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NBDE > Micro/Path Pt 2 > Flashcards

Micro/Path Pt 2 Flashcards

1
Q

Which of the following occurs most ommonly in elferly women and is associated with postmenopausal state and estrogen deficiency?

osteogenesis imperfect
osteoporosis
myasthenia gravis
osteoarthritis

A

osteoporosis

FYI:
osteoarthritis is progressive erosion of articular cartilage
osteogenesis imperfetca - brittle bone, AD, poor teeth
myasthenia gravis - autoimmune, auroAB to ACh receptors at neuromuscular jct

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2
Q

All are features of Albers-Schonberg dz except:

anemia
multiple bone fractures
decreased bone density
blindness
deafness
A

decreased bone density

this is osteopetrosis
anemia is result of decreased marrow space
blindness, deafness and cranial nn involvement due to narrowing of neural foramina
multiple fractures

osteomalacia - vit D deficienct in adults

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3
Q

head of femur osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg
A

Perthes’ dz

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4
Q

tibial tuberosity osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg
A

Osgood-Schlatter

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5
Q

tarsal navicular bone tuberosity osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg
A

Kohler

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6
Q

intervertebral jts osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg
A

Scheuermann

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7
Q

metatarsal head osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg
A

Freiberg

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8
Q

Osteitis deformans present as a mized radiopaque and radiolucent lesion BECAUSE the mized stage of the dz features primnent osteolysis and osteogenesis

A

both true and related

osteitis deformans = Paget’s

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9
Q

Rickets occurs only in children; its typical adult counterpart is called:

osteitis fibrosa cystica
osteitis deformans
osteopetrosis
osteomalacia
osteomyelitis
A

osteomalacia

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10
Q

Order histologic stages of fracture healing:
A. Replacement of callus by lamellar bone
B Remodeling of bone to normal contour
C. Fracture
D. Replacement of granulation tissue by callus
E. Formation of granulation tissue around fractured bone cells

A

C E D A B

fat embolism often sequel of fractured bones

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11
Q

Most common viral cause of pericarditis:

mumps
influenza
herpes
HIV
coxsackie B and echo
A

coxsackie B and echo

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12
Q

Most common cause of right-sided heart failure:

left-sided heart failure
hypertension
ischemic heart disease
aortic and mitral valvular disease

A

left-sided heart failure

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13
Q

Causes of left heart failure:

A

ischemic (esp MI)
hypertension
aortic and mitral valve disease
myocardial disease

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14
Q

Which type of angina is characterized by prolonged or recurrent chest pain at rest?

stable angina
unstable angina
prinzmetal’s angina
variant angina

A

unstable

classic symptom of coronary artery disease

stable: repeated, doesn’t change in character, intensity, frequency or duration for several weeks. Predictable. Relieved by rest or vasodilators (like nitroglycerin).
unstable: variable, irregular, prolonged and recurrent at rest.

Prinzmetal’s: vasospasm, intermittent chest pain at rest.

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15
Q

Which is the first cardiac marker to increase after myocardial infarction?

creatine kinase
troponin
myoglobin
lactate dehydrogenase

A

myoglobin

MI most commonly caused by CAD.

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16
Q

Approximately 50% of cases of subacute (bacterial) endocarditis are caused by:

serratia
pseudomonas
staph aureus
strep viridans

A

strep viridans

infectious endocarditis is inflammation of heart valves

staph is most common in IV drug users

acute endocarditis - 50% is Staph
subacute - 50% is Strep viridans
fever in both

mitral valve most frequently involved

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17
Q

acute vs subacute endocarditis

A

acute is staph, subacute is strep viridans

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18
Q

most commonly encountered neck space infection is:

angioedema
Vincent’s angina
Ludwig’s angina
hereditary angioedema

A

Ludwig’s angina - extension from mandibular lower teeth into floor of mouth

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19
Q

Tetanospasmin is a neurotoxin that inactivates proteins that regulate the release of which of the following neurotransmitters?

glycine and 5-HT
NE and epi
GABA and 5-HT
5-HT and epinephrine
glycine and GABA
A

glycine and GABA

unregulated excitatory synaptic activity, spastic paralysis, no inhibition

botulotoxin prevents release of ACh –> flaccid paralysis

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20
Q

Eosinophilia is often associated with

acute infx
viral infx
tuberculosis
parasitic infx

A

parasitic infx

also allergies

n/ph: acute bacterial infx

lymphocytes: TB, viral
monocytes: TB, malaria, ricketsia

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21
Q

lymphocytosis associated with

A

viral and TB

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22
Q

monocytosis assoc with

A

TB, malaria, ricketsia

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23
Q

n/ph associated with

A

acute bacterial infx

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24
Q

Link between Reye’s Syndrome and use of:

ibuprofen
aspirin
acetaminophen
amoxicillin
diphenhydramine
A

aspirin

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25
Q

Symptoms of TB include all except:

bad cough for 3 wks or longer
pain in chest
coughing up blood or sputum
weakness or fatigue
weight gain
no appetite
chills
fever
sweating at night
A

wt gain

primary TB: Gohn focus
secondary: activation of Ghon; favors upper lobe; tubercle formation (caseous granulomas, cavitary lesions)

secondary may be spread via lymph –> military or disseminated TB

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26
Q

Rebound tenderness in lower right quadrant of abdomen is characteristic of:

cholelithiasis
ulcerative colitis
hepatocellular carcinoma
acute appendicitis

A

acute appendicitis

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27
Q

Chlamydial cervicitis, the most common sexually transmitted infection, is caused byL

