opto prep Systemic Health Flashcards
what are the autoimmune disease ?
1- SLE ( Lupus) 2- Rheumatoid arthritis 3- Juvenile idopathic 4- sjogren syndrom 5- sarcoid 6- Ankly
The presence of a chromosomal abnormality known as the “Philadelphia chromosome” is highly SENSITIVE for which of the following systemic conditions?
Acute myelogenous leukemia
Chronic myelogenous leukemia
Acute lymphoblastic leukemia
Chronic lymphoblastic leukemia
Hodgkin’s lymphoma
Chronic myelogenous leukemia
In up to 95% of patients diagnosed with chronic myelogenous leukemia (CML), the cancer cells contain a chromosomal abnormality known as the Philadelphia chromosome (named after the city where it was discovered). The Philadelphia chromosome results from a reciprocal translocation involving chromosomes 9 and 22. In the 5% of CML patients who do not exhibit the classic Philadelphia chromosome, there are translocations involving the same chromosomal regions, but these appear to be structurally more complex.
The Philadelphia chromosome is highly sensitive for CML because 95% of CML patients posses this abnormality; however, the chromosome can also be present in a subset of patients with acute lymphocytic leukemia (ALL) or (occasionally) in those with acute myelogenous leukemia (AML). Therefore, the presence of the chromosome is not sufficiently specific to diagnose CML.
Which type of receptor responds primarily to changes in pressure?
Chemoreceptors
Nociceptors
Mechanoreceptors
Thermoreceptors
Mechanoreceptors
Mechanoreceptors are designed to respond to different types of mechanical stimuli such as touch, pressure, acceleration, and position. These types of receptors include muscle spindles, Pacinian corpuscles and baroreceptors in the carotid sinuses.
Thermoreceptors are important for detecting the presence of heat (infrared energy).
Nociceptors are responsible for signaling pain or tissue damage.
Chemoreceptors detect changes in chemical substances that are dissolved in the surrounding media.
Which 3 of the following signs are pathognomonic for patients with congenital syphilis, also known as Hutchinson’s triad? (Select 3)
Interstitial keratitis
Difficulty breathing
Maculopapular skin rash
Peg-shaped, widely spaced incisors
Deafness
Conjunctivitis
1- Interstitial keratitis
2- Peg-shaped, widely spaced incisors
3- Deafness
The clinical triad of congenital syphilis is known as Hutchinson’s triad. It consists of interstitial keratitis, peg-shaped and widely spaced incisors, and deafness. Untreated or incompletely treated early congenital syphilis will progress to the classic manifestations of late congenital syphilis. Other possible signs of congenital syphilis include saddle nose, saber shins, mental retardation, hydrocephalus, general paresis, optic nerve atrophy, and Clutton’s joints; however, the presentation of Hutchinson’s triad is pathognomonic for congenital syphilis. These signs are a result of scarring induced by early lesions or reaction to persistent inflammation that was left untreated.
The WHO estimates that up to 1.4 million cases of congenital syphilis occur worldwide each year; the WHO has also estimated that more babies die worldwide from syphilis than any other single curable disease.
What is the correct sequence of structures through which blood passes as it travels through a nephron in the kidney?
Afferent arteriole-> proximal tubule-> loop of Henle-> distal tubule-> glomerulus-> collecting duct
Afferent arteriole-> glomerulus-> proximal tubule-> loop of Henle-> distal tubule-> collecting duct
Afferent arteriole-> loop of Henle-> glomerulus-> distal tubule-> proximal tubule-> collecting duct
Afferent arteriole-> glomerulus-> distal tubule-> loop of Henle-> proximal tubule-> collecting duct
Afferent arteriole-> glomerulus-> proximal tubule-> loop of Henle-> distal tubule-> collecting duct
Blood is delivered to the kidneys via the renal artery, which eventually branches into many afferent arterioles. One afferent arteriole is linked with one nephron. The afferent arteriole then branches to form capillary clusters; these form the glomerulus, which filters into the glomerular capsule. The glomerulus capillaries then leave the capsule by way of the efferent arteriole, which branches into the peritubular capillaries for cortical nephrons; the efferent arteriole branches into the vasa recta for juxtamedullary nephrons. The peritubular capillaries and vasa recta surround the tubular parts of the nephron and reabsorb water and solutes from the tubule. The capillaries then merge into venules and carry filtered blood away from the kidneys. Water and solutes leave the blood from the glomerulus and are carried from Bowman’s capsule to the proximal tubule then into the loop of Henle, where they continue their journey to the distal tubule. The filtrate is then transferred to the collecting duct.
f an antibody binds to an antigen and opsonizes the antigen, this will most directly lead to which of the following processes?
