MIDTERMS Flashcards
Patient presents with mental retardation, long face with large mandible, large everted ears and large testicles. The most likely diagnosis is:
Hunter syndrome
Hurler syndrome
Patau syndrome
Fragile X syndrome
all of the above
Fragile X syndrome
Reprogramming of stem cell pathway is the underlying mechanism of which cellular adaptation?
atrophy
Metaplasia
Hyperplasia
Hypertrophy
all of the above
Metaplasia
Itai-itai disease is a disease seen in ____________ toxicity.
Cadmium
Mercury
Lead
Arsenic
Cadmium
What receptor is expressed on the plasma membrane of dendritic cells that detect fungal glycans and elicit inflammatory reaction against fungi.
Toll like receptor
C-type Lectin Receptors (CLRs)
Rig-Like Receptors (RLR)
G-Protein Coupled Receptors
C-type Lectin Receptors (CLRs)
FUNGI
rig like - virus
g protein - bacterial
tlr - transcription factors
Overdose with acetaminophen can be treated by:
N-acetylcysteine
Thiamine
Naloxone
Activated charcoal
N-acetylcysteine
Activated charcoal - also correct but universal antidote
The following causes vascular permeability except:
Prostaglandin D2
Prostaglandin E2
Leukotriene D4
None of the above
None of the above
DNA structural variations in the genome that involve the deletion, duplication, or rearrangement of large DNA segments.
Single nucleotide polymorphisms
Copy number variation
Tandem repeats
Chromosal aberrations
None of the above
The most potent hallucinogen.
MDMA
LSD
PCP
Cocaine
LSD
Which of the following T cell subset is involved in immediate hypersensitivity reaction?
T-helper 1
T-helper 2
T-helper 3
T-helper 4
T-helper 2
Phenomenon of unresponsiveness to an antigen as a result of lymphocytes to that antigen, describes
Anergy
self tolerance
Autoimmunity
immunologic tolerance
immunologic tolerance
Aflatoxin has been associated with the development of this malignancy.
Lung cancer
Acute Myeloid Leukemia
Angiosarcoma
Liver cancer
Liver cancer
Phenomenon of unresponsiveness to an antigen as a result of lymphocytes to that antigen, describes
Anerygy
Autoimmunity
self tolerance
immunologic tolerance
Anerygy
Tay-Sachs disease is caused by?
Glycogen accumulation within the cells.
Glucocerebrosidase deficiency causing accumulation of glucocerebroside.
Point mutations or deletions in LDL receptors causing abnormal transport.
Deficiency in hexosaminidase A.
Deficiency in hexosaminidase A.
37 years old patient came to you with imaging findings stating that the liver has central vein and sinusoidal distension as well as centrilobular necrosis. You remember during discussion of the acinar model of blood flow that the centrilobular hepatocytes is at what zone?
Zone 1
Zone 2
Zone 3
Zone 4
ZONE 3
Which of the following is an example of intracellular hyaline?
Pink deposits in walls of arterioles in patients with chronic hypertension
Deposition in the basement membrane of the kidney of a patient with CKD
Presence of Russell bodies
All of the above
Presence of Russell bodies
64 years old male was celebrating his birthday with his family when he suddenly clutched his left chest. He was suddenly rushed to the emergency room within minutes. Laboratory shows an elevated Troponin I, and ECG changes were also noted. As he is still within the time of the golden period what is the best emergent therapy than can be administered?
Aspirin
Vitamin K
Tissue plasminogen activator
Heparin
Tissue plasminogen activator
clutched his left chest levine sign(MI)
Which of these cytokine has a role in allergies?
Th1
Th2
Th4
Th17
None of the above
In which of the following organs is the pathologic finding of a focal, hemorrhagic lesion most likely to be seen?
Lung with pulmonary thromboembolism
Kidney with renal artery thrombus
Heart with complete coronary artery occlusion
Brain with middle cerebral artery thrombus
Lung with pulmonary thromboembolism
Which of the following changes best describes the pathophysiology of pulmonary edema in patients with congestive heart failure?
