Rev25 Flashcards
1
Q
What deficiency leads to hyperuricemia and Lesch-Nyhan syndrome?
A
HGPRT deficiency
2
Q
What is the likely cause of iatrogenic chylothorax following thoracic surgery?
A
Thoracic duct injury
3
Q
What embryologic structures are affected in DiGeorge syndrome?
A
Third and fourth pharyngeal pouches
4
Q
What are the synovial fluid findings in rheumatoid arthritis?
A
Decreased Complement (C3)
5
Q
What is the typical MRI finding in Wernicke encephalopathy?
A
Atrophy of mammillary bodies
6
Q
Which monoclonal antibodies can increase the risk of TB reactivation in Crohn’s disease?
A
Anti-TNF-alpha antibodies (infliximab
7
Q
What are the key features of antiphospholipid syndrome?
A
Increased PTT
8
Q
What is the result of extravasated sperm post-vasectomy?
A
Granulomatous response forming a sperm granuloma
9
Q
What is the recurrence risk for congenital heart defects in couples with one affected child?
A
3-5%
10
Q
What can increase pulmonary lymphatic flow in experimental models?
A
Increased pulmonary capillary hydrostatic pressure
11
Q
What are the key factors in grading breast carcinoma?
A
Degree of differentiation
12
Q
What causes normal PT/INR during initial warfarin therapy?
A
Delayed effect of warfarin
13
Q
What is the mechanism of primaquine in malaria treatment?
A
Elimination of hypnozoites to prevent relapse
14
Q
What organism commonly causes diarrhea in HIV patients?
A
Cryptosporidium
15
Q
What compound is reduced in osteoarthritic joints?
A
Proteoglycans
16
Q
What neurodegenerative disease is associated with REM sleep behavior disorder?
A
Parkinson’s disease
17
Q
How does the thyroid hormone receptor affect transcription in the absence of T3?
A
Histone deacetylase activity inhibits transcription
18
Q
How does the thyroid hormone receptor affect transcription in the presence of T3?
A
Histone acetyltransferase activity activates transcription
19
Q
What buffers calcium ion concentration in the sarcoplasmic reticulum?
A
Calsequestrin
20
Q
What mutation prevents plasmid replication in bacteria?
A
Origin of replication (ori) mutation
21
Q
What enzyme deficiency is associated with mucolipidosis II?
A
Defective mannose phosphorylation in the Golgi apparatus
22
Q
What is the cause of increased CK-MB and troponin I post-stenting?
A
Reperfusion injury
23
Q
What causes pulsus paradoxus in cardiac tamponade?
A
Exaggerated decrease in systolic blood pressure during inspiration
24
Q
What increased serum component is indicative of cryoglobulinemia in hepatitis C?
A
Cryoglobulin
25
What causes REM sleep behavior disorder?
Absent muscle atonia during REM sleep
26
What embryologic sites are affected in a right-sided aortic arch and hypocalcemia?
Third and fourth pharyngeal pouches
27
What histologic pattern is seen in Peutz-Jeghers syndrome polyps?
Hamartomatous polyps
28
What enzyme activity decreases in osteoarthritic joints?
Proteoglycans
29
What enzyme deficiency leads to hyperuricemia?
HGPRT deficiency
30
What is the likely cause of iatrogenic chylothorax?
Thoracic duct injury
31
Question
Answer
32
What is the function of Interleukin-1 (IL-1)?
Causes fever, acute inflammation. Activates endothelium to express adhesion molecules. Induces chemokine secretion to recruit WBCs. Also called osteoclast-activating factor.
33
What is the mnemonic for Interleukin-1 (IL-1)?
Hot T-bone stEAK (IL-1: fever [hot])
34
What is the function of Interleukin-2 (IL-2)?
Stimulates growth of helper, cytotoxic, and regulatory T cells, and NK cells.
35
What is the mnemonic for Interleukin-2 (IL-2)?
T-bone stEAK (IL-2: stimulates T cells)
36
What is the function of Interleukin-3 (IL-3)?
Supports growth and differentiation of bone marrow stem cells. Functions like GM-CSF.
37
What is the mnemonic for Interleukin-3 (IL-3)?
T-bone stEAK (IL-3: stimulates bone marrow)
38
What is the function of Interleukin-4 (IL-4)?
