Micro/Path Flashcards
From the following list select THREE items associated with Hep C
picorna ssRNA oral-anal flavivirus dsDNA hepadna blood borne vaccination available
ssRNA
flavi
blood borne
cure available
From the following list select items associated with Hep A
picorna ssRNA oral-anal flavivirus dsDNA hepadna blood borne vaccination available
picorna
ssRNA
oral anal
vaccine available
From the following list select items associated with Hep B
picorna ssRNA oral-anal flavivirus dsDNA hepadna blood borne vaccination available
hepadna
dsDNA
blood borne
vaccination available
no cure
From the following list select items associated with Hep D
picorna ssRNA oral-anal flavivirus dsDNA hepadna blood borne vaccination available
ssRNA
blood borne
deltavirus
only coinfx w B
From the following list select items associated with Hep E
picorna ssRNA oral-anal flavivirus dsDNA hepadna blood borne vaccination available
ssRNA
oral anal
calicivirus
endemic kinda
flu virus:
family, genome, transmission
orthomyxo
ssRNA
respiratory droplets
respiratory syncytial virus:
family genome transmission
paramyxo ssRNA respiratory
bronchiolitis and pneumonia in infants
measles
family genome transmission
paramyxo, ssRNA, respiratory
measles = rubeola
mumps
family genome transmission
paramyxo, ssRNA, respiratory
mumps
rubella
family genome transmission
toga, ssRNA, respiratory
rubella (german measles)
adenovirus
adeno, dsDNA, respiratory
pharyngitis, conjunctivitis, pneumonia
rhinovirus
picorna (LIKE HEP A!), ssRNA, respiratory
common cold
HIV
retro, ssRNA, blood borne and genital
AIDS
CMV
herpesvirus, dsDNA, respiratory
mono
EBV
herpes, dsDNA, respiratory
infx mono
HSV1
herpes, dsDNA, oral
gongovostomatitis, herpes labialis
HSV2
herpes, dsDNA, genital (STD)
genital herpes
Rotaviruses are most common cause of gastroenteritis in children under 2.
Reoviruses have an icosahedral capsid composed of outer and inner protein shell with double-stranded segmented genome.
both true
reo: no envelope; icosahedral capsid; ds segmented RNA
have RNAdRNApol, replicate in c/pl
members of family:
rotaviruses and Colorado tick
non enveloped RNA viruses
reo (rota + colti)
calici (noro and sapo)
picorna (Hep A, rhino, Coxsackie A&B, polio, entero)
calici: envelope?, genome, members
no envelope; ssRNA; noro and sapo
reo: envelope? genome, members
no envelope, ds segmented RNA (THE ONLY)
rota (gastroenteritis in children <2) and Colorado tick fever
rota - which family and what causes
reo family, ds segmented RNA, causes gastroenteritis in children <2
picorna: envelope? genome, members
no envelope, ssRNA
Coxsackie A and B (B –> myocarditis); Hep A; rhino (common cold), polio
Which is a paramyxovirus which causes many respiratory infx in epidemics each winter. Common cause of bronchiolitis in infants, complicated by pneumonia in 10% of cases?
influenza
rubella
coxsackie
respiratory syncytial virus
RSV (ssRNA)
flu is orthomyxo (ssRNA)
coxsackie is picorna (ssRNA)
rubella is toga (ssRNA)
paramyxoviridae: ENVELOPED! have spikes
except RSV, have HA and NA (or fusion protein) in these spikes
paramyxoviridae: genome, envelope? members
ssRNA, envelope (spikes, NA, HA, fusion protein)
RSV, measles, mumps, paraflu
Cytopathic effect (CPE) is a single mechanism of infx.
All viruses cause CPE.
both true
both false
1 true, 2 false
1 false, 2 true
both false
not all cause CPE
CPEs:
necrosis, hypertrophy, giant cell formation, hypoplasia, metaplasia, altered shape, detachment from substrate, lysis, membrane fusion, inclusions, apoptosis
All of the following are Herpesviridae except
VZV
EBV
CMV
coxsackie (A&B)
coxsackies
are picorna (non enveloped, ssRNA)
herpesviridae are dsDNA, enveloped, replicate in nucleus
bud from Golgi!
all can establish silent infxs
DNA enveloped viruses
herpes, pox, hepadna
HSV1 latency site
trigeminal ganglion
HSV2 latency site
sacral ganglia
VZV latency site
DRG and cranial nerve ganglia
CMV latency site
endothelium and T lymphocytes
EBV latency site
memory B
vesicular rash
HSV1, HSV2, VZV
oncogenic herpesviridae
EBV and Kaposi (herpes 8)
Prions are most recently recognized and simplest infx agents, consisting of a single protein molecule
Prions contain no nucleic acid and therefore no genetic info
both true
both false
1 true, 2 false
1 false, 2 true
both true
Creutzfeldt-Jakob, mad cow
HSV2 is mainly spread through sexual contact
It cannot be spread from mother to infant during childbirth
both true
both false
1 true 2 false
1 false 2 true
1 true 2 false
of all herpesviridae, 1 and 2 recur in otherwise healthy ppl
Which of the following herpes lesions can be tx prophylactically by a vaccine?
HSV1 HSV2 VZV EBV CMV
VZV
two distinct phases: varicella (chicken pox) and zoster (shingles)
live attenuated vaccine done
Bacteriophage with ability to form stable, nondisruptive relationship within a bacterium is called a:
virulent phage
plasmid
temperate phage
phage T4
temperate phage
T4 infects E cole
plasmids: extrachoromosomal ds circular DNA with independent replication
bacterial virus
bacteriophage
cell within which virus replicates
host cell
integration into host genome without killing host
lysogenic cycle?
viral multiplication within host cell leading to destruction
lytic cycle
transfer of DNA from donor to recipient with DNA packaged in bacteriophage
transduction
transduction
transfer via bacteriophage
transformation
uptake of naked DNA
conjugation
exchange via F pili
Retroviruses contain RNA genome and reverse transcriptase.
