Mixed smart 2 Flashcards
1
Q
The primary mechanism underlying Giant cell arteritis is
A
Cell- mediated immunity and the production of interleukin-6 is an important driver
2
Q
Acute ureteral constriction or obstruction will cause what to the GFR and FF
A
Decrease GFR and Filtration Fraction (FF)
3
Q
What is important in the formation and maintenance of granulomas in Macrophage -mediated immunity to Mycobacterium tuberculosis
A
Interferon-Y (gama)
IL-12
TNF-a (alpha)
4
Q
What stimulates mast cell histamine release which causes increased vascular permeability and vasodilation
A
C3a
5
Q
Interleukin-4 what does it promote
A
Interleukin-4 promote T helper cell differentiation into Th2 subset. It also stimulate B cell growth and isotype switching to IgE
6
Q
Interleukin-5 what does it promote
A
Differentiation of B cell and eosinophils and stimulates isotype switching to IgA
7
Q
What reaction synthesizes the cofactor during gluconeogenesis, when phosphoenolpyruvate is formed from oxaloacetate
A
Succinyl CoA—–> succinate
GTP– is the cofactor
8
Q
What is the causative
agent of osteomyelitis in person with sickle cell disease
A
Salmonella– mainly
Staph aureus
9
Q
Lymphatic drainage of the rectum proximal to the anal dentate line occurs via
A
Inferior mesenteric and internal iliac lymph nodes
10
Q
Acute onset of confusional state characterized by fluctuating level of consciousness with deficit in attention, memory and executive functions
A
Delirium
11
Q
Deep bleeding ulcer at the duodenal bulb is likely to penetrate
A
Gastroduodenal ateries
12
Q
A viral particle that loses their infectivity once exposed to Ether is likely an
A
Enveloped virus
13
Q
Osteocytes remain connected to each other by
A
Gap junctions
14
Q
Prostate cancer spread to the lumbosacral spine via
A
Prostate venous plexus
part of the Vertebral venous plexus
15
Q
A pregnant person taking valproate acid adverse effect are
A
Neural Tube defect
myelomeningocele
16
Q
Hyperactivity of which cells will cause an excessive increase in plasma normetanephrine and metanephrine levels
A
Chromaffin cells of the adrenal medulla
17
Q
The most common gastrointestinal abnormality associated with down syndrome is
A
Duodenal atresia (double bubble sign)
18
Q
The adenoma to carcinoma sequence is a series of gene mutations that lead to the development of colon cancer. Which gene mutation is involved
A
TP53 tumor suppressor gene mutation
19
Q
The only pathogenic fungus that has a polysaccharide capsule and appears red on mucicarmine stain and as clear unstained zone with india ink is
A
Cryptococcus neofromans
20
Q
Immunocompromised patients are at an increased risk of fungal infection; produce thin, septate hyphea with acute V-shaped branching
A
Aspergillus fumigatus
21
Q
Gas Gangrene is due to clostridium perfringens and the mechanism of action is
A
Phospholipid splitting
22
Q
What is the time frame when a cerebellar lesion shows neurons with eosinophilic cytoplasm and loss of Nissl substances
A
12-24 hours ago
23
Q
Where does timolol ophthalmic drops work to diminish the secretion of aqueous humor
A
Ciliary epithelium
24
Q
Which enzyme is deficient in a person with porphyria cutanea tarda
A
Uroporphyrinogen decarboxylase
25
A kid less than 2 years of age with abdominal mass, periorbital ecchymoses (orbital metastases), spinal cord compression from epidural invasion most likely has
Neuroblastoma
26
What is the best medication for treating Venous thromboembolic disease in a pregnant person
Enoxaparin
27
Lymph drainage from the scrotum goes to
Superficial inguinal lymph nodes
28
Acute rejection is usually seen within 6 months of renal transplant and the cause is
Cell mediated immunity or
| Antibody mediated
29
Which TB medication has Optic neuropathy as the major side effect (RIPE)
Ethambutol
30
Occlusion of which artery causes contralateral motor and sensory deficit of the lower extremities, behavior changes and urinary incontinence
Anterior cerebral arteries
31
During repetitive pronation/supination of the forearm there can be injury to the radial nerve as it passes through the
Supinator canal
32
In a healthy individual sugar alcohol (sorbitol) is normally metabolized into which substance before being excreted or can cause cause blindness when it accumulate
Fructose
33
Inactivated version of influenza vaccine function mainly by inducing Neutralizing antibodies against hemagglutinin antigen in selected viral strains. Upon subsequent exposure to influenza virus through natural infection, what happens
These antibodies inhibit binding of hemagglutinin to sialylated receptors on the host cell wall preventing the live virus from entering cells via endocytosis.
