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SMART 1 > Mixed smart 2 > Flashcards

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

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2
Q

Acute ureteral constriction or obstruction will cause what to the GFR and FF

A

Decrease GFR and Filtration Fraction (FF)

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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)

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4
Q

What stimulates mast cell histamine release which causes increased vascular permeability and vasodilation

A

C3a

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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

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6
Q

Interleukin-5 what does it promote

A

Differentiation of B cell and eosinophils and stimulates isotype switching to IgA

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7
Q

What reaction synthesizes the cofactor during gluconeogenesis, when phosphoenolpyruvate is formed from oxaloacetate

A

Succinyl CoA—–> succinate

GTP– is the cofactor

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8
Q

What is the causative

agent of osteomyelitis in person with sickle cell disease

A

Salmonella– mainly

Staph aureus

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9
Q

Lymphatic drainage of the rectum proximal to the anal dentate line occurs via

A

Inferior mesenteric and internal iliac lymph nodes

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10
Q

Acute onset of confusional state characterized by fluctuating level of consciousness with deficit in attention, memory and executive functions

A

Delirium

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11
Q

Deep bleeding ulcer at the duodenal bulb is likely to penetrate

A

Gastroduodenal ateries

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12
Q

A viral particle that loses their infectivity once exposed to Ether is likely an

A

Enveloped virus

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13
Q

Osteocytes remain connected to each other by

A

Gap junctions

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14
Q

Prostate cancer spread to the lumbosacral spine via

A

Prostate venous plexus

part of the Vertebral venous plexus

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15
Q

A pregnant person taking valproate acid adverse effect are

A

Neural Tube defect

myelomeningocele

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16
Q

Hyperactivity of which cells will cause an excessive increase in plasma normetanephrine and metanephrine levels

A

Chromaffin cells of the adrenal medulla

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17
Q

The most common gastrointestinal abnormality associated with down syndrome is

A 
Duodenal atresia
(double bubble sign)
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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

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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

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20
Q

Immunocompromised patients are at an increased risk of fungal infection; produce thin, septate hyphea with acute V-shaped branching

A

Aspergillus fumigatus

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21
Q

Gas Gangrene is due to clostridium perfringens and the mechanism of action is

A

Phospholipid splitting

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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

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23
Q

Where does timolol ophthalmic drops work to diminish the secretion of aqueous humor

A

Ciliary epithelium

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24
Q

Which enzyme is deficient in a person with porphyria cutanea tarda

A

Uroporphyrinogen decarboxylase

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25
Q

A kid less than 2 years of age with abdominal mass, periorbital ecchymoses (orbital metastases), spinal cord compression from epidural invasion most likely has

A

Neuroblastoma

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26
Q

What is the best medication for treating Venous thromboembolic disease in a pregnant person

A

Enoxaparin

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27
Q

Lymph drainage from the scrotum goes to

A

Superficial inguinal lymph nodes

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28
Q

Acute rejection is usually seen within 6 months of renal transplant and the cause is

A

Cell mediated immunity or

Antibody mediated

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29
Q

Which TB medication has Optic neuropathy as the major side effect (RIPE)

A

Ethambutol

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30
Q

Occlusion of which artery causes contralateral motor and sensory deficit of the lower extremities, behavior changes and urinary incontinence

A

Anterior cerebral arteries

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31
Q

During repetitive pronation/supination of the forearm there can be injury to the radial nerve as it passes through the

A

Supinator canal

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32
Q

In a healthy individual sugar alcohol (sorbitol) is normally metabolized into which substance before being excreted or can cause cause blindness when it accumulate

A

Fructose

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33
Q

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

A

These antibodies inhibit binding of hemagglutinin to sialylated receptors on the host cell wall preventing the live virus from entering cells via endocytosis.