Widespread endothelial damage
Acute lymphatic obstruction
Decreased plasma oncotic pressure
Increased hydrostatic pressure
Increased hydrostatic pressure
B cells develop in the bone marrow, now as a step in their maturation, B cells that recognize self antigen will undergo what process after?
Apoptosis
MHC restriction
Receptor Editing
Somatic recombination
Receptor Editing
Pathology of myasthenia gravis is due to:
Phagocytosis
Vasoactive release of amines
antibody mediated cellular dysfuction
immune complex deposition
Features of acute inflammation except
Mild local and systemic signs
Fast: minutes to hours
Mild tissue injury
Cellular infiltrates are mainly neutrophil
Mild local and systemic signs
A part of histone organization which leads to transcriptional silencing
Histone methylation
Histone phosphorylation
Histone Acetylation
DNA methylation
D.
A lysosomal storage disease with a mutation in the gene that encodes glucosylceraminidase presents with an accumulation of glucosylceramide in mononuclear phagocytic cells in the liver, spleen and marrow. The pathognomonic cells shows:
zebra bodies
wrinkled tissue paper celled cytoplasm
8 to 20 multinucleated cells
hydrophic cells with peri-nuclear halo
all of the above
wrinkled tissue paper celled cytoplasm
GAUCHERS DISEASE
Minamata disease is a disease seen in ____________ toxicity.
Cadmium
Mercury
Lead
Arsenic
Mercury
Deposition of immune complex is seen in which hypersensitivity reaction
TYPE I
TYPE II
TYPE III
TYPE IV
TYPE III
In tuberculosis, naive T-cells are differentiated into Th1 through:
Granuloma formation
PD-1 blockade
IL-12 stimulation
Caseous necrosis and formation of epithelioid cells.
IL-12 stimulation
What is the most common etiologic factor in acute myeloid leukemia?
Benzene
Radiation Exposure
Mercury
Lead
None of the above
Benzene
Perforins and granzymes are used by what cell types?
CD8+ T cells, NK cells
NK cells, Macrophages
CD8+ T cells, CD4+ T cells
CD4+ T cells, NK cells
CD8+ T cells, NK cells
NK CELLS - PRODUC GRANZYME
A 6 y/o child has a legs appearing “bowed” and a chest xray is notable for excess cartilage at the costochondral junction of the ribs. She is most likely suffering from
Ricketts
Achondroplasia - lack cartilage formation, dwarfs
Osteoid osteoma
Osteoporosis
Ricketts
Which cellular change may be reversed when injurious stimuli is removed?
Pyknosis
swelling of endoplasmic reticulum
BOTH
NEITHER
swelling of endoplasmic reticulum
65-year-old patient came for consult and presented with fever, weight loss, and cough. Due to gross negligence, the patient expired and autopsy was done revealing, neutrophilic infiltrates with central liquefaction and surrounding granulation and fibrosis in the absence of granuloma. Microorganism was revealed to have distinctive branched chains and thin aerial filaments resembling hyphae. Which microorganism should be considered?
Aspergillus fumigatus - acute branches, thin filaments
Nocardia spp.
Mycobacterium tuberculosis
Rhizopus spp.
Nocardia spp.
All of the following are true regarding ethanol consumption, except
Acetaldehyde is the major metabolite of alcohol and is responsible for many of the toxic effects
Acute alcohol intoxication results in primarily CNS depressant effects
aldehyde dehydrogenase is the major enzyme responsible for metabolizing alcohol
all of the choices are true.
none of the choices are false
aldehyde dehydrogenase is the major enzyme responsible for metabolizing alcohol
Abundant in liver and gonads where it is used for steroid hormone and lipoprotein synthesis, and modification of hydrophobic compounds into water-soluble molecules
smooth endoplasmic reticulum
rough endoplasmic reticulum
Lysosomes
proteasome
smooth endoplasmic reticulum
Ubiquitous mold that microscopically have septate filaments branching at acute angles
Aspergillus
Mucor spp
Blastomyces dermatitidis
Coccidiodes immitis
Aspergillus
A nematode that causes patchy interstitial myocarditis characterized by many eosinophil and scattered giant cells.
