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
2
Q
What will cause oxygen-hemoglobin dissociation curve to left shift
A
- Decreased H+
- Decreased 2,3-BPG
- Decreased temperature (Hypothermia)
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
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
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
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
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
8
Q
Cat scratch disease which develop following inoculation from infected cat and present with lymphadenopathy
A
Bartonella henslae
9
Q
Dissociative disorder involving recurrent episodes of feeling detached from one’s body and/or feeling of unreality is
A
Depersonalization/derealization disorder
10
Q
What is the source of bleeding Neonatal intraventricular hemorrhage which usually occur in premature babies (born before 32 weeks)
A
Germinal matrix
11
Q
Cytologic evaluation of a mass that shows a malignant cells with deletion of chromosome 3p most likely involve
A
VHL
12
Q
What serum marker is most important to monitor the recurrence of hepatocellular carcinoma
A
Alpha fetoprotein
13
Q
Common tumor marker for recurrence of Ovarian cancer
A
CA 125
14
Q
Tumor marker for Choriocarcinoma and Germ cell tumors
A
Carcinoembryonic antigen
15
Q
Tumor marker CA 19-9 is the marker for
A
Pancreatic cancer
16
Q
What is most likely decreased in a patient with lactase deficiency
A
Stool pH
17
Q
Neurologic deficiency of what substance resembles Friedrichs ataxia
A
Neurologic symptoms of VITAMIN E
18
Q
What property of elastin explains the stretch during active inspiration and recoil during passive expiration
A
Interchain cross-link involving lysine
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
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
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
22
Q
What are some side effects of anticholinergic, antimuscarinic (scopolamine for motion sickness)
A
- Dry mouth
- Blurry vision
- Urinary retention
- constipation
23
Q
A man with bilateral gynecomastia and small, firm testes with long Lower extremities (Klinefelter). Further evaluation will show
A
- Increased Serum LH and FSH
- Decreased Serum Testosterone
- No Sperm Count
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
25
A young man with weakness, malaise and dark urine. Physical exam shows scleral icterus has ? and what is impaired
Glucose 6 Phosphate dehydrogenase (G6PD) deficiency.
Glucose-6-phosphate cant be converted to 6-phosphogluconolactone (6-phosphogluconate)
26
Which medication is effective against (Bacteroides) Beta-lactamase
Combination Piperacillin and Tazobactam
27
In mitral regurgitation, what would increase the ratio of forward flow volume to regurgitant flow volume
Decreasing left ventricular afterload
28
In patients lymph nodes palpated in the inguinal area inferior to the inguinal ligament most likely originated from
Orifice of the anal canal
29
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
Axon terminals of posterior pituitary
30
A patient with hip pain, decreased range of motion and underlying sickle cell disease has
Osteonecrosis
| avascular necrosis of femoral head
31
In a old cerebral infarct. What is most likely to produce a lesion (Liquefactive necrosis)
Lysosomal digestion of the tissue
32
What substance can be added to folate deficiency to inhibit increased apoptosis of hemopoietic cells and megaloblastic anemia
Thymidine supplementation
33
What is likely increased as a result of atorvastatin therapy which causes a decrease in total cholesterol
LDL receptor density---> leading to increased uptake of circulating LDL
34
What is most likely to prevent recurrence of genital herpes simplex virus (HSV) generally due to reactivation of latent HSV-2
Daily Oral VALACYCLOVIR
| can also use acyclovir or famiclovir
35
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
McCune-Albright syndrome (MAS)
36
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
Meningiomas
37
Impetigo blistering eruption that eventually leads to formation of a golden yellow crust is accompanied by what clinical syndrome after such infectiion
Post-streptococcal glomerulonephritis
present with
1. facial puffiness (edema)
2. Dark urine (cola colored urine)
3. Hypertension
4. Hematuria
5. Red blood cell cast
38
What medication is given to a mother that has greatest positive impact on fetal survival to prevent neonatal respiratory distress syndrome
Dexamethasone
Batemethasone
39
Which enzyme functions exclusively in the basophilic region of the nucleus
RNA polymerase I
40
Inflamed and erythematous epiglottis in a young non immunized kid (Haemophilus influenza type B). The major virulence factor is
Polyribosylribitol phosphate (PRP)
41
Enlarged lateral and third ventricles and normal sized fourth ventricles. Where is the blockage
Cerebral aqueduct
42
Which culture type is used used to facilitate the growth corynebacteria Deptheria
Cysteine-tellurite agar
43
Which drug overdose presents with arrhythmia and nonspecific gastrointestinal(nausea, vomiting),neurological (confusion, weakness) and visual symptoms
Digoxin
44
Elevated potassium caused by inhibition of Na-K-ATPase pumps
Digoxin Toxicity
45
Multiple sclerosis is a condition caused by inappropriate immune response directed against
Oligodendrocytes
46
An infant with persistent jaundice, muscle rigidity, lethargy and seizures. What is most likely cause of hyperbilirubinemia is likely to produce neurological abnormalities
Absent liver conjugation enzymes
47
Autosomal recessive disorder of bilirubin metabolism cause the a lack of UGT enzyme needed to catalyze bile glucuronidation.
