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practice test 1 Flashcards

1
Q

A patient that was in a vehicle collision with no other medical conditions and is in a coma, blood pressure 84/50 pulse 122 then resuscitated and put on a ventilator 2 days later develops a bilateral pulmonary edema in the absence of heart failure, what caused the pleural effusion

A

acute respiratory distress syndrome

injury to alveolar pneumocytes and pulmonary endothelium from trauma induced pulmonary contusions or fat emboli

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2
Q 
assign the following speeds of conduction to the either the SA node, AV node, purkinje, ventricular myocardium
1.1 m/sec
.05
2.2
.3
A

1.1: SA node
.05: AV node (slowest)
2.2: purkinje (fastest)
.3: ventricular myocardium

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3
Q

what causes destruction of normal trabecular bone pattern, mixed rasiodense (sclerotic) and radiolucent (lytic) areas, and periosteal new bone formation with lifting of the periosteum

A

osteosarcoma

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4
Q

____ is the feeling of a lump in the throat without accompanying physical, endoscopic, or radiologic findings of esophageal obstruction

A

globus sensation

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5
Q

describe the crystals in gout

A

negatively birefringent: yellow when parallel and blue with perpendicular

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6
Q

What teratogenic effect do ACE inhibitors and ARBs have

A

impair fetal renal development (renal hypoplasia or dysgenesis) and inhibit fetal urine production (oligohydramnios)

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7
Q

What is the treatment for influenza and its mechanism of action

A

oseltamivir (tamiflu)
inhibits neuroaminidase which is normally responsible for cleaving the terminal sialic acid residues on hemagglutinin binding of glycoconjugate receptors
so newly synthesized virions remain adherent to host cell surface and unable to infect new cells

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8
Q

what is the appearance of DNA fragments in multiples of 180 base pairs on gel electrophoresis indicative of

A

“DNA laddering”: indicator of apoptosis

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9
Q

diazepam MOA

A

benzodiazepine

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10
Q

define germline mosaicism

A

presence of genetically different cell lines within the oocytes or spermatocytes
germline mosaicism typically results from a mutation during the first stages of embryonic development

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11
Q

IL-2 is exclusively produced by what cells

A

T lymphocytes

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12
Q

_____ are adhesion molecules that bind epithelial cells together within tissues and bind to cadherin molecules on adjacent cells to form adherens junctions and _____. In contrast, cell adhesion to the basement membrane is mediated primarily by ____ and these structures rely on _____

A

cell to cell: cadherins, desmosomes

cell to basement membrane: hemidesmisomes, integrins

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13
Q

Molluscum contagiosum is caused by what virus? describe how this virus appears histologically

A

poxvirus
epidermal hyperplasia long with molluscum bodies: large eosinophilic cytoplasmic inclusions made of virus particles (cytoplasmic inclusion bodies)

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14
Q

The ____ runs just posterior to the knee joint and is fixed proximally and distally by the adductor magnus and soleus muscles, respectively, making it highly susceptible to injury during tibiofemoral dislocation

A

popliteal artery

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15
Q

define sublimation

A

channeling impulses into socially acceptable behaviors

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16
Q

define projection

A

attributing one’s own feelings to others

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17
Q

What is the GFR (%) compared to normal immediately following a heminephrectomy? six weeks following?

A

50%

80%

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18
Q

Phosphodiesterase-5 inhibitors (sildenafil) increase intracellular concentrations of _____ in the vascular smooth muscle of the corpora cavernosa which leads to smooth muscle relaxation and subsequent engorgement

A

cGMP

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19
Q

Damage to the long thoracic nerve along the lateral chest wall may cause paralysis to what muscle

A

serratus anterior

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20
Q

Describe the relative concentrations of sodium, potassium, bicarb, and chloride excreted by the exocrine pancreas

A

sodium and potassium are fixed and virtually identical to plasma levels
secretin –> increases pancreatic flow rate –> high bicarb and low chloride

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21
Q

what is the difference between schizophreniform disorder and schizophrenia

A

schizophreniform disorder: longer than a month and shorter than 6 months
schizophrenia: longer than 6 months

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22
Q

how can you calculate the false positive rate?

