Micro/Path Pt 2 Flashcards
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
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
All are features of Albers-Schonberg dz except:
anemia multiple bone fractures decreased bone density blindness deafness
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
head of femur osteochondrosis
Perthes' Osgood-Schatter Kohler Scheuermann Freiberg
Perthes’ dz
tibial tuberosity osteochondrosis
Perthes' Osgood-Schatter Kohler Scheuermann Freiberg
Osgood-Schlatter
tarsal navicular bone tuberosity osteochondrosis
Perthes' Osgood-Schatter Kohler Scheuermann Freiberg
Kohler
intervertebral jts osteochondrosis
Perthes' Osgood-Schatter Kohler Scheuermann Freiberg
Scheuermann
metatarsal head osteochondrosis
Perthes' Osgood-Schatter Kohler Scheuermann Freiberg
Freiberg
Osteitis deformans present as a mized radiopaque and radiolucent lesion BECAUSE the mized stage of the dz features primnent osteolysis and osteogenesis
both true and related
osteitis deformans = Paget’s
Rickets occurs only in children; its typical adult counterpart is called:
osteitis fibrosa cystica osteitis deformans osteopetrosis osteomalacia osteomyelitis
osteomalacia
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
C E D A B
fat embolism often sequel of fractured bones
Most common viral cause of pericarditis:
mumps influenza herpes HIV coxsackie B and echo
coxsackie B and echo
Most common cause of right-sided heart failure:
left-sided heart failure
hypertension
ischemic heart disease
aortic and mitral valvular disease
left-sided heart failure
Causes of left heart failure:
ischemic (esp MI)
hypertension
aortic and mitral valve disease
myocardial disease
Which type of angina is characterized by prolonged or recurrent chest pain at rest?
stable angina
unstable angina
prinzmetal’s angina
variant angina
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.
Which is the first cardiac marker to increase after myocardial infarction?
creatine kinase
troponin
myoglobin
lactate dehydrogenase
myoglobin
MI most commonly caused by CAD.
Approximately 50% of cases of subacute (bacterial) endocarditis are caused by:
serratia
pseudomonas
staph aureus
strep viridans
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
acute vs subacute endocarditis
acute is staph, subacute is strep viridans
most commonly encountered neck space infection is:
angioedema
Vincent’s angina
Ludwig’s angina
hereditary angioedema
Ludwig’s angina - extension from mandibular lower teeth into floor of mouth
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
glycine and GABA
unregulated excitatory synaptic activity, spastic paralysis, no inhibition
botulotoxin prevents release of ACh –> flaccid paralysis
Eosinophilia is often associated with
acute infx
viral infx
tuberculosis
parasitic infx
parasitic infx
also allergies
n/ph: acute bacterial infx
lymphocytes: TB, viral
monocytes: TB, malaria, ricketsia
lymphocytosis associated with
viral and TB
monocytosis assoc with
TB, malaria, ricketsia
n/ph associated with
acute bacterial infx
Link between Reye’s Syndrome and use of:
ibuprofen aspirin acetaminophen amoxicillin diphenhydramine
aspirin
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
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
Rebound tenderness in lower right quadrant of abdomen is characteristic of:
cholelithiasis
ulcerative colitis
hepatocellular carcinoma
acute appendicitis
acute appendicitis
Chlamydial cervicitis, the most common sexually transmitted infection, is caused byL
C. diff
c. perfringens
c. trachomatis
c. suis
c. muridarium
trachomatis
gonorrhea is caused by neisseria
Characteristic lesion of secondary syphilis is known as:
chancre
gumma
condyloma lata
condyloma acuminatum
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
Encephalitis is most common caused by:
bacterial infx
viral infx
fungal infx
parasitic infx
viral
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
worldwide
epidemic: more frequently than normal
endemic: minimal levels
highly communicable = contagious
Acute lymphoblastic leukemia equally affects young children and adults.
This acute leukemia is most responsive to tx.
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.
ALL vs AML vs CLL vs CML leukemias
ALL - children, responsive to tx
AML - adults, 90% of leukemias, most malignant
CLL - slow
CML - Philadelphia chromosome
Principal organ(s) involved in acute leukemia is/are the:
bone marrow
brain
lungs
kidneys
bone marrow
Philadelphia chromosome and low levels of leukocyte alkaline phosphatase are common characteristics of:
AML
ALL
CML
CLL
CML
No definitive causes have been identified for leukemia.