Crigler-Najjar syndrome
48
Multiple endocrine neoplasia type 1 is characterized by tumors of the
Pituitary
Parathyroid gland
Pancrease
49
A drug prescribed to manage the acute episode of genital herpes --HSV-2 (acyclovir, valacyclovir) works by
Incorporating into newly replicating viral DNA and ultimately terminating viral DNA chain synthesis
50
Which medication can be given early in methotrexate toxicity.
Folinic acid
| Leucovorin
51
What makes the resting potential under steady state
High potassium efflux and some sodium influx
52
Which three cytokines mediate systemic inflammatory response and stimulate hepatic secretion of acute phase proteins. (eg. fibrinogen)
IL-1, IL-6, TNF-alpha
53
Which cell wall component will cause failure to decolorize with hydrochloric acid and alcohol after staining with carbolfuchsin
Myocolic acid
54
What is most likely effective against urinary tract infection in a person with indwelling catheter
Prompt removal of catheter when no longer indicated
55
In a person with rheumatoid arthritis. The person serum contains IgM antibodies against
F portion of human IgG
56
Fluoxetine used to treat anxiety works by
Inhibiting serotonin found in the Raphe nuclei
57
NADPH generated during the conversion of Glucose-6-phosphate to Ribulosr-5-phosphate is necessary for which biochemical process
Fatty acid synthesis
58
Acute extrapyramidal symptoms (eg, dystonic reaction, akathisia, Parkinsonism) are due to blockade of
Dopaminergic D2
| in the nigrostriatal pathway
59
A patient with absent lactate dehydrogenase activity during strenuous exercise leads to inhibition of glycolysis in skeletal muscle due to intracellular depletion of
NAD+
60
High/Borderline ACTH level. Serum cortisol that is suppressed by HIGH dose DEXAMETHASONE but not by LOW dose most likely has
Pituitary Adenoma
61
Low ACTH levels in combination with clinical features of Cushing syndrome is
Adrenal adenoma
62
When High dose dexamethasone does not cause suppression with elevated ACTH levels is caused by
Ectopic ACTH production by malignant tumor
63
Treatment for Bacterial vaginosis caused by Gardnerella vaginalis (pH <4.5, clue cells) is
Clindamycin
64
Thin yellow-green discharge, pH>4.5 caused by Trichomoniasis
| (trichomonas vaginalis) is treated with
Metronidazole
65
Candida vaginitis (pseudohypae) treated with
Fluconazole
66
In a patient with with post-streptococcal glomerulonephritis (PSGN) what indicates poor prognosis
Adult onset
| most children recover completely but adults have relatively poor prognosis
67
Amniocentesis done at 18 weeks of gestation that shows increased levels of acetylcholinesterase. This results most likely suggest failure of what process
Fusion of the edges of the neural plate
| Neural Tube defect
68
Which drug causes the constellation of aggressive behavior, combative, agitated, disoriented and confused
Phencyclidine (PCP)
69
Constellation of Dysphoria/panic, Euphoria, Tachycardia/hypertension
Lysergic acid diethylamide (LSD)
70
Chest pain, seizures, Mydriasis, Agitation/psychosis
Cocaine
71
Varicose veins increases riski of
1. Skin Ulceration
2. Chronic edema
3. Stasis dermatitis
4. Poor wound healing
5. Infection
72
A medication that selectively decreases the heart rate but NO effect on myocardial contractility or relaxation used for CHF works on
Funny sodium channels during phase 4
73
Myoglobin-rich, glycogen-poor fibers with many mitochondria (Type I fibers)
1. Paraspinal muscles
2. Soleus
(Postural muscle. Slow twitch)
74
What is the most likely site of nerve compression that leads to weakness of dorsiflexion at the ankle
Fibular neck
75
What antibodies is most likely to be found in a patient with CREST syndrome-- Calcinosis, Raynauds phenomenon, Esophageal dysmotility, Sclerodactyly and Telangiectasia
Anti-centromere
76
A selective medium containing vancomycin, colistin, nystatin and trimethoprim (Thayer-Martin) will favor growth of
Neisseria gonorrhoeae
77
Fluphenazine has a side effect of
Muscle Rigidity
(Extrapyramidal side effect).
