Mixed smart 4 Flashcards
1
Q
What is the mechanism of EHEC
A
Inactivates ribosomal subunits
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
3
Q
Decreased activity of which enzyme most likely contributes abdominal cholesterol gallstones (fatty foods) in acute cholecystitis
A
Cholesterol 7a hydroxylase
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
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
6
Q
What is the function f simvastatin and cholestyramine on cholesterol synthesis
A
Simvastatin —> Decrease
Cholestyramine—> Increase
7
Q
First line treatment for arsenic poisoning (garlic odor)
A
Dimercaprol
8
Q
First line for treating cyanide poisoning (confusion, cherry red skin color)
A
Hydroxycobalamin
9
Q
Iron overdose
A
Deferoxamine
10
Q
An irregular mass that continuous into the third portion of the duodenum will invade which structure
A
Superior mesenteric artery
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)
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
13
Q
Serologic tests that show antibodies that react with tissue transglutaminase is celiac disease. How will you confirm the diagnosis
A
Duodenal biopsy
14
Q
How does Hepatitis B assist Hep D
A
Coating of the Hep D Viral particles
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
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
17
Q
Noncaseating granulomas resembling sarcoid granulomas seen on light microscopy of the intestine are characteristic of
A
Crohns disease
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
19
Q
What is the most common cause of acute calculous cholecystitis
A
Gallbladder outflow obstruction
20
Q
Activity of which substance is impaired by the absence of the brush boarder enzyme enteropeptidase in the proximal intestinal villi
A
Trypsin
21
Q
The embryological origin of the spleen is
A
Mesoderm
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
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
24
Q
Months after an infarct in the brain left internal capsule, pyramidal tracts will show
A
Persistent myelin debris
Wallerian degeneration
25
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
Oppositional defiant disorder
26
Impairment of what mechanism most likely contributes to severity of an asplenic patient suffering from streptococcus pneumonia
Systemic bacterial clearance
27
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
Fever
Pruritic skin rash
arthralgias
Low serum C3 and C4 complement levels.
28
What are the laboratory finding in poststreptococcal glomerulonephritis
1. Elevated Anti-streptolysin O titers
2. Elevated anti-DNase B titers
3. Decreased C3 and total complement levels
4. Cryoglobulins
29
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
Live attenuated vaccine
30
Which drug given can lead to improvement by direct dilation of arteries and inhibition of platelet aggregation
Cilostazol
31
What is the best indicator os the severity of a mitral regurgitation
Presence of an audible S3
32
Which biochemical changes contribute to dementia in Alzheimers disease
Decreased choline acetyltransferase activity in nucleus basalis
33
Which antiretroviral medication has an adverse effect of increase blood glucose (hyperglycemia)
Lopinavir
34
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
Drug induced bacterial disintegration
| Rapid lysis of spirochetes
35
Where is the location of the tRNA anticodon that contains UUU
It is located at the hydroxyl end.
| (amino acid binding site CCA)
36
C1 inhibitor (C1INH) deficiency leads to an elevated levels of
Bradykinin
37
Nasal mucosal ulceration and glomerulonephritis are characteristics of GRANULOMATOSIS with POLYANGIITIS. C-ANCA in this condition targets
NEUTROPHIL proteinase 3
38
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
Synthesis of cellular membrane proteins
39
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
ENHANCER
| Can be Located Upstream, Downstream or Within Introns of the gene
40
What is the function of interferon gamma
1. Activates macrophages
2. Increase major histocompability complex expression
3. T helper lymphocytes
41
What cells produce interferon gamma
T lymphocytes
42
A kid with corynebacterium diphtheria wit no history of immunization what is the best intervention to improve symptoms associated to improve condition
Passive immunization
43
The best method used to determine if gene is being expressed is by using
DNA is being transcribed use
Northern blot
Southern blot
44
A protein with reverse transcriptase activity that function to add TTAGGG repeats to the 3' end of chromosomes (telomerase) is mostly found in
Epidermal basal cells
45
Which medication should be administered after hypotension associated with anaphylactic shock
Epinephrine
46
Common drugs to avoid in the elderly include
1. anticholinergics (eg. first-generation antihistamine
2. alpha blockers
3. tricyclics antidepressants
4. most antiarrhythmics
5. skeletal muscle relaxants
47
What substance in involved in the reaction of transfer of nitrogen isotopes to oxaloacetate forming aspartate in the process
Pyridoxine
| Vitamine B6
48
Which dehydrogenase enzymes does Thiamine (Vitamin B1) serve as a coenzyme in