Possible risk factors include genetic predisposition, environmental exposure to chemicals and radiation, and viruses.
both true
viruses: HTLV, EBV
All about immunoglobulins are true except:
secreted by activated plasma cells also known as antibodies have enzymatic activity activate complement are glycoproteins
have enzymatic activity
this is false
Injection of med to someone with allergy to it leads to:
low levels of histamine
hyperglobulinemia
systemic anaphylaxis
localized anaphylaxis
systemic anaphylaxis
most common cause - allergy to penicillin
Cellular immunity is immunity mediated by: B-lymphocytes T-lymphocytes both B and T-lymphocytes neither B not T-lymphocytes
T
Of the anaphylatoxins, C3a is more stable and potent than C5a.
Only mast cells have receptors specific for C5a and C3a.
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
Exaggerated IgE response to environmental allergen (= atopy) manifests in all except:
dermatitis
rhinitis
jaundice
asthma
jaundice
atopic = localized Type I
atopic dermatitis = eczema
in asthma, leukotrienes
rhinitis: histamine
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
immunofluorescence
ELISA - for pt specimens, both antibodies or antigens
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
alternative
lectin only specific mannose-containing PGs of bacteria
all pathways converge to C3
classical pathway of complement
Ag + AB –> C1, C4, C2 –> C3 + C5
alternative pathway of complement
infx but no AB
lectin pathway of complement
mannose in peptidoglycan
type I hypersensitivity
atopic, IgE, degranulation of mast
type II hypersensitivity
IgG-mediated cytotoxicity (–> complement or T killer)
drug allergies
type III hypersensitivity
IgG –> complement
serum sickness
type IV hypersensitivity
T-helpers (mostly Th1) sensitized, recruit destroyers
In passive immunity, antibodies are preformed in another host.
Passive immunity lasts as long as active immunity.
1 true, 2 wrong
active is slow onset but long term
Small molecule, not antigenic by itself, that can react with antibodies is called:
epitope
hapten
plasmid
immunogen
hapten
too small to eb immunogenic
epitope - specific portion of antigen to which antibody binds
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
adoptive immunity
Complement system is a group of plasma proteins that attack pathogens.
These proteins are primatily synthesized by kidney.
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
Each of the following are associated with an anaphylactic hypersensitivity reaction except:
histamine heparin plt-activating factors serotonin dopamine
dopamine
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.
both true
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.
1 false, 2 true
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
extracellulae
B cells
antibodies neutralize and eliminate
in contrast, cell-mediated is T against intracellular
Th activate m/ph and T-killers
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
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
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
Alum and MF59
adjuvants allow smaller and rarer doses
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
toxoid
antitoxin = antibody to toxin
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
artificial passive
All contain attenuated virus except:
yellow fever measles rabies mumps rubella
rabies - inactivated
Each are live attenuated bacterial vaccines except
mycobacterium bovis
salmonella typhi
Yersinia pestis
coxiella burnetti
Yersinia?
has to be killed, for plague
Persons vaccinated against Hep B who have developed immunity are also immune to:
Hep A
Hep C
Hep D
Hep E
Hep D
THREE items associated with rheumatic fever
pancarditis Group B streptococci koplik spots bullous skin lesions aschoff bodies Sydenham chorea
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
All are characteristics of Addison’s excepts:
hypertension
increased pigmentation of skin
hypoglycemia
increased serum K
hypertension
characterized by hypotension
failure of adrenocortical
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
both true
bone polishing
dislodged pieces of cartilage in joint space
osteophytes (bony spurs) at distal (Heberden) or proximal (Bouchard) interphalangeal joints
All can be classified as type of Lagerhans cell histiocytosis except:
Letterer-Siwe
Bruton
Hand-Schuller-Christian
eosinophilic granuloma
Bruton disease
is X-linked agammaglobulinemia
Primary hyperparathyroidism is most often caused by
liver dz
parathyroid adenoma
bronchogenic squamous cell carcinoma
hypoCa of chronic renal dz
parathyroid adenoma
Systemic vasculitis in which dz
polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis
polyarteritis nodosa
Skin rash in which dz
polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis
dermatomyositis
Widespread connective tissue fibrosis in which dz
polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis
scleroderma
butterfly rash
polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis
systemic lupus
stiffness of joints which dz
polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis
rheumatoid arthritis
Most common demyelinating disorder?