78
What are serum Calcium, phosphorous and Parathyroid Hormone levels in celiac disease
```
Decreased
1. Calcium
2. Phosphorous
Increased
3. PTH
```
79
Which tissue is most likely to have the largest increase in protein synthesis in response to long term GLUCOCORTICOID therapy
Liver
80
Unilateral hearing loss in the setting of facial numbness and weakness is highly suggestive of intracranial schwannoma. This is caused by am mass
Between the cerebellum and Lateral pons
| cerebellopontine angle
81
A patient with pure motor hemiparesis and small cavitary lesion in the internal capsule likely has lacunar infarct. Which is mainly caused by
1. Hypertensive arteriolar sclerosis
2. Microatheroma
3. Lipohyalinosis
82
Arteries with myxomatous degeneration (weakening of connective tissue) with pooling proteoglycans in media layer is associated with pathogenesis of
Aortic aneurysm
83
Psychosis in the absence of major mood episodes but mood symptoms present for most of the illness is
Schizoaffective disorder
84
Central Hypogonadism, Delayed puberty plus inability to smell (Anosmia) is consistent with KALLMANN syndrome which result from
Failure of GnRH-secreting neurons to migrate from their origin in the olfactory PLACODE to their normal hypothalamus
(KAL-1 mutation)
85
The most common vascular hemangioma in babies is
Strawberry (Capillary) hemangioma
86
Where is the cell (phagocytic) attachment site in an immunoglobin
The bottom of the Y-shaped structure.
| Fc Receptor
87
Site of attachment of complement in an immunoglobin is
Where the V-part of the structure ends and the tail begins
88
Warfarin induced skin necrosis is caused by depletion of
1. Protein C
2. Factor VII
Due to their short half-life
89
Major side effect of Isoniazed therapy is
Hepatocyte Damage.
| Hepatotoxic
90
A 46 XX patient with Bilateral adrenal hyperplasia and ambiguous genitalia are consistent with Congenital adrenal hyperplasia caused by the conversion of
PROGESTERONE --> 11 - Deoxycorticosterone in the Zona glomerulosa (aldosterone precursor)
91
Males (46 XY) have phenotypically normal genitalis, salt-wasting or precocious puberty appearing later. What is elevated
17- hydroxyprogesterone--> 11 - deoxycortisol in the zona fasciculata
92
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
Abetalipoproteinemia
93
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
Isocitrate dehydrogenase
94
What condition will cause an increase cardiac out put and increase in venous return
1. Chronic arteriovenous shunt (fistula)
| 2.
