Sim 2 Review
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| What are the 'x' and 'y' axis on a ROC curve? | y-axis --> sensitivity
x-axis --> (1-specificity)
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| What is [1-specificity]? | False positive rate
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| What does the area under a ROC curve represent? | Accuracy of the test
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| What is the most common cause of Mitral Stenosis? | Rheumatic fever
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| What murmur(s) are associated with Infective endocarditis? | Mitral and/or tricuspid regurgitation
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| What murmur is associated with DCM? | Secondary MR due to widening of the mitral anulus
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| What causes or lead to secondary MR in DCM? | Widening of the mitral annulus
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| What is the result of mitral annulus widening in DMC? | Secondary MR
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| What are auscultatory findings of TB? | Pericardial rub and distant heart sounds
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| What produces the S2? | Closure of A2 and P2
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| When does A2 occur? | It occurs when LV pressure has fallen just below aortic pressure at the onset of isovolumetric LV relaxation
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| Is A2 associated with isovolumetric relaxation or isovolumetric contraction? | Isovolumetric LV relaxation
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| What causes a normal delay in P2? | Inspiration
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| Which component of the S2 heart sound is associated with an increased by inspiration? | P2
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| Is P2 or A2 increased by inspiration? | P2
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| What is the resulton S2 by increased P2? | Physiologic splitting of S2
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| What causes the physiologic split of S2? | P2 delayed closure by inspiration
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| Common condition in which widening splitting persist during expiration? | Conditions prolong RV ejection time such as Right BBB, pulmonic stenosis, and pulmonary hypertension
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| How is K+ concentration affected by tissue ischemia? | Increase extracellular K+ concentration via reduced functionality of Na/K-ATPase pump in the membrane, leading to K+ leakage from affected cells
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| Which protein is affected in tissue ischemia, leading to K+ leakage out the affected cell? | Na+-K+-ATPase pump
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| What is the hallmark of ischemic injury? | Cytoplasmic Ca2+ accumulation
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| What cues Pemphigus vulgaris? | Autoantibodies directed against Desmoglein 1 and 3
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| Which condition is due to autobodies attacking Desmoglein 1 and 3? | Pemphigus vulgaris
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| What are Desmoglein 1 and Desmoglein 3? | Adhesion molecules that bind epidermal keratinocytes to each other
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| What is the main role of Desmoglein proteins? | Bind epidermal keratinocytes to each other
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| What are findings of IF of Pemphigus vulgaris? | Epidermal IgG and C3 deposits in a net-;ike or chicken-wire appearance
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| Pemphigus vulgaris is associated with an Linear epidermal findings or net-like IF findings? | Net-like findings of epidermal IgG and C3 deposits
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| Which are groups are more prone to develop or present McArdle disease? | Adolescents or early adults
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| How is McArdle disease clinically presented? | Muscle pain, weakness, and decreased exercise tolerance in adolescents
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| Which enzyme is deficiency McArdle disease? | Muscle glycogen phosphorylase
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| What is the role of Muscle glycogen phosphorylase? | Degrades glycogen at 1,4-alpha-glycosidic bonds into glucose-1-phosphate subunits
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| How Graves ophthalmology characterized? | T-cell activation and the simulations of orbital fibroblasts by thyrotropin receptor antibodies
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| Which cells are involved in Graves ophthalmology? | Orbital fibroblasts
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| Which glycosaminoglycan is secreted in excess by fibroblasts in Graves ophthalmology? | Hyaluronic acid
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| What causes a Meckel diverticulum? | Incomplete obliteration of the omphalomesenteric duct
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| What is commonly found to contain a Meckel diverticulum? | Heterotopic gastric tissue hta can ulcerate the small intestinal mucosa, leading to brisk but painless GI bleeding
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| What causes the brisk and painless GI bleeding in a patient with a Meckel diverticulum? | Heterotopic gastric tissue that ucmerate the small intestinal mucosa
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| What is a Pancreatic pseudocyst? | Well-circumscribed fluid collection that typically develop following acute pancreatitis due to walling off necrotic pancreatic tissue/peripancreatic fat.