Devic's dz Tabes dorsalis Optic neuritis Multiple sclerosis Guillain-Barre syndrome
multiple sclerosis
female prevalence
In many cases of primary amyloidosis, the pts have some form of:
m/ph dyscrasia
erythrocyte dyscrasia
hemoglobin dyscrasia
plasma cell dyscrasia
plasma cell dyscrasia
primary amyloidosis related to abnormal production of immunoglobulins
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.
both true
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.
both false
1 is autoimmune, destruction of cells and absolute deficiency of insulin
2 is resistance to insulin and is more common (90-95%)
THREE items associated with rheumatoid arthritis:
joint effusions bouchard's nodes bacterial in nature fungal in nature Still-s dz osteophyte unknown cause
joint effusions
Still’s dz (RA in young ppl)
unknown cause
osteophytes - in osteoarthritis, not rheumatoid!
RA: nonsuppurative proliferative
Which is the prototype of a systemic immune complex dz?
systemic lupus erythematosus acute serum sickness poststreptococcal glomerulonephritis reactive arthritis polyarteritis nodosa
acute serum sickness
______ hypersensitivity rxns are initiated by Ag-activated (sensitized) T lymphocytes, including CD4+ and CD8+.
type I
type II
type III
type IV
type IV
which of the following antibodies are specific for systemic lupus?
anti-Sm
Anti-Jo
anti-Ro
anti-centromere
anti-Sm
particularly ANA and anti-Sm specific for SLE
acrocyanosis (Raynaud’s phenomenon) often associated with SLE
Raynaud’s phenomenon
acrocyanosis., often associated with SLE
anti-Ro
Sjogren
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
myasthenia gravis
In phenylketonuria, tyrosine cannot be synthesized in adequate amounts.
Newborns with phenylketonuria don’t have any symptoms.
both true
phe is essential
tyrosine from phe
Increased melanin pigmentation is seen in:
addison't dz jaundice albinism vitiligo hemosiderosis
Addison’s dz
albinism and vitiligo - decreased
Gout is caused by defect in metabolism that results in overproduction of:
urea
ammonia
Bb
uric acid
uric acid
Cholelithiasis may induce acute cholecystitis.
Enteric bacteria is cultured more commonly in cases of chronic cholecystitis than in acute cholecystitis.
first is true, second is false
Enteric bacteria can be cultured in 80% of acute cases. Chronic usually due to fibrosis.
Which of the following results from inadequate secretion of thyroid hormones during fetal life or early infancy?
myxedema
plummer dz
gigantism
cretinism
cretinism
myxedema is hypothyroidism in adults, more common in women
Which is associated with esophageal varices?
hemoptysis
hematuria
hemophilia
hematemesis
hematemesis
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
bridging veins
epidural is MMA
subdural - between inner of dura and outer of arachnoid
subarachnoid is berry in Willis
Which is a clinical manifestation of vit A deficiency?
rickets
neurological disorders
coagulation defects
night blindness
night blindness
D - rickets, osteomalacia
E - neurological disorders
K - coagulation
neurological disorders which vitamin?
E (= tocopherol)
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.
both true
dystrophic - necrosis
metastatic - when hyperCaemia
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
cheilosis
required for porphyrin
anemia
B1
thiamine, beriberi, Wernicke-Korsakoff in alcoholics
beriberi
B1 = thiamine
Wernicke-Korsakoff
B1 in alcoholics
B2
riboflavin
FAD and FMN
cheilosis, glossitis, dermatitis
FAD and FMN
B2 (riboflavin)
B3
niacin, NAD and NADP
glycolysis
pellagra
niacin
B3
pellagra
B3
B6
pyridoxine
transmination
porphyrin synthesis
cheilosis glossitis anemia
porphyrin synthesis
B6
cheilosis, flossitis - vitamins?
B2 and B6
folic and B12 deficiency
megaloblastic anemia!
in B12 also neurologic
Trachoma is an eye infection caused by
chlamydia trachomatis
bacteroides fragilis
prevotella intermedia
leptospira interrogans
chlamydia
conjunctivitis
Severe mid-abdominal pain
suspect acute pancreatitis
elevated lipase
What other would likely be elevated?
alkaline phosphatase
amylase
glu-6-phosphatase
acid phosphatase
amylase
Neurofibromatosis Type 1 is characterized by all except
multiple skin neurofibromas gliomas of optic nerve mupltiple meningiomas pigmented nodules of iris cutaneous hyperpigmented macules
multiple meningiomas
Type 1 is pretty common.