Provirus forms as viral RNA; directly incorporated in host DNA.
both true
both false
1 true 2 false
1 false 2 true
1 true 2 false
provirus is DNA
for RNA viruses: transcription in c/pl except retroviruses and influenza
RNAdRNApol for all except retro (reverse transcriptase)
for DNA viruses: transcription in nucleus except pox
uses host DNAdRNApol
transcription of RNA viruses
in c/pl except flu and retro
viral RNAdRNApol except reverse transcriptase
transcription of DNA viruses
nucleus except pox
host DNAdRNApol
All these are enveloped RNA except rubella flu A, B, C rota measles
rota is not enveloped
do adenoviridae have envelope?
no
does papilloma have envelope? what’s the genome?
no envelope, DNA
HepC: family, genome, envelope?
flaviviridae, ssRNA, no
retroviridae: envelope?
yes
Human adenoviruses are unlikely to target CNS BECAUSE adenoviruses prefer epithelial cells for replication.
both correct and related both correct but unrelated statement correct, reason wrong statement not correct, reason correct both wrong
both correct and relatedadeno - naked dsDNA
cause pneumonia, bronchitis, conjunctivitis
FOUR items assoc with polio
reo salk vaccine polio sabin vaccine transverse myelitis picorna MME vaccine
salk (IV deactivated)
polio (destroys ventral horns, mm paralysis)
sabin (oral live attenuated)
picorna (no envelope, ssRNA)
other picorna - HepA, rhino, entero, coxsackies
largest and most complex DNA:
pox
herpes
papova
parvo
pox
smallpox
enveloped, complex non-icosahedral shape
replicates in c/pl (unlike other DNA)
requires own DNAdRNApol because of that
other DNAs: hepadna (enveloped), papova (naked), adeno (naked), herpes (enveloped)
sabin vs salk and for what
polio
sabin oral live attenuated
salk IV deactivated
segmented RNA
reo
All are picorna except
polio coxsackie entero hepadna hep A rhino
hepadna
picorna is ssRNA (naked)
hepadna is dsDNA enveloped
coxsackie A - herpangina, foot and mouth
EBV causes all except
Kaposi infx mono nasopharyngeal carcinoma Burkitt's oral hairy leukoplakia
Kaposi (which is herpes 8)
HIV1 and HIV2 are lentiviruses BECAUSE of their slowly progressive clinical effects
both true and related both true but unrelated first true second wrong 1 wrong 2 true both wrong
correct and related
enveloped with spikes
genes: enc (for envelope proteins gp120 (binding) and gp41), pol (enzymes: reverse transcriptase, protease and integrase) and gag (core proteins)
CD4
giant cell CPE
lentiviruses
HIVs
retroviruses
lenti (HIV) and onco (HTLV)
HIV enzymes
env (gp120 and 41)
pol (enzymes: reverse transcriptase, protease and integrase)
gag (core proteins)
All negative polarity except
orthomyxo
paramyxo
rhabdo
retro
retro - + polarity
+ polarity can transcribe from original RNA
- polarity need RNAdRNApol
Child; recent vaccination (vaccinia).
Malaise and fever in hx, now rash on trunk and face.
variola
VZV
CMV
HSV1
VZV
vaccinia is against chicken pox
Flu has all except
ssDNA hemagglutinin neuraminidase genetic reassortment lipoprotein coat
ssDNA
wrong, has ssRNA
orthomyxo
enveloped
hemagglutinin - attachemtn
neuraminidase - penetration
antigenic shifts: reassortment
antigenic drifts: point mutations
Reye’s
encephalopathy, contraindicated in children, aspirin
also flu!
swelling of parotids
mumps
paramyxo, ssRNA, enveloped
orchitis and deafness as complications
skin rash w. Koplik spots
measles = rubeola
paramyxo
flu-like sx and lymphadenopathy + rash on whole body
rubella (toga, enveloped ssRNA)
complications include Reye’s syndrome
influenza!
orthomyxo, enveloped ssRNA
amantadine, rimantadine
Order steps in replicative cycle of virus.
A. release by budding through host plasma membrane or plasma membrane rupture
B. Replication and viral protein production
C. Attachment through receptor
D. Assembly of new virus particles
E. Entry via receptor-mediated endocytosis or membrane fusion
F. Uncoating triggered by pH changes in endosomes
C E F B D A
growth phases: adsorption eclipse (uncoating, can't detect) synthetic (around 12 hours post-infx, assembly of particles) latent - no extracellular
Orthomyxo and Paramyxo share all except:
spherical shape ssRNA segmented RNA hemagglutinin -ssRNA
segmented
both enveloped, -ssRNA
paramyxo form syncytia
All cross placenta except:
rubella herpes HIV measles CMV
measles
reoviruses are the ONLY RNA that are double stranded
Which family includes rubi (rubella) and alpha (arthropod-borne)
picorna reo flavi calici toga
toga
rubella: flu-like, lymphadenopathy, then rash
congenital rubella - deafness, cataracts, heart defects
mumps - orchitis and deafness
Koplick = корь = rubeola aka measles
All are characteristics of Staph aureus except:
coagulase-negative Gram + causes infective endocarditis possesses surface protein A causes Toxic Shock Syndrome
coagulase-negative
Staph aureus is coagulase positive! other staphs are coagulase negative
THREE items associated with Staph aureus
protein A streptokinase causes toxic shock syndrome M protein streptolysin O causes scalded skin syndrome gas gangrene
protein A
toxic shock
scalded skin
M protein
Strep pyogenes
streptolysin
Strep pyogenes
exfoliative toxins
Staph aureus, scalded skin
botulinum neurotoxin
clostridium botulinum, botulism, mm and nn paralysis
gas gangrene
clostridium perfringens exotoxin
Predominant skin bacteria:
lactobacilli
lactic acid bacteria
Neisseria
staph
staph
other is corynebacteria
predominant oral cavity bacteria
streps, lactobacilli
predominant colon bacteria
bacteroides, lactics, enterics, clostridia
Lancefiled groupings are based on antigenic characteristics of cell wall carbohydrate called A substance.