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34
Q

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

A

Need for cardiac surgery

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35
Q

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

A

Urine chloride

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36
Q

Arterial blood pH>7.4 indicates alkalosis. Acid base disturbance can occur due to

A 
Decrease pCO2 (respiratory alkalosis) or
Increased HCO3 (metabolic alkalosis)
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37
Q

Metabolic and Respiratory alkalosis is characterized by

A

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

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38
Q

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

A

Type 1 hypersensitivity

Caused by Histamine release

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39
Q

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

A

Antiretroviral chemotherapy

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40
Q

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

A

Pol gene mutation

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41
Q

Elevated level of arginine in CSF and plasma in indicative of arginase deficiency. ARGINASE is normally involved in the production of which product

A

Urea and Ornithine from arginine

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42
Q

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

A

Middle cerebral artery

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43
Q

What is consistent with a malignancy in Lymphadenopathy

A

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

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44
Q

What medication can be used to relieve hypertension, tachycardia, fatigue, tremors, heat intolerance and weight loss associated with hyperthyroidism (graves disease

A

Propranolol

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45
Q

Which side effect of Graves disease cant propranolol be used to treat and why

A

Exophthalmos;

because it is due to increased soft tissue mass within the obit

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46
Q

Endometrial sampling that shows coiled glands filled with carbohydrate-rich mucus, edematous stroma and tortuous spiral arteries is

A

Secretory Phase

Progesterone is released, happens 15-28 days in preparation for implantation

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47
Q

In what stage will endometrial biopsy show an endometrium with coiled glands and occasional cytoplasmic vacuoles in the glandular epithelium

A

Proliferative phase

Estrogen rises and LH rises

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48
Q

Sudden onset of dyspnea (difficulty breathing) in the setting of recent calf swelling is strongly suggestive of

A

Pulmonary embolism (PE)

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49
Q

Pulmonary embolism leads to hyperventilation that causes alkalosis however what will remain normal

A

Bicarbonate level will remain normal ( 22-28) which is Respiratory alkalosis

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50
Q

Bleeding spot within a cluster of enlarged tortuous veins in the gastric fundus is caused by pressure in which vascular structure

A

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

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51
Q

Which artery supplies the Inferior Surface of the heart

A

Right coronary artery

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52
Q

Which artery supplies the Lateral and posterior superior wall of the left ventricle

A

Left circumflex coronary artery

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53
Q

The Right marginal branch of the right coronary artery supplies the

A

Wall of the right ventricle and provide collateral circulation to patients with LAD occlusion

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54
Q

A patient that develops and embolus after a total hip replacement should have been give

A

Low dose Heparin to prevent the embolus or clotting

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55
Q

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)

A

Internal iliac arteries also known as hypogastric arteries

56
Q

A person with TB should never be treated with drug mono-therapy dues to rapid emergence of antibiotic resistance. Isoniazid mono-therapy will

A
  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
Q

Cryptococcus neoformans infection in a HIV patient will manifest as

A

Meningoencephalitis

58
Q

Cryptococcus neoformans is diagnosed by

A

Mucicarmine staining of lungs tissue and bronchoalveolar washings ( lavage)

59
Q

Levels of which substance will be higher in the pulmonary vein compared to the pulmonary artery of patient with congestive heart failure

A

Angiotensin II

angiotensin I is converted to angiotensin II primarily in the pulmonary vessels

60
Q

What medication is used for long term treatment of alcohol redrawing fir it self tapering effect resulting in smoother course of redrawal

A

(Long-term acting Benzodiazepines)

Chlordiazepoxide
Diazepam

61
Q

Enoxaparin (LMWH) therapy in expected to bind what substance in a patients blood

A

Antithrombin III

(antithrombin when bound activates factor Xa and stop factor Xa from converting prothrombine to thrombin