95
A patient whose labs indicate the presence of anti nuclear antibodies (ANA) has drug induced lupus. Which medication can cause Drug induced lupus
1. Hydralazine
2. Procainamide
3. Isoniazid
96
What is the adherence site for strep viridans
Fibrin-platelet aggregate
97
The effect of a drug (CORTISOL) to augments the vasoconstrictive effect of another drug is termed
Permissiveness
98
What condition is likely responsible for maintaining cardiac output in the setting of severe aortic regurgitation
Increase the left ventricular stroke volume
99
Which labs should be obtained before starting a person on STATINS
Liver Transaminase levels
| LTAs
100
n methylene tetrahydrofolate reductase gene defect,, a person is unable to convert homocysteine to which product
Methionine
101
What artery lies medial to the obturator artery and run superiorly and medially up the abdomen
Inferior epigastric.
| which is 1 or 2 branches of the external ilac artery
102
Early diastolic murmur is associated with
Aortic regurgitation
103
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
Valvular heart disease
104
What medication can be improves survival in congestive heart failure patient
Spironolactone
Eplerenone
(Mineralocorticoids receptor antagonist)
105
Which binding curve of the sodium channel blockers has a weakest binding and faster dissociation, more than Quinidine
Lidocaine
| Mexiletine
106
In Tetralogy of Fallot what is the major determinant of symptom severity.
Right ventricular outflow tract obstruction
107
In ACE inhibitor therapy, angioedema is a rare potential serious adverse effect caused by
Bradykinin accumulation
108
What is consistent with acute graft rejection
Dense interstitial lymphocytic infiltrate
109
In Polyarteritis Nodosa (PAN) which arteries are spared by the disease
Pulmonary arteries
110
Intermittent muscle pain reproducibly caused by exercise and relieved by a brief period of rest defines claudication which is caused by
Lipid -filled intimal plaque
| (atherosclerosis of large arteries)
111
What enzyme is responsible for removing short fragments of RNA that a base paired to DNA
DNA polymerase I
112
What structure does ETOPOSIDE targets to cause fractures
Topoisomerase II
113
Which medication target microtubules
Vinca Alkaloids.
| (Vincristine and vinblastine
114
What is the cause of linear, shallow ulceration in the lower esophagus in cytomegalovirus (CMV) esophagitis
Enlarged cells with intranuclear inclusions
115
Fetal anomalies associated with impaired swallowing (polyhydromnios). LOTS OF FLUID
Anencephaly
| Gastrointestinal obstruction
116
Statins responsible for myopathy also causes what other effects
Increased hepatocyte LDL receptor recycling
117
What laboratory finding can be observed in a patient with alpha-1 antitrypsin deficiency
1. Decreased forced expiratory volume in 1 second/ forced vital capacity
2. Increased total lung capacity
3. decrease Diffusing capacity for carbon monoxide
118
What is the most primary focus of infection of an HIV patient with cryptococcus neoformans
Lungs
119
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
Langerhans cells
120
Compression of the left renal vein between the superior mesenteric artery and aorta causes
Varicocele
121
Pustular skin lesion that form thick scabs when broken down is impetigo which is caused by ? and what does it demonstrate?
1. Staphylococcus aureus
| 2. Pyrrolidonyl arylamidase positivity
122
In benz(o)pyrene-induced lung cancer which enzyme is most likely overactive
Microsomal monooxygenase
123
Burkitt lymphoma is caused by
c-Myc oncogene overexpression
124
Over espression of n-Myc is usually found in
neuroblastoma
125
Which substance is likely to accumulate i embryonic tissue with treatment of methotrexate
Dihydrofolate polyglutamate
126
According to epidemiological studies overdose of which substance can lead to death in a depressed patient
Opioids
127
What is the compensatory metabolism of fructose when there is still presence of large amount of fructose in urine despite moderate intake
Hexokinase
128
In Fructose kinase deficiency the compensatory metabolism of glucose can be done by
Hexokinase
129
Warfarin administration that leads to severe subcutaneous fat necrosis is caused by a defect in
Protein C activity
130
Subacute combined degeneration which involves both the ascending (dorsal columns) and descending (corticospinal tract) pathways is caused by
Vitamin B12 deficiency
131
The most common primary cerebral neoplasm of adults that typically located within the cerebral hemisphere and may cross the mid line is
Glioblastoma
132
Which substance released from mitochondria can lead to shrunken eosinophilic cells within tumor
Cytochrome C