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| What are consequences of an infected Pancreatic pseudocyst? | Abdominal pain, small bowel/biliary obstruction, or fistula formation into neighboring structure.
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| What is the role of prokaryotic DNA pol I? | Removal of RNA primer and the synthesis of new DNA in their place.
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| What is the use for PCR? | Amplify target DNA segments via repeated replication
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| What is the initial step in PCR? | It requires 2 primers that are complementary to the flanking regions target DNA sequence
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| What is the second step in PCR? | DNA polymerase synthesises strands in a 5' to 3' direction, so that nucleotides are added only to the 3' hydroxyl end of the elongating end
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| In PCR, to which end of the enolgingating strand, do nucleotides attach only? | 3' end
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| In which direction are DNA strands synthesized by DNA pol in PCR? | 5' to 3' direction
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| What specific characteristic of Warfarin makes a teratogen? | Low molecular weight, allowing it to cross the placenta
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| What are the teratogenic effects associated with Warfarin? | Fetal nasal limb hypoplasia, and fetal bleeding
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| Why is Heparin preferred over Warfarin in pregnant women? | Heparin has a high molecular weight and cannot cross the placenta, contrary to warfarin
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| Warfarin or Heparin. Low molecular weight? | Warfarin
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| Warfarin or Heparin. Used in pregnancy? | Heparin
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| Warfarin or Heparin. High molecular weight? | Heparin
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| What are fundoscopic findings of CMV-retinitis? | Bilateral hemorrhages and cotton-wool exudates on ophthalmoscopic examination in the setting of progressive vision loss.
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| What are the common treatment options of CMV-retinitis? | Valganciclovir, ganciclovir, and Foscrcint
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| What is interrupted by Ganciclovir? | Interfere with DNA replication
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| What is the common name for Apical Bronchogenic carcinoma? | Pancoast tumor
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| What is the most significant clinical feature of Pancoast tumor? | Horner syndrome
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| What ganglion is suppressed by Pancoast tumor leading to Horner syndrome? | Compression of the superior cervical ganglion
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| What pulmonary malignancy often compresses the superior cervical ganglion? | Pancoast tumor
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| What syndrome is often caused by compressive the Superior cervical ganglion? | Horner syndrome
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| How is Horner syndrome clinically characterized? | Interrupted sympathetic nerve supply to the head, eye, and neck
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| How Is Alcohol-related cerebellar degeneration characterized? | Cerebellar vermis atrophy which presents with gait ataxia, truncal instability, an a rhythmic,postural tremor of fingers and hands
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| What condition is often seen in homeless with alcohol abuse? | Alcohol-related cerebellar degeneration?
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| What part of the brain is atrophied in Alcohol-related cerebellar degeneration? | Cerebellar vermis
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| What causes Parkinsonism? | Depletion of dopaminergic neuron in the substantia nigra
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| Where the Substantia nigra located in the brain? | In the midbrain just deep into the corticobulbar tract in the cerebral peduncle
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| What is found in the midbrain just deep into the corticobulbar tract on the cerebra peduncle? | Substantia nigra
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| What is a common result of Pineal tumors such as a Pinealoma? | Parinaud syndrome
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| What malignancy is often associated with development of Parinaud syndrome? | Pinealoma
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| What is the cause of Parinaud syndrome due to a Pinealoma? | Mass effect on the dorsal midbrain in the superior colliculus region
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| What are the common findings of Parinaud syndrome? | Upward gaze palsy, absent pupillary light reflex, and impaired convergence.
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| What type of mutation leads to Lynch syndrome? | AD mutation of mismatch repair genes leading to microsatellite instability
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| To which cancers are patients with Lynch syndrome predisposed to? | Colon, endometrial, and ovarian cancers
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| How is an Ovarian cancer often presented? | Ovarian mass, ascites and an elevated CA125.