Antigen presentation
Complement fixation
Phagocytosis
Antigen inactivation
Additional specific antibody secretion
Phagocytosis
Opsonization is process by which an antibody binds to an antigen and identifies it as a target for phagocytosis by a phagocytic cell. Antigen-antibody binding can lead to complement fixation, but this process is not known as opsonization. After an antigen is phagocytosed, further signaling can ultimately lead to antigen presentation and stimulation of secretion of specific antibodies, but this question asks for the direct effect of the opsonization of an antigen by an antibody, which is phagocytosis.
Which of the following represents the most common genetic chromosomal disorder?
Edward syndrome
Turner syndrome
Down syndrome
Klinefelter syndrome
Down syndrome
Down syndrome is considered the most prevalent chromosomal disorder and is the most frequently recognizable cause of mental or intellectual disability. It is caused by extra genetic material on chromosome 21 (also known as trisomy 21). Down syndrome occurs once in about every 700 births, is seen in all ethnic groups, and has a slight predilection for males over females, although this predilection is very small. The most commonly associated risk factor for Down syndrome is increased maternal age, as the chances of having a child with Down syndrome increases significantly with a maternal age of about 35 years and older.
Turner syndrome is a chromosomal disorder in which all or part of one of the sex chromosomes is missing or abnormal. It typically occurs in about 1 in 2,000 live female births (this number varies slightly according to literature).
Edward syndrome is a genetic chromosomal disorder cause by the presence of either all or a portion of an extra 18th chromosome (also known as trisomy 18). It occurs in about 1 in 6,000 births.
Klinefelter syndrome is a chromosomal abnormality that results from additional genetic material on the X chromosome in males (also known as XXY). It exists in roughly 1 in 500 and 1 in 1000 live male births, but many of these males do not show symptoms. If the physical characteristics inherent in this abnormality have not become apparent earlier, they typically appear after the onset of puberty.
A goiter is caused by a deficiency of which of the following substances?
Iron
Iodine
Vitamin D
Riboflavin
Calcium
Iodine
The thyroid secretes thyroxine (T4), triiodothyronine (T3) and calcitonin. Proper feedback is required to ensure that adequate levels are synthesized and secreted. A lack of iodine causes circulating levels of thyroid hormones to decrease, causing the anterior pituitary to secrete the thyroid-stimulating hormone thyrotropin. This cycle causes overstimulation of the thyroid gland, resulting in glandular enlargement and the formation of a goiter.
Which class/isotype of immunoglobulins is responsible for the primary immune response?
IgA
IgE
IgG
IgD
Correct answer IgM
IgM
Motor neurons carry information to and from which of the following structures respectively?
Neurons and the skin
The brain and the muscles
Correct answer Muscles and the brain
Skin and neurons
There are three different classes of neurons: motor neurons, interneurons, and sensory neurons. Sensory neurons respond to stimuli and relay the information to the brain for interpretation. Interneurons receive sensory messages and combine them with other information to alter the activity of other neurons. Motor neurons relay information away from the brain and spinal cord to the muscles or glands to carry out the required actions
A patient presents to your office with decreased vision of the right eye. Dilated fundus exam shows midperipheral retinal hemorrhages in the right eye and a clear and healthy fundus in the left eye. In addition, you note iris neovascularization to be present on slit lamp evaluation. What test should be ordered next for this patient?
Heidelberg Retina Tomography
Amsler grid
Correct answer Carotid Doppler
Humphrey visual fields
Optical coherence tomography
Unilateral, midperipheral hemorrhages are characteristic of Ocular Ischemic Syndrome (OIS). OIS is typically a result of carotid disease where 90% or more of the ipsilateral carotid artery is blocked. This limits blood flow to the eye resulting in signs such as midperipheral hemorrhages, iris neovascularization, and posterior segment neovascularization. More than 50% of patients with OIS will also manifest iris neovascularization.