A

either (1 - specificity) or

number of false positive tests/healthy controls

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23
Q 
How can you calculate the following:
 absolute risk reduction
relative risk reduction
relative risk
number needed to treat
A 
ARR = control rate of event - treatment rate of event
RRR= ARR/control rate of event
RR = treatment rate of event/control rate of event
NNT= 1/ARR
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24
Q

Fever and mental status/behavior changes with temporal lobe hemorrhage/edema on MRI indicates what diagnosis

A

encephalitis: HSV1 is the most common cause of sporadic encephalitis

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25
Q

Acute intermittent porphyria is caused by deficiency of ___ and is characterized by intermittent episodes of abdominal pain with neurological manifestations following exposure to an offending medication

A

porphobilinogen deaminase

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26
Q

Acute intermittent porphyria results from a autosomal dominant defect in porhophilinogen deaminase that can lead to elevated levels of ____ and _____

A 
porphobilinogen
aminolevulinic acid (ALA)
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27
Q

In an alcoholic presenting with neurologic symptoms, how can a cobalamin and thiamine deficiency be distinguished

A 
cobalamin deficiency (B12): degeneration of  lateral corticospinal tracts (babinski)
thiamine deficiency: does not commonly affect lateral corticospinal tracts (no babinski sign)
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28
Q

Surgical removal of what organ leads to improvement in many patients with myasthenia gravis

A

thymus

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29
Q

A patient presenting with dysmorphic face, cleft palate, and recurrent infections likely has what diagnosis

A

DiGeorge syndrome (defective development of the pharyngeal pouches –> absent or hypoplastic thymus, craniofacial deformities, conotruncal cardiac defects)

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30
Q 
How are the following serum levels effected in DKA: 
ketone
serum pH
glucose
potassium
sodium
A

hyperketonemia
metabolic acidosis
hyperglycemia (decreased glucose utilization)
hyperkalemia (acidemia drives K+ out of cells through K/H exchangers and lack of insulin to drive K into cells)
hyponatremia (due to osmotic activity of serum glucose –> osmotic diuresis)

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31
Q

What causes a female external genitalia and breasts with a vagina ending in a blind pouch, elevated serum testosterone and LH and normal FSH

A

complete androgen insensitivity

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32
Q

Before surgical removal of a pheochromocytoma, what medication should be administered

A

phenoxybenzamine
and a beta blocker
(beta blocker should never be administered first bc of unopposed alpha stimulation)

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33
Q

Premature infants are at high risk of intraventricular hemorrhage due to what?

A

germinal matrix fragility

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34
Q

Misoprostol MOA

A

prostaglandin E1 analog (receptor agonist)

can be used to prevent or treat NSAID induced gastritis and peptic ulcer formation and fetal loss

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35
Q

Patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease often have nasal polyps and chronic rhinosinusitis and develop worsening nasal congestion and/or bronchospasm after ingesting aspirin or NSAIDS due to build up of what

A

leukotrienes

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36
Q

Intercellular bridging and keratin pearls (foci of central keratinization within concentric layers of squamous cells) are characteristic of what tumor

A

squamous cell carcinoma

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37
Q

what secondary effect does nitroglycerin have on heart rate

A

reflex tachycardia

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38
Q

How does the function of CTFR differ in the lungs vs sweat glands

A

sweat glands: resorb chloride and enhances sodium resorption
respiratory (and intestine): secretes chloride in lumen and has an inhibitory effect on ENaC, decreasing luminal sodium absorption
(sweat–> resorb electrolytes; intestine and resp –> secrete electrolyte in lumen)

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39
Q

describe allelic heterogeneity

A

different mutations in the same genetic locus cause similar phenotypes
(ex. patients with beta thalassemia can have 3 different mutations that all cause the disease. but, like duchenne vs becker, the exact phenotype can vary based on individual mutations)