C. diff

c. perfringens
c. trachomatis
c. suis
c. muridarium

A

trachomatis

gonorrhea is caused by neisseria

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28
Q

Characteristic lesion of secondary syphilis is known as:

chancre
gumma
condyloma lata
condyloma acuminatum

A

condyloma lata

syphilis caused by treponema pallidum

primary: chancre
secondary (highly infectious): maculopapular rash and condyloma lata (flat gray) on skin and mucosal surfaces
tertiary: gumma (focal nodular mass)

condyloma acuminaum is caysed by HPV

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29
Q

Encephalitis is most common caused by:

bacterial infx
viral infx
fungal infx
parasitic infx

A

viral

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30
Q

An infection is pandemic if:

it has a worldwide distribution
it is constantly present at minimal levels within a population
it occurs more frequently than normal within a population
it is highly communicable

A

worldwide

epidemic: more frequently than normal
endemic: minimal levels
highly communicable = contagious

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31
Q

Acute lymphoblastic leukemia equally affects young children and adults.

This acute leukemia is most responsive to tx.

A

1 false, 2 true.

acute lymphoblastic - most common in children, ost responsive to tx.

acute myeloid leukemia is most malignant; 90% of adult acute leukemias.

chronic lymphocytic - least malignant, slow.

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32
Q

ALL vs AML vs CLL vs CML leukemias

A

ALL - children, responsive to tx
AML - adults, 90% of leukemias, most malignant
CLL - slow
CML - Philadelphia chromosome

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33
Q

Principal organ(s) involved in acute leukemia is/are the:

bone marrow
brain
lungs
kidneys

A

bone marrow

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34
Q

Philadelphia chromosome and low levels of leukocyte alkaline phosphatase are common characteristics of:

AML
ALL
CML
CLL

A

CML

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35
Q

No definitive causes have been identified for leukemia.

Possible risk factors include genetic predisposition, environmental exposure to chemicals and radiation, and viruses.

A

both true

viruses: HTLV, EBV

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36
Q

All about immunoglobulins are true except:

secreted by activated plasma cells
also known as antibodies
have enzymatic activity
activate complement
are glycoproteins
A

have enzymatic activity

this is false

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37
Q

Injection of med to someone with allergy to it leads to:

low levels of histamine
hyperglobulinemia
systemic anaphylaxis
localized anaphylaxis

A

systemic anaphylaxis

most common cause - allergy to penicillin

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38
Q 
Cellular immunity is immunity mediated by:
B-lymphocytes
T-lymphocytes
both B and T-lymphocytes
neither B not T-lymphocytes
A

T

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39
Q

Of the anaphylatoxins, C3a is more stable and potent than C5a.

Only mast cells have receptors specific for C5a and C3a.

A

both false

C5a is more stable and potent
phagocytes, endothelial cells and mast cells have receptors for both

anaphylatoxins increase blood flow and vascular permeability

only IgG and IgM fix complement

anaphylaxis by complement components is less common than that caused by Type I (IgE-mediated) hypersensitivity

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40
Q

Exaggerated IgE response to environmental allergen (= atopy) manifests in all except:

dermatitis
rhinitis
jaundice
asthma

A

jaundice

atopic = localized Type I
atopic dermatitis = eczema
in asthma, leukotrienes
rhinitis: histamine

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41
Q

Which is most frequently used diagnostic technique for detection of antigens in tissue secretions or cell suspensions?

immunofluoresecence
agglutination
radioimmunoassay
precipitation
enzyme-linked immunosorbent assay
A

immunofluorescence

ELISA - for pt specimens, both antibodies or antigens

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42
Q

Which of the following major pathways of complement activation is triggered by the presence of infection, but does not involve antibody?

classical pathway
alternative pathway
lectin pathway

all of the above

A

alternative

lectin only specific mannose-containing PGs of bacteria

all pathways converge to C3

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43
Q

classical pathway of complement

A

Ag + AB –> C1, C4, C2 –> C3 + C5

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44
Q

alternative pathway of complement

A

infx but no AB

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45
Q

lectin pathway of complement

A

mannose in peptidoglycan

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46
Q

type I hypersensitivity

A

atopic, IgE, degranulation of mast

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47
Q

type II hypersensitivity

A

IgG-mediated cytotoxicity (–> complement or T killer)

drug allergies

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48
Q

type III hypersensitivity

A

IgG –> complement

serum sickness

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49
Q

type IV hypersensitivity

A

T-helpers (mostly Th1) sensitized, recruit destroyers

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50
Q

In passive immunity, antibodies are preformed in another host.

Passive immunity lasts as long as active immunity.

A

1 true, 2 wrong

active is slow onset but long term

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51
Q

Small molecule, not antigenic by itself, that can react with antibodies is called:

epitope
hapten
plasmid
immunogen

A

hapten

too small to eb immunogenic

epitope - specific portion of antigen to which antibody binds

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52
Q

Whicg of the following types of immunity os conferred by transferring lymphoid cells from actively immunized donor to a naïve or immunocompromised host?

acquired immunity
humoral immunity
passive immunity
active immunity
adoptive immunity
A

adoptive immunity

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53
Q

Complement system is a group of plasma proteins that attack pathogens.

These proteins are primatily synthesized by kidney.