1. Transketolase
2. alpha-ketoglutarate dehydrogenase
3. pyruvate dehydrogenase
49
What accounts for the difference in drug concentration following rectal administration when compared to oral administration
Decreased drug delivery to the liver
50
How is a fixed dose of Isonizide metabolized
Acetylation
51
Facial flushing and pupillary dilation are common findings in patients taking medication with
Anticholinergic effects
52
Flushed skin and mydriasis results from
Muscarinic receptor blockade
| eg. atropine, amitriptyline, diphenhydramine, neuroleptic and antiparkinsonian drugs
53
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
2/3 x 1/2= 1/3
54
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)
Tryptase
55
What is likely to trigger vasoactive substance release by antigen-specific IgE antibodies attached to high affinity receptors on surface of mast cells
Receptor aggregtion
56
A cyanotic and mottled Graft soon after its blood vessels are connected with those of the recipient is caused by
Antibody-mediated hypersensitivity
57
Defective signaling between activated CD4+ T cells and B lymphocyte in a person with recurrent sinopulmonary and gastrointestinal infection is consistent with
Hyperimmunoglobulin M
| IgM will have the highest serum concentration
58
Many frequently encountered disease (eg. hypertension, spinal bifida) display
Multifactorial inheritance
| it involves numerous complex interaction of genetic and environmental factors to determine phenotype expression
59
Medication used to treat hypertensive emergency as a result of tyramine containing foods work by
Monoamine degradation
60
Long term treatment with which medication reduces mortality in patients with Congestive Heart Failure
Lisinopril
| ACE inhibitors and ARBS
61
Heavy calcification (Dystrophic) of aortic valve due to aging. What proceeded these changes in the aortic valve
Cell necrosis
| Dystrophic calcification is considered a hallmark of cell injury. Occurs in damaged or necrotic tissue
62
What hemodynamic changes is associated with aortic stenosis when there is an onset of arterial fibrillation
Sudden decrease in left ventricular preload
63
What is likely to increase the intensity of a murmur in hypertrophic cardiomyopathy
Sudden Standing up
64
Pulsus paradoxus is defined as a decrease in systolic blood pressure of >10 mmHg with inspiration. Most commonly seen in patient with
```
1. Cardia tamponade
But can also be seen in
a. severe asthma
b. chronic obstructive pulmonary disease
c. constrictive pericarditis
```
65
Which changes help to control the exacerbation of Asthma and chronic obstructive pulmonary disease the most frequent causes of pulses paradoxus
cAMP accumulation in smooth muscle cells
66
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
Aortic Isthmus
67
What is a side effect of Isosorbide dinitrate therapy
1. Throbbing headache
2. Cutaneous flushing
3. Hypotension
68
Watery diarrhea without blood or mucus. Outbreaks common in schools, cruise ships, nursing homes) is caused by
Norovirus
| Most common cause of viral gastroenteritis
69
Dull low back pain and morning stiffness without any recent trauma is ankylosing spondylitis. People with this disease have a strong association with
Specific human leukocyte antigen class I serotype
| HLA B27
70
Influenza epidemic and pandemic are typically caused by RNA segment coding for hemagglutinin or neuraminidase proteins through
Genetic Reassortment
71
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
Axonal reaction
72
Maintenance of blood glucose despite 24hours of fasting is facilitated by hepatic conversion of pyruvate into glucose by the enzyme
Pyruvate carboxylase which is directly stimulated by Acetyl-CoA
73
A small to medium vessel vasculitis characterized by late onset of asthma, rhinosinusitis and eosinophilia with antibodies against NEUTROPHIL MYELOPEROXIDASE is
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
74
A pattern of behavior characterized by social inhibition, feeling of inadequacy and fear of embarrassment and rejection is
Avoidant personality
75
Sputum microscopy shows many granule-containing cells and crystalloid masses, suggest the role of
IL-5
76
Which medication is useful in treating combative, confusional and agitation associated with delirium
Haloperidol
77
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
Bile acid malabsorption
| It is necessary for the absorption of fat soluble vitamins A, D, E, K
78
Histological changes in the brain of a person whose alpha helical structures have undergone conformational changes to beta pleated sheets will show
Spongiform transformation of gray matter
79
Which medication used to treat pulmonary edema due to CKD has a side effect of hearing loss (ototoxicity)
Loop Diuretics
| Furosemide, Torsemide, Bumetanide
80
Which medication is useful in treating male pattern baldness. This shows a polygenic inheritance
Finasteride
81
Which medication is useful for the reversal of atropine toxicity
Physostigmine
82
Excessive consumption of raw egg white is associated with a deficiency in______ which is used as a cofactor in the conversion of______
Biotin (B7)
