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PMB - 2010 Flashcards

1
Q

large, syncytial, multinucleated giant cells

(Warthin-Finkeldey) are seen in cells infected with…

A

MEASLES VIRUS (RUBEOLA)

also assoc w/ fever, cough, conjunctivitis, coryza, diffuse rash

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2
Q

Abnormal hormone production, with presenting paraneoplastic syndrome, is

characteristic of which tumor?

A

Renal cell carcinoma of the kidney;

  • **most common primary renal malignancy; inc incidence w/ smoking and obesity
    • MC subtype: Clear cell - assoc w/ gene deletion on Chromosome 3
  • think: paraneoplastic syndrome = eg, PT ilrP, Ec topic EPO, ACTII, Renin

(“PEAR”-a neoplastic)

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3
Q

which pair of nerves combine to form the SURAL NERVE?

A
  1. sural communicating branch
  2. medial sural cutaneous
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4
Q

which disease is due to ALTERED VITAMIN D METABOLISM

in adults?

A

OSTEOMALACIA;

def: defective mineralization of osteoid or cartilaginous growth plates,

MC due to VITAMIN D DEFICIENCY;

children: Rickets

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5
Q

which hormone’s synthesis is decreased by

POLYCYSTIC OVARIES?

A

PROGESTERONE;

aka Stein-Leventhal syndrome;

path: hyperinsulinemia and/or insulin resistance –> alters hormonal feedback –> inc LF:FSH, inc Androgens,

common cause of dec fertility and anovulation

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6
Q

*an occlusion of the anterior cerebral artery (ACA) is most likely to cause somesthetic sensory losses involving the CONTRALATERAL:

A

LEG AND FOOT;

ACA occlusions affect frontal lobe fxn. Findings incl:

  • CONTRALATERAL WEAKNESS (greater in legs than arms)
  • CONTRALATERAL cortical sensory deficits
  • gait apraxia, urinary incontinence, altered mental status, disinhibition and speech preservation
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7
Q

_________ is CONSTIPATING and may cause milk-alkali syndrome,

but taste the best

A

CALCIUM SALTS;

milk-alkali syndrome is characterized by high blood calcium and metabolic alkalosis caused by taking in too much calcium and absorbable alkal

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8
Q

what is the first choice insulin in emergency hyperglycemia?

A

CRYSTALLINE ZINC,

  • crystalline zinc insulin is regular insulin;
  • is a fast-acting preparation
  • this is the ONLY preparation that can be administered intravenously and subcutaneously –> therefore, also used for perioperative tx of DM
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9
Q

which phalangeal bones posses a

double concave oval fossa separated by a vertical ridge?

A

MIDDLE AND DISTAL ROWS;

of note, the proximal surface of the proximal phalanx

only has one articular facet, whereas the intermediate & distal have 2 facets

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10
Q

the BIFURCATE LIGAMENT is a component of which of the following joints?

A

CALCANEOCUBOID

(CC Joint) ;

  • Y-SHAPED ligament; attaches calcaneus to both the cuboid & the navicular;
  • begins at lateral end of the sulcus calcanei and splits into
    • calcaneocuboid portion
    • calcaneonavicular portion
  • *EXTRACAPSULAR
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11
Q

which enzyme is responsible for

hydrolysis of fatty acids in ADIPOSE TISSUE?

A

HORMONE SENSITIVE LIPASE;

this enzyme specifically “Degrades TGs stored in ADIPOCYTES”

The related enzymes:

  • Cholesteryl ester transfer protein: mediates transfer of cholesterol esters to other lipoprotein particles
  • Hepatic lipase: degrades TGs remaining in IDL
  • Lipoprotein lipase: degrades TGs in CIRCULATING CHYLOMICRONS
  • Pancreatic lipase: degrades detary TGs in SMALL INTESTINE
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12
Q

what are the products of BETA-OXIDATION?

A

This is a catabolic process by which FATTY ACID molecules are BROKEN DOWN. Products incl:

  • beta-ketoacyl CoA
  • Acetyl CoA
  • NADH
  • FADH2

CO2 IS NOT AN END PRODUCT OF BETA-OXIDATION

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13
Q

which of the followign classes of fungi are common pathogens?