34
Early penicillin treatment of group A streptococcal pharyngitis is important for the prevention of acute rheumatic fever, a major cause of cardiovascular death. So penicillin prophylaxis will reduce future
Need for cardiac surgery
35
In the work up for metabolic alkalosis what is checked to ascertain the patient volume status (acid-base abnormality) or cause of the metabolic alkalosis
Urine chloride
36
Arterial blood pH>7.4 indicates alkalosis. Acid base disturbance can occur due to
```
Decrease pCO2 (respiratory alkalosis) or
Increased HCO3 (metabolic alkalosis)
```
37
Metabolic and Respiratory alkalosis is characterized by
pCO2 (<40mm Hg) because of hyperventilation causes RESPIRATORY Alkalosis
High pCO2 (>40mm Hg) because the accumulated HCO3 causes a compensatory decrease in ventilation. This is metabolic alkalosis
38
After an insect bite the erythematous papule or plaque often with the central pallor (wheal and flare reaction) and peripheral erythema is an indication of
Type 1 hypersensitivity
| Caused by Histamine release
39
An observed mutation in a pol gene (responsible for the emergence of HIV protease variants that are resistant to standard protease inhibitors) is most likely related to
Antiretroviral chemotherapy
40
What is responsible for the emergence of HIV protease variants that are resistant to standard protease inhibitor and also responsible for structural changes in HIV-1 reverse transcriptase that render enzyme resistant to the drugs
Pol gene mutation
41
Elevated level of arginine in CSF and plasma in indicative of arginase deficiency. ARGINASE is normally involved in the production of which product
Urea and Ornithine from arginine
42
Branch occlusion of which artery is responsible for a patient that is unable to communicate effectively but speaks clearly but sentences are incomprehensible, does not follow instruction and cannot repeat simple phrases (fluent aphasia)--Wernicke area
Middle cerebral artery
43
What is consistent with a malignancy in Lymphadenopathy
Malignant transformation is Monoclonal in that it results from the unchecked proliferation of a single genetically unique cell from only one cell line. The clonality of T cells population is assessed to examine the rearrangement of T-cell receptor genes
44
What medication can be used to relieve hypertension, tachycardia, fatigue, tremors, heat intolerance and weight loss associated with hyperthyroidism (graves disease
Propranolol
45
Which side effect of Graves disease cant propranolol be used to treat and why
Exophthalmos;
| because it is due to increased soft tissue mass within the obit
46
Endometrial sampling that shows coiled glands filled with carbohydrate-rich mucus, edematous stroma and tortuous spiral arteries is
Secretory Phase
| Progesterone is released, happens 15-28 days in preparation for implantation
47
In what stage will endometrial biopsy show an endometrium with coiled glands and occasional cytoplasmic vacuoles in the glandular epithelium
Proliferative phase
| Estrogen rises and LH rises
48
Sudden onset of dyspnea (difficulty breathing) in the setting of recent calf swelling is strongly suggestive of
Pulmonary embolism (PE)
49
Pulmonary embolism leads to hyperventilation that causes alkalosis however what will remain normal
Bicarbonate level will remain normal ( 22-28) which is Respiratory alkalosis
50
Bleeding spot within a cluster of enlarged tortuous veins in the gastric fundus is caused by pressure in which vascular structure
SPLENIC VEIN
The short gastric vein drains blood from the gastric fundus into the splenic vein
(splenic vein runs along the posterior surface of the pancreas and can develop a blood clot from pancreatic inflammation
51
Which artery supplies the Inferior Surface of the heart
Right coronary artery
52
Which artery supplies the Lateral and posterior superior wall of the left ventricle
Left circumflex coronary artery
53
The Right marginal branch of the right coronary artery supplies the
Wall of the right ventricle and provide collateral circulation to patients with LAD occlusion
54
A patient that develops and embolus after a total hip replacement should have been give
Low dose Heparin to prevent the embolus or clotting
55