Main pathogenic groups for humans are A, B, C, D, and G.
both true
both false
1 true 2 false
1 false 2 true
1 false, 2 true
Streps: catalase negative (unlike staphs!)
facultative anaerobes
Lancefield is classification of Streps based on C substance in cell wall (A-G pathogenic for human)
hemolysis patterns: complete beta, incomplete alpha, no gamma
beta hemolysis
complete
alpha hemolysis
incomplete (viridans?)
catalase in streps and staphs
streps -, staphs +
coagulase in staphs
all - except aureus
phases of bacterial growth
A - lag (active but not dividing)
B - log (growing and dividing exponentially, fastest most constant growth)
C - maximum stationary, some nutrients become depleted, toxic wastes accumulate
D - death - logarithmic decrease
Endotoxins are part of outer membrane of cell wall of
G+ only
G- only
both G+ and G-
neither; only in viruses
G-
endotoxin is LPS!
very pyrogenic, very potent, non-specific
Which is essential to the fx of outer membrane of G-?
protein
p-antigen receptors
coagulase
LPS
LPS
LPS = lipid A, core polysaccharide and O antigenic side chain
LPS composition
lipid A, core polysaccharide and O antigenic side chain
Detection of protein A can be used as specific id test for
strep pyrogenes
Neisseria gonorrhoeae
salmonella
staph aureus
staph aureus
Each produce hyaluronidase except:
staph aureus
strep pyogenes
bordetella pertussis
clostridium perfringens
bordetella pertussis
streps staphs and clostrs mak hyaluronidase and hymolysins
cholera and shigella make neuraminidase
which bacteria make neuraminidase
vibrio cholera and shigella dysenteriae (degrade intestinal mucosa)
Mycobacterium along with related Nocardia are classified as
coagulase +
collagenase +
acid-fast
phospholipase +
acid-fast
collagenase + is clostridium
coagulase + is only staph aureus
phospholipase + is clostridium perfringens
collagenase +
clostridium
phospholipase +
clostridium perfringens
In addition to peptidoglycan, acid fast cell wall of mycobacterium contains a large amt of glycolipids, especially _______ that make up ~60% of acid-fast cell wall
beta-lactamases
LPS
teichoic acids
mycolic acids
mycolic acids
tubercle of Ghon - primary lung lesion
teichoic acids
in G+ walls
Major factor of cariogenicity of S mutans is ability to adhere to tooth surface. Attachment achieved due to presence of extracellular glycocalyx, or:
plasma membrane
capsule
pellicle
reticulum
capsule
protects against phagocytosis, mediates adherence
Associated with G- cell wall:
thick murein layer LPS teichoic acids mycolic acids thin murein layer
LPS, thin murein
murein is cell wall PG
N-acetylmuramic acid
component of bacterial PGs
N-acetylmuramic acid
most species of lactic acid bacteria ferment glucose to galactose
lactobacillus specs frequently found in association with dental caries
both true
both false
1 true 2 false
1 false 2 true
1 false 2 true
ferment glucose into lactate (hence name)
strep is culprit in dental caries
actinomyces - root surface caries
Localized aggressive periodontitis bacteria are capnocytophaga ochraceus and
actinobacillus actinomycetemcomitans
wolinella recta
porphyromonas gingivalis
actinomyces israelii
Actinobacillus actinomycetemcomitans (Aa)
Generalized aggressive: Prevotella intermedia and Eikinella corrodens
–> rapid severe periodontal destruction around most teeth
15-25 yo
Localized aggressive: Capnocytophaga + Aa
12-19 yo
rapid and sever attachment loss at incisors and first molars + relative absence of plaque
also assoc w periodontitis in juvenile diabetes
Generalized aggressive periodontitis
15-25 yo
rapid sever generalized attachment loss
Prevotella intermedia and Eikenella corrodens
Localized aggressive periodontitis
12-19 yo
first molars and incisors, no plaque (n/ph dysfx?)
Capnocytophaga and Aa
Strep mutans grows optimally at pH < 7. It is
acidophilic acidogenic aciduric alkaliphilic neutrophilic
acidophilic
lactic acid is main enamel decalcifier
E coli is in family Enterobacteriaceae. All characteristic except:
capnophilic facultative anaerobes G- rod shaped flagellated
capnophilic
other well known enterics and Salmonella (typh) and Shigella (dysent)
Which is not characteristic of Strep pyogenes:
group A
G-
nonmotile
catalase -
G-
this is false, it’s G+
most streps are facultative anaerobes
alpha hemolytic streps
strep pneumoniae, strep viridans (endocarditis + caries)
Order phases of phagocytosis:
A. Fusion of phagosome with lysosome to form phagolysosome
B. Formation of residual body containing indigestible material
C. Formation of phagosome
D. Chemotaxis and adherence of microbe to phagocyte
E. Discharge of waste material
F. Ingestion of microbe by phagocyte
G. Digestion of ingested microbe by enzymes
D F C A G B E
Which is transferring DNA by cell-cell contact?
conjugation
ability to conjugate depends on presence of F+, coded by plasmid
Transcription occurs in:
c/pl of prokaryotes and nucleus of eukaryots
c/pl of eukaryotes and nucleus of prokaryotes
nucleus of both
c/pl of both
c/pl in prokaryotes, nucleus in eukaryotes
transcription - from DNA to short-lived mRNA
Attachment of microbes and other foreign cells to phagocytes by antibody molecules such as IgG and complement proteins such as C3b is called
conjugation
transformation
opsonization
adhesion
opsonization
two major opsonins are IgG and C3b
M protein of Strep
resistance to phagocytosis
DNAses A to D
cleaves DNA
Streptococcal pyrogenic exotoxins
many manifestations
Streptolysin O and S
lysis of blood cells
Streptokinase A and B
dissolves fibrin
hyaluronidase
breaks down hyaluronic acid
strep exotoxin A
toxic shock
strep exotoxin B
rapidly destroys tissue
Spirochetes are a principal etiologic factor in necrotizing ulcerative gingivitis.