A carotid Doppler is indicated in these patients in order to evaluate the extent of the carotid artery occlusion and to determine if a carotid endarterectomy is needed. There is a sense of urgency for care in these patients because of the possibility of a stroke. Additionally, the prognosis is generally poor with a 40% mortality rate within 5 years.
Which of the following is a co-morbid condition that simultaneously affects a large percentage of patients diagnosed with myasthenia gravis?
Correct answer Thymus gland abnormalities
Sleep apnea
Diabetes mellitus
Hypertension
Thyroid disease
Lung carcinoma
Approximately 75% of patients diagnosed with myasthenia gravis have concurrent thymus gland abnormalities; of these patients, 85% show hyperplasia or germinal center formation. Encapsulated tumors or thymomas occur in the remaining 10-30% of these patients. In patients diagnosed with ocular myasthenia only, the overall risk of thymoma is reduced to approximately 4%. Due to the relationship between the occurrence of myasthenia gravis and thymus gland abnormalities, it is thought that the thymus may play a significant role in the autoimmune response seen in this condition. In addition to thymus gland abnormalities, patients with myasthenia gravis also tend to have an association with hyper and/or hypothyroidism (3-15%), rheumatoid arthritis (5%), and systemic lupus erythematosus (2%).
Which of the following signs and/or symptoms can help differentiate between chronic bronchitis and emphysema?
Patients with emphysema are also known as “blue bloaters”
The predominant symptom of chronic bronchitis is dyspnea
Respiratory infections occur more frequently in patients with emphysema
Correct answer Sputum is typically produced in larger quantities in patients with bronchitis
Patients with chronic bronchitis typically have decreased body mass
The following differences in the signs and symptoms of bronchitis and emphysema can aid in the diagnosis of the conditions:
- Patients with bronchitis are often referred to as “blue bloaters”; patients with emphysema are known as “pink puffers”
- Body mass is typically increased in bronchitis and decreased in emphysema
- Coughing is the predominant symptom in bronchitis and occurs intermittently in emphysema
- Sputum is produced in a large quantity in bronchitis and is rare in emphysema
- Dyspnea (shortness of breath) is the predominant symptom in emphysema, whereas patients with bronchitis usually experience it primarily during exercise
- Respiratory infections occur more frequently in bronchitis as compared to emphysema
You have a patient who you correctly diagnose with idiopathic demyelinating optic neuritis. The presence of which of the following characteristics on magnetic resonance imaging (MRI) testing represents the greatest risk for the future development of multiple sclerosis?
MRI shows six or more grey matter lesions
MRI shows one ovoid grey matter lesion greater than 3mm in size
Correct answer MRI shows six or more white matter lesions
Normal MRI
MRI shows one ovoid white matter lesion greater than 3mm in size
MRI shows six or more white matter lesions
MRI shows six or more white matter lesions
Patients diagnosed with idiopathic optic neuritis are at a very high risk of subsequent development of multiple sclerosis; the risk can be as high as 74% at 15 years. The results of initial magnetic resonance imaging (MRI) testing are highly correlated with this risk and can help predict the chances of future development of multiple sclerosis (MS).
- The overall risk for development of MS after optic neuritis is 50% (at 15 years)
- When an MRI of the brain is normal, there is still a 23% chance of MS at 15 years
- If a brain MRI shows one T-2 weighted ovoid lesion of the white matter (greater than 3mm in diameter), the 15-year risk of MS increases to 56%
- The highest risk factor for MS is an MRI that shows at least six T2-weighted white matter lesions. These patients have a 74% chance of developing MS at 15 years.
Therefore, patients with normal MRIs may develop MS, and patients with abnormal MRIs may never develop MS. It is important to closely follow these patients with regular eye examinations and to coordinate care with their primary care physician.
A contracting muscle that develops tension but does not shorten displays which type of muscle tension?
Isovelocity
Isovolume
Isotonic
Correct answer Isometric
Isometric contraction occurs when a muscle is contracting but is not shortening. This type of muscle tension is used for load-bearing situations such as holding a plate of food in front of you. Muscles that shorten but maintain the same amount of tension are said to display isotonic contraction. An isovelocity contraction follows when the force of the contraction varies while the velocity remains constant.