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| What type of action is often encouraged by motivational interviewing in the medical field? | Smoking cessation
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| When are motivation interviewing techniques often used? | Psychotherapy in patients who are ready to make a change
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| What cells are involved in development of NRDS? | Type 2 Pneumocytes
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| How does Type 2 pneumocytes promote NRDS development? | Pneumocytes II produced insufficient quantities of surfactant
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| What are examples of condition sth may lead to insufficient surfactant production by type II pneumocytes leading to NRDS? | Prematurity and maternal DM
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| Other than surfactant prosecution , what is an added role or function of Pneumocytes II ? | Responsible for regeneration of alveolar epithelium after lung injury
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| Which cells are responsible for alveolar epithelium regeneration after lung injury? | Type 2 Pneumocytes
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| What measure or lab evaluates surfactant functionality? | Foam stability index
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| How is the Foam stability index test of surfant performed? | Multiple wells containing mixture ethanol and amniotic fluid are shanken and then exint to find highest value well that contain a ring of stable foam.
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| What are two common Calcineurin inhibitors? | Tacrolimus, and Cyclosporine
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| What type of immunosuppressive agents are often used to prevent rejection of transplanted solid organs (liver)? | Calcineurin inhibitors
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| WHat the main adverse effect associated with Calcineurin inhibitors? | Nephrotoxicity
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| How the Calcineurin inhibitor-induced nephrotoxic presented? | Resulting in hypertension an da rise in serum BUN and Cr levels
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| What is a possible adverse effect of long-term use of Calcineurin inhibitors? | Oblictervive vasculopathy
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| Which enzyme is deficient in Alkaptonuria? | Homogentisic Acid Dioxygenase
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| What is Alkaptonuria? | AR disease due to deficiency in Homogentisic Acid dioxygenase
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| What are the most significant clinical features of Alkaptonuria? | 1. Darikin of urine after exposure to air
2. Blue-black darkening of cartilage and skin, and
3. Debilitating osteoarthropathy
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| In a normal kidney, what is the most probable protein accumulated close the renal glomerulus? | Renin
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| What is sensitized by the Juxtaglomerular cell in the Juxtaglomerular apparatus? | Renin
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| Which cells store and secrete Renin? | Juxtaglomerular cells
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| Which hypothalamic pathway may be suppressed by chronic energy deficiency restricted caloric intake? | GnRH secretion
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| What is the result of a decreased GnRH secretion? | Decreased secretion of FSH and LH, leading t a decreased production of Estrogen.
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| What are some long-term consequences of early low estrogen levels? | Decreased peak bone mass, accelerated bone les, and early-onset osteoporosis.
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| What is a bone-related risk in ayoung woman that lives on a caloric deficit and exercises so intensely that is always tired? | Early-onset osteoporosis due to low estrogen levesl
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| What causes the low estrogen level in patients with anorexia and early-onset osteoporosis? | Suppression of the GnRH hypothalamic secretion leading to low FSH and LH secretion
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| What are the most common cell surface receptors of G protein-coupled receptors? | 7 alpha-helical transmembrane domains
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| What type of amino acids make up the transmembrane domain of any protein? | Hydrophobic amino acids
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| What are common condition associated with chromosomal aneuploidy? | Turner syndrome and Trisonomies
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| What genetic process is associated with development of Cystic hygromas? | Chromosomal aneuploidy
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| What is an important clinical feature of Cystic hygromas? | Transilluminate
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| Where is the most common location to find a Cystic hygromas? | Head and neck, typically on the left side
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| Which side, right or left, is more common to develop Cystic hygromas? | Left
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| What dermal condition is due to hyperkeratosis and epidermal hyperplasia? | Psoriasis
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| What is a common factor that predisposes patients to develop Psoriasis? | Disruption of the normal skin barrier leads to activation of dendritic cells, which induces recruited and differentiation of T helper cells.
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| What is normal process shown by normal and healthy cells as they are grown in a Petri dish? | Contact inhibition
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| What is contact inhibition? | Process in normal cell in which growth stops as the cells make contact with each other
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| Which controlled growth process of normal cells is not present in malignant cells? | Contact inhibition
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| What would be the result of malignant cells cultured and grown in a Petri dish? | Cell will cover the surface of the Petri dish, and then not stop growing creating mounds of cells.