Tricnella spiralis
T. cruzi - american treponemiasis (bed bug,painless)
S. mansoni - trematode (hematodium x cause scc (urinary bladder), japonicum)
N. gonorrhea
Tricnella spiralis
- only nematode
- can only cause myocarditis
The following agents may cause lung cancer except
Berrylium
Asbestos
Radon
Chromium
Cadmium
all can cause lung cancer
Chromium
The following are primary granules except:
Elastase
Collagenase
Acid hydrolase
Myeloperoxidase
Collagenase
Rocker bottom feet is frequently observed in patients with
TRISOMY 13
TROSOMY 21
TRISOMY 18
NONE OF THE ABOVE
TRISOMY 13 - FREQUENTLY
TRISOMY 18 - NOT FREQUENT
Which of the following viruses can enter latency?
HSV
HPV
CMV
JC virus
HSV
HSV 1 AND 2
VARICELLA ZOSTER
FLIP is a protein produced by poxvirus and herpes virus which inhibits apoptotic process by blocking what specific molecule?
BCL-XL
Fas Ligand
FADD
TNF-1
FADD
Type of mutation occur when the insertion or deletion of one or two base pairs alters the reading frame of the DNA strand
silent mutation
frame shift mutation
missense mutation
non-sense mutation
all of the above
frame shift mutation
Release of this molecule happens as a protective response to deal with hypoxic stress; this molecule promotes new blood vessel formation, stimulates cell survival pathways, and enhances glycolysis.
VEGF-A
Angiostatin
VEGF-D
HIF-1
A clinicopathologic entity with a triad of dry eyes, dry mouth and arthritis.
Scleroderma
sjogren syndrome
SLE
dermatomyositis
sjogren syndrome
An alteration within cells or in extracellular space which gives a homogenous glassy pink appearance in routine H&E histologic sections is called:
coagulation necrosis
Steatosis
hyaline change
fibrinoid necrosis
Receptor protein responsible for the binding of platelets to vwf on ECM?
gpIa
gpIb
GpIIb
GpIIb/IIIa
gpIb
Good pasture syndrome is what type of hypersensitivity reaction?
TYPE I
TYPE II
TYPE III
TYPE IV
TYPE II
It is the basic subunit of chromatin which consists of 147 base pairs of DNA wrapped in approximately two turns around an octameric protein core containing two copies each of histones
Histone
Nucleosome
Chromatin
Centromere
Nucleosome
This vitamin A derivative is used in the treatment of Acute Promyelocytic Leukemia.
13-cis-retinoic acid
Beta-carotene
Isotretinoin
all-trans-retinoic acid
all-trans-retinoic acid
This complement protein acts as an opsonin when fixed to the microbial cell wall.
C1q
C5a
C3b
C3a
C3b
An alteration within cells or in extracellular space which gives a homogenous glassy pink appearance in routine H&E histologic sections is called _____.
coagulation necrosis
Steatosis
hyaline change
fibrinoid necrosis
liquefaction necrosis
hyaline change
Glycogen storage diseases arises with lack of the following enzyme, except
Acid maltase
Muscle phosphorylase
glucose 6 phospatase
ALL OF THE ABOVE
NONE OF THE ABOVE
NONE OF THE ABOVE
A 68 year old female with multiple myeloma dies of acute renal failure. At autopsy, her kidneys and liver were pale gray, with waxy cut sections, while her spleen showed tapioca-like granules. On histology, these organs show deposits that
have empty vacuoles that uptake Sudan black -AML
are infiltrated by neutrophils and histiocytes
will fluoresce an apple green color when stained with Congo red
are bluish, with concentric laminations -SCWANOMA BODIES
will fluoresce an apple green color when stained with Congo red
TAPIOCA LIKE
-amyloid
The following categories of pathophysiology of edema and the clinical condition are correct, except:
Nephrotic syndrome- decreased oncotic pressure
Sodium retention- increased hydrostatic pressure
Kwashoirkor- decreased oncotic pressure
Filariasis- lymphatic obstruction
None of the above
All are correct
Abnormal fusion of primary granules which results in a malfunctioning WBC with a diminished phagocytic capability
Chediak-Higashi syndrome
Leukocyte adhesion defect
Chronic granulomatous disease
Myeloperoxidase deficiency
Chediak-Higashi syndrome
-neutropenia
-defectuve granulation
-delayed microbial killing
CGD-OXIDATIVE BURST
MPO-PEROCYTE SYSTEM
An example of point mutation wherein a purine base is replaced by another purine base or a pyrimidine base is replaced by another pyrimidine base.