In a laparotomy which arteries need to be ligated to stop bleeding after uterine massage and uterotonic medication; oxytocin fail to stop the bleed (postpartum hemorrhage)
Internal iliac arteries also known as hypogastric arteries
56
A person with TB should never be treated with drug mono-therapy dues to rapid emergence of antibiotic resistance. Isoniazid mono-therapy will
1. Decrease bacterial expression of catalase-peroxidase enzyme that is required for isoniazid activation
2. Modification of protein target binding site for isoniazid
(selective survival of bacterial cells secondary to gene mutation)
57
Cryptococcus neoformans infection in a HIV patient will manifest as
Meningoencephalitis
58
Cryptococcus neoformans is diagnosed by
Mucicarmine staining of lungs tissue and bronchoalveolar washings ( lavage)
59
Levels of which substance will be higher in the pulmonary vein compared to the pulmonary artery of patient with congestive heart failure
Angiotensin II
| angiotensin I is converted to angiotensin II primarily in the pulmonary vessels
60
What medication is used for long term treatment of alcohol redrawing fir it self tapering effect resulting in smoother course of redrawal
(Long-term acting Benzodiazepines)
Chlordiazepoxide
Diazepam
61
Enoxaparin (LMWH) therapy in expected to bind what substance in a patients blood
Antithrombin III
(antithrombin when bound activates factor Xa and stop factor Xa from converting prothrombine to thrombin
62
Fenofibrate therapy mechanism is to
Reduce hepatic VLDL production
63
Before starting a patient on Canagliflozin (SGLT-2)
| inhibitors (FLOZINS) what labs should be ordered
Blood urea nitrogen and Creatinine test
| BUN
64
Individual smoker or people with an occupational exposure to rubber, plastic, aromatic amine-containing dyes, textile or leather are at increased risk of which renal cancer
Transitional cell carcinoma
| appear as multifocal sessile or papillary tumors
65
Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement and patchy squamous metaplasia of the bronchial mucosa are features of
Chronic Bronchitis
| cigarette smoking is the leading cause
66
Round or Oval cells with scant cytoplasm and large hyperchromatic nuclei is microscopic finding in
Small cell lung carcinoma (oat cell)-- strongly associated with smoking
67
Polygonal cells with eosinophilic cytoplasm and distinct boarders is
Squamous cell cancer
68
Presence of Kimmelstiel-Wilson nodules (located in the peripheral mesangium, ovoid or spherical in shape, lamellated appearance) is diagnostic for
Nodular glomerulosclerosis
69
The most common cause of nodular glomerulosclerosis is
Diabetic Neuropathy
| Diabetes Mellitus
70
When URACIL is found in association bacterial DNA during prokaryotic DNA replication. What is the implication?
Uracil is only found in RNA so its presence in DNA replication symbolizes the presence of PRIMASE which is responsible for synthesizing a short RNA primer
71
In neurofibromatosis type 1, the cutaneous neurofibromas are made of Schwann cell which are embryologically derived from
Neural crest
72
A patient with neurologic symptoms (eg. tingling, difficulty concentrating) and recurrent episodes of nonspecific abdominal pain likely has
cute intermittent porphyria
73
Acute intermittent porphyria is an autosomal dominant disease charactarized by
Porphobilinogen deaminase deficiency
74
Management of acute intermittent porphyria includes infusion of Hemin (heme) or glucose which down regulates hepatic
Aminolevulinate (ALA) synthase
75
Elevated levels of somatostatin (somatostatinoma) leading to biliary stones is as a result of suppression of
Cholecystokinin (CCK)
(stones form because inhibition causes poor gallbladder contracttility
76
Burn patients are at an increased risk of what bacterial infection
Both gram positive and gram negative infection
77
When a burnt patient is affected by Gram-negative rod, that are oxidase-positive and non-lactose fermenting it is
P. Aeroginosa (the major pathogen in burnt patient)
Treatment
Cefepime or
Ceftazidme
78
What is the underlining mechanism of Zenker diverticulum
Abnormal spasm or diminished relaxation of Cricopharyngeal muscle during swallowing
(CRICOPHARYNGEAL MOTOR DYSFUNCTION)
79