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| How is diarrhea caused by Entamoeba histolytica characterized? | Bloody diarrhea
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| What is the route of transmission of E. histolytica? | Fecal-oral route
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| Description of E. histolytica trophozoites? | Multinucleate and typically possess phagocytosed erythrocytes within their cytoplasm
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| What is an important histological finding of E. histolytica trophozoites? | Phagocytosed RBCs within their cytoplasm
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| How does women compensate for additional X chromosome? | One X chromosome is inactivated in each somatic cell
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| Does female or male, has one X chorose inactivated in each somatic cell? | Female
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| While inactivated X chromosome selection is random, women tend to produce: | Skewed inactivation
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| What does an skewed inactivation of X chromosome selection in women mean? | Women are more susceptible to displaying manifestation of X-linked disease
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| What is the reason women are more prone to display X-linked diseases? | Skewed inactivation selection of X chromosome
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| What is a fatal splenic complication of Sickle cell disease? | Splenic sequestration crisis
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| What does Splenic sequestration crisis means? | Trapping of sickled RBCs within the spleen
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| What are common results in a patient with Splenic sequestration crisis? | Acute anemia, thrombocytopenia, and splenomegaly
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| What is an important feature of an attenuated live virus vaccine? | It can revert of a virulent form and cause vaccine-associated illness
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| Which type of vaccine cannot revert into a vrilen form, live attenuated or inactivated (killed) vaccine? | Inactivated (killed) vaccine
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| A patient unsure of which type of polio vaccine received, but now he presents with Paralytic poliomyelitis few weeks after vaccine was given? | Oral polio vaccine, because it is live attenuated and can revert into viral form.
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| What is the mode of action of Aminoglycosides? | Inhibit bacterial synthesis by binding the 16S ribosomal RNA with the 30s ribosomal subunit
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| What is used concurrently with aminoglycosides in order to be more effective? | B-lactams
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| Why do beta lactams improve effectiveness of aminoglycosides and other antibiotics? | They dirump cell cell synthesis, leading to better aminoglycoside penetration into bacterial cell.
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| What is a self-limited syndrome characterized by fever and parotitis, and lack of booster or vaccination Hx? | Mumps
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| What is male-only symptom of Mumps? | Orchitis
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| What is the result of orchitis in men with Mumps? | Leydig cell atrophy and decreased testosterone production
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| Is a male patient with the Mumps expected to have elevated or decreased levels of Testosterone? | Decreased testosterone
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| The Adenoviridae are a family of: | Double-stranded-DNA viruses
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| What type of polymerase are used by Adenoviridae ? | DNA-dependent DNA polymerase
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| Why is DNA-dependent DNA polymerase needed in Adenoviridae? | To replicate their genomes in the host cell nucleus
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| What is the main cause of Kluver-Bucy syndrome? | Bilateral damage to the temporal lobes, especially the amygdala
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| What possible causes of Kluver-Bucy syndrome? | 1. HSV encephalitis, and
2. Traumatic brain injury
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| What are the most common symptoms associated with Kluver-Bucy syndrome? | Oral fixation, hyperphagia, hypersexuality, visual agnosia, placidity, and amnesia.
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| What is the pathognomonic feature of Rabies infection? | Eosinophilic neuron cytoplasmic inclusion bodies
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| What is the common name for the cytoplasmic inclusion bodies associated with Rabies? | Negri bodies
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| What are the most classic signs of Rabies infection? | Painful pharyngeal muscle spams and hydrophobia
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| What is the most common vector of Rabies in the USA? | Bats
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| What is the most common vector of Rabies worldwide? | Unvaccinated dogs
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| From where does the Cavernous sinus receive blood flow from? | From the face via the superior and inferior ophthalmic veins
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| Which veins of the face drain into the Cavernous sinus? | Superior and Inferior Ophthalmic veins
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| What is a common cause of Cavernous sinus thrombosis? | Spread of infection from the orbit, nose, and paranasal sinuses along the superior and inferior valveless venous systems
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| Which nerve is often affected by Cavernous sinus thrombosis? | Cranial nerve VI
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| What is the physical sign of an affected CN VI ? | Lateral gaze palsy
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| What nerve is suspected to be damaged in Lateral Gaze palsy? | CN VI
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| What condition is often and strongly associated with lateral gaze palsy | Cavernous sinus thrombosis
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| What is Tardive dyskinesia? | Medication-induced movement disorder characterized by abnormal, involuntary movements of the mouth, tongue, trunk and extremiites
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| What is the MCC of Tardive dyskinesia? | Prolonged exposure to dopamine-blocking agents
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| What is a normal action of healthy kidneys? | Maintain a relative contact GFR across a wide range for perfusion pressures.
