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SMART 1 > Mixed smart 4 > Flashcards

Mixed smart 4 Flashcards

1
Q

What is the mechanism of EHEC

A

Inactivates ribosomal subunits

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2
Q

What is the quickest way of determining the cause of malabsorption of nutrients that may present with with steatorrhea.

A

Stool microscopy with Sudan III stain

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3
Q

Decreased activity of which enzyme most likely contributes abdominal cholesterol gallstones (fatty foods) in acute cholecystitis

A

Cholesterol 7a hydroxylase

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4
Q

Fluid filled cavity within right lobe of the liver is suggestive of of hepatic abscess. Which microorganism/route is most likely

A

Staphylococcus aureus by hematogenous route

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5
Q

Cirrhotic liver disease can cause hyperammonemia which lead to jerky irregular flexion-extension tremors involving hands and wrist as a results of elevation of which compound in astrocytes

A

Glutamine

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6
Q

What is the function f simvastatin and cholestyramine on cholesterol synthesis

A

Simvastatin —> Decrease

Cholestyramine—> Increase

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7
Q

First line treatment for arsenic poisoning (garlic odor)

A

Dimercaprol

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8
Q

First line for treating cyanide poisoning (confusion, cherry red skin color)

A

Hydroxycobalamin

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9
Q

Iron overdose

A

Deferoxamine

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10
Q

An irregular mass that continuous into the third portion of the duodenum will invade which structure

A

Superior mesenteric artery

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11
Q

Host defense against mycobacterial infections depends on interactions between macrophages and T cells. What is important in eliminating the infection

A

Interferon gamma (INF-gamma)

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12
Q

Gastroesophageal reflux disease is caused primarily by gastroesophageal junction incompetence and can be associated with

A

Extraesophageal symptoms such as nocturnal cough in the absence of heartburn

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13
Q

Serologic tests that show antibodies that react with tissue transglutaminase is celiac disease. How will you confirm the diagnosis

A

Duodenal biopsy

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14
Q

How does Hepatitis B assist Hep D

A

Coating of the Hep D Viral particles

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15
Q

Recurrent episodes of multi-lobar pneumonia, sinusitis and poor growth. Absence of both vas deferens is found in cystic fibrosis. What else can be seen

A

Distension and obstruction of pancreatic ducts

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16
Q

Gastroesophageal reflux with an increased risk of Barrets esophagus and stricture formation can be caused by systemic sclerosis which may result in

A

Esophageal dysmotility and incompetence of lower esophageal sphincter due to atrophy and fibrous replacement of the esophageal muscularis

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17
Q

Noncaseating granulomas resembling sarcoid granulomas seen on light microscopy of the intestine are characteristic of

A

Crohns disease

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18
Q

Which test should be considered in a person hospitalized for acute pancreatitis whose gall bladder ultrasound are normal with no history of of alcohol consumption

A

Serum triglyceride

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19
Q

What is the most common cause of acute calculous cholecystitis

A

Gallbladder outflow obstruction

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20
Q

Activity of which substance is impaired by the absence of the brush boarder enzyme enteropeptidase in the proximal intestinal villi

A

Trypsin

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21
Q

The embryological origin of the spleen is

A

Mesoderm

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22
Q

What is the cause of a pulsating, central abdominal mass in a patient with high blood pressure

A

Chronic transmural inflammation

abdominal aortic aneurysm

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23
Q

Migratory arthralgias and skin rash that are exacerbated by sun exposure in a young caucasian female is SLE. Serum autoantibodies will react specifically to

A

Double stranded DNA

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24
Q

Months after an infarct in the brain left internal capsule, pyramidal tracts will show

A

Persistent myelin debris

Wallerian degeneration

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25
Q

Behavior disorder in a child characterized by argumentative and defiant behavior towards authority figures which does not involve the more severe violation of basic rights of others seen in conduct disorder is

A

Oppositional defiant disorder

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26
Q

Impairment of what mechanism most likely contributes to severity of an asplenic patient suffering from streptococcus pneumonia

A

Systemic bacterial clearance

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27
Q

Serum sickness is a type 3 hypersensitivity reaction to nonhuman proteins that are characterized by vasculitis resulting from tissue deposition of circulating immune complexes. Clinical findings include

A

Fever
Pruritic skin rash
arthralgias
Low serum C3 and C4 complement levels.