Prevotella intermedia is the most common spirochete found in pts with this dz.
both true
both false
1 true 2 false
1 false 2 true
1 true, 2 false
ANUG: Prevotella intermedia and spirochetes (like Treponema denticola)
Prevotella is not a spirochete
Prevotella intermedia dzz
Generalized aggressive periodontitis and ANUG
All are eukaryotes except:
fungi
plants
protozoa
bacteria
bacteria
Aerobic respiration is more efficient than fermentation BECAUSE aerobic respiration utlizies metabolically derived organic acids as terminal electron acceptors.
both correct and related both correct but not related 1 true 2 false 1 false 2 true both false
1 true 2 false
Bacteria most strongly linked with localized aggressive periodontitis is
porphyromonas gingivalis
tannerella forsythia
Aa
prevotella intermedia
Aa
Anaerobic bacteria produce superoxide dismutase and catalase.
Most bacteria grow in either presence or absence of oxygen.
both true
both false
1 true 2 false
1 false 2 true
1 false 2 true
superoxide dismutase and catalase in obligate aerobes
Some G+ but never G- (like Bacillus and Clostridium) are spore formers.
Spore contains complete cope of chromosome, bare minimum of essential proteins and ribosomes and high amts of Ca bound to dipicolinic.
both true
both false
1 true 2 false
1 false 2 true
both true
One of the most common forms of traveler’s diarrhea is caused by an enterotoxin produced by
bacteroides
E coli
Neisseria
eikenella
e coli
s aureus and vibrio cholera also produce enterotoxin
DNA is generally confined to
nucleoid
site of translation
ribosomes
storage of reserves of nutrients
inclusions
attachment to surfaces
capsulealso protective against phagocytosis
permeability barrier
plasma membrane
motility
flagella
which of the following opportunistically infects the host and utilizes exotoxin A?
Neisseria gonorrhoeae
helicobacter pylori
pseudomonas aerugonisa
staph aureus
Pseudomonas aeruginosa
G-, aerobic, has cytochrome oxidase (Fe cofactor)
Which of the following is a symbiotic relationship in which both members benefit?
parasitism
mutualism
commensalism
margination
mutualism
A missense mutation is a genetic mutation in which nucleotides are either inserted or deletd from a DNA sequene.
Translation of mRNA derived from this mutated gene results in a protein with the incorrect AA sequence
both true
both false
1 true 2 false
1 false 2 true
1 false 2 true
Shrinkage in cell size by loss of cellular substance is known as
atrophy
hypertrophy
hyperplasia
metaplasia
atrophy
Tissue transferred between genetically different members of same species is known as
autologous graft
allogeneic graft
syngeneic graft
xenogeneic graft
allogeneic graft
autologous - from self
syngeneic - genetically identical individuals
allogeneic - same species
CD4 and CD8 most of destruction in graft rejection
most common hyperacute rejection is ABO mismatch
cellular degradation by enzymes derived from sources extrinsic to the cell is known as: necrosis heterolysis autolysis apoptosis
heterolysis
Interferons are species-specific proteins.
In contrast to antibodies, interferons are virus specific but not host specific.
both true
both false
1 true 2 false
1 false 2 true
first true, second false
IFNs are non-specific for viruses but specific for host
Small polypeptides released by a cell in order to change the fx of same or another cell are called
collectins
cytokines
defensins
effector cells
cytokines
Which metabolic pathway is used to convert arachidonic acid into PGs, prostacyclin or TXAs?
lipoxygenase
pentose phosphate
HMG-CoA reductase
COX
COS
lipoxygenase - related but LTS (bronchocontrictors)
pentose phosphate - regeneration of NADH
HMG-CoA - cholesterol synthesis
phospholipase A2 splits arachidonic acid from phospholipid
Serotonin (5 HT) is a preformed vasoactive mediator with actions similar to
heparin
thrombin
ACh
histamine
histamine
synthesized from tryptophan
Histamine is released largely by
m/ph enteroendocrine cells lymphocytes n/ph mast cells
mast cells
two major vasoactive amines are histamine and serotonin
anaphylaxis, dilation of arterioles, increased permeability of venules
All about plasmin are correct except:
also called fibrinolysin
proteolytic enzyme derived from plasminogen
essential in blood clot dissolution (fibrinolysis)
component of non-specific immune system
most important fibrinolytic protease
immune
Autoimmune dz impairs fx of cells in kidney that produce renin. Which product of adrenal cortex is affected?
Angiotensinogen angiotensin I angiotensin II angiotensin converting enzyme aldosterone
aldosterone
angiotensinogen is constantly circulating
converting enzymes - in lungs
Cytochromes are found in m/ch inner membrane of prokaryotes.
M.ch electron transport proteins are clustered into complexes I, II, III and IV
both true
both false
1 true 2 false
1 false 2 true
1 false 2 true
I - FMN
II - CFAD
III - CoQ cytochrome c
IV - cytochrome c oxidase (components are cytochromes a)
cytochrome oxidase is terminal enzyme
Which interleukin favors TH-1 type responses and counteracts IL-10?