Which of the following best describes a monocyte?
Correct answer An immature macrophage located in the blood
A type of granulocytic white blood cell
A leukocyte that triggers the formation of membrane attack complexes
A type of leukocyte responsible for mast cell release
There are two major classes of leukocytes: granulocytes and agranulocytes. Neutrophils, basophils and eosinophils all fall under the category of granulocytes due to the fact that they contain a lobed nucleus and possess cytoplasmic granules visible upon staining.
The second class of leukocytes is agranulocytes, aptly named because they do not possess cytoplasmic granules. This class contains two types of cells, monocytes and lymphocytes. Monocytes are immature macrophages that move into an infection site and divide and differentiate into macrophages and dendritic cells that destroy microbes and debris via phagocytosis. Lymphocytes, the T cells and the B cells, are involved in hosting specific immune responses.
Basophils release histamine, along with other substances, that prolong the inflammatory response.
The common cold is an example of a disease with which type of pattern of occurrence?
An epidemic
A pandemic
Sporadic
Correct answer An endemic
A pandemic is defined as an epidemic breakout of a disease across a large geographical area (i.e. several countries) for a given time span. An example of a pandemic disease is AIDS.
An epidemic is a rapid outbreak of a disease that affects many individuals at the same time and is well above a predicted rate for a given area or community.
Sporadic diseases don’t occur very often and affect very few individuals.
Endemic diseases are those that occur frequently or continuously with predictability. Examples of endemic conditions include ringworm and the common cold.
When determining a newborn’s APGAR score, which 2 of the following are NOT included in the 5 items that the physician evaluates? (Select 2)
Correct answer Length
Color
Reflex irritability
Muscle tone
Respiratory effort
Correct answer Weight
Heart rate
The APGAR scoring system is a quick and accurate way of evaluating a baby’s physical status directly after delivery. A physician or nurse will observe 5 signs and record a score for each on a scale of 0-2 based upon the degrees to which the sign is present (0-poor, 1-fair, 2-good). The 5 scores are then added together and range from 0-10. A score of 10 implies that the baby is in the best possible condition. A score of 8 or 9 indicates that the baby is in good condition, 4-7 indicates a fair condition, and 0-3 indicates a poor condition and the need for prompt diagnosis and treatment. The 5 signs are:
- Heart rate: 0-not detectable, 1-slow (less than 100), 2-Above 100
- Respiratory effort: 0-absent, 1-slow, irregular, 2-good; crying
- Muscle tone: 0-flaccid, 1-some flexion of extremities, 2-active motion
- Reflex irritability: 0-no response, 1-grimace, 2-cry, cough, or sneeze
- Color: 0-blue, pale, 1-body pink, extremities bluish, 2-completely pink or absence of cyanosis
Weight and length of the baby are not related to the APGAR score.
Haversian canals are found in which type of tissue?
Muscle
Nervous
Brain
Adipose
Correct answer Bone
Haversian canals are located within compact bone tissue. This type of tissue is organized into small circular layers that form around canals. The canals are connected to one another and house blood vessels and nerves used to maintain osteocytes.
Haversian canals are located within compact bone tissue. This type of tissue is organized into small circular layers that form around canals. The canals are connected to one another and house blood vessels and nerves used to maintain osteocytes.
What is the proper term for division of the cytoplasm during mitosis?
Correct answer Cytokinesis
Telophase
Cytosynthesis
Anaphase
During late anaphase/telophase, a layer forms at the center of the cell around the microtubules. An indent forms above this layer that leads to a cleavage furrow in which actin, a contractile protein, pulls at the plasma membrane of the cell, pulling it inwards and using it to essentially cut the cell in half, creating two daughter cells.
Which 2 of the following systemic conditions are NOT considered HLA-B27 associated diseases? (Select 2)
Psoriatic arthritis
Correct answer Behcet’s disease
Ankylosing spondylitis
Reiter’s syndrome
Correct answer Sarcoidosis
Crohn’s Disease
Of the above systemic conditions, all are considered HLA-B27 related diseases except for sarcoidosis and Behcet’s disease. HLA-B27 refers to a specific genotype related with chromosome 6. These disorders have a strong association with anterior uveitis; however, the trigger mechanism for acute uveitis in patients demonstrating this genotype remains unknown.