A

First true, second wrong

mainly made by liver; C1 is made in GI epithelium

C-reactive protein - binds to bacterial in classical pathway

membrane attack complex comes after C5

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54
Q

Each of the following are associated with an anaphylactic hypersensitivity reaction except:

histamine
heparin
plt-activating factors
serotonin
dopamine
A

dopamine

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55
Q

IgM, IgA, and IgG are main antibodies present in blood, lymph and intercellular fluid in connective tissues.

IgA is also made in lymphoid tissues underlying mucosa and then selectively transported across mucosal epithelium to bind extracellular pathogens and their toxins on mucosal surfaces.

A

both true

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56
Q

Type II hypersensitivity rxns result from binding of antigen to antigen-specific IgE bound to its Fc receptor, principally on mast cells.

Type III hypersensitivity rxns are caused by small soluble immune complexes formed by soluble protein antigens binding to IgG made against them.

A

1 false, 2 true

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57
Q

THREE items associated with humoral immunity

provides immunity against extracellular pathogens
provides immunity against intracellular pathogens
mediated by T cells
mediated by antibodies produced by B cells
antibodies neutralize and eliminate pathogens and toxins

A

extracellulae
B cells
antibodies neutralize and eliminate

in contrast, cell-mediated is T against intracellular
Th activate m/ph and T-killers

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58
Q

All about MHC are true except:

plays a role in acute rejection of transplanted tissue
assist T-cells in recognition of intracellular pathogens
glycoprotein secreted by activated plasma cells
able to interact with T-cell receptor
coded by group of highly polymorphic genes

A

glycoprotein secreted by activated plasma cells

this is wrong
not secreted at all

MHCI - all cells - recognized by CD8+ - from cytosolic proteins

MHCII - only professionals (APC, m/ph, B) - CD4+ - from endocytosed proteins

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59
Q

Although many substances and preparations are know to be adjuvants, the only adjuvants approved for use in human vaccines are:

Freund’s complete adjuvant and Alum
Freund’s incomplete adjuvant and MF59
Immune stimulatory complexes and Alum
Alum and MF59

A

Alum and MF59

adjuvants allow smaller and rarer doses

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60
Q

Bacterial toxin that has been weakened until it is no longer toxic but is strong enough to induce formation of antibodies and immunity to the specific dz caused by the toxin is called:

antitoxin
antivenin
antiserum
toxoid

A

toxoid

antitoxin = antibody to toxin

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61
Q

Human HBIG to prevent Hep B in those not actively immunized with the Hep B vaccine is an example of

naturally acquired passive immunity
naturally acquired active immunity
artificially acquired active immunity
artificially acquired passive immunity

A

artificial passive

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62
Q

All contain attenuated virus except:

yellow fever
measles
rabies
mumps
rubella
A

rabies - inactivated

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63
Q

Each are live attenuated bacterial vaccines except

mycobacterium bovis
salmonella typhi
Yersinia pestis
coxiella burnetti

A

Yersinia?

has to be killed, for plague

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64
Q

Persons vaccinated against Hep B who have developed immunity are also immune to:

Hep A
Hep C
Hep D
Hep E

A

Hep D

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65
Q

THREE items associated with rheumatic fever

pancarditis
Group B streptococci
koplik spots
bullous skin lesions
aschoff bodies
Sydenham chorea
A

pancarditis
aschoff bodies
Sydenham chorea

acute rheumatoid fever - group A streps!
manifestations: migratory polyarthritis, pancarditis, subcutaneous nodules, erythema, Sydenham chorea

Aschoff bodies - foci of lymphocytes in heart

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66
Q

All are characteristics of Addison’s excepts:

hypertension
increased pigmentation of skin
hypoglycemia
increased serum K

A

hypertension

characterized by hypotension
failure of adrenocortical

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67
Q

Osteoarthritis (degenerative joint dz) is the most common type of joint disease.

Heberden nodes, bony swellings in the distal interphalangeal joints, are a characteristic morphological changes

A

both true

bone polishing
dislodged pieces of cartilage in joint space
osteophytes (bony spurs) at distal (Heberden) or proximal (Bouchard) interphalangeal joints

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68
Q

All can be classified as type of Lagerhans cell histiocytosis except:

Letterer-Siwe
Bruton
Hand-Schuller-Christian
eosinophilic granuloma

A

Bruton disease

is X-linked agammaglobulinemia

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69
Q

Primary hyperparathyroidism is most often caused by

liver dz
parathyroid adenoma
bronchogenic squamous cell carcinoma
hypoCa of chronic renal dz

A

parathyroid adenoma

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70
Q

Systemic vasculitis in which dz

polyarteritis nodosa
dermatomyositis
scleroderma
systemic lupus
rheumatoid arthritis
A

polyarteritis nodosa

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71
Q

Skin rash in which dz

polyarteritis nodosa
dermatomyositis
scleroderma
systemic lupus
rheumatoid arthritis
A

dermatomyositis

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72
Q

Widespread connective tissue fibrosis in which dz

polyarteritis nodosa
dermatomyositis
scleroderma
systemic lupus
rheumatoid arthritis
A

scleroderma

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73
Q

butterfly rash

polyarteritis nodosa
dermatomyositis
scleroderma
systemic lupus
rheumatoid arthritis
A

systemic lupus

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74
Q

stiffness of joints which dz

polyarteritis nodosa
dermatomyositis
scleroderma
systemic lupus
rheumatoid arthritis
A

rheumatoid arthritis

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75
Q

Most common demyelinating disorder?

