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SMART 1 > Mixed smart 3 > Flashcards

Mixed smart 3 Flashcards

1
Q

A person whiles maintaining a particular posture elicit hand tremor and symptoms subsides with small amount of alcohol consumption has essential tremor. What is the best treatment for this patient

A

Propranolol

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2
Q

What will cause oxygen-hemoglobin dissociation curve to left shift

A
  1. Decreased H+
  2. Decreased 2,3-BPG
  3. Decreased temperature (Hypothermia)
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3
Q

Bilateral descended testicles with enlarged, fluctuant hemi-scrotum that transilluminates brightly is most likely caused by a swelling in which location

A

Tunica vaginalis

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4
Q

What is the most likely cause of tamoxifen ineffectiveness in a subset of patients treated with it

A

Polymorphism of cytochrome P450 enzyme

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5
Q

A patient with indwelling catheter, with patient’s culture from catheter site grows Non-Lactose fermenting Gram-Negative Rod is most likely

A

Pseudomonas aeruginosa

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6
Q

Which substance is most likely to be increased in tumor cells during vascular basement membrane invasion to gain access to the circulation

A

Metalloproteinase

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7
Q

What organism is found in the mouth of dogs that is responsible for the majority of acute skin infection following a bite with a mouse-like odor characteristic

A

Pasteurella multocida

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8
Q

Cat scratch disease which develop following inoculation from infected cat and present with lymphadenopathy

A

Bartonella henslae

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9
Q

Dissociative disorder involving recurrent episodes of feeling detached from one’s body and/or feeling of unreality is

A

Depersonalization/derealization disorder

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10
Q

What is the source of bleeding Neonatal intraventricular hemorrhage which usually occur in premature babies (born before 32 weeks)

A

Germinal matrix

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11
Q

Cytologic evaluation of a mass that shows a malignant cells with deletion of chromosome 3p most likely involve

A

VHL

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12
Q

What serum marker is most important to monitor the recurrence of hepatocellular carcinoma

A

Alpha fetoprotein

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13
Q

Common tumor marker for recurrence of Ovarian cancer

A

CA 125

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14
Q

Tumor marker for Choriocarcinoma and Germ cell tumors

A

Carcinoembryonic antigen

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15
Q

Tumor marker CA 19-9 is the marker for

A

Pancreatic cancer

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16
Q

What is most likely decreased in a patient with lactase deficiency

A

Stool pH

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17
Q

Neurologic deficiency of what substance resembles Friedrichs ataxia

A

Neurologic symptoms of VITAMIN E

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18
Q

What property of elastin explains the stretch during active inspiration and recoil during passive expiration

A

Interchain cross-link involving lysine

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19
Q

Administration of a drug that causes redistribution of blood flow away from ischemic areas leading to exacerbating existing myocardial ischemia is associated with which phenomenon

A

Coronary arteriolar dilation

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20
Q

A bone biopsy that show numerous multinucleated cells containing over 100 nuclei is associated with which factor essential for the differentiation of the cells described

A

Receptor activator of nuclear factor kappa-B ligand

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21
Q

Diminished strength on right elbow flexion and an absent biceps reflex is most likely caused by a MUSCULOCUTANEOUS nerve injury (base ball pitching). Sensory loss is most likely to occur at

A

Lateral Forearm

coracobrachialis

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22
Q

What are some side effects of anticholinergic, antimuscarinic (scopolamine for motion sickness)

A
  1. Dry mouth
  2. Blurry vision
  3. Urinary retention
  4. constipation
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23
Q

A man with bilateral gynecomastia and small, firm testes with long Lower extremities (Klinefelter). Further evaluation will show

A
  1. Increased Serum LH and FSH
  2. Decreased Serum Testosterone
  3. No Sperm Count
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24
Q

What is the best next step in a patient taking an antithyroid medication. (methimazole/ propylthiouracil)

Why?

A

White blood cell count with differential

Thionamides can cause agranulocytosis

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25
Q

A young man with weakness, malaise and dark urine. Physical exam shows scleral icterus has ? and what is impaired

A

Glucose 6 Phosphate dehydrogenase (G6PD) deficiency.

