian curve, what percentage of the curve is between: ± 1 SD and ± 2 SDs?
13.50%
In a classic gaussian curve, what percentage of the curve is between: ± 2 SDs and ± 3 SDs?
2.40%
In a classic gaussian curve, what percentage of the curve is between: ± 3 SDs?
0.15%
What is the range for a high-average IQ?
110 to 119
What test is used when you have one set of interval data and one set of nominal data with more than two groups?
One-way analysis of variance (ANOVA)
What test measures spatial construction and drawing tasks?
Benton visual retention test
What type of personality is impatient, competitive, preoccupied with deadlines, highly involved with work, and has a high prevalence and incidence of coronary attacks?
Type A personality
What test uses nominal data only and has more than 25 subjects associated with the study?
Chi square
What test uses nominal data only, uses a 2 X 2 table, and has fewer than 25 subjects?
Fischer exact test
In what two areas of learning do boys often excel?
Mathematics and visual-spatial tasks
What is the range of superior IQ?
120 to 129
What form of test shows one or more persons in ambiguous situations and then requires the patient to tell a story about what is going on in the picture?
Thematic apperception test (TAT)
Name the disorder described by the following symptoms: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, affective flattening, social dysfunction; persistence for at least 6 months?
Schizophrenia
Name the type of schizophrenia in which the person is preoccupied with delusions of persecution, frequently has auditory hallucinations, and shows little or no impairment in cognitive testing?
Paranoid schizophrenia
In what form of schizophrenia is the person child-like, primitively active but aimless, and most regressed?
Disorganized schizophrenia
Name the form of schizophrenia in which the person presents in complete stupor, has a rigid posture with violent/destructive outbursts, is mute, and has psychomotor disturbances?
Catatonic schizophrenia
What personality disorder does an estimated 75% of the total prison population have?
Antisocial personality disorder
What is the probable diagnosis of a person who suddenly and unexpectedly leaves home, cannot recall his past, and is confused about his identity?
Dissociative fugue
What form of amnesia is usually retrograde, with the patient unable to remember facts about himself?
Psychogenic amnesia (Amnesia associated with head trauma is usually antegrade.)
What is the probable personality disorder of: A person who is shy and who has always been eccentric and content to be alone?
Schizoid personality disorder
What is the probable personality disorder of: A person who seems a little odd and who has magical thinking, ideas of reference, and illusions?
Schizotypal personality disorder
How does 1-tryptophan affect sleep?
It increases REM and total sleep time.
What disorder is described by the following: associated with great apprehension and fear; the person has three or more attacks in a 3-week period; the attacks can happen “out of the blue” and can be induced; the drug of choice is alprazolam (Xanax)?
Panic disorder
In what personality disorder may a person be frequently suicidal, impulsive, have intense, unstable relationships, engage in risky behaviors, have fear of abandonment, and even self-mutilate?
Borderline personality disorder
The typical person with this disorder is an obsessive-compulsive 7-year-old boy with an elevated dopamine level, ADHD, and multiple motor/vocal tics for longer than 1 year?
Tourette’s syndrome
What medications are used to treat this disorder?
Haloperidol (Haldol), pimozide, and clonidine
What type of seizure involves no loss of consciousness, altered sensory perception, and an EEG focal spike or a spike with a slow wave pattern?
Simple partial seizure
What is the probable diagnosis of a person with fragile self-esteem who is prone to depression, has a grandiose sense of self-importance, and needs constant attention?
Narcissistic personality disorder
What type of seizure is characterized by major motor activity, loss of consciousness, and no true aura?
Grand mal seizure
Name the type of seizure in which the person smells “burning rubber,” has hallucinations and illusions, demonstrates automatism after aura, experiences focal sensory perceptions, and loses consciousness?
Complex partial seizure
What acute and reversible disease involving a thiamine deficiency is characterized by ataxia, nystagmus, and ophthalmoplegia?
Wernicke’s encephalopathy
What disorder involving a lesion of the frontal lobe (Brodmann’s area 44) is characterized by the following: there is no problem with comprehension; speech is broken, telegraphic, and ungrammatical; the person may be mute?
Broca’s aphasia
Where is the lesion if the person refuses to accept that there is a problem, neglects the left side, and has constructional apraxia?
Right parietal lobe
What disease involves a lesion of the superior temporal gyros (Brodmann’s area 22), impaired comprehension, fluent but incoherent and rapid speech, and hyperactivity, but no muscle weakness?
Wernicke’s aphasia
What is the most common dementia in persons older than 65 years of age that is more common in women, and that involves diffuse atrophy, flattened cortical sulci, senile plaques, enlarged cerebral ventricles, and neuro6brillary tangles?
Alzheimer’s disease
A lesion in what lobe of the cerebral cortex would present with euphoria, auditory hallucinations, delusions, and thought disorders?
Dominant temporal lobe lesion
What form of dementia is found in hypertensive patients, usually affects men between the ages of 60 and 70 years, is characterized by decremental or patchy deterioration in cognitive function owing to the cardiovascular disease, and is of sudden onset?