Devic's dz
Tabes dorsalis
Optic neuritis
Multiple sclerosis
Guillain-Barre syndrome
A

multiple sclerosis

female prevalence

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76
Q

In many cases of primary amyloidosis, the pts have some form of:

m/ph dyscrasia
erythrocyte dyscrasia
hemoglobin dyscrasia
plasma cell dyscrasia

A

plasma cell dyscrasia

primary amyloidosis related to abnormal production of immunoglobulins

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77
Q

Urticaria (hives) is a common disorder of skin characterized by localized mast cell degranulation and resultant dermal microvascular hyperpermeability. This gives rise to pruritic edematous plaques called wheals.

Angioedema is closely related to urticaria and is characterized by deeper edema of both the dermis and subcutaneous fat.

A

both true

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78
Q

Type 1 diabetes is caused by a reduction in sensitivity of insulin’s target cells.

Type 1 diabetes is more common than type 2 diabetes.

A

both false

1 is autoimmune, destruction of cells and absolute deficiency of insulin
2 is resistance to insulin and is more common (90-95%)

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79
Q

THREE items associated with rheumatoid arthritis:

joint effusions
bouchard's nodes
bacterial in nature
fungal in nature
Still-s dz
osteophyte
unknown cause
A

joint effusions
Still’s dz (RA in young ppl)
unknown cause

osteophytes - in osteoarthritis, not rheumatoid!

RA: nonsuppurative proliferative

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80
Q

Which is the prototype of a systemic immune complex dz?

systemic lupus erythematosus
acute serum sickness
poststreptococcal glomerulonephritis
reactive arthritis
polyarteritis nodosa
A

acute serum sickness

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81
Q

______ hypersensitivity rxns are initiated by Ag-activated (sensitized) T lymphocytes, including CD4+ and CD8+.

type I
type II
type III
type IV

A

type IV

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82
Q

which of the following antibodies are specific for systemic lupus?

anti-Sm
Anti-Jo
anti-Ro
anti-centromere

A

anti-Sm

particularly ANA and anti-Sm specific for SLE

acrocyanosis (Raynaud’s phenomenon) often associated with SLE

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83
Q

Raynaud’s phenomenon

A

acrocyanosis., often associated with SLE

84
Q

anti-Ro

A

Sjogren

85
Q

Which of the following autoimmune disorders are caused by production of antibodies against ACh receptor which results in inhibition of neuromuscular transmission and eventual paralysis?

eaton-lambert syndrome
myyastenia gravis
graves disease
Addison's disease
hashomoto's throiditis
A

myasthenia gravis

86
Q

In phenylketonuria, tyrosine cannot be synthesized in adequate amounts.

Newborns with phenylketonuria don’t have any symptoms.

A

both true

phe is essential
tyrosine from phe

87
Q

Increased melanin pigmentation is seen in:

addison't dz
jaundice
albinism
vitiligo
hemosiderosis
A

Addison’s dz

albinism and vitiligo - decreased

88
Q

Gout is caused by defect in metabolism that results in overproduction of:

urea
ammonia
Bb
uric acid

A

uric acid

89
Q

Cholelithiasis may induce acute cholecystitis.

Enteric bacteria is cultured more commonly in cases of chronic cholecystitis than in acute cholecystitis.

A

first is true, second is false

Enteric bacteria can be cultured in 80% of acute cases. Chronic usually due to fibrosis.

90
Q

Which of the following results from inadequate secretion of thyroid hormones during fetal life or early infancy?

myxedema
plummer dz
gigantism
cretinism

A

cretinism

myxedema is hypothyroidism in adults, more common in women

91
Q

Which is associated with esophageal varices?

hemoptysis
hematuria
hemophilia
hematemesis

A

hematemesis

92
Q

Which vessels are particularly prone to tearing along their ourse through the subdural space and are the source of bleeding in most cases os subdural hematoma?

MMA
middle cerebral arteries
berry aneurysm in circle of Willis
bridging vv

A

bridging veins

epidural is MMA
subdural - between inner of dura and outer of arachnoid

subarachnoid is berry in Willis

93
Q

Which is a clinical manifestation of vit A deficiency?

rickets
neurological disorders
coagulation defects
night blindness

A

night blindness

D - rickets, osteomalacia
E - neurological disorders
K - coagulation

94
Q

neurological disorders which vitamin?

A

E (= tocopherol)

95
Q

Pathologic calcification is the abnormal tissue deposition of Ca salts, together with smaller amounts of Fe, Mg, and other mineral salts.

There are two forms of pathologic calcification: dystrophic and metastatic.

A

both true

dystrophic - necrosis
metastatic - when hyperCaemia

96
Q

THREE items associated with vitamin B6

component of NAD and NADP
component of FAD and FMN
wet beriberi
cheilosis
pellagra
required for porphyrin synthesis
required for hydroxylation of proline and lysine
anemia
A

cheilosis
required for porphyrin
anemia

97
Q

B1

A

thiamine, beriberi, Wernicke-Korsakoff in alcoholics

98
Q

beriberi

A

B1 = thiamine

99
Q

Wernicke-Korsakoff

A

B1 in alcoholics

100
Q

B2

A

riboflavin
FAD and FMN

cheilosis, glossitis, dermatitis

101
Q

FAD and FMN

A

B2 (riboflavin)

102
Q

B3

A

niacin, NAD and NADP
glycolysis
pellagra

103
Q

niacin

A

B3

104
Q

pellagra

A

B3

105
Q

B6

A

pyridoxine
transmination
porphyrin synthesis

cheilosis glossitis anemia

106
Q

porphyrin synthesis

A

B6

107
Q

cheilosis, flossitis - vitamins?