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28
Q

What are the laboratory finding in poststreptococcal glomerulonephritis

A
  1. Elevated Anti-streptolysin O titers
  2. Elevated anti-DNase B titers
  3. Decreased C3 and total complement levels
  4. Cryoglobulins
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29
Q

An infant with hearing loss, white pupils and a continuous machinery murmur over infraclavicular area is suggestive of RUBELLA. What could have prevented this condition in the infant

A

Live attenuated vaccine

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30
Q

Which drug given can lead to improvement by direct dilation of arteries and inhibition of platelet aggregation

A

Cilostazol

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31
Q

What is the best indicator os the severity of a mitral regurgitation

A

Presence of an audible S3

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32
Q

Which biochemical changes contribute to dementia in Alzheimers disease

A

Decreased choline acetyltransferase activity in nucleus basalis

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33
Q

Which antiretroviral medication has an adverse effect of increase blood glucose (hyperglycemia)

A

Lopinavir

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34
Q

Acute febrile syndrome a few hours (fever, chills, myalgia etc) after the administration of benzathine penicillin G for syphilis is (Jarisch-Herxheimer reaction) is caused by

A

Drug induced bacterial disintegration

Rapid lysis of spirochetes

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35
Q

Where is the location of the tRNA anticodon that contains UUU

A

It is located at the hydroxyl end.

(amino acid binding site CCA)

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36
Q

C1 inhibitor (C1INH) deficiency leads to an elevated levels of

A

Bradykinin

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37
Q

Nasal mucosal ulceration and glomerulonephritis are characteristics of GRANULOMATOSIS with POLYANGIITIS. C-ANCA in this condition targets

A

NEUTROPHIL proteinase 3

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38
Q

In reversible cellular injury, cells that are exposed longer to ischemic periods have reduced numbers of ribosomes attached to the endoplasmic reticulum. This changes is most likely impair which cellular functions

A

Synthesis of cellular membrane proteins

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39
Q

Decreased coagulation of Factor VIII activity is an indiction of hemophilia A which is characterized by easy bruising and excessive bleeding. Its can be caused by a deletion of an

A

ENHANCER

Can be Located Upstream, Downstream or Within Introns of the gene

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40
Q

What is the function of interferon gamma

A
  1. Activates macrophages
  2. Increase major histocompability complex expression
  3. T helper lymphocytes
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41
Q

What cells produce interferon gamma

A

T lymphocytes

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42
Q

A kid with corynebacterium diphtheria wit no history of immunization what is the best intervention to improve symptoms associated to improve condition

A

Passive immunization

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43
Q

The best method used to determine if gene is being expressed is by using

DNA is being transcribed use

A

Northern blot

Southern blot

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44
Q

A protein with reverse transcriptase activity that function to add TTAGGG repeats to the 3’ end of chromosomes (telomerase) is mostly found in

A

Epidermal basal cells

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45
Q

Which medication should be administered after hypotension associated with anaphylactic shock

A

Epinephrine

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46
Q

Common drugs to avoid in the elderly include

A
  1. anticholinergics (eg. first-generation antihistamine
  2. alpha blockers
  3. tricyclics antidepressants
  4. most antiarrhythmics
  5. skeletal muscle relaxants
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47
Q

What substance in involved in the reaction of transfer of nitrogen isotopes to oxaloacetate forming aspartate in the process