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40
Q

In asthma, mast cells and eosinophils release _____ that trigger bronchospasm, bronchial mucus secretin, and bronchial edema

A

cysteinyl-containing leukotrienes (C4, D4, E4)

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41
Q

list clinical manifestations of hereditary hemochromatosis

A

hyperpigmentation (bronze diabetes)
arthralgia
hepatomegaly, cirrhosis, hepatocellular carcinoma
diabetes mellitus, secondary hypogonadism and hypothyroidism
restrictive or dilated cardiomyopathy and conduction abnormalities
increased susceptibility to listeria, vibrio vulnificus, and yersinia enterocolitica

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42
Q

what is the pathogenesis of hemochromatosis

A

excessive gastrointestinal absorption of iron

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43
Q

How does Cirrhosis cause splenomegaly

A

increased pressure in the portal venous system causes splenic vein hypertension and splenomegaly

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44
Q

FGFR3 gene mutation results in what

A

achondroplasia

gain of function of fibroblast growth factor receptor 3 –> inhibits excessive cartilage proliferation

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45
Q

A patient with low immunoglobulins, low CD19 cells and normal T cells that has recurrent infections likely has what disease and what is the gene mutation

A

X-linked agammaglobulinemia

BTK gene mutation –> defective Bruton tyrosine kinase –> impaired B cell maturation and immunoglobulin production

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46
Q

Proteins destined for the endoplasmic reticulum posses _____ signal sequences that identify them as such. These sequences are translated in the ____ and are rapidly recognized by ____ which halt translation and target the ribosome to protein pores in the rough endoplasmic reticulum.

A

N-terminal peptide
cytosol
SRPs (signal recognition particles)
(without the N-terminal hydrophobic amino acid sequence, these would accumulate in the cytosol)

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47
Q

High amounts of branched chain alpha keto acids in the blood and urine in a baby with poor feeding and occasional vomiting likely has what disease

A

maple syrup urine disease

defect in the branched-chain alpha keto acid dehydrogenase complex

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48
Q

what cofactors/coenzymes are required by branched chain alpha keto acid dehydrogenase

A 
thiamine (B1)
FAD
NAD+ 
CoA
lipoic acid
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49
Q

What is the diagnosis of a a fetus who demonstrates ascites, bilateral pleural effusions, and pericardial effusion who is the child of 2 asian decent parents who both have histories of blood disorders

A

hydrops fetalis secondary to alpha thalassemia

50
Q

what is seen on blood smear of alpha thalssemia minor

A

mild microcytic anemia

51
Q

In a patient with normal serum concentrations of testosterone and LH, but low testosterone concentrations in the seminiferous tubules and epididymis, what cells are likely dysfunctioning

A

sertoli cells

produce androgen binding protein which binds testosterone and DHT to reduce their diffusion out of the luminal fluid

52
Q

what hormone promotes glycogenolysis and gluconeogenesis in the liver

A

glucagon (and epinephrine)

53
Q

what receptor does glucagon bind

A

Gs –> adenylate cyclase –> cAMP

54
Q 
Where do the following supply sympathetic innervation: 
stellate ganglion
superior cervical ganglion
thoracic splanchnic nerves
thoracic sympathetic trunk
vagus nerve
A

stellate (cervicothoracic): upper extremity
superior cervical: head and neck
thoracic splanchnic: abdomen
thoracic: axilla, ect.
vagus: viscera of thorax, foregut, midgut

55
Q

osteoarthritis is characterized by the degredation of ____- and _____ within articular cartilage

A

type II collagen

proteoglycans

56
Q

In females, the gubernaculum becomes the _____ which passes through the inguinal canal and out to attach to the labia majora and the superior portion persists as the ______ which connects the uterus to the ovary

A

round ligament

uteroovarian

57
Q

Paragangliomas, arising from chromaffin cells at the organ of Zuckerkandl are similar to what tumors that arise in the adrenal medulla

A

pheochromocytoma

58
Q

How are the following effected in a PE:
pH
PaCO2
PaO2

A

pH: decreased
PaCO2: increased
PaO2: decreased

59
Q

Pulmonary arterial hypertension is a result from what?