A

B2 and B6

108
Q

folic and B12 deficiency

A

megaloblastic anemia!

in B12 also neurologic

109
Q

Trachoma is an eye infection caused by

chlamydia trachomatis
bacteroides fragilis
prevotella intermedia
leptospira interrogans

A

chlamydia

conjunctivitis

110
Q

Severe mid-abdominal pain
suspect acute pancreatitis
elevated lipase

What other would likely be elevated?

alkaline phosphatase
amylase
glu-6-phosphatase
acid phosphatase

A

amylase

111
Q

Neurofibromatosis Type 1 is characterized by all except

multiple skin neurofibromas
gliomas of optic nerve
mupltiple meningiomas
pigmented nodules of iris
cutaneous hyperpigmented macules
A

multiple meningiomas

Type 1 is pretty common.

Neurofibromatosis Type 2 is bilateral VIII schwannomas and multiple meningiomas

both AD

112
Q

Most common cause of hypothyroidism in adults is Graves’ disease.

Hypothyroidism can be caused by iodine deficiency.

A

first wrong, second true

most common cause of hypothyroidism in adults is Hashimoto thyroiditis (autoimmune)

Graves is hyperthyroidism

myxedema and cretinism hypothyroidism is caused by I deficiency

113
Q

Somatotyopic adenoma with hypersecretion of growth hormone that develops before epiphyseal closure results in

cretinism
acromegaly
gigantism
myxedema

A

gigantism

after fusion - acromegaly

114
Q

Pathognomonic lesion of erythema multiforme is

butterfly rash
target lesion
pasten-on plaque
hill-sachs lesion

A

target

often in Stevens-Johnson

115
Q

Vesicles on mucosa

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

pemphigus
autoAB against desmosomes between keratinocytes

pemphigoid - larger bullae

116
Q

large red nose

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

rosacea

117
Q

honey colored crust, superficial skin infection

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

impetigo caused by Staph aureus or group A streps

118
Q

herald patch

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

pityriasis

119
Q

irregular pigmentation

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

vitiligo

120
Q

hyperlipidemia in skin

pemphigus
rosacea
impetigo
pityriasis
vitiligo
xanthoma
A

xanthoma

121
Q

Recurrent peptic ulcers in aberrant sites such as jejunum is suggestive of

cushing syndrome
acromegaly
sipple syndrome
zollinger-ellison syndrome

A

ZES

122
Q

vasopressin is produced in which of the following:

paraventricular of HT
suprachiasmatic of HT
arcuate
supraoptic
preoptic
A

supraoptic

diabetes insipidus - deficiency in ADH
polyuria

123
Q

Infx mono is a benign, self-limiting disorder caused by:

VZV
HSV1
CMV
EBV

A

EBV

also Burkitt
hairy leukoplakia
nasopharyngeal carcinoma

124
Q

Half of first cases of asthma occur in

middle age adults
teenagers
elderly
children <10

A

children <10

125
Q

Which is characterized by breakdown in self tolerance to thyroid auto-antigens, most importantly the TSH receptor?

Graves
thyroiditis
muxedema
cretinism

A

Graves

thyrotoxicosis, overproduction, more frequent in F
with protruding eyeballs

it is autoimmune, autoAB to TSH receptor –> no negative feedback

Plummer is v similar but without protruding eyes, toxic goiter, never in children

126
Q

First WBCs during acute or early stage of inflammation are

basophils
eosinophils
neutrophils
monocytes

A

n/ph

127
Q

Abscesses are localized collections of purulent inflammatory tissue caused by suppuration that buries in a tissue, an organ, or a confined space.

Abscesses are produced by deep seeding of pyogenic bacteria into a tissue

A

both true

128
Q

Gas gangrene occurs as result of infection by Clostridium perfringens

Clostridia are obligate aerobes, G- bacteria capable of endospore production

A

1 true, 2 false

anaerobes!

129
Q

Which of the following types of necrosis is the most basic and most common?

coagulation
liquefaction
caseous
gangrenous
fibrinoid
A

coagulation

130
Q

Epithelioid cells and giant cells are derived from m/ph and are important in development of

initial inflammation
granulomatous inflammation
acute inflammation
subacute inflammation

A

granulomatous

granulomatous infxs:

TB, leprosy, syphilis, sarcoidosis, Crohn

131
Q

In response to an injury, mononuclear inflammatory cells couple with the production of fibrous connective tissue are indicative of

acute inflammation
chronic inflammation
edema
gangrene

A

chronic inflammation

132
Q

In response to an injury, capillary permeability increases resulting in formation of

plasma
serum
exudate
transudate

A

exudate

–> edema

transudates are non-inflammatory conditions

133
Q

Acute inflammation is an early defense mechanism to contain an infx, prevent its spread from the initial focus and signal subsequent specific immune receptors.

Tissue damage is caused to some extent by complement and macrophages but mostly by neutrophils.

A

both true

m/ph are transition from acute to chronic

134
Q

THREE items associated with biotin

ataxia
beriberi
seborrheic dermatitis
nervous disorders
anemia
scurvy
can be induced by avidin
A

seborrheic dermatitis
nervous disorders
can be induced by avidin

B12 malabsorption also occurs in Crohn’s!