A. Actinomycetes

B. Ascomycetes

C. Basidiomycetes

D. Deuteromycetes

E. Zygomycetes

A
  • D. Deuteromycetes, aka fungi imperfecti, though this is no longer a valid taxonomic group

Other answer choices:

  • Actinomycetes :
  • Ascomycetes
  • Basidiomycetes
  • Zygomycetes
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14
Q

which muscles in the posterior compartment of the leg is known to UNLOCK the knee joint and MEDIALLY ROTATE the knee (internally rotate)

A

POPLITEUS

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15
Q

which bony structures contribute to the SINUS TARSI?

A

Sinus tarsi: a large triangular space between anterior/middle and posterior facets

  • neck of the talus and anterosuperior aspect of the calcaneus (SULCUS TALI).
  • The tarsal sinus opens medially, posterior the sustentaculum tali of the calcaneus, as a funnel-shaped tarsal canal.
  • The sinus tarsi separates the anterior subtalar joint and posterior subtalar joint
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16
Q

what forms the base of the femoral triangle?

A

base = “superiorly”

INGUINAL LIGAMENT

  • medially: adductor longus musc
  • laterally: sartorious musc
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17
Q

which of the barbiturates has the SHORTEST duration of action

A

THIOPENTAL;

thiopental is ultrashort action, phenobarbital is long action

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18
Q

21 y/o with several months hx of restlessness, nervousness, inc food intake, weight loss, bulging eyes.

She most likely has:

A

Grave’s disease:

  • MC cause of HYPERTHYROIDISM
  • Path: Thyroid stimulating immunoglobulin –> stim TSH receptors on thyroid/dermal fibroblasts/orbital fibroblasts
  • HIsto: tall, crowded follicular epithelial cells; SCALLOPED COLLOID
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19
Q

What is the FIRST CHOICE for dysmenorrheal pain, and in acute gouty attacks,

but DECREASES DIURETIC ACTION OF FUROSEMIDE?

A

NAPROXEN;

  • COX-1, COX-2 *reversible* NSAID –> blocks PG synthesis
    • (recall: aspirin is the only irreversible NSAID)
  • decreases diuretic action of furosemide because of prostaglandin inhibition
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20
Q

which nerve innervates the DORSAL INTERDIGITAL space

between the first and second toes?

A
  • medial terminal branch of the deep peroneal

(Recall: the superficial peroneal nerve supplies cutaneous sensation to the dorsum of the foot and the distal leg)

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21
Q

articularis genu is innervated by a branch of which nerves?

A
  • nerve to the VASTUS INTERMEDIUS
  • femoral nerve (L2-L4)
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22
Q

the acid-fast staining characteristic of the genus

MYCOBACTERIUM is due to what?

A

MYCOLIC ACID;

def: long fatty acids found in the cell walls of the Mycolata taxon, a group of bacteria that includes Mycobacterium tuberculosis, the causative agent of the disease tuberculosis.

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23
Q

what are the characteristics for congenital syphilis?

A
  • rhagades (linear scars at angle of mouth)
  • saddle nose (loss of height of nose, bc of collapse of nose)
  • sabre shin (sharp anterior bowing or convexity of tibia)
  • notched (Hutchinson) teeth (smaller and more widely spaced than normal)
  • snuffles (nasal discharge)
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24
Q

a 47 y/o with episodic hypertension and elevated catecholamines is most likely to have:

A

PHEOCHROMOCYTOMA:

  • MC tumor of adrenal medulla in adults; derived from chromaffin cells (arise from neural crest_
  • may be associated w/ germline mutations: NF-1, VHL, RET
  • Sxs:
    • inc in catecholamines and their metabolites in plasma
    • episodic adrenergic symptoms (5 Ps) -
      • Pressure (BP)
      • Pain (HA)
      • Perspiration
      • Palpitations
      • Pallor
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25
Q

what is the most useful by oral administration for the

treatment of onychomycosis nail infections?

A

TERBINAFINE (oral);

  • mech: inhibits fungal enzyme squalene expoxidase
  • used for dermatophytes
  • AEs: GI upset, HA, hepatotoxicity, taste disturbance
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26
Q

STH (somatrotropin) aka growth hormone, causes increased blood levels of:

A

LIPIDS, CARBOHYDRATES

(inc amino acid uptake, inc protein synthesis, which would decrease protein levels in blood)

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27
Q

the medial crest of the fibula is located on which surface?