Which human immune component is important for the prevention of superficial Candida infection (eg, oral-esophageal candidiasis, cutaneous candidiasis, candida vulvovaginitis)
T- Lymphocytes (particularly TH cells)
80
Prevention of Hematogenous spread of candida; (Disseminated candidiasis) is more likely in patients who are neutropenic or otherwise immunocompromised (systemic infection) is done by
Neutrophils
81
Which defense mechanism is responsible for clearing particle from the respiratory bronchioles and alveolar ducts
Alveolar Phagocytosis
82
The elimination of medium particles that get trapped in the Bronchi and proximal bronchioles is done by
Mucociliary transport
83
The antibodies causing RBC destruction in Mycoplasma pneumonia are called
Cold agglutinins
84
Months after Treatment of mycoplasma pneumonia with azithromycin symptoms of anemia are resolved what is the significce
Fading of immune response
85
A small circular DNA molecule that resemble a bacteria chromosome that is able to code for proteins, transfer RNA and ribosomal RNA is
Mitochondrial DNA
86
Clostridium difficile colitis is responsible for cellulitis and gas gangrene. The toxin mostly damage which intestinal mucosal cells
Cytoskeleton integrity
87
Which antidepressant medication used occasionally for insomnia or adjunctive pain management can lead to CONFUSION, constipation and acute URINARY RETENTION
AMITRIPTYLINE
88
Which segment of the nephron does Antidiuretic hormone act to increase urea and water reabsorption, allowing for the production of maximally concentrated urine
Medullary segment of the collecting duct
89
Prolonged Corticosteroid therapy for SLE management can lead to Cushing syndrome. Evaluation of the adrenal glands will show
Bilateral Cortical atrophy
90
Absence/ Hypoplasia of the cerebellar Vermis and cystic dilation of the fourth ventricle with posterior fossa enlargement is
Dandy Walker malformation
91
Which receptors is especially usefully for chemotherapy induced vomitting
1. 5-HT3 (serotonin
receptor antagonist)
2. NK 1 (Neurokinin 1 receptor antagonist)
92
Elevated serum alkaline phosphatase level and marginally elevated aminotransferase level with a contrast enhanced hypodense masses in the liver is consistent with
Metastatic liver disease
93
Decrease activity of which neurotransmitter is associated with Capsaicin cream use
Substance P
| it is involved in the transmission of pain
94
Which test should be obtained before the initiation of Metformin in a diabetes mellitus patient
Serum creatinine
| renal function
95
What should be the most important prognostic marker in a patent with Bladder carcinoma (painless gross hematuria)
Involvement of the muscular layer
96
Toxic shock syndrome toxin (TSST) are superantigens that interact with major histocompatibility complex like
Macrophages (IL 1 and TNF) and T-lymphocytes (IL-2)
97
Decreased number of somatostatin-producing Antral cells is most likely to cause
Duodenal ulceration and
| Duodenal gastric metaplasia
98
Paroxysmal nocturnal hemoglobinuria is due to a defect that leads to uncontrolled complement-mediated hemolysis. This can lead to
Iron deposition in the kidney (hemosiderosis)
99
Which hormone can bind to specific DNA sequence
Progesterone
100
Activation of a diabetic medication that binds to PEROXISOME-PROLIFERATOR ACTIVATED RECEPTOR - GAMMA (PPAR-Y) GLITAZONES will cause
A decrease in Insulin resistance
101
What diabetic medication is useful in lowering Triglyceride levels
Fibrates (fenofibrate, gemfibrozil)
| Bind to PPAR-alpha
102
What is the cause of kidney stones in a person crohns
Reduced intestinal calcium oxalate binding
103
A medication that is an irreversible alpha 1 and alpha 2 adrenergic antagonist that effectively reduces arterial vasoconstriction induced by Norepinephrine
Phenoxybenzamine
104
Which area of the nephron is normally impermeable to water regardless of serum vasopressin Levels
Thick and thin ascending limbs of Henle
105
Damage in which brain part leading to loss of gray-white matter with sulcal effacement after cardiac arrest causes nonreactive pupils to light stimulatiion
Upper Midbrain
106
At what stage in meiosis is the Oocyte (secondary Oocyte) most likely arrested immediately prior (before) fertilization
Metaphase of Meiosis II
107