Glucose-6-phosphate cant be converted to 6-phosphogluconolactone (6-phosphogluconate)

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26
Q

Which medication is effective against (Bacteroides) Beta-lactamase

A

Combination Piperacillin and Tazobactam

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27
Q

In mitral regurgitation, what would increase the ratio of forward flow volume to regurgitant flow volume

A

Decreasing left ventricular afterload

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28
Q

In patients lymph nodes palpated in the inguinal area inferior to the inguinal ligament most likely originated from

A

Orifice of the anal canal

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29
Q

Antidiuretic hormone (vasopressin) and oxytocin are synthesized within the magnocellular neurons found in the supraoptic and paraventricular nuclei and they are released into circulation from

A

Axon terminals of posterior pituitary

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30
Q

A patient with hip pain, decreased range of motion and underlying sickle cell disease has

A

Osteonecrosis

avascular necrosis of femoral head

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31
Q

In a old cerebral infarct. What is most likely to produce a lesion (Liquefactive necrosis)

A

Lysosomal digestion of the tissue

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32
Q

What substance can be added to folate deficiency to inhibit increased apoptosis of hemopoietic cells and megaloblastic anemia

A

Thymidine supplementation

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33
Q

What is likely increased as a result of atorvastatin therapy which causes a decrease in total cholesterol

A

LDL receptor density—> leading to increased uptake of circulating LDL

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34
Q

What is most likely to prevent recurrence of genital herpes simplex virus (HSV) generally due to reactivation of latent HSV-2

A

Daily Oral VALACYCLOVIR

can also use acyclovir or famiclovir

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35
Q

A patient with a triad of fibrous dysplasia (multiple osteolytic appearing lesions of the hip and pelvis), endocrine abnormalities and cafe-au-lait spots suggest diagnosis of

A

McCune-Albright syndrome (MAS)

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36
Q

Histopathologic features of WHORLED pattern of cellular growth that forms nest which may calcify into round, eosinophilic laminar structures called psammoma bodies is associated with

A

Meningiomas

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37
Q

Impetigo blistering eruption that eventually leads to formation of a golden yellow crust is accompanied by what clinical syndrome after such infectiion

A

Post-streptococcal glomerulonephritis

present with

  1. facial puffiness (edema)
  2. Dark urine (cola colored urine)
  3. Hypertension
  4. Hematuria
  5. Red blood cell cast
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38
Q

What medication is given to a mother that has greatest positive impact on fetal survival to prevent neonatal respiratory distress syndrome

A

Dexamethasone

Batemethasone

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39
Q

Which enzyme functions exclusively in the basophilic region of the nucleus

A

RNA polymerase I

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40
Q

Inflamed and erythematous epiglottis in a young non immunized kid (Haemophilus influenza type B). The major virulence factor is

A

Polyribosylribitol phosphate (PRP)

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41
Q

Enlarged lateral and third ventricles and normal sized fourth ventricles. Where is the blockage

A

Cerebral aqueduct

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42
Q

Which culture type is used used to facilitate the growth corynebacteria Deptheria

A

Cysteine-tellurite agar

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43
Q

Which drug overdose presents with arrhythmia and nonspecific gastrointestinal(nausea, vomiting),neurological (confusion, weakness) and visual symptoms

A

Digoxin

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44
Q

Elevated potassium caused by inhibition of Na-K-ATPase pumps

A

Digoxin Toxicity

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45
Q

Multiple sclerosis is a condition caused by inappropriate immune response directed against

A

Oligodendrocytes

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46
Q

An infant with persistent jaundice, muscle rigidity, lethargy and seizures. What is most likely cause of hyperbilirubinemia is likely to produce neurological abnormalities

A

Absent liver conjugation enzymes

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47
Q

Autosomal recessive disorder of bilirubin metabolism cause the a lack of UGT enzyme needed to catalyze bile glucuronidation.

A

Crigler-Najjar syndrome

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48
Q

Multiple endocrine neoplasia type 1 is characterized by tumors of the

A

Pituitary
Parathyroid gland
Pancrease

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49
Q

A drug prescribed to manage the acute episode of genital herpes –HSV-2 (acyclovir, valacyclovir) works by

A

Incorporating into newly replicating viral DNA and ultimately terminating viral DNA chain synthesis

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50
Q

Which medication can be given early in methotrexate toxicity.