genomic imprinting
Transition
silent mutation
gonadal mosaicism
all of the above
Transition
Formed by homotypic extracellular interactions between transmembrane glycoproteins that mechanically attach cells and their cytoskeletons to other cells.
Occluding junctions
Anchoring junctions
Gap junctions
Communicating junctions
Member of the immunoglobulin superfamily, is an adhesion molecule present in the intercellular junction
CD34
CD31
ICAM
VCAM
CD31
-PECAM
ENDOTHELIUM TO VASCULAR
True about EXUDATE
low protein and little to no cellular debris
it is essentially an ultrafiltrate of the blood
this is an implication that there is increased permeability triggered by some sort of tissue injury.
this is an implication of osmotic or hydrostatic imbalances in the vessels, without an increase in the permeability of the vascular walls.
this is an implication that there is increased permeability triggered by some sort of tissue injury.
The most common sexually transmitted bacterial disease is
N. gonrrhea
C. trachomatis
Both
none of the above
Which of the following is NOT TRUE of the effects of alcoholism on cellular processes?
Depletion of NAD impairs fatty acid oxidation leading to steatosis.
Depletion of NAD impairs conversion of lactate to pyruvate leading to acidosis.
Reactive oxygen species derived from alcohol metabolism causes lipid peroxidation of hepatocyte membranes.
Acetaldehyde triggers enterotoxin release from gram-positive bacteria.
Acetaldehyde triggers enterotoxin release from gram-positive bacteria.
should be gram negative
This is produced by COX-1 which is expressed constitutively by “healthy” endothelium under normal flow conditions.
PGE2
PGF2
PGI2
PGD2
PGI2
PROSTACYCLIN
Increased number of hemosiderin-laden macrophages is a tell-tale sign of _____.
old hemorrhage
Melanoma
sunburn or radiation injury
formation of myelin figures
all of the above
What is the second most common cause of mental retardation after trisomy 21?
TURNER’S SYNDROME
FRAGILE X SYDROME
MARFAN SYNDROME
KLIENFELTER’S SYDNROME
Which of the following does not belong to Adaptive immunity?
Antibodies
Dendritic cell
Epithelial barriers
T-Lymphocyte
Epithelial barriers
innate - skin and leukocytes and complement activation
adaptive - acquired (humoral extra, intra-cell med)
Alcohol metabolism by the enzyme catalase is seen in which part of the hepatocyte?
Peroxisome
Mitochondria
Microsomes
Cytosol
Peroxisome
A patient takes aspirin for arthritis. Although her joint pain is reduced with this therapy, the inflammatory process continues. Aspirin therapy alleviates pain via reduction in the synthesis of
Complement C1q
Histamine
Leukotriene E4
Prostaglandins
Prostaglandins
What do both the skin and gut epithelial cells produce to protect against infectious disease?
IgA antibodies - mucous
IgG antibodies - cross placenta
IgM antibodies - only pentamer, 1st
IgE antibodies - hypersensitivity and parasitis
IgA antibodies
Which of the following are not involved in the measurement of extrinsic pathway of coagulation cascade?