A

Pyridoxine

Vitamine B6

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48
Q

Which dehydrogenase enzymes does Thiamine (Vitamin B1) serve as a coenzyme in

A
  1. Transketolase
  2. alpha-ketoglutarate dehydrogenase
  3. pyruvate dehydrogenase
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49
Q

What accounts for the difference in drug concentration following rectal administration when compared to oral administration

A

Decreased drug delivery to the liver

50
Q

How is a fixed dose of Isonizide metabolized

A

Acetylation

51
Q

Facial flushing and pupillary dilation are common findings in patients taking medication with

A

Anticholinergic effects

52
Q

Flushed skin and mydriasis results from

A

Muscarinic receptor blockade

eg. atropine, amitriptyline, diphenhydramine, neuroleptic and antiparkinsonian drugs

53
Q

If a mother is a carrie of cystic fibrosis is 2/3 and probability of transmitting it to a child with a father with the disease is

A

2/3 x 1/2= 1/3

54
Q

What is likely to be elevated in a patient serum as a results of Cefazolin administration that caused the increased vascular permeability and multi-system edema (anaphylatic reaction)

A

Tryptase

55
Q

What is likely to trigger vasoactive substance release by antigen-specific IgE antibodies attached to high affinity receptors on surface of mast cells

A

Receptor aggregtion

56
Q

A cyanotic and mottled Graft soon after its blood vessels are connected with those of the recipient is caused by

A

Antibody-mediated hypersensitivity

57
Q

Defective signaling between activated CD4+ T cells and B lymphocyte in a person with recurrent sinopulmonary and gastrointestinal infection is consistent with

A

Hyperimmunoglobulin M

IgM will have the highest serum concentration

58
Q

Many frequently encountered disease (eg. hypertension, spinal bifida) display

A

Multifactorial inheritance

it involves numerous complex interaction of genetic and environmental factors to determine phenotype expression

59
Q

Medication used to treat hypertensive emergency as a result of tyramine containing foods work by

A

Monoamine degradation

60
Q

Long term treatment with which medication reduces mortality in patients with Congestive Heart Failure

A

Lisinopril

ACE inhibitors and ARBS

61
Q

Heavy calcification (Dystrophic) of aortic valve due to aging. What proceeded these changes in the aortic valve

A

Cell necrosis

Dystrophic calcification is considered a hallmark of cell injury. Occurs in damaged or necrotic tissue

62
Q

What hemodynamic changes is associated with aortic stenosis when there is an onset of arterial fibrillation

A

Sudden decrease in left ventricular preload

63
Q

What is likely to increase the intensity of a murmur in hypertrophic cardiomyopathy

A

Sudden Standing up

64
Q

Pulsus paradoxus is defined as a decrease in systolic blood pressure of >10 mmHg with inspiration. Most commonly seen in patient with

A 
1. Cardia tamponade
 But can also be seen in
a. severe asthma
b. chronic obstructive pulmonary disease
c. constrictive pericarditis
65
Q

Which changes help to control the exacerbation of Asthma and chronic obstructive pulmonary disease the most frequent causes of pulses paradoxus

A

cAMP accumulation in smooth muscle cells

66
Q

Traumatic aortic rupture is most often caused by the rapid deceleration that occurs in motor vehicle collisions. The most common site of injury is the

A

Aortic Isthmus

67
Q

What is a side effect of Isosorbide dinitrate therapy

A
  1. Throbbing headache
  2. Cutaneous flushing
  3. Hypotension
68
Q

Watery diarrhea without blood or mucus. Outbreaks common in schools, cruise ships, nursing homes) is caused by

A

Norovirus

Most common cause of viral gastroenteritis

69
Q

Dull low back pain and morning stiffness without any recent trauma is ankylosing spondylitis. People with this disease have a strong association with

A

Specific human leukocyte antigen class I serotype

HLA B27

70
Q

Influenza epidemic and pandemic are typically caused by RNA segment coding for hemagglutinin or neuraminidase proteins through