Induces differentiation of T cells into Th2 cells. Promotes growth of B cells. Enhances class switching to IgE and IgG.
39
What is the mnemonic for Interleukin-4 (IL-4)?
Ain’t too proud 2 BEG 4 help (IL-4)
40
What is the function of Interleukin-5 (IL-5)?
Promotes growth and differentiation of B cells. Enhances class switching to IgA. Stimulates growth and differentiation of eosinophils.
41
What is the mnemonic for Interleukin-5 (IL-5)?
I have 5 BAEs
42
What is the function of Interleukin-6 (IL-6)?
Causes fever and stimulates production of acute-phase proteins.
43
What is the mnemonic for Interleukin-6 (IL-6)?
T-bone stEAK (IL-6: stimulates aKute-phase protein production)
44
What is the function of Tumor Necrosis Factor-α (TNF-α)?
Activates endothelium. Causes WBC recruitment, vascular leak. Causes cachexia in malignancy. Maintains granulomas in TB. Can mediate fever and sepsis.
45
What is the function of Interleukin-8 (IL-8)?
Major chemotactic factor for neutrophils.
46
What is the mnemonic for Interleukin-8 (IL-8)?
Clean up on aisle 8
47
What is the function of Interleukin-12 (IL-12)?
Induces differentiation of T cells into Th1 cells. Activates NK cells. Facilitates granuloma formation in TB.
48
What is the function of Interferon-γ (IFN-γ)?
Secreted by NK cells and T cells in response to antigen or IL-12 from macrophages. Stimulates macrophages to kill phagocytosed pathogens. Inhibits differentiation of Th2 cells. Induces IgG isotype switching in B cells. Increases MHC expression and antigen presentation by all cells. Activates macrophages to induce granuloma formation.
49
What is the function of Interleukin-10 (IL-10)?
Attenuates inflammatory response. Decreases expression of MHC class II and Th1 cytokines. Inhibits activated macrophages and dendritic cells. Also secreted by regulatory T cells.
50
What is the function of Interleukin-13 (IL-13)?
Promotes IgE production by B cells. Induces alternative macrophage activation.
51
What is the mnemonic for Interleukin-13 (IL-13)?
Interleukin thirtEEn promotes IgE
52
What is the defect in X-linked (Bruton) Agammaglobulinemia?
Defect in BTK, a tyrosine kinase gene → no B-cell maturation; X-linked recessive (↑ in Boys)
53
What is the presentation of X-linked (Bruton) Agammaglobulinemia?
Recurrent bacterial and enteroviral infections after 6 months (↓ maternal IgG)
54
What are the findings in X-linked (Bruton) Agammaglobulinemia?
Absent B cells in peripheral blood, ↓ Ig of all classes, absent/scanty lymph nodes and tonsils (1° follicles and germinal centers absent)
55
What is the defect in Selective IgA Deficiency?
Unknown
56
What is the presentation of Selective IgA Deficiency?
Majority Asymptomatic; can see airway and GI infections, autoimmune disease, atopy, anaphylaxis to IgA in blood products
57
What are the findings in Selective IgA Deficiency?"
↓ IgA with normal IgG, IgM levels; ↑ susceptibility to giardiasis
58
What is the defect in Common Variable Immunodeficiency?
Defect in B-cell differentiation. Cause unknown in most cases
59
What is the presentation of Common Variable Immunodeficiency?
May present in childhood but usually diagnosed after puberty. ↑ risk of autoimmune disease, bronchiectasis, lymphoma, sinopulmonary infections
60
What are the findings in Common Variable Immunodeficiency?
↓ plasma cells, ↓ immunoglobulins
61
What is the defect in Thymic Aplasia (DiGeorge Syndrome)?
22q11 microdeletion; failure to develop 3rd and 4th pharyngeal pouches → absent thymus and parathyroids
62
What is the presentation of Thymic Aplasia (DiGeorge Syndrome)?
CATCH-22: Cardiac defects, Abnormal facies, Thymic hypoplasia, Cleft palate, Hypocalcemia
63
What are the findings in Thymic Aplasia (DiGeorge Syndrome)?
↓ T cells, ↓ PTH, ↓ Ca2+, thymic shadow absent on CXR
64
What is the defect in IL-12 Receptor Deficiency?
↓ Th1 response; autosomal recessive
65
What is the presentation of IL-12 Receptor Deficiency?