Factor XII
Factor X
Factor VII
Factor V
Factor XII
These are selectins found in lymphocytes and monocytes.
L-selectin
P-selectin
E-selectin
CD-31
L-selectin
These are intracellular proteins expressed from the bile duct epithelia.
Uric acid
Troponin
Alkaline phosphatase
Transaminase
Which among the following is a feature of irreversible cell injury?
Presence of small clear vacuoles within cytoplasm
Dilation of endoplastic reticulum
Changes in cellular membrane, specifically blebbing
None of the above
Leukocytes inability to migrate to the site of infection and inflammation due to a mutation in fucosyl transferase
Leukocyte adhesion defect 1
Leukocyte adhesion defect 2
Myeloperoxidase deficiency
Chronic granulomatous disease
Plasma membrane transport proteins where transport is relatively slow, solute binds and undergo a series of conformational changes to transport the ligand across the membrane
Carrier protein
Channel protein
Facilitated Diffusion proteins
None of the above
Carrier protein
The increase in heart size in chronic hemodynamic overload due to hypertension is largely due to
fatty change
myocyte intracellular accumulation
muscle hyperplasia
myocyte hypertrophy
HIV viral surface proteins essential for viral entry into cells.
Gp41
P17
Gp120
p24
Gp120
receptor - CXCR
Autoimmune haemolytic anemia is an example of this hypersensitivity
TYPE I
TYPE II
TYPE III
TYPE IV
A patient with prolonged PTT and normal PT likely has a deficiency in which of the following coagulation factors?
Factor VIII
Factor VII
Factor V
Thrombin
Factor VIII
Along with SLE, Antiphospholipid antibody syndrome (APAS) has this target antibody which is present in endothelial cell walls, platelets, macrophages, and the mitochondria.
Lipooligosaccharide
Lipopolysaccharide
Cardiolipin
M protein
Cardiolipin
and betaglycoprotein 1
Initial receptor for viral infection of measles virus expressed on activated lymphocytes, dendritic cells and monocytes.
CD46
Nectin 4
SLAMF-1
CD155
SLAMF-1
CD155 - POLIO
Numerous factors are considered in platelet adhesion defects including loss of factors and glycoprotein deficiencies. One such deficiency is Glanzmann thrombasthenia which primarily involves which of the following complexes?
gpIIb-IIa complex
gpIIa-IIb complex
gpIIb-IIIa complex
gpIIa-IIIb complex
gpIIb-IIIa complex
This is a basic form of nuclear chromatin which is cytochemically dense and transcriptionally inactive
Telomere
Centromere
Heterochromatin
Euchromatin
Heterochromatin
Which of the following is responsible for Neutralization of microbe, phagocytosis and complement activation?
Regulatory T-Lymphocyte
Cytotoxic T-Lymphocyte
Helper T-lymphocyte
B-lymphocyte
B-lymphocyte
-HELPER ONLY, SUPPORT
Which of the following is a stable cell
Epidermis
Cardiac Myocytes
Neuron
Hepatocyte
Hepatocyte
Indicate type of hypersensitivity reaction: Poststreptococcal glomerulonephritis
TYPE I
TYPE II
TYPE III
TYPE IV
TYPE III
1-IgE,th1
2-antibodies
3-antigen and antibody plus depositions
4-chronic clinical features
This occurs when a venous embolus passes through an interatrial or intraventricular defect and gains access to the systemic arterial circulation.
air embolism
Caisson’s disease
paradoxical embolism
fat embolism
paradoxical embolism
caissons - air emboli
Cell death by necrosis due to mitochondrial dysfunction will be preceded by which event?
increased sirtuins
release of cytochrome C
formation of mitochondrial permeability transition pores
imbalance of BCL2 proteins causing outer membrane leakiness
formation of mitochondrial permeability transition pores
A 14 year-old female suddenly notices enlargement of her breast followed by cramping in the hypogastric area and episodic fatigue. What could be the cause of the changes in her breast?