IL-1
IL-2
IL-6
Il-12
IL-12
m/ph IL
IL-1, promotes inflammation
IL that stimulates proliferation and activation of T and B
IL-2
IL that promotes B activation and IgE antibodies
IL-4
IL that causes B cells to produce IgA
IL-5
stimulates eosinophils
IL that produces fever
IL-6
IL that inhibits TNF and IL-12 and suppresses inflammatory rxns and TH-1
IL-10
stimulates hematopoiesis
IL-3
can induce apoptosis
TNF alpha
simulates IL-2 secretion, induces fever
IL-1
stimulates T-killers
IL-2
stimulates chemotaxis and adhesions of neutrophils
IL-8 sticky
bacterial cell wall component susceptible to lysozyme is
LPS
teichoic acid
lipoprotein
peptidoglycan
peptidoglycan
Which is site of mRNA attachment and AA assembly?
nucleolus lysosomes plasma membrane Golgi ribosomes
ribosomes
catalase and other enzymes that break down hydrogen peroxide are located in
lysosomes
inclusion bodies
microbodies
centrioles
microbodies (eg peroxisomes)
superoxide dismutase catalase glutathione peroxidase ceruloplasmin transferrin
All are potential characteristics of T cells except
CD3+ CD4+ CD8+ antigen recognition requires MHC proteins frontline phagocytic cells
frontline phagocytic cells
this is wrong
CD3 is for T-cell receptor recognition of MHC
Surface membrane Ig is a marker for
mature T
n/ph
mature B
monocytes
mature B
IL-2 potentiates natural killers
CD8+ release perforins and induce apoptosist cells - cell-mediated immunity
Surgical wound closed by sterile suture would heal by
first intention
second intention
third intention
keloid formation
first intention
inflammation without infx
second closes without suture, too large, edges don’t approximate, via granulation and filling with connective tissue
1 vs 2 determined by type of wound
third - with scar
Susceptibility to teratogens is specific for each developmental stage BECAUSE teratogens are dose dependent
both true but unrelated
maternal infx: TORCH
toxo other rubella CMV HSV
critical phase is first trimester
Sxx of sepsis include all except
fever weakness painful urination nausea vomiting
painful urination
cytokines of sepsis: TNF and IL-1
Which organ has a remarkable capacity to regenerate?
heart
brain
lungs
liver
liver
M/ph is dominant cellular player in chronic inflammation.
Mononuclear phagocyte system (reticuloendothelial system) concists of closely related cells of bone marrow origin, including blood monocytes and tissue macrophages.
both true
Order sequence of healing.
a. Epithelial bridges cross the wound.
B. Inflammation subsides and blanching begins.
C. Clotted blood covers incision and n/ph accumulate at wound margins
D. Connective tissue bridges the wound
E. Inflammatory cells are entirely absent
F. Granulation tissue fills the incision space
C A F D B E
inflammation absent after 1 month
Each causes dermatophytosis except:
blastomyces
microsporum
trichophyton
epidermophyton
blastomyces
most effective anti-fungal is griseofulvin
All are possible characteristic of fungi except:
dimorphic
prokaryotic
septated
sporulate
prokaryotic
Fungus that produces sexual spores is
anamorph
promorph
metamorph
teleomorph
teleomorph
Fungus with asexual spores
anamorph
Endemic mycoses are fungal infx caused by dimorphic fungal pathogens Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis, Coccidioides posadasoo, and Paracocccodioides brasiliensis.
All of these agents produce primary infx in heart, with subsequent dissemination to other organs and tissues
1 true 2 false
Coccidio is respiratory
Blastomycosis too
Histoplasmosis can cause tuberculosis-like infx
Meds: amphotericin B, fluconazole
Which is opportunistic in diabetes, leukemia, sever burns or malnutrition?
aspergillosis
cryptococcosis
zygomycosis
dermatophytoses
zygomycosis
cryptococcus
meningitis, esp HIV
pigeons
aspergilllus
lungs, birds
All are superficial mycoses except
malassezia furfur aspergillus fumigatus hortae werneckii piedraia hortae trichosporon spp
aspergillus is lungs
Malaria in humans is caused by one of four protozoan species of the genus:
trichomonas
plasmodium
cryptosporidium
toxoplasma
plasmodium
most serious is falciparum
others are vivax, malariae and ovale
toxoplasma
cat feces, crosses placenta, encephalitis in AIDS
etiologix agent of amebic dysentery?
giardia lamblia
trichomonas vaginalis
balantidium coli
entamoeba histolytica
entamoeba histolytica
trophozoite - active phase, cyst - dormant
tx w metronidazole
giardia also exists in two forms
trichomonas exists only as trophozoite, STD
balantidium is largest protozoan parasite
Which is acquired by ingesting undercooked meat containing tissue cysts or food contaminated by cat feces
cryptosporidiosis
trichomoniasis
toxoplasmosis
giardiasis
toxoplasmosis
Helminths are the largest internal human parasite
helminths reproduce sexually, generating millions of eggs and larvae
both true
nematodes - round worms
trematodes - flukes
cestodes - tape worms
nematodes: hookworms, ascaris
trematodes: blood flukes (schistosome), lung flukes, intestinal/hepatic flukes
cestodes: ribbon-shaped, intestinal adult worms (no intestinal tract in these worms): taenia, diphyllobothrium
marked eosinophilia
cestodes are
tapeworms
nematodes are
roundworms (ascaris, hookworms)
trematodes are
blood flukes (schistosome)
THREE items associated with adult polycystic kidney disease:
autosomal dominant shrunken kidneys corticomedullary cysts large multicystic kidneys liver cysts hepatic fibrosis
AD
corticomedullary cysts
large multicystic kidneys
most common inherited nephropathy
for comparison, childhood PKD is recessive + hepatic fibrosis
Malignant HTN can adversely affect all major organ systems. The most susceptible is
intestines lungs heart brain kidneys
kidneys
chronic HTN leads to arteriosclerosis
Nephrolithiasis is manifested by severe spasms of pain (renal colic) and hematuria, often with recurrent stone formation.
Most commonly occurring form is strutive.
1 true, 2 wrong.
80-90% of kidney stones are Ca.