A

found on the POSTERIOR SURFACE of the fibula

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28
Q

which of the following is most useful in the

acute treatment of organophosphate intoxication?

A

ATROPINE AND PRALIDOXIME;

  • atropine reverses the MUSCARINIC effects
  • pralidoxime reverses the NICOTINIC effects
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29
Q

Rhabdomyosarcoma is a tumor

with differentiation towards:

A

SKELETAL MUSCLES;

(occurs in the striated/ skeletal muscle)

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30
Q

oxidative deamination is a property of which amino acid?

A

GLUTAMATE;

as it can be converted to GABA or Glutathione

(Recall: oxidative deamination is an amino acid is converted into the corresponding keto acid by the removal of the amine functional group as ammonia and the amine functional group is replaced by the ketone group)

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31
Q

which of the following would prevent a

MIDSAGITTAL intervertebral disk herniation into the spinal (vertebral) canal?

A

POSTERIOR LONGITUDINAL ligament;

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32
Q

the origin of the tensor fasciae latae includes which of the following?

A

Origin includes:

  • ASIS (anterior superior iliac spine)
  • Interspinous fossa (outer lip of anterior iliac crest)
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33
Q

when glucose enters a tissue, how is it trapped inside?

A

By being converted into glucose-6-phosphate;

can be produced by phosphorylation of glucose on the 6th carbon

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34
Q

What is considered a SYSTEMIC ANTACID?

A

SODIUM BICARBONATE;

  • referred to as a “systemic” antacid because the unreacted fraction is readily absorbed into the general circulation and may alter systemic pH.
  • The potential for Na+ overload and systemic alkalosis limits its use to short-term relief of indigestion.
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35
Q

POLIOMYELITIS affects which part of the spinal cord?

A

ANTERIOR HORNS;

  • caused by poliovirus (fecal-oral transmission); spreads via bloodstream to CNS
  • causes destruction of cells in ANTERIOR HORN of spinal cord (LMN death)
36
Q

which of the antifungal drugs act on the cell membrane?

A

NYSTATIN;

  • MOA: binds ergosterol (unique to fungi); forms membrane pores that allow leakage of electrolytes
  • Same MOA as Amphotericin B
  • Admin: too toxic for systemic use; “swish and swallow” for oral candidiasis
37
Q

what is byssinosis?

A

It’s an example of hypersensitivity pneumonitis;

rare lung diease caused by prolonged inhalation of textile fiber dust

38
Q

why should aspirin be used CAUTIOUSLY in a patient receiving heparin treatment?

(aka what’s the concern w/ aspirin and heparin)

A

ASPIRIN INCREASES THE RISK OF BLEEDING;

(causes you to bleed more easily –> unusual bleeding, bruising, vomiting, blood, headache, dizziness, or weakness)

39
Q

what structure separates the GLUTEUS MEDIUS from the GLUTEUS MINIMUS?

A

DEEP DIVISION of the SUPERIOR GLUTEAL neurovascular bundle;

Gluteus medius is related to the branches of the superior gluteal artery and nerve, which run between the adjacent surfaces of the gluteus medius and minimus muscles. This is an important relation, as these vessels and nerves may be damaged during surgical procedures that involve the incision of gluteus medius.

40
Q

what does the insulin receptor have?

A

has TYROSINE KINASE RECEPTOR

(aka insulin receptor is a type of tyrosine kinase receptor);

*in which the binding of an agonistic ligand triggers autophosphorylation of the tyrosine residues, with each subunit phosphorylating its partner. The addition of the phosphate groups generates a binding site for the insulin receptor substrate (IRS-1), which is subsequently activated via phosphorylation

41
Q

which of the following viruses has both LIVE ATTENUATED and KILLED vaccines available?

A. Measles

B. Mumps

C. Rubella

D. Polio

A

POLIO has both live attenuated and killed vaccines;

whereas the Measles, Mumps, Rubella (MMR) combined vaccine is ONLY live attenuated

42
Q

what are the primary manifestations of herpes viruses?

A
  • gingivostomatitis
  • cytomegalovirus mononucleosis
  • herpes gladiatorum
  • herpetic whitlow
43
Q

which drug is least likely to be associated with HYPOGLYCEMIA as a side effect?