Disseminated mycobacterial and fungal infections; may present after administration of BCG vaccine
66
What are the findings in IL-12 Receptor Deficiency?"
↓ IFN-γ
67
What is the defect in Hyper-IgE Syndrome (Job Syndrome)?
Deficiency of Th17 cells due to STAT3 mutation → impaired recruitment of neutrophils to sites of infection
68
What is the presentation of Hyper-IgE Syndrome (Job Syndrome)?
Cold staphylococcal abscesses, retained baby teeth, coarse facies, eczema, ↑ IgE, bone fractures from minor trauma
69
What are the findings in Hyper-IgE Syndrome (Job Syndrome)?"
↑ IgE, ↑ eosinophils
70
What is the defect in Chronic Mucocutaneous Candidiasis?
T-cell dysfunction; impaired cell-mediated immunity against Candida sp.
71
What is the presentation of Chronic Mucocutaneous Candidiasis?
Persistent noninvasive Candida albicans infections of skin and mucous membranes
72
What are the findings in Chronic Mucocutaneous Candidiasis?"
Absent in vitro T-cell proliferation in response to Candida antigens, absent cutaneous reaction to Candida antigens
73
What is the defect in Severe Combined Immunodeficiency (SCID)?
Several types including defective IL-2R gamma chain (most common, X-linked recessive); adenosine deaminase deficiency (autosomal recessive); RAG mutation → VDJ recombination defect
74
What is the presentation of Severe Combined Immunodeficiency (SCID)?
Failure to thrive, chronic diarrhea, thrush, recurrent infections
75
What are the findings in Severe Combined Immunodeficiency (SCID)?"
↓ T-cell receptor excision circles (TRECs), absence of thymic shadow, germinal centers, and T cells
76
What is the defect in Ataxia-Telangiectasia?
Defects in ATM gene → failure to detect DNA damage → failure to halt cell cycle progression → mutations accumulate; autosomal recessive
77
What is the presentation of Ataxia-Telangiectasia?
Triad: cerebellar defects (Ataxia), spider Angiomas (telangiectasia), IgA deficiency
78
What are the findings in Ataxia-Telangiectasia?"
↑ AFP, ↓ IgA, IgG, and IgE, lymphopenia, cerebellar atrophy
79
What is the defect in Hyper-IgM Syndrome?
Most commonly due to defective CD40L on Th cells → class switching defect; X-linked recessive
80
What is the presentation of Hyper-IgM Syndrome?
Severe pyogenic infections early in life; opportunistic infection with Pneumocystis, Cryptosporidium, CMV
81
What are the findings in Hyper-IgM Syndrome?"
Normal or ↑ IgM, ↓ IgG, IgA, IgE, failure to make germinal centers
82
What is the defect in Wiskott-Aldrich Syndrome?
Mutation in WAS gene; leukocytes and platelets unable to reorganize actin cytoskeleton → defective antigen presentation; X-linked recessive
83
What is the presentation of Wiskott-Aldrich Syndrome?
WATER: Wiskott-Aldrich: Thrombocytopenia, Eczema, Recurrent infections; ↑ risk of autoimmune disease and malignancy
84
What are the findings in Wiskott-Aldrich Syndrome?"
↓ to normal IgG, IgM; ↑ IgE, IgA; fewer and smaller platelets
85
What is the defect in Leukocyte Adhesion Deficiency (Type 1)?
Autosomal recessive defect in LFA-1 integrin (CD18) protein on phagocytes leads to impaired migration and chemotaxis by C5a, IL-8, and leukotriene B4
86
What is the presentation of Leukocyte Adhesion Deficiency (Type 1)?
Late separation (>30 days) of umbilical cord, absent pus, dysfunctional neutrophils → recurrent skin and mucosal bacterial infections
87
What are the findings in Leukocyte Adhesion Deficiency (Type 1)?"
↑ neutrophils in blood, absence of neutrophils at infection sites
88
What is the defect in Chédiak-Higashi Syndrome?
Defect in lysosomal trafficking regulator gene (LYST); microtubule dysfunction in phagosome-lysosome fusion; autosomal recessive
89
What is the presentation of Chédiak-Higashi Syndrome?