A

pulmonary arterial endothelial dysfunction
(hypertrophy of smooth muscle medial layer and hyperplasia of the intimal layer followed by progressive intimal fibrosis with eventual development of plexiform lesions)

60
Q

what genetic disorder results in early onset osteoporosis/increased bone fragility which may also cause visibility of the choroid layers underlying the sclera of eye

A 
osteogenesis imperfecta
(mutation in COL1A1 and COL1A2 genes which encode proteins that form type I collagen)
61
Q

Hypoglycemia after prolonged fasting with inappropriately low ketone bodies suggest impairment of what metabolic process

A

beta oxidation

or ketone production

62
Q

Ras is an oncoprotein that is a component of what intracellular function

A

MAP-kinase signal transduction

transmits stimulus from the receptor on the cell surface to the nucleus promoting mitogenesis

63
Q

What is the function of MYC

A

nuclear phosphoprotein that functions as a transcription activator controlling cell proliferation, differentiation, and apoptosis

64
Q

what is the function of BRCA1

A

encodes DNA repair enzyme

65
Q

what is the function of cyclin D1

A

promoter of G1 to S during the cell cycle

66
Q

what is the function of Rb

A

nuclear phosphoprotein that regulates the G1 to S checkpoint

67
Q

What tumor is composed of polygonal, eosinophilic cells that stain positive for neuropeptides such as chromogranin and syntaptophysin and what do they typically release

A

carcinoid tumor

serotonin

68
Q

What is required in order for an organism to be susceptible to any penicillins

A

cell wall with peptidoglycan

69
Q

Eukaryotic translation is initiated why the small ribosomal subunit binds the 5’cap of mRNA and scans for the start codon(___) within the Kozak consensus sequence. Ribosomal binding of the 5’ cap is facilitated by a family of proteins known as the ______

A

AUG

eukaryotic initiation factors

70
Q

During apoptosis, the activation of caspases results in degradation of ____, leading to interruption of translation. As a result, many proteins necessary for apoptosis are translated using what alternative method?

A

eIF (eukaryotic initiation factors)
internal ribosome entry: internal ribosome entry site (IRES) attracts ribosome to mRNA and allows translation to begin in the middle of the mRNA sequence

71
Q

fissures, abcesses, fistulae, mouth ulcers accompanied by abdominal pain, diarrhea, and low grade fever are seen in what disease? where does it most frequently involve, which is a good site for biopsy

A

Crohn disease

ileum

72
Q

What location is most commonly affected by ulcerative colitis?

A

colon

73
Q

what are the most commonly effected locations by celiac

A

distal duodenum and proximal jejunum

74
Q

In treating hepatic encephalopathy, should the urine or colon be acidified or alkalinized

A

colon
acidified
(lactulose is degraded by colonic bacteria to form lactic acid and acetic acid which convert NH3 to NH4)

75
Q

CYP450 inducers have what effect on INR of patients taking warfarin

A

decrease

increased metabolism of warfarin –> decreased warfarin effect –> more clotting

76
Q

name 4 CYP450 inducers

A

carbamazepine
phenytoin
phenobarbital
rifampin

77
Q

inorder to induce bronchodilation, what should be increased intracellularly

A

cAMP (beta 2 –> Gs –> cAMP)

78
Q

Bone pain and weakness in the setting of limited nutritional intake and minimal sunlight exposure is highly suggestive of what diagnosis

A

osteomalacia (decreased mineralization of osteoid)

79
Q

In a patient with longstanding diabetes, exertional leg pain that has begun to hurt at night unless he sleeps sitting up, thin skin, and a small ulcer at the tip of toe likely has what underlying pathology

A

peripheral arterial disease

arterial atherosclerosis

80
Q

What is LiFraumeni syndrome and what is the genetic cause

A

autosomal dominant inactivating mutation of TP53 (needs 2 hit for malignant transformtation)
causes early onset malignancies including breast cancer, bone and soft tissue sarcomas, adrenocortical carcinoma, and brain tumors