Causes of hydronephrosis include all except:
nephrolithiasis blood clot tumor in or around ureter bacterial infx pregnancy
bacterial infx
–> causes pyelonephritis
urolithiasis is Ca or oxalate or both
in gout, hyperPTH, hyperCa emia
nephrotic syndrome (glomerular dz) - all except
heavy proteinuria lipiduria hyperalbuminemia hyperlipidemia severe edema
hyperalbuminemia
albumin is lost! everything is lost, increased permeability
nephritic vs nephrotic
nephritic is inflammation, ischemia, HTN, hematuria
nephrotic is proteinuria and edema
Which is classic presentation of acute poststreptococcal glomerulonephritis?
rapidly progressing glomerulonephritis
nephroti syndrome
nephritic syndrome
nephrolithiasis
nephritic syndrome
nephritic syndrome is due to glomerular dz; CLASSIC presentation of acute poststreptococcal glomerulonephritis
Dominant intrahepatic cause of portal hypertension is
obstructive thrombosis
sever right-sided heart failure
cirrhosis
constrictive pericarditis
cirrhosis
prehepatic: obstructive thrombosis, massive splenomegaly
posthepatic: tight heart failure, pericarditis, outflow obstruction (Budd-Chiari)
four major clinical consequences are: ascites; portosystemic shunts; congestive splenomegaly; hepatic encephalopathy, upper GI bleeds
posthepatic portal HTN causes:
hepatic vein obstruction, right side failure, pericarditis
sequelae of portal HTN
ascites, splenomegaly, hepatic encephalopathy, portosystemic shunts,
upper GI bleeds
prehepatic portal HTN causes
thrombosis, splenomegaly
Ascites is accumulation of excess fluid in pleural cavity.
In 85% cases, ascites is caused by cirrhosis.
1 false, 2 true
peritoneal accumulation
Aside from xanthomas and pruritis, other manifestation of cholestasis is:
proteinuria
hypoBbemia
albuminemia
jaundice
jaundice
Most common symptom of hepatocellular carcinoma is:
abdominal pain confusion wt loss impotence nausea
abdominal pain
Hep C - 80% cases with cirrhosis
Hep B - without cirrhosis
viral incubation generally 2-8 wks
THREE items associated with hepatitis B
fecal-oral transmission IV drug abuse anti-HAV IgM anti-delta agent antibody perenteral transmission HBsAg
IV, parenteral, HBsAg
HBsAg - first positive marker of acute infx
most pts recover fully
no association of HepA with HCC (yes for B and C)
All are characteristics or sequelae of cirrhosis except:
fibrous septae more prevalent in females parenchymal regeneration portal HTN hepatocellular carcinoma
more prevalent in females
this is false; twice as common in men
cirrhosis: nodules + fibrosis
most common cause - alcohol abuse
which type of emphysema is associated with aging and alpha1-antitrypsin deficiency?
paraseptal (distal acinar)
centriacinar (centrilobular)
panacinar (panlobular)
irregular
panacinar (panlobular)
emphysema = irreversible enlargement of airspaces DISTAL to terminal bronchiole + destruction of walls WITHOUT fibrosis.
lack of elastic recoil, increase in compliance
types:
centriacinar: chronic bronchitis and smoking; most common; upper lobes, respiratory bronchioles
panacinar: aging and alpha1-antitrypsin deficiency; lower loves, alveoli and acinar ducts
paraseptal (distal): spontaneous pneumothorax in young adults
emphysema + chronic bronchitis = COPD
centriacinar emphysema
most common; respiratory bronchioles; upper lobes; smoking and bronchitis
panacinar emphysema
alpha1-antitrypsin deficiency and aging; lower lobes; alveoli and alveolar ducts
COPD = which two?
emphysema + chronic bronchitis
smooth mm hyperplasia, excess mucus, inflammation in lungs
asthma
mucous gland hyperplasia, hypersecretion
chronic bronchitis
at least 3 months in at least 2 consecutive yrs
airspace enlargement, wall destruction
emphysema
airway dilation and scarring
bronchiectasis
inflammatory scarring/obliteration
bronchiolitis
Most common type of asthma, atopic asthma, is a classis example of:
type I IgE-mediated hypersensitivity
type II IgE-mediated hypersensitivity
type III IgE-mediated hypersensitivity
type IV IgE-mediated hypersensitivity
type I
atopic - with evidence of sensitization
bronchospasm, mucus hypersecretion, inflammation in lungs, smooth mm hyperplasia
chronic bronchitis
mucus hypersecretion and hyperplasia
Causes of left-sided congestive heart failure include all except:
pulmonary edema
ischemic heart dz
mitral regurgitation
myocarditis
pulmonary edema
malabsorption of fat soluble citamins is likely in most patients with:
Von Hippel-Lindau
cystic fibrosis
marfan’s syndrome
familial hypercholesterolemia
cystic fibrosis
bc impaired exocrine fxs
sweat test - diagnostic (reabsorption impaired)
Marfan typical
tall, thin, long legs and arms; connective tissue disorder
What’s caused by inhalation of carbon dust:
asbestosis
silicosis
coal worker’s pneumonia
anthracosis
anthracosis
pneumoconiosis: inhalation of inorganic dust particles; lead to fibrosis of lungs
anthracosis: carbon dust
coal workers - coal dust (C + Si); can be simple and progressive massive
silicosis - free Si dust; most common, most serious, assoc with TB
asbestosis –> diffuse interstitial fibrosis; bronchiogenic carcinoma and malignant mesothelioma of pleura
asbestosis
most malignant, diffuse interstitial fibrosis
silicosis
associated with TB, most serious and common
coal workers
Si + C; simple and progressive massive
anthracosis
C
Interstitial pneumonia is most often caused by Strep pneumoniae.