PLAIN: Progressive neurodegeneration, Lymphohistiocytosis, Albinism (partial), recurrent pyogenic Infections, peripheral Neuropathy
90
What are the findings in Chédiak-Higashi Syndrome?"
Giant granules in granulocytes and platelets, pancytopenia, mild coagulation defects
91
What is the defect in Chronic Granulomatous Disease?
Defect of NADPH oxidase → ↓ reactive oxygen species (e.g., superoxide) and ↓ respiratory burst in neutrophils; X-linked form most common
92
What is the presentation of Chronic Granulomatous Disease?
↑ susceptibility to catalase-positive organisms, recurrent infections, and granulomas
93
What are the findings in Chronic Granulomatous Disease?"
Abnormal dihydrorhodamine (flow cytometry) test (↓ green fluorescence), nitroblue tetrazolium dye reduction test fails to turn blue
94
What is the change in cardiac parameters during inspiration?
↑ RV preload, ↓ LV preload
95
What murmurs increase during inspiration?
Most right-sided murmurs (↑ RV blood volume)
96
What murmurs decrease during inspiration?
Most left-sided murmurs (↓ LV blood volume)
97
What is the change in cardiac parameters during Valsalva strain phase?
↓ RV & LV preload
98
What murmurs increase during Valsalva strain phase?
MVP & HCM (↓ LV blood volume)
99
What murmurs decrease during Valsalva strain phase?
Most valvular murmurs (↓ flow through valve)
100
What is the change in cardiac parameters during abrupt standing?
↓ RV & LV preload
101
What murmurs increase during abrupt standing?
MVP & HCM (↓ LV blood volume)
102
What murmurs decrease during abrupt standing?
Most valvular murmurs (↓ flow through valve)
103
What is the change in cardiac parameters during squatting?
↑ RV & LV preload, ↑ LV afterload
104
What murmurs increase during squatting?
Most valvular murmurs (↑ flow through valve)
105
What murmurs decrease during squatting?
MVP & HCM (↑ LV blood volume)
106
What is the change in cardiac parameters during passive leg raise?
↑ RV & LV preload
107
What murmurs increase during passive leg raise?
Most valvular murmurs (↑ flow through valve)
108
What murmurs decrease during passive leg raise?
MVP & HCM (↑ LV blood volume)
109
What is the change in cardiac parameters during hand grip?
↑ LV afterload
110
What murmurs increase during hand grip?
AR, MR & VSD (↑ aortic & LV pressure)
111
What murmurs decrease during hand grip?
AS (↓ transvalvular pressure gradient)
112
What is the protein defect in Familial Chylomicronemia Syndrome (Type I)?
Lipoprotein lipase, ApoC-2
113
What are the elevated lipoproteins in Familial Chylomicronemia Syndrome (Type I)?
Chylomicrons
114
What are the major manifestations of Familial Chylomicronemia Syndrome (Type I)?
Acute pancreatitis, Lipemia retinalis, Eruptive xanthomas
115
What is the protein defect in Familial Hypercholesterolemia (Type II A)?
LDL receptor, ApoB-100
116
What are the elevated lipoproteins in Familial Hypercholesterolemia (Type II A)?
LDL
117
What are the major manifestations of Familial Hypercholesterolemia (Type II A)?"
Premature atherosclerosis, Tendon xanthomas, Xanthelasmas
118
What is the protein defect in Familial Dysbetalipoproteinemia (Type III)?
ApoE
119
What are the elevated lipoproteins in Familial Dysbetalipoproteinemia (Type III)?
Chylomicron & VLDL remnants
120
What are the major manifestations of Familial Dysbetalipoproteinemia (Type III)?"
Premature atherosclerosis, Tuboeruptive & palmar xanthomas
121
What is the protein defect in Familial Hypertriglyceridemia (Type IV)?
Polygenic
122
What are the elevated lipoproteins in Familial Hypertriglyceridemia (Type IV)?
VLDL
123
What are the major manifestations of Familial Hypertriglyceridemia (Type IV)?"
Associated with coronary disease, pancreatitis & diabetes
124
If the concentration of Drug X is 100 times greater than Km, what governs the reaction?
A zero-order rate of metabolism governs the reaction
125
In a tumor cell line where MHC I expression is inhibited, what is the response of CD8+ T lymphocytes, CD4+ T lymphocytes, and natural killer cells?