135
Q

Which malabsorption syndrome is caused by a sensitivity to gluten in cereal?

tropical sprue
celiac dz
whipple dz
autoimmune enteropathy

A

celiac dz

136
Q

Which is characterized by presence of numerous polyps along with skin and bone tumors?

Turcot
Gardner
Peutz-Jeghers
familial adenomatous polyposis

A

Gardner

Turcot - polyps + brain tumors
Peutz-Jeghers: non-neoplastic polyps, melanin hyperpigmentation

137
Q

Pts with Down syndrome are at increased risk for

osteosarcoma
lymphoblastic leukemia
berry aneurysm
fabry dz

A

lymphoblastic leukemia

138
Q

Each are symptoms of Sjogren except

xerostomia
keratoconjunctivitis sicca
sarcoidosis
associated CT dz

A

sarcoidosis

dx of Sjogren - at least two
antiRo and antiLa

139
Q

Chvostek’s sign and Trousseau’s sign are reliable indicators of

bell’s palse
botulism
rickets
tetany

A

tetany

also hypoCa

140
Q

DiGeorge syndrome adversely affects development of 3 and 4 pharyngeal pouches. Result on immune syste, will most likely be deficiency in

B cells
T cells
complement
innate immunity

A

T cells

also hypoCa (because no parathyroids) –> tetany

141
Q

Which immunodeficiency disorder features incompetent or absent T and B cells?

wiskott-aldrich
sever combined immunodeficiency
ataxia-telangiectasia
hyper-IgE syndrome

A

SCID

142
Q

THREE items associated with Klinefelter’s

extra 21
XO
XXY
extra 18
affects 1 in 500 men
affects women
hypergonadism
hypogonadism
A

XXY
1 in 500 men
hypogonadism

143
Q

X-linked agammaglobulinemia is characterized by failure of T cell precursors to develop into mature T cells.

Usually not apparent until 6 mo, as maternal Igs are depleted.

A

First false, second true

X-linked agammaglobulinemia = Bruton’s
failure of B
T are normal

144
Q

Right sided heart failure results in

pulmonary edema
peripheral edema
lymphedema
cirrhosis of liver

A

peripheral edema

left sided failure –> pulmonary edema

pitting edema - acute
non-pitting - chronic

145
Q

Which thrombi from as result of damage to ventricular endocardium (usually left ventricle following myocardial infarct)?

agonal
white
red
fibrin
mural
A

mural

agonal - in fyind after long heart filure
mural - damage to ventricular endotheliu,
white - blood plts
red - coagulation of stagnant blood

146
Q

Intracellular anaerobic glycolysis and subsequent buildup of lactic acid occur in which stage of shock?

non-progressive
progressive
irreversible
cardiogenic

A

progressive

beginning of failure after attempts to compensate
glycolysis and anaerobic not enough, cells begin to die

refractory - point of no return

147
Q

Most common type of shock:

cardiogenic
septic
neurogenic
hypovolemic

A

hypovolemic

148
Q

Standard prophylactic regimen for prevention of bacterial endocarditis:

penicillin VK
tetracyclin
erythromycin
amoxicillin

A

amoxicillin

if allergy: clindamycin, azithromycin, clarithromycin

149
Q

Nystatin and Clindamycin are the two antifungals used as “swish and swallow” tx for oral candidiasis.

Nystatin is taken as a troche (lozenge) that is slowly in the mouth and swallowed.

A

both false

nystatin (suspension) + clotrimazole (lozenge) are for swish and swallow of oral candida

150
Q

Which Abx is used cautiously due to its side effects (pseudomembranous colitis, sever GI upset)?

azithromycin
clindamycin
penicillin VK
cephalexin

A

clindamycin

151
Q

Pt allergic to penicillin is mot likely to have cross allergy with

carbapenem
macrolide
quinolone
cephalosporin
glycopeptide
A

cephalosporin

beta-lactam Abx: penicillins, cephalosporins, and newer: carbapenems and monobactams

152
Q

Each affects bacterial cell wall except:

bacitracin
azithromycin
penicillin
vancomycin
aztreonam
A

azithromycin

cell wall:
penicillins, cephalosporins, bacitracin,
vancomycin, aztreinam, imipenem

protein synthesis: tetracycline, aminoglycosides, chloramphenicol, -mycins (except vanco)

biosynthetic pathways: sulfonamides, trimethoprim, quinolones (floxacins)

153
Q

cell wall abx

A

penicillins, cephalosporins, carbapenems, monobactams
vancomycin, aztreonam

= bacitracin

154
Q

protein synthesis abx

A

-mycins, tetracycline, aminoglycosides

+ chloramphenicol

155
Q

synthetic pathways

A

quinolones (floxacins), sulfonamides

+trimethoprim

156
Q

Tetracyclines are first choice in all except:

mycoplasma pneumonia
chlamydia infx
rickettsial infx
staphylococcal infx

A

staphs

157
Q

Which penicillin is prescribed for sever penicillinase-producing staphylococcal infxs?

methicillin
ampicillin
penicillin VK
carbenicillin

A

methicillin (MRSA)

158
Q

Which is antifungal?

bacitracin
amphotericin B
polymyxin B
neomycin

A

amphotericin B

159
Q

Major cariogenic property of S. mutans appears to be its ability to produce which of the following enzymesL

lactase
beta-glucosidase
cellulose
glucosyltransferase

A

glucosyltransferase (make dextrans)