Neurofibromatosis Type 2 is bilateral VIII schwannomas and multiple meningiomas
both AD
Most common cause of hypothyroidism in adults is Graves’ disease.
Hypothyroidism can be caused by iodine deficiency.
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
Somatotyopic adenoma with hypersecretion of growth hormone that develops before epiphyseal closure results in
cretinism
acromegaly
gigantism
myxedema
gigantism
after fusion - acromegaly
Pathognomonic lesion of erythema multiforme is
butterfly rash
target lesion
pasten-on plaque
hill-sachs lesion
target
often in Stevens-Johnson
Vesicles on mucosa
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
pemphigus
autoAB against desmosomes between keratinocytes
pemphigoid - larger bullae
large red nose
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
rosacea
honey colored crust, superficial skin infection
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
impetigo caused by Staph aureus or group A streps
herald patch
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
pityriasis
irregular pigmentation
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
vitiligo
hyperlipidemia in skin
pemphigus rosacea impetigo pityriasis vitiligo xanthoma
xanthoma
Recurrent peptic ulcers in aberrant sites such as jejunum is suggestive of
cushing syndrome
acromegaly
sipple syndrome
zollinger-ellison syndrome
ZES
vasopressin is produced in which of the following:
paraventricular of HT suprachiasmatic of HT arcuate supraoptic preoptic
supraoptic
diabetes insipidus - deficiency in ADH
polyuria
Infx mono is a benign, self-limiting disorder caused by:
VZV
HSV1
CMV
EBV
EBV
also Burkitt
hairy leukoplakia
nasopharyngeal carcinoma
Half of first cases of asthma occur in
middle age adults
teenagers
elderly
children <10
children <10
Which is characterized by breakdown in self tolerance to thyroid auto-antigens, most importantly the TSH receptor?
Graves
thyroiditis
muxedema
cretinism
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
First WBCs during acute or early stage of inflammation are
basophils
eosinophils
neutrophils
monocytes
n/ph
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
both true
Gas gangrene occurs as result of infection by Clostridium perfringens
Clostridia are obligate aerobes, G- bacteria capable of endospore production
1 true, 2 false
anaerobes!
Which of the following types of necrosis is the most basic and most common?
coagulation liquefaction caseous gangrenous fibrinoid
coagulation
Epithelioid cells and giant cells are derived from m/ph and are important in development of
initial inflammation
granulomatous inflammation
acute inflammation
subacute inflammation
granulomatous
granulomatous infxs:
TB, leprosy, syphilis, sarcoidosis, Crohn
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
chronic inflammation
In response to an injury, capillary permeability increases resulting in formation of
plasma
serum
exudate
transudate
exudate
–> edema
transudates are non-inflammatory conditions
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.
both true
m/ph are transition from acute to chronic
THREE items associated with biotin
ataxia beriberi seborrheic dermatitis nervous disorders anemia scurvy can be induced by avidin
seborrheic dermatitis
nervous disorders
can be induced by avidin
B12 malabsorption also occurs in Crohn’s!
Which malabsorption syndrome is caused by a sensitivity to gluten in cereal?
tropical sprue
celiac dz
whipple dz
autoimmune enteropathy
celiac dz
Which is characterized by presence of numerous polyps along with skin and bone tumors?
Turcot
Gardner
Peutz-Jeghers
familial adenomatous polyposis
Gardner
Turcot - polyps + brain tumors
Peutz-Jeghers: non-neoplastic polyps, melanin hyperpigmentation
Pts with Down syndrome are at increased risk for
osteosarcoma
lymphoblastic leukemia
berry aneurysm
fabry dz
lymphoblastic leukemia
Each are symptoms of Sjogren except
xerostomia
keratoconjunctivitis sicca
sarcoidosis
associated CT dz
sarcoidosis
dx of Sjogren - at least two
antiRo and antiLa
Chvostek’s sign and Trousseau’s sign are reliable indicators of
bell’s palse
botulism
rickets
tetany
tetany
also hypoCa
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
T cells
also hypoCa (because no parathyroids) –> tetany
Which immunodeficiency disorder features incompetent or absent T and B cells?
wiskott-aldrich
sever combined immunodeficiency
ataxia-telangiectasia
hyper-IgE syndrome
SCID
THREE items associated with Klinefelter’s
extra 21 XO XXY extra 18 affects 1 in 500 men affects women hypergonadism hypogonadism
XXY
1 in 500 men
hypogonadism
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.