62
Q

Fenofibrate therapy mechanism is to

A

Reduce hepatic VLDL production

63
Q

Before starting a patient on Canagliflozin (SGLT-2)

inhibitors (FLOZINS) what labs should be ordered

A

Blood urea nitrogen and Creatinine test

BUN

64
Q

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

A

Transitional cell carcinoma

appear as multifocal sessile or papillary tumors

65
Q

Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement and patchy squamous metaplasia of the bronchial mucosa are features of

A

Chronic Bronchitis

cigarette smoking is the leading cause

66
Q

Round or Oval cells with scant cytoplasm and large hyperchromatic nuclei is microscopic finding in

A

Small cell lung carcinoma (oat cell)– strongly associated with smoking

67
Q

Polygonal cells with eosinophilic cytoplasm and distinct boarders is

A

Squamous cell cancer

68
Q

Presence of Kimmelstiel-Wilson nodules (located in the peripheral mesangium, ovoid or spherical in shape, lamellated appearance) is diagnostic for

A

Nodular glomerulosclerosis

69
Q

The most common cause of nodular glomerulosclerosis is

A

Diabetic Neuropathy

Diabetes Mellitus

70
Q

When URACIL is found in association bacterial DNA during prokaryotic DNA replication. What is the implication?

A

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
Q

In neurofibromatosis type 1, the cutaneous neurofibromas are made of Schwann cell which are embryologically derived from

A

Neural crest

72
Q

A patient with neurologic symptoms (eg. tingling, difficulty concentrating) and recurrent episodes of nonspecific abdominal pain likely has

A

cute intermittent porphyria

73
Q

Acute intermittent porphyria is an autosomal dominant disease charactarized by

A

Porphobilinogen deaminase deficiency

74
Q

Management of acute intermittent porphyria includes infusion of Hemin (heme) or glucose which down regulates hepatic

A

Aminolevulinate (ALA) synthase

75
Q

Elevated levels of somatostatin (somatostatinoma) leading to biliary stones is as a result of suppression of

A

Cholecystokinin (CCK)

(stones form because inhibition causes poor gallbladder contracttility

76
Q

Burn patients are at an increased risk of what bacterial infection

A

Both gram positive and gram negative infection

77
Q

When a burnt patient is affected by Gram-negative rod, that are oxidase-positive and non-lactose fermenting it is

A

P. Aeroginosa (the major pathogen in burnt patient)

Treatment
Cefepime or
Ceftazidme

78
Q

What is the underlining mechanism of Zenker diverticulum

A

Abnormal spasm or diminished relaxation of Cricopharyngeal muscle during swallowing

(CRICOPHARYNGEAL MOTOR DYSFUNCTION)

79
Q

Which human immune component is important for the prevention of superficial Candida infection (eg, oral-esophageal candidiasis, cutaneous candidiasis, candida vulvovaginitis)

A

T- Lymphocytes (particularly TH cells)

80
Q

Prevention of Hematogenous spread of candida; (Disseminated candidiasis) is more likely in patients who are neutropenic or otherwise immunocompromised (systemic infection) is done by

A

Neutrophils

81
Q

Which defense mechanism is responsible for clearing particle from the respiratory bronchioles and alveolar ducts

A

Alveolar Phagocytosis

82
Q

The elimination of medium particles that get trapped in the Bronchi and proximal bronchioles is done by

A

Mucociliary transport

83
Q

The antibodies causing RBC destruction in Mycoplasma pneumonia are called

A

Cold agglutinins

84
Q

Months after Treatment of mycoplasma pneumonia with azithromycin symptoms of anemia are resolved what is the significce

A

Fading of immune response

85
Q

A small circular DNA molecule that resemble a bacteria chromosome that is able to code for proteins, transfer RNA and ribosomal RNA is

A

Mitochondrial DNA

86
Q

Clostridium difficile colitis is responsible for cellulitis and gas gangrene. The toxin mostly damage which intestinal mucosal cells

A

Cytoskeleton integrity

87
Q

Which antidepressant medication used occasionally for insomnia or adjunctive pain management can lead to CONFUSION, constipation and acute URINARY RETENTION