Strep mutans is primary cariogenic

160
Q

Which has been shown to be most effective antimicrobial agent for reducing plaque and gingivitis long-term?

stannous fluoride
phenolic compounds
chlorhexidine
quaternary ammonium compounds

A

chlorhexidine

fluorides - anticavoty
phenolic - listerine
ammonium - for bad breath

161
Q

Principal oral site for growth of spirochetes, fusobacteria and other G- negative anaerobes is

saliva
calculus
gingival margin
gingival sulcus

A

sulcus

for stagnation and bacterial proliferation

162
Q

Order stages in plaque formation:

A. Streps colonize acquired pellicle
B. Filamentous bacteria colonize acquired pellicle
C. Formation of pellicle
D. Rod-shaped microorganisms colonize acquired pellicle
E. Calcification of crystalline structure

A

C A D B E

pellicle - primarily salivary proteins
colonization: streps –> rods –> filamentous (actinomyces)

eventually calcifies –> calculus

163
Q

Organic constituents of plaque include polysaccharides, proteins, glycoproteins, and lipid material.

Inorganic components of plaque are predominantly Ca and P with trace amts of other minerals.

A

both true

164
Q

Calculus is mainly organic.

It is covered by a layer of bacterial plaque.

A

First wrong, second true.

Calculus is mineralized plaque.

165
Q

All are true about supragingival and subgingival plaque except

subgingival plaque can be attached or loosely adherent
supragingival plaque is attached or tooth associated
subgingival plaque is dominated by G-
supragingival is domninated by G-
supragingival plaque has more anaerobes than subgingival

A

last is wrong

subgingival has more anaerobes

166
Q

Which is commonly implicated with etiology of acute necrotizing gingivitis?

S. sanguis
Actinomyces israeilii
prevotella intermedia
strep uberis

A

prevotella

also generalized aggressive perio

other ANUG is treponema

167
Q

Quaternary ammonium compounds are cationic detergents.

They can be used for skin antisepsis.

A

both true

soaps are anionic

168
Q

Which is a powerful oxidizing agent that inactivates bacteria and most viruses by oxidizing free sulfhydrul groups?

alcohol
chlorine
formaldehyde
phenol

A

chlorine

phenol too caustic
formaldehyde denatures protein and nucleic acids

disinfectants kill; not safe on living tissue (antiseptics are).

169
Q

How long does it take to kill bacterial endospores when a dental instrument is immersed in a chemical sterilant such as 2% glutaraldehyde, hydrogen peroxide or peracetic acid?

10-30 minutes
1-2 hours
10-12 hours
24 hours

A

10-12 hours

alcohols, chlorhexidine, ammonium - disinfectants, less powerful

170
Q

alcohol - steril or disinf?

A

disinf

171
Q

examples of sterilants?

A

glutaraldehyde, peroxide

172
Q

Effectiveness of autoclaving is best determined by culturing bacterial spores.

Spore testing on autoclave units is recommended monthly.

A

first true, second false

testing should be weekly

173
Q

Proper time and temperature for dry heat sterilization

160C for 2 hours
121 C for 20-30 minutes
232 for 5 minutes
31 for 30 minutes

A

160 for 2 hours (or 170 for 1 hour)

174
Q

Which is minimum required temperature to positively destroy all living organisms?

100
121
134
250

A

121

steam autoclaves: 121 for 15-20
270 for 3 minutes

175
Q

Ethylene oxide sterilization is faster than moist heat autoclave.

Ethylene oxide sterilization can be used to sterilize heat sensitive instruments.

A

first false, second true

sterilization with ethylene ozide is 10-16 hours (vs 2 hours)

176
Q

Killing or removal of all microorganisms, including bacterial spores, is called

disinfection
cleaning
sterilization
wiping

A

sterilization - absence of all living forms

disinfection - killing of many but not all (does not include spores)

177
Q

All are advantages of using alcohols as surface disinfectants except:

they are bactericidal
they are sporicidal
they are tuberculocidal
they are economical

A

sporicidal
they are not

iodine - most effective skin antiseptic (oxidizing agent)

178
Q

Greatest occupational health care worker risk for bloodborne infx is

hep C
HIV
hep B
TB

A

hep B

179
Q

Antimicrobial chemical agents which destroy microorganisms when applied on to inanimate surfaces, such as counter tops or lights, are called

antiseptics
sterilants
disinfectant
microbicides
antibacterials
A

disinfectant

180
Q

Which of these antiseptics does NOT exhobot persistent activity?

isopropyl alcohol
chlorhexidine gluconate
triclosan
quaternary ammonium compounds

A

isopropyl alcohol

persistent activity - ability to prevent after being applied

181
Q

Bactericidal agents work best during which phase of bacterial growth?

lag
log
stationary
death

A

log

182
Q

marker microorganism for intermediate surface disinfection is

bacillus stearothermophilus
pseudomonas aeruginosa
hepatitis B virus
myco TB

A

myco TB

- significant benchmark criterion

183
Q

Antigens most responsible for immediate Type I reaction to natural rubber latex are

proteins
accelerators
corn starch powders
anti-oxidants

A

proteins

184
Q

Cleaning surfaces prior to disinfection in clinical settings is required to

destroy all pathogens
inhibit pathogen growth
reduce concentration of pathogens
weaken the virulence of pathogens