First false, second true
X-linked agammaglobulinemia = Bruton’s
failure of B
T are normal
Right sided heart failure results in
pulmonary edema
peripheral edema
lymphedema
cirrhosis of liver
peripheral edema
left sided failure –> pulmonary edema
pitting edema - acute
non-pitting - chronic
Which thrombi from as result of damage to ventricular endocardium (usually left ventricle following myocardial infarct)?
agonal white red fibrin mural
mural
agonal - in fyind after long heart filure
mural - damage to ventricular endotheliu,
white - blood plts
red - coagulation of stagnant blood
Intracellular anaerobic glycolysis and subsequent buildup of lactic acid occur in which stage of shock?
non-progressive
progressive
irreversible
cardiogenic
progressive
beginning of failure after attempts to compensate
glycolysis and anaerobic not enough, cells begin to die
refractory - point of no return
Most common type of shock:
cardiogenic
septic
neurogenic
hypovolemic
hypovolemic
Standard prophylactic regimen for prevention of bacterial endocarditis:
penicillin VK
tetracyclin
erythromycin
amoxicillin
amoxicillin
if allergy: clindamycin, azithromycin, clarithromycin
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.
both false
nystatin (suspension) + clotrimazole (lozenge) are for swish and swallow of oral candida
Which Abx is used cautiously due to its side effects (pseudomembranous colitis, sever GI upset)?
azithromycin
clindamycin
penicillin VK
cephalexin
clindamycin
Pt allergic to penicillin is mot likely to have cross allergy with
carbapenem macrolide quinolone cephalosporin glycopeptide
cephalosporin
beta-lactam Abx: penicillins, cephalosporins, and newer: carbapenems and monobactams
Each affects bacterial cell wall except:
bacitracin azithromycin penicillin vancomycin aztreonam
azithromycin
cell wall:
penicillins, cephalosporins, bacitracin,
vancomycin, aztreinam, imipenem
protein synthesis: tetracycline, aminoglycosides, chloramphenicol, -mycins (except vanco)
biosynthetic pathways: sulfonamides, trimethoprim, quinolones (floxacins)
cell wall abx
penicillins, cephalosporins, carbapenems, monobactams
vancomycin, aztreonam
= bacitracin
protein synthesis abx
-mycins, tetracycline, aminoglycosides
+ chloramphenicol
synthetic pathways
quinolones (floxacins), sulfonamides
+trimethoprim
Tetracyclines are first choice in all except:
mycoplasma pneumonia
chlamydia infx
rickettsial infx
staphylococcal infx
staphs
Which penicillin is prescribed for sever penicillinase-producing staphylococcal infxs?
methicillin
ampicillin
penicillin VK
carbenicillin
methicillin (MRSA)
Which is antifungal?
bacitracin
amphotericin B
polymyxin B
neomycin
amphotericin B
Major cariogenic property of S. mutans appears to be its ability to produce which of the following enzymesL
lactase
beta-glucosidase
cellulose
glucosyltransferase
glucosyltransferase (make dextrans)
Strep mutans is primary cariogenic
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
chlorhexidine
fluorides - anticavoty
phenolic - listerine
ammonium - for bad breath
Principal oral site for growth of spirochetes, fusobacteria and other G- negative anaerobes is
saliva
calculus
gingival margin
gingival sulcus
sulcus
for stagnation and bacterial proliferation
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
C A D B E
pellicle - primarily salivary proteins
colonization: streps –> rods –> filamentous (actinomyces)
eventually calcifies –> calculus
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.
both true
Calculus is mainly organic.
It is covered by a layer of bacterial plaque.
First wrong, second true.
Calculus is mineralized plaque.
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
last is wrong
subgingival has more anaerobes
Which is commonly implicated with etiology of acute necrotizing gingivitis?
S. sanguis
Actinomyces israeilii
prevotella intermedia
strep uberis
prevotella
also generalized aggressive perio
other ANUG is treponema
Quaternary ammonium compounds are cationic detergents.