A

Folinic acid

Leucovorin

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51
Q

What makes the resting potential under steady state

A

High potassium efflux and some sodium influx

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52
Q

Which three cytokines mediate systemic inflammatory response and stimulate hepatic secretion of acute phase proteins. (eg. fibrinogen)

A

IL-1, IL-6, TNF-alpha

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53
Q

Which cell wall component will cause failure to decolorize with hydrochloric acid and alcohol after staining with carbolfuchsin

A

Myocolic acid

54
Q

What is most likely effective against urinary tract infection in a person with indwelling catheter

A

Prompt removal of catheter when no longer indicated

55
Q

In a person with rheumatoid arthritis. The person serum contains IgM antibodies against

A

F portion of human IgG

56
Q

Fluoxetine used to treat anxiety works by

A

Inhibiting serotonin found in the Raphe nuclei

57
Q

NADPH generated during the conversion of Glucose-6-phosphate to Ribulosr-5-phosphate is necessary for which biochemical process

A

Fatty acid synthesis

58
Q

Acute extrapyramidal symptoms (eg, dystonic reaction, akathisia, Parkinsonism) are due to blockade of

A

Dopaminergic D2

in the nigrostriatal pathway

59
Q

A patient with absent lactate dehydrogenase activity during strenuous exercise leads to inhibition of glycolysis in skeletal muscle due to intracellular depletion of

A

NAD+

60
Q

High/Borderline ACTH level. Serum cortisol that is suppressed by HIGH dose DEXAMETHASONE but not by LOW dose most likely has

A

Pituitary Adenoma

61
Q

Low ACTH levels in combination with clinical features of Cushing syndrome is

A

Adrenal adenoma

62
Q

When High dose dexamethasone does not cause suppression with elevated ACTH levels is caused by

A

Ectopic ACTH production by malignant tumor

63
Q

Treatment for Bacterial vaginosis caused by Gardnerella vaginalis (pH <4.5, clue cells) is

A

Clindamycin

64
Q

Thin yellow-green discharge, pH>4.5 caused by Trichomoniasis

(trichomonas vaginalis) is treated with

A

Metronidazole

65
Q

Candida vaginitis (pseudohypae) treated with

A

Fluconazole

66
Q

In a patient with with post-streptococcal glomerulonephritis (PSGN) what indicates poor prognosis

A

Adult onset

most children recover completely but adults have relatively poor prognosis

67
Q

Amniocentesis done at 18 weeks of gestation that shows increased levels of acetylcholinesterase. This results most likely suggest failure of what process

A

Fusion of the edges of the neural plate

Neural Tube defect

68
Q

Which drug causes the constellation of aggressive behavior, combative, agitated, disoriented and confused

A

Phencyclidine (PCP)

69
Q

Constellation of Dysphoria/panic, Euphoria, Tachycardia/hypertension

A

Lysergic acid diethylamide (LSD)

70
Q

Chest pain, seizures, Mydriasis, Agitation/psychosis

A

Cocaine

71
Q

Varicose veins increases riski of

A
  1. Skin Ulceration
  2. Chronic edema
  3. Stasis dermatitis
  4. Poor wound healing
  5. Infection
72
Q

A medication that selectively decreases the heart rate but NO effect on myocardial contractility or relaxation used for CHF works on

A

Funny sodium channels during phase 4

73
Q

Myoglobin-rich, glycogen-poor fibers with many mitochondria (Type I fibers)

A
  1. Paraspinal muscles
  2. Soleus

(Postural muscle. Slow twitch)

74
Q

What is the most likely site of nerve compression that leads to weakness of dorsiflexion at the ankle

A

Fibular neck

75
Q

What antibodies is most likely to be found in a patient with CREST syndrome– Calcinosis, Raynauds phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia

A

Anti-centromere

76
Q

A selective medium containing vancomycin, colistin, nystatin and trimethoprim (Thayer-Martin) will favor growth of

A

Neisseria gonorrhoeae

77
Q

Fluphenazine has a side effect of

A

Muscle Rigidity

(Extrapyramidal side effect).