A

AMITRIPTYLINE

88
Q

Which segment of the nephron does Antidiuretic hormone act to increase urea and water reabsorption, allowing for the production of maximally concentrated urine

A

Medullary segment of the collecting duct

89
Q

Prolonged Corticosteroid therapy for SLE management can lead to Cushing syndrome. Evaluation of the adrenal glands will show

A

Bilateral Cortical atrophy

90
Q

Absence/ Hypoplasia of the cerebellar Vermis and cystic dilation of the fourth ventricle with posterior fossa enlargement is

A

Dandy Walker malformation

91
Q

Which receptors is especially usefully for chemotherapy induced vomitting

A
  1. 5-HT3 (serotonin
    receptor antagonist)
  2. NK 1 (Neurokinin 1 receptor antagonist)
92
Q

Elevated serum alkaline phosphatase level and marginally elevated aminotransferase level with a contrast enhanced hypodense masses in the liver is consistent with

A

Metastatic liver disease

93
Q

Decrease activity of which neurotransmitter is associated with Capsaicin cream use

A

Substance P

it is involved in the transmission of pain

94
Q

Which test should be obtained before the initiation of Metformin in a diabetes mellitus patient

A

Serum creatinine

renal function

95
Q

What should be the most important prognostic marker in a patent with Bladder carcinoma (painless gross hematuria)

A

Involvement of the muscular layer

96
Q

Toxic shock syndrome toxin (TSST) are superantigens that interact with major histocompatibility complex like

A

Macrophages (IL 1 and TNF) and T-lymphocytes (IL-2)

97
Q

Decreased number of somatostatin-producing Antral cells is most likely to cause

A

Duodenal ulceration and

Duodenal gastric metaplasia

98
Q

Paroxysmal nocturnal hemoglobinuria is due to a defect that leads to uncontrolled complement-mediated hemolysis. This can lead to

A

Iron deposition in the kidney (hemosiderosis)

99
Q

Which hormone can bind to specific DNA sequence

A

Progesterone

100
Q

Activation of a diabetic medication that binds to PEROXISOME-PROLIFERATOR ACTIVATED RECEPTOR - GAMMA (PPAR-Y) GLITAZONES will cause

A

A decrease in Insulin resistance

101
Q

What diabetic medication is useful in lowering Triglyceride levels

A

Fibrates (fenofibrate, gemfibrozil)

Bind to PPAR-alpha

102
Q

What is the cause of kidney stones in a person crohns

A

Reduced intestinal calcium oxalate binding

103
Q

A medication that is an irreversible alpha 1 and alpha 2 adrenergic antagonist that effectively reduces arterial vasoconstriction induced by Norepinephrine

A

Phenoxybenzamine

104
Q

Which area of the nephron is normally impermeable to water regardless of serum vasopressin Levels

A

Thick and thin ascending limbs of Henle

105
Q

Damage in which brain part leading to loss of gray-white matter with sulcal effacement after cardiac arrest causes nonreactive pupils to light stimulatiion

A

Upper Midbrain

106
Q

At what stage in meiosis is the Oocyte (secondary Oocyte) most likely arrested immediately prior (before) fertilization

A

Metaphase of Meiosis II

107
Q

A person wit oral thrush, cervical and inguinal lymphadenopathy and brain lesion most likely has HIV. What is the cause of this

A

Toxoplasmosis Gondi

CD4 < 200

108
Q

A patient with a travel history to South or central America that present with multiple ring enhancing lesion in the brain is

A

Neurocysticercosis

due to Taenia solium–pork tapeworm

109
Q

An enlarging thyroid nodule associated with an elevated calcitonin level is concerning for medullary thyroid cancer. With associated marfanoid habitus suggest

A

Multiple Endocrine neoplasia type 2B (MEN2B)

110
Q

An injury to the heart, brain or skeletal muscle Will cause which cells to get into circulation