They can be used for skin antisepsis.
both true
soaps are anionic
Which is a powerful oxidizing agent that inactivates bacteria and most viruses by oxidizing free sulfhydrul groups?
alcohol
chlorine
formaldehyde
phenol
chlorine
phenol too caustic
formaldehyde denatures protein and nucleic acids
disinfectants kill; not safe on living tissue (antiseptics are).
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
10-12 hours
alcohols, chlorhexidine, ammonium - disinfectants, less powerful
alcohol - steril or disinf?
disinf
examples of sterilants?
glutaraldehyde, peroxide
Effectiveness of autoclaving is best determined by culturing bacterial spores.
Spore testing on autoclave units is recommended monthly.
first true, second false
testing should be weekly
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
160 for 2 hours (or 170 for 1 hour)
Which is minimum required temperature to positively destroy all living organisms?
100
121
134
250
121
steam autoclaves: 121 for 15-20
270 for 3 minutes
Ethylene oxide sterilization is faster than moist heat autoclave.
Ethylene oxide sterilization can be used to sterilize heat sensitive instruments.
first false, second true
sterilization with ethylene ozide is 10-16 hours (vs 2 hours)
Killing or removal of all microorganisms, including bacterial spores, is called
disinfection
cleaning
sterilization
wiping
sterilization - absence of all living forms
disinfection - killing of many but not all (does not include spores)
All are advantages of using alcohols as surface disinfectants except:
they are bactericidal
they are sporicidal
they are tuberculocidal
they are economical
sporicidal
they are not
iodine - most effective skin antiseptic (oxidizing agent)
Greatest occupational health care worker risk for bloodborne infx is
hep C
HIV
hep B
TB
hep B
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
disinfectant
Which of these antiseptics does NOT exhobot persistent activity?
isopropyl alcohol
chlorhexidine gluconate
triclosan
quaternary ammonium compounds
isopropyl alcohol
persistent activity - ability to prevent after being applied
Bactericidal agents work best during which phase of bacterial growth?
lag
log
stationary
death
log
marker microorganism for intermediate surface disinfection is
bacillus stearothermophilus
pseudomonas aeruginosa
hepatitis B virus
myco TB
myco TB
- significant benchmark criterion
Antigens most responsible for immediate Type I reaction to natural rubber latex are
proteins
accelerators
corn starch powders
anti-oxidants
proteins
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
reduce concentration
Most efficient way to kill microbes is:
cold sterilization
proper handwashing with sterilizing antiseptics
heat sterilization
immersion of contaminated items in chemical sterilants
heat
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
irritation dermatitis (20-30%)
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
wear vinyl or nitrile
Which is killing all microorganisms on an object or in a material?
standardization
sanitization
disinfection
sterilization
sterilization
sanitization lowers total microbial load
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.
1 false 2 true
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
opportunistic
It is recommended that face masks be changed
between pts
daily
twice per day
twice in the morning and twice in the afternoon
between pts
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
persons w allergy to pollen
Instrument that contacts mucous membranes or non-intact skin is classified into which of the following categories?
critical
semicritical
subcritical
noncritical
semicritical
critical - penetrate
semicritical - contact
noncritical - intact skin
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
does not require precleaning
preclean everything!
Personal protective equipment clinic jackets should be
short sleeve, high neck
short sleeve, turtle neck
long sleeve, high neck
long sleeve, turtle neck
long sleeve, high neck
In healthcare what is the primary disease prevention measure?
wipe-wipe
spray-wipe-spray
handwashing
vaccines
handwashing (at least 10 seconds)
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
bacterial endospores
some G+ but NEVER G- are spore formers
high concentration of Ca and dipicolinic acid
Thermometer is an example of which of the following Spaulding classifications?
critical
semicritical
subcritical
noncritical
semicritical
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
removal of organic debris from contaminated hands
must be washed with soap
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
blood saturated - considered infectious
also microbiological waste tissues and extracted teeth (w/o amalgam) blood and by products sharps anesthetic carpules
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
all
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
have a low risk of transmitting HIV
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
1 true 2 wrong
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
as soon as practical
as soon as feasible when torn
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
was designed to primarily protect against bloodborne pathogens
standard: added all body fluids, moist body surfaces etc
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
all of the above
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.
both false
contaminated waste can be discarded with office trash