78
Q

What are serum Calcium, phosphorous and Parathyroid Hormone levels in celiac disease

A 
Decreased
1. Calcium
2. Phosphorous
Increased
3. PTH
79
Q

Which tissue is most likely to have the largest increase in protein synthesis in response to long term GLUCOCORTICOID therapy

A

Liver

80
Q

Unilateral hearing loss in the setting of facial numbness and weakness is highly suggestive of intracranial schwannoma. This is caused by am mass

A

Between the cerebellum and Lateral pons

cerebellopontine angle

81
Q

A patient with pure motor hemiparesis and small cavitary lesion in the internal capsule likely has lacunar infarct. Which is mainly caused by

A
  1. Hypertensive arteriolar sclerosis
  2. Microatheroma
  3. Lipohyalinosis
82
Q

Arteries with myxomatous degeneration (weakening of connective tissue) with pooling proteoglycans in media layer is associated with pathogenesis of

A

Aortic aneurysm

83
Q

Psychosis in the absence of major mood episodes but mood symptoms present for most of the illness is

A

Schizoaffective disorder

84
Q

Central Hypogonadism, Delayed puberty plus inability to smell (Anosmia) is consistent with KALLMANN syndrome which result from

A

Failure of GnRH-secreting neurons to migrate from their origin in the olfactory PLACODE to their normal hypothalamus

(KAL-1 mutation)

85
Q

The most common vascular hemangioma in babies is

A

Strawberry (Capillary) hemangioma

86
Q

Where is the cell (phagocytic) attachment site in an immunoglobin

A

The bottom of the Y-shaped structure.

Fc Receptor

87
Q

Site of attachment of complement in an immunoglobin is

A

Where the V-part of the structure ends and the tail begins

88
Q

Warfarin induced skin necrosis is caused by depletion of

A
  1. Protein C
  2. Factor VII
    Due to their short half-life
89
Q

Major side effect of Isoniazed therapy is

A

Hepatocyte Damage.

Hepatotoxic

90
Q

A 46 XX patient with Bilateral adrenal hyperplasia and ambiguous genitalia are consistent with Congenital adrenal hyperplasia caused by the conversion of

A

PROGESTERONE –> 11 - Deoxycorticosterone in the Zona glomerulosa (aldosterone precursor)

91
Q

Males (46 XY) have phenotypically normal genitalis, salt-wasting or precocious puberty appearing later. What is elevated

A

17- hydroxyprogesterone–> 11 - deoxycortisol in the zona fasciculata

92
Q

patient evaluated for poor weight gain since birth and noted for bulky greasy stools. Jejunal biopsy shows normal intestinal mucosal architecture but the enterocytes contain clear or foamy cytoplasm most likely suffer from

A

Abetalipoproteinemia

93
Q

A condition characterized by photosensitive dermatitis, diarrhea and dementia occurring secondary to vitamin B3 (niacin) deficiency is most likely caused by decrease activity of which enzyme

A

Isocitrate dehydrogenase

94
Q

What condition will cause an increase cardiac out put and increase in venous return

A
  1. Chronic arteriovenous shunt (fistula)

2.

95
Q

A patient whose labs indicate the presence of anti nuclear antibodies (ANA) has drug induced lupus. Which medication can cause Drug induced lupus

A
  1. Hydralazine
  2. Procainamide
  3. Isoniazid
96
Q

What is the adherence site for strep viridans

A

Fibrin-platelet aggregate

97
Q

The effect of a drug (CORTISOL) to augments the vasoconstrictive effect of another drug is termed

A

Permissiveness

98
Q

What condition is likely responsible for maintaining cardiac output in the setting of severe aortic regurgitation

A

Increase the left ventricular stroke volume

99
Q

Which labs should be obtained before starting a person on STATINS

A

Liver Transaminase levels

LTAs

100
Q

n methylene tetrahydrofolate reductase gene defect,, a person is unable to convert homocysteine to which product

A

Methionine

101
Q

What artery lies medial to the obturator artery and run superiorly and medially up the abdomen

A

Inferior epigastric.

which is 1 or 2 branches of the external ilac artery

102
Q

Early diastolic murmur is associated with

A

Aortic regurgitation

103
Q

A child that experienced some sore throat and now experiencing rapid, irregular jerking movements involving arm, face and legs has ACUTE RHEUMATIC FEVER. This child is at an increased risk of what condition in the future

A

Valvular heart disease

104
Q

What medication can be improves survival in congestive heart failure patient

A

Spironolactone
Eplerenone

(Mineralocorticoids receptor antagonist)

105
Q

Which binding curve of the sodium channel blockers has a weakest binding and faster dissociation, more than Quinidine

A

Lidocaine

Mexiletine

106
Q

In Tetralogy of Fallot what is the major determinant of symptom severity.