Virulence of pneumococcus is associated with its capsular polysacch.
first false, second true
types of pneumonia:
lobar (Strep, intra-alveolar, middle age)
bronchopneumonia (wide variety of m/o, patchy, bronchioles and alveoli, elderly and infants)
interstitial (Mycoplasma or viruses; diffuse and patchy in walls, young children)
most common cause of pneumonia in young children
viruses
virulence of streps - main component
polysaccharide capsule
which is most often responsible for ling abscesses
proteus
klebsiella
staphs
pseudomonas
staph
TWO items associated with nodular melanoma
most common type of melanoma radial growth phase predominates vertical growth phase predominates Hutchinson freckle least common type of melanoma bleeding or ulceration
vertical growth predominates
bleeding or ulceration
melanoma is most deadly skin cancer
related to sun exposure (sunburns during childhood)
melanocytes
growth phases:
radial (initial): horizontal spread in epidermis and supf dermis; prominent lymphocyte response, no metastatic
vertical: invade deeper layers; nodule appears; metastatic potential
clinical variants: most common is supf spreading (large flar, pigmented, mostly radial)
nodular is most aggressive, poorest prognosis, mostly vertical
lentigo - radial growth, Hutchinson freckle
acral-lentiginous - least common, on palm or sole; maybe not sun-related
most aggressive melanoma
nodular, vertical
most common melanoma
superficial, radial
Hutchinson freckle
lentigo melanoma
All are symptoms of pheochromocytoma except:
bradycardia HTN headaches palpitations diaphoresis
bradycardia
pheochromocytomas - chromaffin cells; catecholamines
Most aggressive lung tumors, metastasize widely and are virtually incurable by surgical means:
epidermoid (squamous cell)
adenocarcinoma
small cell (oat cell)
large cell (anaplastic)
small cell (oat cell)
epidermoid (squamous cell): near hilus, related to smoking and men
adenocarcinoma:
periphery of lung, women, most common
small cell - most aggressive and highly malignant, near hilus; related to smoking
large cell(anaplastic) - variable, least common
lung cancers related to smoking
squamous cell and small cell, both near hilum
squamous is male
small cell is v malignant and aggressive
Which of these lymphomas usually involves abdominal organs and is closely linked to EBV?
non-Hodgkin Hodgkin mantle cell burkitt's follicular
burkitt’s
extra-nodal presentation is common in non-Hodgkin
Hodgkin vs non-Hodgkin
presence of Reed-Sternberg in Hodgkin
All of the following are peripheral T-cell and NK-cell neoplasms except:
mycosis fungoides/sezary syndrome
large granular lymphocytic leukemia
anaplastic large-cell lymphoma
Burkitt’s
Burkitt’s
is aggressive B
Invasion of dermis by sheets and islands of neoplastic epidermal cells, often with keratin pearls, is characteristic of:
squamous cel carcinoma basal cell carcinoma malignant melanoma nodular melanoma lentigo maligna melanoma
squamous cell
more aggressive than basal; sun exposure
often keratotic, may ulcerate
90% of malignant cancers of oral cavity
most cancers in oral cavity are
squamous cell carcinomas
Basal cell carcinomas frequently metastasize BECAUSE they are locally aggressive and can form ulceration and bleed
first wrong, second true
basal cancers are invasive but not very metastatic
characterized by palisading
most invasive cancer
basal cell
most severe skin tumor
malignant melanoma
Which is most likely to produce free radicals:
alkylating agent
UV light
virus
ionizing radiation
ionizing radiation
UV - cross-linking of bases in DNA
ionizing – free radicals
cells with high proliferation more sensitive to radiation
_____ of the coon is most common malignancy of GI tract and is a major cause of morbidity and mortality worldwide.
sarcoma
adenocarcinoma
lymphoma
adeno
small intestine is uncommon for tumors
colorectal adenocarcinoma is second only to lung cancer
sigmoid most common
Pt has prostate cancer. In addition to increase in prostate-specific antigen (PSA), which serum marker might also be elevated?
human chorionic gonadotropin
acid phosphatase
carcinoembryonic antigen-125
bence jones protein
acid phosphatase
prostate - most common cancer in men
lung cancer - most common killer on both genders
Rhabdomyosarcoma is benign neoplasm from skeletal mm.
Leiomyomas, malignant smooth mm neoplasms, are most common neoplasm in women.
both false
sarcoma is malignant
leiomyoma is most common in women but benign
All are characteristic or associations of breast cancer except:
positive family hx late menarche diet high in animal fats delayed first pregnancy obesity
late menarche
breast cancer - most common cancer; number 2 killer in women after lung
more commonly in left, outer upper quadrant
lymphatic widespread metastasis
early menarche, late menopause!
late first pregnancy (after 30)
5yr survival rate of bronchogenic carcinoma is close to:
10% 20% 50% 60% 80%
10%
bronchogenic carcinoma - leading cayse of death from cancer
directly proportional to smoking
50% inoperable at time of diagnosis
Often first signs of lung cancer are related to metastatic spread, particularly to:
liver
heart
brain
thyroid
brain
metastasis through lymphatic channels
lung cancer gender prevalence
M:F = 4:1
Hallmark of ___ is resebce of clonal malignant Reed-Sternberg cell in a lymph node biopsy or (rarely) extranodal tissue
chornic lymphocytic leukemia
non-Hodgkin lymphoma
multiple myeloma
Hodgkin lymphoma
Hodgkin
predominantly young men
commonly assoc w EBV and HIV
Palpable mass lesions on digital rectal exams. What is most likely to indicate that neoplasm is malignant?
pleomorphism atypia metastasis increased nuclear/cytoplasmic ratio necrosis
metastasis
most important characteristic that distinguishes malignant from benign
THREE items associated with multiple myeloma:
"punched-out" bone lesions hypoCaemia peak age 25-30 bence jones protein T-cell proliferation B-cell proliferation urticaria
“punched-out” bone lesions
bence jones protein
B-cell proliferation
multiple myeloma - multifocal in skeleton
chiefly in elderly, 65-70 yo
Bence-Jones - free Ig in urine
hyperCaemia bc escapes from bones
excessive growth and malfx of plasma cells in bone marrow
Which contains recognizable mature or immature cells or tissues representative of more than one germ cell layer and sometimes all three?