Physiologic hypertrophy
Pathologic hypertrophy
Physiologic hyperplasia
Metaplasia
Physiologic hyperplasia
A 26-year- old man has a sudden loss of vision in the right eye. On physical examination, there is a subluxation of the right crystalline lens. On auscultation of the chest, a mid-systolic click is audible. Echocardiogram was requested showing a floppy mitral valve and dilated aortic arch. On interview, patient says his brothers also have similar symptoms. This is caused by a defect in?
Collagen
NF-2
NF-1
Fibrillin-1
Fibrillin-1
MARFAN SYNDROME
NF - NEUROFIBROMATOSIS
COLLAGEN - EHLER DANLOS
coagulation factors are inhibited by Protein C and S?
Factors VIII and VWF
Va and VIIIa
II and IX
IX and XIII
What is it called when viral agents have a predilection for certain types of cell to infect?
Tropism
Antigenic variation
Transmission
Virulence
Tropism
Cell change characterized by fading basophilia, presumably due to enzymatic degradation by endonucleases.
Karyorrhexis
Karyolysis
Karyoptosis
Pyknosis
Karyolysis
The following are autosomal dominant disorders except:
Huntington disease
Myotonic dystrophy
Duchenne muscular dystrophy
Hereditary spherocytosis
Duchenne muscular dystrophy
There is progressive fibrosis interstitial and perivascular fibrosis in the skin and multiple organs
Mixed connective tissue disease
SLE
Sjogren
scleroderma
scleroderma
- CHRONIC INFLAMMATION
*SJOGREN - DRY EYES, DRY MOUTH, DESTRUCTION LACRIMAL AND SALIVARY GLANDS
*SLE -MULTIPLE ORGANS
*MIXED CT -
A 24-year-old male student came for consult due to occasional dysuria. Further PE revealed a red swollen, tender “mass” in the left inguinal area and scanty, clear-to-white penile discharge. He admits to being sexually active with multiple partners. As a medical practitioner, your initial suspect would be infection caused by?
Neisseria gonorrheae
Treponema pallidum
Chlamydia trachomatis
Haemophilus ducreyi
Chlamydia trachomatis
DYSURIA - STI-PENILE DISCHARGE
YELLOWISH - GONORRHEA
TREPONEMA - CHUNKER NOT PAINFUL
HAEMOPHLUS - CHUNKROID PAINFUL
A 1-year-old child with failure to thrive now exhibits frequent episodes of seizure. Physical examination shows hepatomegaly and ecchymoses of the skin. His blood glucose is abnormally low. Biopsy of his liver was done revealing vacuolated cells positively staining for glycogen. The disease most likely to cause this is?
Tay-Sachs disease
McArdle Disease
von Gierke Disease
Pompe Disease
von Gierke Disease
*G6 PHOSPHATASE
SEVERE HYPOGLYCEMIA
Surface protein is S. pyogenes responsible for antibodies and T cells cross-reacting with cardiac proteins.
LPS
m protein
c protein
s protein
none of the above
m protein
A Trinucleotide repeat Mutations are amplifications of a sequence of three nucleotides, they also are associated with an Anticipation-type of inheritance, An example is the second most common cause of Mental retardation with a prominent PE finding of Macro-orchidism. What Nucleotide repeat will be seen in this patient?
CAG
GAA
CGA
GCA
NONE OF THE ABOVE
ALL ARE CORECT
NONE OF THE ABOVE
FRAGILE X SYNDROME (FMR-1)
200 OR MORE REPEATS
A 19 y/o female develops a sore throat and fever during the past day. Physical Exam shows pharyngeal erythema and congestion. She is given naproxen. Which of the following features of the acute inflammatory response is most affected by the drug
Vasodilation
Emigration
Leukocytosis
Phagocytosis
Vasodilation
NSAIDS- NAPROXEN-PROSTAGLANDINS
Opportunistic pathogen that causes progressive multifocal leukoencephalopathy
B. burgdorferi - lyme disease
JC Virus
C. difficile -psedomembranous colitis
M. furfur - fungi
JC Virus