A

reduce concentration

185
Q

Most efficient way to kill microbes is:

cold sterilization
proper handwashing with sterilizing antiseptics
heat sterilization
immersion of contaminated items in chemical sterilants

A

heat

186
Q

Most common form of adverse epithelial reaction noted for healthcare professionals is

irritation dermatitis
type I immediate latex allergy
type IV delayed latex allergy
superficial fingal infx of fingers

A

irritation dermatitis (20-30%)

187
Q

Pt develops immediate Type I to latex. From now on you can

wear vinyl or nitrile gloves
wear hypoallergenic latex gloves
get an exemption and not wear gloves
refuse to treat him

A

wear vinyl or nitrile

188
Q

Which is killing all microorganisms on an object or in a material?

standardization
sanitization
disinfection
sterilization

A

sterilization

sanitization lowers total microbial load

189
Q

Most likely route for dentist to be infected with Hep C from patient is from inhalation of aerosols.

There is no vaccination for Hep C.

A

1 false 2 true

190
Q

Infx caused by normally non-pathogenic microorganism in a host whose resistance has been decreased or compromised is known as

nosocomial infx
secondary infx
opportunistic infx
medical infx

A

opportunistic

191
Q

It is recommended that face masks be changed

between pts
daily
twice per day
twice in the morning and twice in the afternoon

A

between pts

192
Q

Latex allergy risk factors include all except:

persons with multiple surgeries
atopy
rubber industry workers
persons w allergy to pollen
persons w allergy to bananas
A

persons w allergy to pollen

193
Q

Instrument that contacts mucous membranes or non-intact skin is classified into which of the following categories?

critical
semicritical
subcritical
noncritical

A

semicritical

critical - penetrate
semicritical - contact
noncritical - intact skin

194
Q

Each are advantages of rapid heat sterilization except

very fast cycle time
no dulling or cutting edges
dry instruments after cycle
does not require precleaning

A

does not require precleaning

preclean everything!

195
Q

Personal protective equipment clinic jackets should be

short sleeve, high neck
short sleeve, turtle neck
long sleeve, high neck
long sleeve, turtle neck

A

long sleeve, high neck

196
Q

In healthcare what is the primary disease prevention measure?

wipe-wipe
spray-wipe-spray
handwashing
vaccines

A

handwashing (at least 10 seconds)

197
Q

Because ________ are the hardest icrobes, their destruction is required before defined parameters/levels of sterilization have been met

Hep B
bacterial endospores
mycobacteria
vegetative bacteria

A

bacterial endospores

some G+ but NEVER G- are spore formers

high concentration of Ca and dipicolinic acid

198
Q

Thermometer is an example of which of the following Spaulding classifications?

critical
semicritical
subcritical
noncritical

A

semicritical

199
Q

Each is characteristic of alcohol-based hand hygiene antiseptics except:

broad antimicrobial spectrum
removal of organic debris from contaminated hands
rapid antibacterial action
greater antibacterial effect than anionic detergents

A

removal of organic debris from contaminated hands

must be washed with soap

200
Q

Which is considered regulated medical waster and cannot be disposed of with general office trash?

gauze soiled with blood, plaque, and saliva used in a dental prophy procedure
blood-saturated gauze used in oral surgical procedures
visibly contaminated environmental surface barriers
plastic saliva ejectors and high-volume evacuator tips

A

blood saturated - considered infectious

also microbiological waste
tissues and extracted teeth (w/o amalgam)
blood and by products
sharps
anesthetic carpules
201
Q

Iatrogenic infx in dental setting may be induced

by failure to perform hand hygiene between pt procedures
by performing tx pocedures
in pts with debilitated or compromised immune defenses
all

A

all

202
Q

Occupational exposure incidents involving saliva and/or intact skin in dental settings typically:

require special evaluation and prophylaxis by a qualified health care professional
have a low risk of transmitting HIV dz
have a >20% risk for subsequent HCV transmission
have a >15% risk for subsequent HBV transmission

A

have a low risk of transmitting HIV

203
Q

Using automated cleaning equipment is more time efficient, improves cleaning effectiveness, and is safer than hand-scrubbing.

Cleaned instruments need not be wrapped not heat sterilized prior to use on subsequent patients

A

1 true 2 wrong

204
Q

According to OSHA bloodborne pathogen standard, disposable glovea that have been contaminated shall be replaced

immediately
as soon as possible
as soon as feasible
as soon as practical

A

as soon as practical

as soon as feasible when torn

205
Q

One major difference between current “standard” infection control precautions and previous “universal” precautions recommendations, is that “universal” precautions:

primarily targeted protection against respiratory infx
provided specific precautions to protect against all known microbial pathogens
was designed to primarily protect against bloodborne pathogens
addressed inection control precautions to eliminate opportunistic pathogen risks

A

was designed to primarily protect against bloodborne pathogens

standard: added all body fluids, moist body surfaces etc

206
Q

Using cassettes to process and re-circulate instruments in clinical settings can

make instrument processing more efficient
increase organization of dental instruments
decrease handling of contaminated instruments during cleaning procedures
reduce the potential for accidental sharps injuries
all of the above

A

all of the above

207
Q

Using latex gloves, masks, and gauze that are contaminated with saliva and blood after pt care should always be placed in a medical waste container.

Contaminated waste is routinely considered infectious.

A

both false

contaminated waste can be discarded with office trash

NBDE (15 decks)

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