CD8+ T lymphocytes: –; CD4+ T lymphocytes: –; Natural killer cells: +
126
What is the most likely cause of a 56-year-old man with alcoholism having severe stomach pain, foul-smelling stool, significant weight loss, and pancreatic calcifications?
Decrease in fecal elastase (indicative of exocrine pancreatic insufficiency)
127
Lesch-Nyhan Syndrome: Defect in the salvage of which bases?
Purine bases (HGPRT enzyme deficiency)
128
Symptoms of Lesch-Nyhan Syndrome?
Intellectual disability
129
Peripheral Blood Smear Analysis suggests megaloblastic anemia when?
Hypersegmented neutrophils and oval macrocytes are present
130
Most likely cause of Philadelphia chromosome in leukemia?
BCR-ABL gene involvement
131
Key exposure and radiographic findings for Histoplasma Capsulatum?
Bat habitats
132
Histoplasma Capsulatum virulence depends on?
Ability to survive and multiply within macrophages
133
Mechanism of Donepezil in Alzheimer's disease?
Acetylcholinesterase inhibition increases acetylcholine levels
134
Treatment for Methanol Poisoning?
Fomepizole inhibits alcohol dehydrogenase
135
COPD diagnosis is based on which PFT findings?
Decreased FEV1/FVC ratio
136
Symptoms and lab findings of Medium-Chain Acyl-CoA Dehydrogenase Deficiency?
Hypoglycemia with normal fasting ketogenesis when fed medium-chain triglycerides
137
Carnitine Palmitoyltransferase II (CPT II) Deficiency symptoms and labs?
Muscle weakness
138
Attributable Risk (AR) formula?
AR = Incidence in Exposed - Incidence in Unexposed
139
Relative Risk (RR) formula?
RR = Incidence in Exposed / Incidence in Unexposed
140
Relative Risk Reduction (RRR) formula?
RRR = 1 - RR
141
Number Needed to Treat (NNT) formula?
NNT = 1 / ARR
142
Number Needed to Harm (NNH) formula?
NNH = 1 / AR
143
Cutaneous T-cell Lymphoma (Mycosis Fungoides) symptoms?
Chronic skin lesions
144
Renal Tubular Acidosis in children symptoms?
Short stature
145
Pathology of increased lysosomal enzyme activity?
Defective protein targeting
146
Risk of Huntington's Disease for a son of a potential carrier mother?
0.25
147
Blood flow redistribution during exercise affects which circulation?
Increased vascular resistance in splanchnic (GI) circulation
148
Volume of Distribution (Vd) formula?
Vd = Dose / C0
149
Clearance (Cl) formula?
Cl = 0.693 * Vd / t1/2
150
Loading Dose (LD) formula?
LD = Desired Concentration * Vd / F
151
Maintenance Dose (MD) formula?
MD = Desired Concentration * Cl * Dosing Interval / F
152
Bioavailability (F) formula?
F = AUC_oral / AUC_IV
153
Corrected Calcium formula?
Corrected Ca = Measured Ca + 0.8 * (4.0 - Albumin)
154
What is the key interaction in the development of the metanephros?
Induction of the ureteric bud by the metanephric mesenchyme. **Reciprocal induction**
155
How do you calculate heterozygote frequency in Hardy-Weinberg equilibrium?
2pq = 2 x 0.1 x 0.9 = 0.18 or 18%
156
What is a key diagnostic sign of Hemolytic Uremic Syndrome (HUS)?
Malaise, dark urine, anemia, low platelets, renal impairment, and schistocytes on blood smear.
157
What enzyme deficiency causes Lesch-Nyhan syndrome?
HGPRT deficiency.
158
How do you calculate incidence in a population?
Incidence = (New cases) / (Population at risk) = 200/2000 = 0.10 or 10%
159
Which structure is crucial for clavicle fracture healing?
Periosteum.
160
What genetic condition is characterized by intellectual disability
large head
161
What increases susceptibility to infections in myeloperoxidase deficiency?
Impaired production of hydroxy-halide free radicals.
162
What type of collagen is affected in osteoarthritis?
Type II collagen.
163
What phase of the menstrual cycle is indicated by secretory endometrium?
Secretory phase.
164
What enzyme deficiency is associated with lead poisoning?
δ-ALA dehydratase.
165
Which secondary mediator is released in type I hypersensitivity reactions?