A

Right ventricular outflow tract obstruction

107
Q

In ACE inhibitor therapy, angioedema is a rare potential serious adverse effect caused by

A

Bradykinin accumulation

108
Q

What is consistent with acute graft rejection

A

Dense interstitial lymphocytic infiltrate

109
Q

In Polyarteritis Nodosa (PAN) which arteries are spared by the disease

A

Pulmonary arteries

110
Q

Intermittent muscle pain reproducibly caused by exercise and relieved by a brief period of rest defines claudication which is caused by

A

Lipid -filled intimal plaque

(atherosclerosis of large arteries)

111
Q

What enzyme is responsible for removing short fragments of RNA that a base paired to DNA

A

DNA polymerase I

112
Q

What structure does ETOPOSIDE targets to cause fractures

A

Topoisomerase II

113
Q

Which medication target microtubules

A

Vinca Alkaloids.

(Vincristine and vinblastine

114
Q

What is the cause of linear, shallow ulceration in the lower esophagus in cytomegalovirus (CMV) esophagitis

A

Enlarged cells with intranuclear inclusions

115
Q

Fetal anomalies associated with impaired swallowing (polyhydromnios). LOTS OF FLUID

A

Anencephaly

Gastrointestinal obstruction

116
Q

Statins responsible for myopathy also causes what other effects

A

Increased hepatocyte LDL receptor recycling

117
Q

What laboratory finding can be observed in a patient with alpha-1 antitrypsin deficiency

A
  1. Decreased forced expiratory volume in 1 second/ forced vital capacity
  2. Increased total lung capacity
  3. decrease Diffusing capacity for carbon monoxide
118
Q

What is the most primary focus of infection of an HIV patient with cryptococcus neoformans

A

Lungs

119
Q

Which cells are found on the skin that act as antigen presenting cells and are derived from myeloid cell line and possess characteristic Racquet-shaped intracytoplasmic granules known as Birbeck granules

A

Langerhans cells

120
Q

Compression of the left renal vein between the superior mesenteric artery and aorta causes

A

Varicocele

121
Q

Pustular skin lesion that form thick scabs when broken down is impetigo which is caused by ? and what does it demonstrate?

A
  1. Staphylococcus aureus

2. Pyrrolidonyl arylamidase positivity

122
Q

In benz(o)pyrene-induced lung cancer which enzyme is most likely overactive

A

Microsomal monooxygenase

123
Q

Burkitt lymphoma is caused by

A

c-Myc oncogene overexpression

124
Q

Over espression of n-Myc is usually found in

A

neuroblastoma

125
Q

Which substance is likely to accumulate i embryonic tissue with treatment of methotrexate

A

Dihydrofolate polyglutamate

126
Q

According to epidemiological studies overdose of which substance can lead to death in a depressed patient

A

Opioids

127
Q

What is the compensatory metabolism of fructose when there is still presence of large amount of fructose in urine despite moderate intake

A

Hexokinase

128
Q

In Fructose kinase deficiency the compensatory metabolism of glucose can be done by

A

Hexokinase

129
Q

Warfarin administration that leads to severe subcutaneous fat necrosis is caused by a defect in

A

Protein C activity

130
Q

Subacute combined degeneration which involves both the ascending (dorsal columns) and descending (corticospinal tract) pathways is caused by

A

Vitamin B12 deficiency

131
Q

The most common primary cerebral neoplasm of adults that typically located within the cerebral hemisphere and may cross the mid line is

A

Glioblastoma

132
Q

Which substance released from mitochondria can lead to shrunken eosinophilic cells within tumor

A

Cytochrome C

SMART 1 (14 decks)

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