A neuron is stimulated 12 points above threshold, resulting in an action potential. The same neuron is stimulated a few minutes later 60 points above threshold; how will the neuron respond?
Correct answer It will generate an action potential equal to the first
It will generate an action potential of greater magnitude
It will generate an action potential of longer duration
It will generate an action potential involving a greater number of sodium channels
It will generate an action potential that involves more potassium channels
Action potentials fire based upon an all-or-none principle. That is, once threshold is reached, an action potential will ensue, and its signal will not decay along the length of the axon. The magnitude and length of the action potential is always the same, regardless of the strength of the stimulus. However, in order to code for the strength of the stimulus, more action potentials will be generated with increased frequencies, which in turn determines the amount of neurotransmitter released by the pre-synaptic terminals.
What is the correct order in which inhaled air reaches our lungs?
Nasal cavity-> bronchi-> pharynx-> trachea-> larynx-> lungs
Nasal cavity-> pharynx-> bronchi ->larynx-> trachea -> lungs
Correct answer Nasal cavity-> pharynx-> larynx-> trachea-> bronchi-> lungs
Nasal cavity-> larynx -> pharynx ->trachea-> bronchi-> lungs
Nasal cavity-> larynx-> trachea-> pharynx-> bronchi-> lungs
Inhaled air enters through the nasal or the oral cavity and is then swept down the pharynx. The pharynx, also known as the throat, connects the mouth and the nose to the larynx. The pharynx is also attached to the esophagus. Air then passes through the larynx (also called the voice box). From the larynx, air flows through the trachea which divides into 2 bronchi leading to the right or left lung.
Which of the following biochemical structures can act as antigenic material?
Correct answer All of the above
Nucleic acids
Proteins
Polysaccharides
Lipids
Any of the above biochemical structures have antigenic potential. Proteins are excellent T lymphocyte-dependent antigens. Examples include diphtheria and tetanus. Polysaccharide antigens are T lymphocyte-independent antigens and hence do not require T cell input. Examples of polysaccharide immunizations include meningococcal and pneumococcal immunizations
Which of the following microvascular events occur in response to prolonged hyperglycemia?
Thinning of vascular basement membrane
Correct answer Degeneration and loss of pericytes
Decreased plasma viscosity
Loss of vascular endothelial cells
Prolonged hyperglycemia in patients with diabetes appears to have the following effects on hematologic and microvascular structures, potentiating the development of diabetic retinopathy:
- Degeneration and loss of pericytes: these cells envelope capillaries and are thought to aid in the autoregulatory processes of microvascular circulation
- Thickening of capillary basement membrane and proliferation of endothelial cells: this change can result in eventual capillary occlusion and retinal non-perfusion
- Increased plasma viscosity and amplified platelet aggregation and adhesiveness: decreased capillary blood flow
Cartilage is an important transition tissue during development. The cartilage matrix is composed of which type of cell?
Fibroblasts
Osteocytes
Correct answer Chondroblasts
Oligodendrocytes
Chondroblasts are important for the production of the cartilage matrix. Once mature, chondroblasts become chondrocytes and reside in cavities within the cartilage matrix called lacunae.
Osteocytes are found in the bone matrix in small cavities, lacunae. Osteocytes are derivatives of osteoblasts and are important in bone remodeling. These cells serve an important role in releasing calcium from bones when the body’s calcium level becomes depleted.
Fibroblasts are found in abundance throughout the body and are important in the secretion of ground substance or extracellular matrix (generally proteins and polysaccharides) as well as the secretion of collagen fibers.
Oligodendrocytes are important for the production of the myelin sheath in the central nervous system.
What common ocular finding is seen in patients with Osteogenesis Imperfecta (OI)?
Glaucoma
Iris colobomas
Cataracts
Correct answer Blue Sclera
Blue Sclera
The fact that you no longer feel the pressure of your clothes on your skin after several minutes of wearing them is an example of which of the following phenomena?
Somatic secretion
Increased perception
Sensory sensation
Correct answer Sensory adaptation
Sensory adaptation occurs when a stimulus is continually applied to a receptor or several receptors. Rather than continually signaling the presence of the stimulus, some receptors will cease to fire action potentials or decrease the frequency of action potentials.