Multi-infarct dementia (vascular)
With what lesion do you see irritability and a decreased visual and music ability?
Lesion in right temporal lobe
Where is the lesion if the patient has apathy, aggression, and memory problems?
Limbic system
Where is the lesion if the patient presents with apathy, decreased drive, poor grooming, decreased attention span, and a poor ability to abstract?
Dorsal prefrontal cortex lesion
In what disease does the patient present with a history of insidious onset, worsening cognition, a normal level of consciousness, and often “sundowning”?
Dementia
What reversible disease is characterized by a rapid onset in days to weeks, fluctuating levels of consciousness, impaired memory, and visual hallucinations?
Delirium
Where is the lesion if the patient presents with fearfulness, explosive moods, decreased inhibition, withdrawal, and violent outbursts?
Orbitomedial frontal cortex lesion
What syndrome is characterized by the following: bilateral medial temporal lobe lesion, placidity, hyperorality, hypersexuality, hyperreactivity to visual stimuli, and visual agnosia?
Kliiver-Bucy syndrome
If there is a lesion in the lateral hypothalamus, how does the patient present?
With anorexia and starvation
In what chronic and irreversible disease does the patient present with thiamine deficiency, confusion, confabulations, and amnesia?
Korsakoff’s syndrome (alcohol induced amnestic syndrome)
Where is the lesion if short-term memory is spared, while long-term memory and new learning are impaired?
Hippocampus
Where is the lesion if the patient presents with hyperphagia and obesity?
Ventromedial hypothalamus
How is sleep affected in a person with alcohol intoxication?
Decreased REM sleep and REM rebound during withdrawal
What happens to REM, REM latency, and stage 4 sleep during major depression?
Increased REM sleep, decreased REM latency, and decreased stage 4 sleep, leading to early morning awakening
What aspects of sleep are affected during benzodiazepine use?
They decrease REM and stage 4 sleep
How do barbiturates affect sleep?
Rebound insomnia, Decrease in REM sleep
What is the rate-limiting step of: Glycolysis?
PFK-1
What is the rate-limiting step of: Gluconeogenesis?
Pyruvate carboxylase
What is the rate-limiting step of: TCA (Krebs) cycle?
Isocitrate dehydrogenase
What is the rate-limiting step of: Glycogenesis (glycogen synthesis)?
Glycogen synthase
What is the rate-limiting step of: Glycogenolysis?
Glycogen phosphorylase
What is the rate-limiting step of: Hexose monophosphate (HMP) shunt?
Glucose-6-phosphate dehydrogenase (G-6-PD)
What is the rate-limiting step of: Fatty acid synthesis?
Acetyl CoA carboxylase
What is the rate-limiting step of: Ã-Oxidation?
Carnithine acyltransferase I
What is the rate-limiting step of: Ketogenolysis?
HMG CoA synthase
What is the rate-limiting step of: Cholesterol synthesis?
HMG CoA reductase
What is the rate-limiting step of: Urea cycle?
Carbamoyl phosphate synthetase I
What is the rate-limiting step of: Heme synthesis?
Delta-Aminolevulinic acid (ALA) synthase
What is the rate-limiting step of: Pyrimidine synthesis?
Aspartate transcarbomylase
What is the rate-limiting step of: Purine synthesis?
Phosphoribosyl pyrophosphate (PRPP) glutamyl amido transferase
What is the only fatty acid that is gluconeogenic?
Propionic acid
Aldose reductase converts galactose to what?
Galactitol
How many ATPs are generated from glycolysis?
8
In the mitochondria, what complex is needed in order for pyruvate carboxylase to catalyze the reaction from pyruvate to OAA?
Biotin, ATP, and COZ
What is the enzyme for the oxidative reaction in glycolysis?
Glyceraldehyde dehydrogenase
What three substrates control the enzyme phosphoenolpyruvate carboxykinase (PEPCK) for the conversion of OAA to pyruvate in the cytoplasm?
- Cortisol (stimulates PEPCK) 2. Glucagon 3. Guanine triphosphate (GTP)
What is released from the reaction of phosphoenolpyruvate carboxykinase (PEPCK) for the conversion of OAA to pyruvate?
C02
What enzyme deficiency causes cataracts, galactosemia, and galactosuria?
Galactokinase deficiency
The addition of D-2,3-bisphosphoglycerate (D-2,3-BPG) to HbA does what to the 02 saturation curve?
Shifts it to the right
In what benign condition do you see excretion of large amounts of fructose after ingestion?
Essential fructosuria (fructokinase deficiency)
What is the glycolysis enzyme found only in the liver?
Glucokinase
How many ATPs are generated per acetyl CoA?
12 (Not 15-that would be the answer if you included the pyruvate to acetyl CoA step.)
What enzyme is associated with the substrate-level phosphorylation in the TCA cycle?
Succinate thiokinase
The availability of OAA and acetyl CoA regulates what pathway?
TCA cycle
What complex of the electron transport chain (ETC) is inhibited by malonate?