A person wit oral thrush, cervical and inguinal lymphadenopathy and brain lesion most likely has HIV. What is the cause of this
Toxoplasmosis Gondi
| CD4 < 200
108
A patient with a travel history to South or central America that present with multiple ring enhancing lesion in the brain is
Neurocysticercosis
| due to Taenia solium--pork tapeworm
109
An enlarging thyroid nodule associated with an elevated calcitonin level is concerning for medullary thyroid cancer. With associated marfanoid habitus suggest
Multiple Endocrine neoplasia type 2B (MEN2B)
110
An injury to the heart, brain or skeletal muscle Will cause which cells to get into circulation
Creatine Kinase leaks across the DAMAGED CELL MEMBRANE
111
Wheezing, diarrhea and facial flushing in association with ileal tumor with hepatic metastasis is suggestive of carcinoid syndrom which is treated with
Octreotide
112
Proximal tubular ballooning and vacuolar degeneration in a patient with acute renal failure is consistent with
Acute tubular necrosis
113
Presence of OXALATE CRYSTALS in tubular lumen is highly suggestive of ethylene glycol poisoning. What will be the cause of renal failure
Toxic renal injury
114
Presence of orotic acid crystals in urine is suggestive of Hereditary Orotic aciduria. Supplementation with which substance would benefit the patient
Uridine
115
The presence of rod-shaped intracytopasmic inclusion know as Auer rods are associated with many form of
Acute myeloblastic Leukemia (AML)
116
The M3 variant of Acute myeloblastic leukemia which is ACUTE PROMYELOCYSTIC LEUKEMIA is associated with cytogenetic abnormality of
t(15;17)
117
Chronic myelogenous leukemia is associated with
t(9;22)
| ABL gene from chromosome 9 to chromosome 22
118
t(8;14) is associated with
Burkitt Lymphoma
| translocation c-Myc protooncogen on chromosome 8 and Ig heavy chain region of chromosome 14
119
t(11;14) is associated with
Mantle cell Lymphoma
| B cell lymphoma, results in activation of cyclin D gene
120
Secretion of interferons (alpha and beta) in response to viral infection will cause
A decrease in protein synthesis by infected cells
| suppresses viral replication
121
What is expected to increase at the peak of exertion during excercise
CO2 content in the mixed venous blood
122
Deficiency of the complement factors that form the membrane attack complex (C5b----C9) results in
Recurrent infection by Neisseria species
| Neisseria meningitidis and gonorrhea
123
A self-limiting year round infection that causes acute onset of fever, cough, congestion, pharyngitis and conjunctivitis n a crowded living quarters (camp dormitories, military barracks etc)
Adenovirus
124
Rapid onset, self-limiting gastroenteritis in outbreak settings (eg. restaurants, child care facilities, cruise ships) is caused by
Norovirus
125
Erythema infectiosum (fifth disease) in school aged children and presents with fever, malaise and classic (slapped cheek" rash
Parvovirus B19
126
What should be regularly monitored when a person is taking CLOZAPINE
Absolute neutrophil count
127
Thyroid function test and creatine should be monitored in patients taking which medication
Lithuim
128
Bleeding esophageal varices, splenic enlargement with a normal liver biopsy is mostly caused by
Portal Vein Thrombosis
129
Hypoxia causes an increase in
Erythropoietin production by cortical cells of the kidney
130
What is the drug of choice for beta blocker overdose
Glucagon
131
What receptor does glucagon work on
G protein-coupled receptors increasing intracellular cAMP
132
In adequate calcium and phosphorus for bone leads to rickets which is characterized by
Unmineralized osteoid matrix and epiphyseal (growth plate) cartilage
133
Tricyclic antidepressants overdose leads to prolong QRS duration, ventricular arrhythmia. What is used to treat the cardiac toxicity (abnormalitise)
Sodium Bicarbonate
134
The neuropathological findings in Friedreich ataxia is characterized by
Degeneration of the spinocerebellar tract
135
Demyelination of peripheral nerve which typically presents with distal leg weakness/atrophy with sensory deficits, pes cavus and kyphoscoliosis is
Charcot-Marie Tooth
136
Which anti fungal medication work by binding to ergosterol in the fungal cell wall
Amphotericin B
| Nystatin
137
What is the cause of neonatal hypoglycemia
Beta cell hypoplasia