A

Genetic Reassortment

71
Q

The changes in a neuronal body after the axon is SEVERED; (swollen and rounded, with nucleus displaced to the periphery, nissl substance becomes fins, granular and dispersed throughout the cytoplasm) is called

A

Axonal reaction

72
Q

Maintenance of blood glucose despite 24hours of fasting is facilitated by hepatic conversion of pyruvate into glucose by the enzyme

A

Pyruvate carboxylase which is directly stimulated by Acetyl-CoA

73
Q

A small to medium vessel vasculitis characterized by late onset of asthma, rhinosinusitis and eosinophilia with antibodies against NEUTROPHIL MYELOPEROXIDASE is

A

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)

74
Q

A pattern of behavior characterized by social inhibition, feeling of inadequacy and fear of embarrassment and rejection is

A

Avoidant personality

75
Q

Sputum microscopy shows many granule-containing cells and crystalloid masses, suggest the role of

A

IL-5

76
Q

Which medication is useful in treating combative, confusional and agitation associated with delirium

A

Haloperidol

77
Q

What is the cause of easy bruising, several ecchymoses on the lower extremities of a person that has undergone partial bowl resection for CROHN Disease

A

Bile acid malabsorption

It is necessary for the absorption of fat soluble vitamins A, D, E, K

78
Q

Histological changes in the brain of a person whose alpha helical structures have undergone conformational changes to beta pleated sheets will show

A

Spongiform transformation of gray matter

79
Q

Which medication used to treat pulmonary edema due to CKD has a side effect of hearing loss (ototoxicity)

A

Loop Diuretics

Furosemide, Torsemide, Bumetanide

80
Q

Which medication is useful in treating male pattern baldness. This shows a polygenic inheritance

A

Finasteride

81
Q

Which medication is useful for the reversal of atropine toxicity

A

Physostigmine

82
Q

Excessive consumption of raw egg white is associated with a deficiency in______ which is used as a cofactor in the conversion of______

A

Biotin (B7)

Pyruvate to Oxaloacetate

83
Q

A person with hyperphenylalanemia and elevated prolactin most likely has a deficiency in

A

Dihydrobiopterin reductase

84
Q

Abnormality in MINIMAL CHANGE DISEASE (MCD) can be seen on

A

Electron microscopy of glomerular filtration unit

Diffuse foot process effacement

85
Q

Lactic acidosis due to lactic acid levels of 4 (normal<2) in septic shock from tissue hypoxia is due to

A

Decreased oxidative phosphorylation

86
Q

Which enzyme when inhibited with medication (aspirin) reduces risk of developing recurrent adenoma or adenomatous

A

Cyclooxygenase-2

87
Q

Severe nausea and vomiting hours after consuming food at an outdoor picnic is from

(most tested food is mayonnaise containing food like potato or macroni)

A

Exotoxin formed prior to ingestion

staph aureus

88
Q

which medication inhibits primary active transport

A

Omeprazole

Proton pump inhibitors because they block H/K ATPase

89
Q

Acidophilic bodies (pink staining on H&E) in a hepatocyte known as councilman bodies is the result of

A

Apoptosis

90
Q

A blind pouch connected to the ileum with a fibrous band seen attaching to the end of the pouch of the umbilicus is made up of

A

Mucosa, submucosa and muscular layers

Meckel’s Diverticulum

91
Q

What test is most likely to establish the diagnosis of Clostridium botulinum

A

Stool for bacterial toxin

92
Q

A patient with slow/incomplete gallbladder emptying in response to cholecystokinin stimulation is consistent with

A

gallbladder hypomotility from biliary sludge

93
Q

Periumbilical (bellybutton) pain that migrates to the right lower quadrant is a classic for acute appendicitis which is caused by

A

Lumen Obstruction

94
Q

A patient that dies of coronary artery disease dues to familial hypercholesterolemia is due to a defect in the