Pyruvate to Oxaloacetate
83
A person with hyperphenylalanemia and elevated prolactin most likely has a deficiency in
Dihydrobiopterin reductase
84
Abnormality in MINIMAL CHANGE DISEASE (MCD) can be seen on
Electron microscopy of glomerular filtration unit
| Diffuse foot process effacement
85
Lactic acidosis due to lactic acid levels of 4 (normal<2) in septic shock from tissue hypoxia is due to
Decreased oxidative phosphorylation
86
Which enzyme when inhibited with medication (aspirin) reduces risk of developing recurrent adenoma or adenomatous
Cyclooxygenase-2
87
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)
Exotoxin formed prior to ingestion
| staph aureus
88
which medication inhibits primary active transport
Omeprazole
| Proton pump inhibitors because they block H/K ATPase
89
Acidophilic bodies (pink staining on H&E) in a hepatocyte known as councilman bodies is the result of
Apoptosis
90
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
Mucosa, submucosa and muscular layers
| Meckel's Diverticulum
91
What test is most likely to establish the diagnosis of Clostridium botulinum
Stool for bacterial toxin
92
A patient with slow/incomplete gallbladder emptying in response to cholecystokinin stimulation is consistent with
gallbladder hypomotility from biliary sludge
93
Periumbilical (bellybutton) pain that migrates to the right lower quadrant is a classic for acute appendicitis which is caused by
Lumen Obstruction
94
A patient that dies of coronary artery disease dues to familial hypercholesterolemia is due to a defect in the
LDL receptor found in the LIVER
95
A person with small bowel resection that exhibits macrocytic anemia and low vitamin B12 level is due to
Loss of intestinal absorptive area
96
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
Gastric hypersecretion
97
What acid base balance is involved in Mallory Weiss tear (Linear tear at the gastroesophageal junction from alcoholism)
Metabolic Alkalosis
98
What is the major risk factor for esophageal carcinoma (squamous cell cancer-->keratin nest pearls)
Alcohol and smoking
99
Which gastric ulcer in not associated with an increased risk of a carcinoma
Duodenal ulcer
100
Which medication block the common pathway of gastric acid secretion
Proton pump inhibitor
| Omeprazole, Lansoprazole, esmoprazole
101
What can cause vitamin A deficiency (night blindness, hyperkeratosis)
Prolonged Biliary tract obstruction
102
Acute hepatitis dues to most hepatotropic virus causes
Hepatocyte ballooning
103
Genetic mutation that causes decreased activity of NF-kB (pro inflammatory) pathway impair
Cytokine production
104
Duodenal ulcer is mainly caused by H pylori which occurs in the antrum of the stomach located at the
Prepyloric area
105
Yellowing of the skin and shortness of breath with exercise with a history of jaundice soon after birth is consistent with
Alpha-1 antitrypsin deficiency
106
Live attenuated oral (Sabin) poliovirus vaccine produces a stronger mucosal
IgA immune response at site of viral entery
107
A medication that increases bronchial diameter by blocking action of acetylcholine at muscarinic receptors is
Ipratropium
108
A mutation in what caused progression from from a early adenoma to late features of an adenoma
KRAS
109
Malignant transformation from late adenoma t carcinoma is caused by mutation in
TP53
110
Which cerebral arteries is compromised in a person that demonstrate contralateral homonymous hemianopia with macular sparing
Posterior cerebral artery
111
Red ragged muscle fiber are seen in mitochondria disease. The probability of a man passing it on to the offsprings is
0%
Its gotten thru maternal inheritance
112
Anemia is characterized by decreased hemoglobin concentration in the setting of
Normal SaO2 and PaO2
113
A restriction in what substance will improve a person with an impaired transport of ornithine from cytosol to mitochondria
Proteins
| ornithine transport is into mitochondria is necessary for the proper functioning of the urea cycle
114
When dilated Lateral ventricles are left uncorrected it can lead to what complication
Muscle hypertonicity and hyperreflexia
| This is from upper motor neuron injury
115
What medication is useful in treating restless leg syndrome
Dopamine agonist
| ropinirole, pramipexole
116
Antibodies against which condition is associated to increased carbon monoxide diffusing capacity on pulmonary function test in Goodpasture syndrome
Alpha 3 chain of type IV collagen
117
A person with Toxic megacolon as a result of ulcerative colitis. The best next step in the diagnosis is
Plain abdominal x-ray
118
The use of Thiazide diuretics decreases intravascular fluid volume which stimulates aldosterone secretion, excretion of potassium and hydrogen resulting in
Hypokalemia
119
Patients who undergo lung transport are at an increased risk of CMV; which is
Enveloped double-stranded DNA virus
120
The treatment of choice for diabetic ketoacidosis is intravenous
Normal saline and insulin
121
Homogeneous deposition of eosinophilic hyaline material in the intima and media of small arteries and arterioles is a characteristic of poorly controlled
Hypertension and/or Diabetes mellitus