A

METFORMIN;

not associated w/ hypoglycemia;

Adverse effects can include: GI upset, lactic acidosis (use with caution in renal insufficiency), B12 deficiency, promotes weight loss

44
Q

which drug reduces intestinal motility?

A

LOPERAMIDE;

  • A GI drug that is an agonist of mu-opioid receptors; SLOWS GUT MOTILITY; poor CNS penetration
  • used for Diarrhea –> AEs: constipation, nausea
45
Q

which areas are involved in ULCERATIVE COLITIS?

A

COLON AND RECTUM;

think: UC = COLON; w/ continuous colonic involvement
* (Recall: whereas Crohn disease can affect any portion of GIT, usually TERMINAL ILEUM AND COLON; skip lesions)*

46
Q

viridans streptococci are common etiologic agents of what?

A

BACTERIAL ENDOCARDITIS;

(endocarditis presentation assoc w/ bacterium)

  • S. viridans –> assoc w/ subacute, dental procedure
47
Q

the axillary artery continues as what?

A

continues as the BRACHIAL ARTERY;

it is a continuation of the SUBCLAVIAN ARTERY (beginning at outer border of 1st rib)

48
Q

which reverse transcriptase inhibitor is used in treatment of HIV?

A

ZIDOVUDINE;

a nucleotide reverse transcriptor (NRTI);

others pictured

49
Q

name which drug from the list can cause Parkinson-like symptoms?

  • Trihexphenidyl
  • Haloperidol
  • Benztropine
  • Selegiline
  • Bromocroptine
A

HALOPERIDOL is assoc w/ parkinson-like sxs;

(Recall: other drugs assoc w/ parkinson-like sxs incl:

Antipsychotics, Reserpine, Metoclopramide

(cogwheel rigidity of ARM)

50
Q

the direct ANTI-HUMAN globulin test (DAT, Coomb’s test) for

immunoglobulin used by blood banks helps to detect what?

A

IgG;

Recall

  • Direct Coombs test-anti-lg antibody (Coombs reagent) added to patient’s RBCs. RBCs agglutinate if RBCs are coated with lg.
  • Indirect Coombs test- normal RBCs added to patient’s serum. If serum has anti-RBC surface lg, RBCs agglutinate when Coombs reagent added.
51
Q

with regard to lyme disease, describe the causative agent:

A

BORRELIA BURGDORFERI;

  • large microaerophilic spirochete
  • w/ two outer surface proteins conded for by a linear plasmid
52
Q

in a family with medullary thyroid carcinoma AND pheochromocytoma,

there is most likely to be a germline mutation in:

A

RET;

Recall

  • MEN 2A (autosomal dominant RET mutation) –> Thyroid and parathyroid tumors, pheochromocytoma
  • MEN 2B (autosomal dominant RET mutation) –> Thyroid tumors, pheochromocytoma,
    ganglioneuromatosis, Marfanoid habitus
53
Q

if viewed after addition of IODINE to gram-stain,

gram-negative bacilli will appear as:

A

PURPLE RODS;

(because the iodine stage is BEFORE adding the counter-stain)

54
Q

what drug is most effective in treating

STATUS EPILEPTICUS?

A

DIAZEPAM;

benzodiazepine is best for anxiety, panic disorder, spasticity, status epilepticus

Status epilepticus: continuous 5 min) or recurring seizures that may result in brain injury;

55
Q

**which enzyme would NOT be affected by THIAMINE DEFICIENCY?

A

HEXOKINASE is not affected by thiamine deficiency;

56
Q

*which amino acid cannot be used for NET SYNTHESIS OF GLUCOSE?

A

LYSINE cannot be used for net synthesis of glucose

57
Q

what type of joint is the INTERCUNEIFORM joint?

A

PLANE SYNOVIAL JOINT

58
Q

**which muscles in the PLANTAR FOOT has part origin from the

flexor retinaculum?

A

abductor hallucis;

59
Q

african sleeping sickness is caused by what?

  • amoeba
  • nematode
  • plasmodium
  • trematode
  • trypanosome
A

TRYPANOSOME;

aka African trypanosomiasis;

  • insect-borne parasitic infection of humans and other animals. It is caused by the species Trypanosoma brucei
60
Q

Actinomycosis is also known as what?