A

LDL receptor found in the LIVER

95
Q

A person with small bowel resection that exhibits macrocytic anemia and low vitamin B12 level is due to

A

Loss of intestinal absorptive area

96
Q

History of fatigue, rash, flushing and abdominal cramps and itching after hot showers with skin biopsy showing positive KIT (CD117) is indicative of systemic mastocytosis . Additional findings will be

A

Gastric hypersecretion

97
Q

What acid base balance is involved in Mallory Weiss tear (Linear tear at the gastroesophageal junction from alcoholism)

A

Metabolic Alkalosis

98
Q

What is the major risk factor for esophageal carcinoma (squamous cell cancer–>keratin nest pearls)

A

Alcohol and smoking

99
Q

Which gastric ulcer in not associated with an increased risk of a carcinoma

A

Duodenal ulcer

100
Q

Which medication block the common pathway of gastric acid secretion

A

Proton pump inhibitor

Omeprazole, Lansoprazole, esmoprazole

101
Q

What can cause vitamin A deficiency (night blindness, hyperkeratosis)

A

Prolonged Biliary tract obstruction

102
Q

Acute hepatitis dues to most hepatotropic virus causes

A

Hepatocyte ballooning

103
Q

Genetic mutation that causes decreased activity of NF-kB (pro inflammatory) pathway impair

A

Cytokine production

104
Q

Duodenal ulcer is mainly caused by H pylori which occurs in the antrum of the stomach located at the

A

Prepyloric area

105
Q

Yellowing of the skin and shortness of breath with exercise with a history of jaundice soon after birth is consistent with

A

Alpha-1 antitrypsin deficiency

106
Q

Live attenuated oral (Sabin) poliovirus vaccine produces a stronger mucosal

A

IgA immune response at site of viral entery

107
Q

A medication that increases bronchial diameter by blocking action of acetylcholine at muscarinic receptors is

A

Ipratropium

108
Q

A mutation in what caused progression from from a early adenoma to late features of an adenoma

A

KRAS

109
Q

Malignant transformation from late adenoma t carcinoma is caused by mutation in

A

TP53

110
Q

Which cerebral arteries is compromised in a person that demonstrate contralateral homonymous hemianopia with macular sparing

A

Posterior cerebral artery

111
Q

Red ragged muscle fiber are seen in mitochondria disease. The probability of a man passing it on to the offsprings is

A

0%

Its gotten thru maternal inheritance

112
Q

Anemia is characterized by decreased hemoglobin concentration in the setting of

A

Normal SaO2 and PaO2

113
Q

A restriction in what substance will improve a person with an impaired transport of ornithine from cytosol to mitochondria

A

Proteins

ornithine transport is into mitochondria is necessary for the proper functioning of the urea cycle

114
Q

When dilated Lateral ventricles are left uncorrected it can lead to what complication

A

Muscle hypertonicity and hyperreflexia

This is from upper motor neuron injury

115
Q

What medication is useful in treating restless leg syndrome

A

Dopamine agonist

ropinirole, pramipexole

116
Q

Antibodies against which condition is associated to increased carbon monoxide diffusing capacity on pulmonary function test in Goodpasture syndrome

A

Alpha 3 chain of type IV collagen

117
Q

A person with Toxic megacolon as a result of ulcerative colitis. The best next step in the diagnosis is

A

Plain abdominal x-ray

118
Q

The use of Thiazide diuretics decreases intravascular fluid volume which stimulates aldosterone secretion, excretion of potassium and hydrogen resulting in

A

Hypokalemia

119
Q

Patients who undergo lung transport are at an increased risk of CMV; which is

A

Enveloped double-stranded DNA virus

120
Q

The treatment of choice for diabetic ketoacidosis is intravenous

A

Normal saline and insulin

121
Q

Homogeneous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles is a characteristic of poorly controlled

A

Hypertension and/or Diabetes mellitus

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