Complex II
What drug blocks the FO portion of the adenosine triphosphatase (ATPase) system of the electron transport chain (ETC)?
Oligomycin
In what two places is glycogen made and stored?
- Liver 2. Muscle: Liver stores are for blood glucose; muscle stores are for energy reserves.
What drug blocks the ETC by attaching itself to K+ for passage through the membrane, negating the charge gradient?
Valinomycin
At what step of the TCA cycle is FADH2 generated?
Succinate dehydrogenase (inhibited by malonate)
What inhibits complex III of the ETC?
Antimycin A
What inhibits the ATP/ADP translocase of the ETC?
Atractyloside
Thiamine pyrophosphate (TPP) is associated with what three enzymes?
- a-ketoglutarate dehydrogenase 2. Pynivate dehydrogenase 3. Transketolase
What hormone stimulates glycogen synthesis?
Insulin
Deficiency in what enzyme leads to insoluble glycogen formation?
A-1,6 transferase
The reduced nicotinamide adenine dinucleotide phosphate (NADPH) generated from the G-6-PD reaction is used exclusively for what?
Fatty acid synthesis
What enzyme requires selenium (Se) to function?
Glutathione peroxidase
What are the two essential fatty acids?
- Linoleic acid 2. Linolenic acid
What intermediate of the HMP pathway is used to generate nucleotides?
Ribose-5-phosphate
A deficiency in what enzyme causes a decrease in oxidoreductase activity in neutrophils?
G-6-PD
What are the nonoxidative enzymes of the HMP shunt?
Transketolase and transaldolase
Are the reactions they catalyze reversible or irreversible?
Reversible
A patient who presents with cardiomegaly and hepatomegaly has what glycogen storage disease?
Pompe’s disease (lysosomal glucosidase deficiency)
Very low density lipoprotein (VLDL) remnants are known as what?
Intermediate-density lipoproteins (IDLs)
What carries triacylglycerols (TAGS) and cholesterol from the diet?
Chylomicrons
What protein is required for the uptake of low-density lipoproteins (LDLs) in the peripheral tissue?
Apoprotein B-100
What 3 apoproteins are on the surface of chylomicrons?
Apoprotein B-48, C-II, and E
What protein carries free fatty acids to the liver?
Albumin
What hormone is activated in adipose tissue when blood glucose levels decrease?
Hormone-sensitive lipase
In the P-oxidation pathway, what enzyme generates the FADH2?
Acyl CoA dehydrogenase
How many ATPs are generated per acetyl CoA in [3-oxidation?
5
How many ATPs are generated per acetyl CoA from [3-oxidation if it is run through the TCA cycle?
12
What is the only organ in the body that can produce ketone bodies?
The liver (in the mitochondria)
What two tissues prefer ketone bodies over glucose?
- Heart muscle 2. Renal cortex
What enzyme is absent in the liver so that ketogenolysis cannot occur?
Thiophorase
What pathway utilizes HMG-CoA synthetase in the cytoplasm?
Cholesterol biosynthesis
What two vitamins are inactivated when they come in contact with acetaldehyde?
- Thiamine 2. Folate
What is the precursor of all sphingolipids?
Ceramide
What two sugars can be used to produce cerebrosides?
- Glucose 2. Galactose
Where does the energy for the urea cycle come from?
Fat metabolism
What are the two major carriers of nitrogen from tissues?
- Glutamine (most tissues) 2. Alanine (muscle)
What are the ketogenic amino acids?
Leucine and lysine
What is the storage form of folate?
N-methyl folate
What disease is produced by a deficiency in the enzyme tyrosinase?
Albinism (Tyrosine is converted to melanin by the enzyme tyrosinase.)
What two enzymes are blocked by lead?
- ALA dehydratase 2. Ferrochelatase
Where in the body is heme converted to bilirubin?
Reticular endothelial system (RES)
What type of bilirubin is found in neonatal jaundice?
Indirect or unconjugated
What is the primary end product of pyrimidine synthesis?
Uridine monophosphate (UMP)
All amino acids have titration plateaus at what pH values?
PH of 2 and 9
What amino acid is a good buffer at a pH of 7?
Histidine
What is the only way to increase maximum velocity (VmaY)?
Increase enzyme concentrations
What happens to affinity if you increase KÀ?
Affinity decreases (they are inversely proportional)
What two amino acids disrupt an a-helix?
- Glycine 2. Proline
What amino acid is a phenol?
Tyrosine
What enzyme requires molybdenum (Mo) as a cofactor?
Xanthine oxidase
What determines the rate of a reaction?
The energy of activation (Ea)
What substrate concentration is required to produce 1/2 Vmax?
Km
What enzyme is blocked by allopurinol?
Xanthine oxidase (“suicide inhibitor”)
What enzyme is stimulated by PTH to produce 1,25 vitamin D3?
1-a-Hydroxylase
What three organs are used to produce vitamin D?
- Skin 2. Liver 3. Kidney
What vitamin is an important component of rhodopsin?
Vitamin A