Leukotrienes.
166
What surface marker indicates Langerhans cell activation?
CD1a.
167
What causes HIV drug resistance in patients on reverse transcriptase inhibitors?
Mutations in reverse transcriptase.
168
What developmental failure causes cleft lip?
Failure of fusion of the maxillary and medial nasal processes.
169
What principle explains mitochondrial inheritance patterns?
Maternal inheritance.
170
What disease is associated with retinal hemangioblastomas and cerebellar tumors?
Von Hippel-Lindau disease.
171
What is the inheritance pattern of spinal muscular atrophy?
Autosomal recessive.
172
Where is the sphenoethmoidal recess located?
Superior to the superior concha.
173
What is the pathogenesis of allopurinol-induced acute interstitial nephritis?
Immune-mediated hypersensitivity reaction.
174
Which mediator causes tissue injury in pneumonia?
Neutrophil elastase.
175
How are patients allocated in an intention-to-treat analysis?
400 in the surgical group and 400 in the medical management group.
176
What nerve roots are affected in musculocutaneous nerve injury?
C5 and C6.
177
What brain region is affected in a hypoglossal nerve lesion causing tongue deviation?
Medulla (left side).
178
What pharmacokinetic change increases drug sensitivity in the elderly?
Decreased hepatic metabolism and renal clearance.
179
What explains CD8+ T cell activation in malaria infection?
Invasion of malaria parasite into cytoplasm leading to MHC class I presentation.
180
What type of nerves use norepinephrine as a neurotransmitter?
Postganglionic sympathetic nerves in the prostate.
181
How many ATP molecules are hydrolyzed per H+ ion secreted by H+
K+ ATPase?
182
How long does it take to reach steady-state concentration of a drug?
Approximately 4-5 half-lives.
183
What hormone is produced by adipose tissue contributing to estrogen levels?
Estrogen.
184
What substance is increased in venous blood in carbonic anhydrase deficiency?
HCO3−.
185
What gene is mutated in abetalipoproteinemia?
MTTP (microsomal triglyceride transfer protein).
186
What is the result of a p53 mutation in Li-Fraumeni syndrome?
Decreased gene transcription for DNA repair proteins.
187
What enzyme activates pancreatic trypsinogen?
Enterokinase (enteropeptidase).
188
What movement weakness confirms C5-C6 nerve compression?
Elbow flexion (biceps).
189
What is the most likely predisposing factor for ureteral lesions in a smoker?
Cigarette smoking (transitional cell carcinoma).
190
What enzyme deficiency is common in congenital adrenal hyperplasia (CAH)?
21-hydroxylase deficiency.
191
What type of receptor interaction does aripiprazole have?
Partial agonist at dopamine receptors.
192
What condition is diagnosed by acute myocardial infarction (MI) symptoms in the elderly?
Acute myocardial infarction (MI).
193
Which mRNA is increased by AGEs in mesangial cells?
Collagen type IV.
194
What is the role of IκB in the NF-κB pathway?
Inhibits NF-κB by sequestering it in the cytoplasm until degraded.
195
What is convenience sampling?
Selection based on availability and willingness to participate.
196
What enzyme deficiency is associated with homocystinuria?
Cystathionine beta-synthase.
197
How does decreased calcium intake affect bone mineralization?
Decreased bone mineral density.
198
What enzyme deficiency causes acute intermittent porphyria?
Porphobilinogen deaminase.
199
What organism causes plague with symptoms of lymphadenopathy and respiratory issues?
Yersinia pestis.
200
Why do men generally have higher bone mass than women?
Men have higher peak bone mass.
201
What is the likely mutation in androgen insensitivity syndrome?
Androgen receptor gene.
202
What is the catheter path to the renal artery via femoral access?
Femoral artery → external iliac artery → common iliac artery → aorta → renal artery.
203
What physiological change is increased in newborns immediately after birth?
Increased blood pressure.
204
What are examples of lysosomal storage diseases?
Gaucher disease, Tay-Sachs disease, Niemann-Pick disease.
205
What enzyme deficiencies are associated with glycogen storage diseases?
Glucose-6-phosphatase, acid alpha-glucosidase, debranching enzyme, muscle phosphorylase.
206
How do you calculate pretest probability of disease?
Pretest Probability = (Number of True Positives + Number of False Negatives) / Total Population