A

LUMPY JAW;

actinomycosis is commonly called LUMPY JAW;

because it is a localized, chronic, progressive, granulomatous abscess that most frequently involves the mandible, the maxillae, or other bony tissues in the head.

61
Q

the reticular arteries supply blood to what?

A

the neck and head of the femur;

(the reticular arteries supply blood to the head and neck of femur)

62
Q

which of the following does NOT possess an envelope?

  • rubella
  • papilloma virus
  • cytomegalovirus
  • human immunodeficiency virus
A

Papilloma virus is NAKED;

rubella virus, cytomegalovirus, and human immunodeficiency viruses are all ENVELOPED

63
Q

Conida are asexual spores

(T/F)

A

True

  • Hyphae do NOT produce blasospheres;
  • sexual spores are NOT the most important for maintaining the species;
  • fungi are NOT identified mainly by their sexual spores
64
Q

where are LOWER MOTOR NEURON cell bodies located?

A

in the MOTOR NUCLEI OF CRANIAL NERVES;

(Recall: LMNs are found in both the:

  1. ventral horn of the spinal cord gray matter, and in
  2. motor nuclei of the cranial nerves in the brainstem)
65
Q

in type II diabetes, low activity of what would contribute to HYPERTRIGLYCERIDEMIA?

A

LIPOPROTEIN LIPASE;

RECALL:

  • Lipoprotein lipase: degrades TGs in CIRCULATING CHYLOMICRONS
  • Cholesteryl ester transfer protein: mediates transfer of cholesterol esters to other lipoprotein particles
  • Hepatic lipase: degrades TGs remaining in IDL
  • Pancreatic lipase: degrades detary TGs in SMALL INTESTINE
66
Q

an inability to extend the wrist would result from a lesion of the:

what?

A

RADIAL NERVE;

The radial nerve (and its deep branch) provides motor innervation to the muscles in the posterior compartment of the arm and forearm, which are mostly extensors.

67
Q

the cell bodies of most pain fibers coming from the heart are located where?

A

DORSAL ROOT GANGLIA OF CERVICAL AND THORACIC SPINAL NERVES;

68
Q

the intrinsic muscles of the foot, with only a couple of exceptions, are supplied by which of the following spinal cord nerves

A

S2 and S3;

(Lateral plantar nerve (S2-S3)

  • All the muscles are innervated either by the medial plantar nerve or the lateral plantar nerve, which are both branches of the tibial nerve.
  • include the abductor halluces, the flexor digitorum brevis, the abductor digiti minimi, and the quadratus plantae.
69
Q

in a cell deprived of oxygen during a myocardial infarction,

what will happen

A

the mitochondrial proton pump will increase

(the TCA cycle will decrease, anaerobic glycolysis will increase, and levels of NADH will increase)

70
Q

if pt has weakness in muscles of facial expression located in lower half of the face on the right, the symptoms suggests a lesion where?

A

in the PRIMARY MOTOR CORTEX ON THE LEFT;

(Recall: Signals from M1 cross the bodys midline to activate skeletal muscles on the opposite side of the body, meaning that the left hemisphere of the brain controls the right side of the body, and the right hemisphere controls the left side of the body)

71
Q

polymyxins act by inhibiting protein synthesis:

true/ false

A

FALSE;

polymyxins act by decreasing membrane integrity ;

Recall: Cation polypeptides that bind to phospholipids on cell membrane of gram 8 bacteria. Disrupt cell
membrane integrity –> leakage of cellular components –> cell death.

72
Q

an increase in motor activity of which of the following will result in more rapid emptying of solids from the stomach?

  • antrum only
  • fundus only
  • both fundus and antrum
  • these do not have an effect on rate of emptying
A

ANTRUM ONLY;

Recall: rate of emptying is affected by

1) Peristaltic waves, (2) systolic contractions of the antrum, and (3) reduction in size of the stomach.

73
Q

a patient presents with numbness of the lateral and dorsal aspects of the right foot, including the 1st inerspace.

this presentation is likely due to what?

A

a MONONEUROPATHY;

Recall:

  • mononeuropathy: when one nerve is affected by peripheral neuropathy
  • polyneuropathy: many nerves are affected
  • mononeuropathy multiplex: when there is damage to two or more nerves in different nerve areas; this is actually a group of symptoms rather than its own disease
74
Q

which is an INEFFECTIVE physiological buffer?