81
Q

Aneurysmal dilation of the aortic arch can compress the _____, resulting in hoarseness due to paralysis of what muscles

A

left recurrent laryngeal nerve
intrinsic muscles of the larynx responsible for sound production (posterior and lateral cricoartenoids, oblique and transverse arytenoids, thyroarytenoid) except the cricothyroid

82
Q

In general, DNA viruses (except for ____ ) replicate in the _____. RNA viruses (except for _____ and _____) replicate in the _____

A 
pox virus
nucleus
orthomyxoviruses
retroviruses
cytoplasm
83
Q

____ is most commonly asymptomatic or a mild pneumonia with pleural effusion. A rash and symmetric arthralgias can develop. Rarely, it can cause formation of a thin-walled cavity in the lung which may produce hemoptysis in addition to fever and cough.

A

coccidioides immitis (coccidioidomycosis)

84
Q

What are characteristic findings of Hashimoto thyroiditis on biopsy

A

lymphocytic infiltration
follicular destruction
germinal center formation
Hurthle cells (enlarged epithelial cells with eosinophilic cytoplasm and prominent nucleoli)

85
Q

ASD is associated with what heart sound

A

fixed widened S2 split

86
Q

What is the immature defense mechanism of focusing on nonemotional aspects to avoid distressing feelings

A

intellectualization

87
Q

What is the pathogenesis of Achalasia

A

an inflammatory infiltrate composed of mainly lymphocytes and eosinophils develops around the nitric oxide-producing neurons in the myenteric plexus, these neurons, responsible for esophageal smooth muscle relaxation, are preferentially destroyed

88
Q

Acute onset anemia in a male of African, Asian, or Mediterranean descent who is being treated with a sulfonamide is most likely due to what

A

G6PD deficiency

89
Q

compare Brocas aphasia to Wernickes aphasia

A 
Brocas= expressive/motor aphasia
Wernicke= speech comprehension
90
Q

Efferent neuron axons tend to be myelinated, with what notable exception?

A

postganglionic autonomic neurons

91
Q

How does sample size effect the standard of error

A

standard of error decreases and sample size increases

92
Q

What is the most common cause of viral meningitis and is positive sense single stranded RNA

A

enteroviruses which are in the picornavirdae family

93
Q

What brings together the alpha and beta chains of the MHC class II molecule and is then degraded before an extracellular peptide is inserted between the alpha and beta chains

A

invariant chain

94
Q

what cause of microcytic, hypochromatic anemia may present with burning sensation in mouth, reduced taste, and lip dryness

A

iron deficiency

95
Q

compare the clinical features of prader willi syndrome and angelman syndrome

A

prader-willi: hypotonia, hyperphagia/obesity, short stature, small hands/feet, hypogonadism, dysmorphic face, intellectual disability

angelman: epilepsy, seizure, ataxic gait/tremor, poor motor and language development, inapporpriate laughter/smiling, intellectual disability

96
Q

compare the genetic cause of prader-wili vs angelman syndrome

A

prader-wili: loss of paternally inherited allele from chromosome 15 (15q11-13) (paternal microdeletion or maternal uniparental disomy)

angelman: the opposite (maternal microdeletion or paternal uniparental disomy)

97
Q

What cause of chronic diarrhea is associated with a skin rash

A

celiac

cross reactivity between anti-gliadin IgA antibodies and translutaminase at the dermal basement membrane

98
Q

Lesch-Nyhan syndrome is an X linked disorder caused by deficiency of ______ that results in hyperuricemia

A

hypoxanthine-guanine phosphoribosyltransferase

99
Q

Describe the pathogenesis of pernicious anemia including its effect on gastrin

A 
atrophic gastritis (likely autoimmune related) causes hypochlorydria --> increased serum gastrin release (normally inhibitted b yhydrochloric acid) 
damage to parietal cells --> decreased intrinsic factor release ---> depleted B12 stores --> macrocytic anemia and degeneration of ascending and descending spinal tracts
100
Q