A

Creatine Kinase leaks across the DAMAGED CELL MEMBRANE

111
Q

Wheezing, diarrhea and facial flushing in association with ileal tumor with hepatic metastasis is suggestive of carcinoid syndrom which is treated with

A

Octreotide

112
Q

Proximal tubular ballooning and vacuolar degeneration in a patient with acute renal failure is consistent with

A

Acute tubular necrosis

113
Q

Presence of OXALATE CRYSTALS in tubular lumen is highly suggestive of ethylene glycol poisoning. What will be the cause of renal failure

A

Toxic renal injury

114
Q

Presence of orotic acid crystals in urine is suggestive of Hereditary Orotic aciduria. Supplementation with which substance would benefit the patient

A

Uridine

115
Q

The presence of rod-shaped intracytopasmic inclusion know as Auer rods are associated with many form of

A

Acute myeloblastic Leukemia (AML)

116
Q

The M3 variant of Acute myeloblastic leukemia which is ACUTE PROMYELOCYSTIC LEUKEMIA is associated with cytogenetic abnormality of

A

t(15;17)

117
Q

Chronic myelogenous leukemia is associated with

A

t(9;22)

ABL gene from chromosome 9 to chromosome 22

118
Q

t(8;14) is associated with

A

Burkitt Lymphoma

translocation c-Myc protooncogen on chromosome 8 and Ig heavy chain region of chromosome 14

119
Q

t(11;14) is associated with

A

Mantle cell Lymphoma

B cell lymphoma, results in activation of cyclin D gene

120
Q

Secretion of interferons (alpha and beta) in response to viral infection will cause

A

A decrease in protein synthesis by infected cells

suppresses viral replication

121
Q

What is expected to increase at the peak of exertion during excercise

A

CO2 content in the mixed venous blood

122
Q

Deficiency of the complement factors that form the membrane attack complex (C5b—-C9) results in

A

Recurrent infection by Neisseria species

Neisseria meningitidis and gonorrhea

123
Q

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)

A

Adenovirus

124
Q

Rapid onset, self-limiting gastroenteritis in outbreak settings (eg. restaurants, child care facilities, cruise ships) is caused by

A

Norovirus

125
Q

Erythema infectiosum (fifth disease) in school aged children and presents with fever, malaise and classic (slapped cheek” rash

A

Parvovirus B19

126
Q

What should be regularly monitored when a person is taking CLOZAPINE

A

Absolute neutrophil count

127
Q

Thyroid function test and creatine should be monitored in patients taking which medication

A

Lithuim

128
Q

Bleeding esophageal varices, splenic enlargement with a normal liver biopsy is mostly caused by

A

Portal Vein Thrombosis

129
Q

Hypoxia causes an increase in

A

Erythropoietin production by cortical cells of the kidney

130
Q

What is the drug of choice for beta blocker overdose

A

Glucagon

131
Q

What receptor does glucagon work on

A

G protein-coupled receptors increasing intracellular cAMP

132
Q

In adequate calcium and phosphorus for bone leads to rickets which is characterized by

A

Unmineralized osteoid matrix and epiphyseal (growth plate) cartilage

133
Q

Tricyclic antidepressants overdose leads to prolong QRS duration, ventricular arrhythmia. What is used to treat the cardiac toxicity (abnormalitise)

A

Sodium Bicarbonate

134
Q

The neuropathological findings in Friedreich ataxia is characterized by

A

Degeneration of the spinocerebellar tract

135
Q

Demyelination of peripheral nerve which typically presents with distal leg weakness/atrophy with sensory deficits, pes cavus and kyphoscoliosis is

A

Charcot-Marie Tooth

136
Q

Which anti fungal medication work by binding to ergosterol in the fungal cell wall

A

Amphotericin B

Nystatin

137
Q

What is the cause of neonatal hypoglycemia

A

Beta cell hypoplasia

SMART 1 (14 decks)

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