carcinoma
sarcoma
teratoma
APUDoma
teratoma
APUDoma - amine precursor uptake and decarboxylation - produces hormone-like substances
Which is histologic landmark of malignancy?
dysplasia
anaplasia
metaplasia
desmoplasia
anaplasia - absence of differentiation
histologic features of malignancy:
anaplasia, hyperchromatism, pleomorphism, abnormal mitosis
desmoplasia is forming fibrous stroma – firm feel on palpation
All are benign mesenchymal tumors except:
osteogenic sarcoma
lipoma
fibroma
chondroma
osteogenic sarcoma
is malignant
Ewing sarcoma family of tumors encompasses Ewing sarcoma and primitive neuroectodermal tumor (PNET), which are primary malignant small round-cell tumors of bone and soft tissue.
Ewing sarcoma and PNET together account for 6-10% of primary malignant bone tumors and follow osteosarcoma as second most common group of bone sarcomas in children.
both true?
malignant bone tumors
osteosarcoma and Ewing/PNET, in children
All are benign except:
adenoma fibroma carcinoma hemangioma lipoma
carcinoma
in general, benign tumors are well-differentiated
anaplasia (lack of differentiation) is characteristic of malignant tumors
Tumor from osteoclasts and osteoblasts
osteogenic sarcoma
On surface of bone instead of interior
parosteal osteogenic sarcoma
Malignant tumor from cartilage
Chondrosarcoma
Most commonly in long bones, especially knee
malignant giant cell tumor
Which bone tumor of nonosseous origin is characterized by constipation and visual disturbances?
Ewing
fibrosarcoma
chordoma
none
chordoma
Ewing - from bone marrow
chordoma - from notochord
Which is a cutaneous disorder marked by hyperkeratosis and pigmentation of axilla, neck, flexures and anogenital region?
dermatofibroma seborrheic keratosis acrochordon acanthosis nigricans actinic keratosis
acanthosis nigricans
most pts have cancer
dermatofibromas - benign nodules, accumulation of fibrobalsts
acrochordon - skin tag (neck, armpit, groin)
actinic keratosis - premalignant, sunlight
seborrheic keratosis - warts in older people
Melanoma in vertical growth that has invaded 1.5 mm into dermal layer has a higher metastatic potential than melanoma in horizontal growth phase.
Prognosis is best determined by measuring diameter of lesion.
first true, second false
prognosis determined by vertical growth
horizontal growth – no metastatic potential
Schilling test may be used to detect:
folate deficiency
aplastic anemia
pernicious anmia
myelophthisic anemia
pernicious anemia
pernicious is B12 deficient megaloblastic anemia
Schilling tests for B12 absorption
stomatitis and atrophic glossitis are common
megaloblastic pernicious erythrocytes are macrocytic and hyperchromic
Arterial or cardiac thrombi usually begin at sites of turbulence or endothelial injury.
Venous thrombi tend to grow retrograde from point of attachment.
1 true, 2 false
Virchow’s triad for thrombus formation: endothelial injury, stasis or turbulence, hypercoagulability.
All thrombi grow towards heart! Arterial retrograde, venous anterograde.
Venous mostly in legs. DVT can fly to lungs.
Body structures most vulnerable to high blood pressure include all of the following except:
blood vessels small intestines brain kidneys heart
small intestine
Most common cause of secondary HTN is:
pheochromocytoma
kidney dz
hypothyroidism
hyperparathyroidism
kidney dz
THREE items associated with normocytic classification of anemia
iron deficiency thalassemias aplastic anemia anemia of chronic dz liver dz vitamin B12 and folate deficiency acute and chronic blood loss
aplastic
chronic dz
acute and chronic blood loss
Macrocytic anemias:
liver dz
B12 and folate deficiency (this is megaloblastic)
Normocytic anemias:
aplastic
chronic dz
acute and chronic blood loss
Microcytic:
iron deficiency
thalassemias
Warfarin is an effective anticoagulant that fx by its antagonistic action on:
Vit A
Vit D
Vit E
Vit K
Vit K
Most common form of erythroblastosis fetalis is ABO incompatibility, which can vary in severity.
The less common form is called Rh incompatibility, which can cause very sever anemia in the baby.
both true
erythroblastosis fetalis is when mom and baby have different blood types. Mom’s ABs attack baby’s RBCs.
Classic pentad of thrombotic thrombocytopenic purpura includes all except:
microangiopathic hemolytic anemia thrombocytopenia liver dysfx transient neurologic deficits fever renal failure
liver dysfx
Idiopathic is when low plt count
Which arteriosclerosis is characterized by calcific deposits in muscular arteries in persons older than 50?
Monckeberg medial sclerosis
atherosclerosis
hyperplastic arteriolosclerosis
hyaline arteriolosclerosis
monckeberg medial sclerosis
atherosclerosis is intimal lesions
In sickle cell anemia, globin portion is abnormal die to valine being substituted for which?
glutamine
glutamic acid
aspartic acid
glycine
glutamic acid
HbS
[in HbC, lysine replaces –> decreased plasticity of RBCs]
Flu-like symptoms but without fever. Cherry-red discoloration of skin, mucosa and tissues.
CO poisoning mercury poisoning fluoride poisoning sarcoidosis military TB
CO poisoning
affinity b/w CO and Hb is 200 stronger than with oxygen.
Hg –> renal
methanol –> blindness
Hemophilia A and von Willebrand dz both directly involve clotting factors.
Hemophilia B also directly affects clotting factor VIII.
first is true, second is false
A - 8 (classical), B - 9
all lab tests normal except: prolonged partial thromboplastin time
vWF is AD