  • phosphate
  • sulfate
  • bicarbonate
  • hemoglobin
A

SULFATE is an ineffective physiological buffer,

because it is a salt that might capture hydrogen ions –> preventing these H+ ions from combining with bicarb to produce CO2 –> contributing to pH imbalance and acidosis

bicarbonate and phosphate

75
Q

what is a violent movement of an extremity due to forceful contraction of proximal limb musculature?

A

HEMIBALLISM;

a type of chorea, usually involving VIOLENT, involuntary flinging of one arm and/or one leg

Recall:

  • tremor: involuntary, somewhat rhythmic, muscle contraction and relaxation involving oscillations or twitching movements of one or more body parts
  • chorea: abnormal involuntary movement (Greek word “dance”); brief, abrupt, irregular, unpredictable, non-stereotyped movements;
  • dystonia: a movement disorder in which a person’s muscles contract uncontrollably. The contraction causes the affected body part to twist involuntarily, resulting in repetitive movements or abnormal postures
76
Q

cortisol can cause osteoporosis by what mechanism?

A

INCREASING THE NUMBER OF OSTEOCLASTS;

iT DOES NOT dec calcium intestinal absorption, and it does not block calcitonin bone sparing effects

77
Q

the conjugation of bilirubin in the liver requires a molecule produced by which of pathway?

A

URONIC ACID PATHWAY;

alternative oxidative pathway for glucose metabolism. It catalyzes the conversion of glucose to glucuronic acid, ascorbic acid, and pentoses. It does not lead to the formation of ATP

78
Q

the most important cell cycle regulatory molecules that are synthesized and degraded each cell cycle are called what?

A

CYCLINS;

Recall:

  • cdk: families of protein kinases first discovered for role in regulating cell cycle; regulate transcription, mRNA processing, differentiation of nerve cells
  • protooncogenes: normal gene which, when altered by mutation, becomes an oncogene that can contribute to cancer; can signal cell division or apoptosis
  • growth factors:
79
Q

a peripheral smeal showing MICROCYTIC red blood cells that are HYPERCHROMIC is consistent with?

A

HEREDITARY SPHEROCYTOSIS;

Recall:

  • B12 deficiency: megaloblastic anemia
  • Iron deficiency: microcytic, hemoglobin affected
  • Viral infection: hemolytic extrinsic
  • Sickle cell disease: hemolytic intrinsic
80
Q

amyloid deposition in the pancreatic islets is most likely to be found in a patient with what condition?

A

TYPE II DIABETES MELLITUS;

In type 2 diabetes, this peptide (islet amyloid polypeptide) aggregates to form amyloid fibrils that are toxic to beta-cells.

81
Q

catalytic receptors on the cell surface

…

A

often activate cells by PHOSPHORYLATION

82
Q

which drugs can be used to treat:

HEROIN ADDICTION?

A
  • methadone
  • buprenorphine
  • clonidine
83
Q

which hormones can cause INCREASE in serum glucose levels?

A
  • EPINEPHRINE
  • CORTISOL
  • GLUCAGON

(insulin and secretin do not increase serum glucose)

84
Q

a 56 y/o patient w/ sensory and motor deficiencies in her legs;

what is the most likely primary site of primary cancer that would cause this?

A

LUNG;

  • Recall: Sites of metastases from lung cancer: Liver (jaundice, hepatomegaly), Adrenals, Bone (pathologic fracture), Brain;
  • “Lung ‘mets’ Love Affective Boneheads and Brainiacs.”
85
Q

which of the following can activate the classical complement pathway?

A

a single molecule of IgG can activate the classical complement pathway

Recall: the classical complement pathway can be initiated by the binding of antigen-antibody complexes to the C1q protein. The globular regions of C1q recognize and bind to the Fc region of antibody isotypes _IgG or IgM._

86
Q

which mycotic disease is characterized by the formation of RAISED, COLORED CAULIFLOWER-LIKE LESIONS and sclerotic bodies in tissue?

A

CHROMOBLASTOMYCOSIS;

Recall: Buzz word “Great lakes and Ohio River Valley”

Boards - Practice Test Qs (3 decks)

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