What cause of a not transilluminating testicular mass diminshes in size when laying down

A

varicocele

hydrocele may also change in size based on position but would transilluminate

101
Q

what are possible causes of acanthosis nigricans

A

insulin resistance
obesity
malignancy (if it appears suddenly, spreads quickly, or involves mucous membranes, or palms and soles)

102
Q

During normal embryonic development, ____ migrate from the neural crest to the epidermis and _____ migrate from the yolk sac to the gonadal ridge

A

melanocytes

germ cells

103
Q

What type of heart malformations are most common in DiGeorge syndrome

A

conotruncal (outflow tract) defects:
persistent truncus arteriosus
tetralogy of fallot
interrupted aortic arch

104
Q

In order for class switching to occur, B cells must undergo costimulation by ___ ligand which is expressed on the surface of activated T cells

A

CD40

105
Q

hepatosplenomegaly, bone pain with marked osteopenia with cortical collapse, and an enzyme deficiency in an 18 yr old is due to what enzyme deficiency? what is the diagnosis?

A

Beta-glucocerebrosidase

Gaucher

106
Q

Angiokeratomas, peripheral neuropathy, and glomerulopathy with an enzyme deficiency is due to what enzyme deficiency and what is the daignosis

A

alpha galactosidase A

Fabry disease

107
Q

inflizimab MOA

A

monoclonal antibody to TNF alpha

108
Q

etanercept MOA

A

recombinant TNF receptor fusion protein which inhibits TNF alpha effects

109
Q

By inhibiting COX-1 in platelets, aspirin prevents the synthesis of _____, a potent stimulator of platelet aggregation and vasoconstriction

A

thromboxane A2

110
Q

what organism has reproductive forms that classically exhibit a “broom like” structure on silver staining

A

aspergillus

111
Q

Describe transformation mechanism of genetic transfer between bacteria

A

bacteria uptake naked DNA from the environment and incorporate it into their own genome

112
Q

describe the conjugation mechanism for genetic transfer between bacteria

A

DNA is passed from one bacterium to another by direct cell-cell interaction

113
Q

describe the transduction mechanism of genetic transfer between bacteria

A

bacteriophage mediated transfer of genetic information

114
Q

what cause of nephropathy fits the following description as seen in an HIV patient: proteinuria, glomerular epithelial cell enlargement and vacuolization, varying degrees of glomerular capillary wall collapse with many renal tubules showing cystic dilation and are filled with proteinaceous material

A

focal segmental glomerulosclerosis

115
Q

What is initial treatment for pneumothorax

A

needle aspiration or chest tube

patients with suspected tension pneumo should undergo immediate decompression

116
Q

HOXA13 mutation is a rare, dominantly inherited condition characterized by what malformations

A 
distal limbs (hypoplastic first digits)
mullerian fusion abnormalities (uterus didelphys, which can cause miscarriages)
117
Q 
Correction of celiac disease by placing a patient on a gluten free diet will likely lead to what changes in the following: 
bone resoprtion
intestinal Ca absorption
renal phosphate reabsorption
PTH secretion
A 
bone resorption: decrease
intestinal Ca absorption: increase
renal phosphate reabsorption: increased
PTH secretion: decreased
(all do to increased vit D absorption)
118
Q

The maxillary sinuses are the most commonly affect by rhinosinusitis a their path of drainage , the semilunar hiatus in the _____ nasal meatus, is located superior to the floor of the sinus, impairing drainage while upright

A

middle

119
Q

Infarction of territories supplied by the middle cerebral, posterior cerebral, or anterior choroidal arteries may result in what type of vision loss

A

homonymous hemianopsia

120
Q

Within the sarcomere: the ___ lengthens during muscle relaxation and shortens during contraction

A

I band and H band
( I band = sections of thin (actin) filaments that do not overlap the thick (myosin) filaments and H band is the opposite)
(more overlapping occurs in contraction)

UWorld (19 decks)

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