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| What are some consequences of a fall in renal perfusion pressure? | 1. Efferent arteriolar constriction,
2. Increase in Filtration fraction (FF)
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| How does Efferent arteriolar constriction in the glomeruli help improve GFR? | At expense of a decreased RPF
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| How Membranous nephropathy characterized? | Immune-complex deposition in the subepithelial portion of glomerular capillary wall, resulingin nephrotic syndrome
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| Although mostly of idiopathic origin, Membranous nephropathy is associated with: | Solid tumors
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| What is seen in LM of Membranous nephropathy? | Diffuse thickening of glomerular basement membrane
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| What are the common findings of Membranous nephropathy under EM? | Subepithelial immune-complex deposits forming "spikes" visible with silver stain and EM
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| Immune-complex deposits forming "spikes" is associated with which nephrotic syndrome? | Membranous nephropathy
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| What are common poisons that elicit Contact dermatitis? | Poison ivy and Poison oak
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| What is the first line of treatment for back pain? | NSAID or acetaminophen
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| What common practice is not advised for back pain? | Bed rest
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| What is the reason to use mTOR inhibitors in stents? | Preveven neointimal hyperplasia an luminal restenosis following intracoronary stent placement
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| How do mTOR inhibitors prevent neointimal hyperplasia following an intracoronary stent placement? | Reducing smooth muscle cell proliferation
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| What is the common Neprilysin inhibitor-ARB combination used in treatment of HF? | Scubitril-Vasaltran
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| What is the effect of Neprilysin inhibition? | Increased Natriuretic peptide levels to promote vasodilation and diuretics
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| What is unwanted or adverse effect of using an Neprilysin inhibitor? | Unwanted increase in AT II levels
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| Why are increased ATII levels an unwanted adverse effect of Neprilysin inhibitors in HF patients? | Promote vasoconstriction and fluid retention
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| What is the effect of Natriuretic peptides associated with Aldosterone? | Aldosterone-mediated sodium retention is minimized due to inhibitor of aldosterone secretion by natriuretic peptides
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| How is 17-alpha- hydroxylase deficiency characterized? | Mineralocorticoid excess with deficiency in cortisol an sex steroids
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| Which CAH is known to have increased levels of mineralocorticoids and low cortisol and low sex steroids? | 17 a-hydroxylase deficiency
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| What are typical findings of 17 a-hydroxylase deficiency? | Hypertension, hypokalemia with primarily amenorrhea (women) and lack o secondary sexual characters in girls and ambiguous genitalia in boys
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| Is there hypokalemia or hyperkalemia with 17 a-hydroxylase deficiency? | Hypokalemia
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| What is the effect of insulin on glucose in adipocytes and skeletal muscle? | Increases cellular uptake of glucose by increasing the translocation of GLUT-4, from intracellular vesicles of the cell membrane
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| What is GLUT4? | Passive glucose transporter
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| Which GLUT expression is increased by insulin in adipose tissue? | GLUT-4
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| What is the reason of the lack of secondary sexual characteristics in females with 17 alpha-hydroxylase deficiency? | Insufficient production of sex hormones and cortisol, and overproduction of mineralocorticoids
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| How are the levels of LH, ACTH and renin in 17-a-(OH) deficiency? | LH and ACTH are increased and Renin is decreased
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| What is MCAD deficiency? | AR disorder charatec by the inability to degrade medium-linge fatty acids by B-oxidation
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| Which metabolic process is affected by MCAD deficiency? | Beta oxidation of fatty acids
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| What are clinical signs of child with MCAD deficiency? | Hypoketotic hypoglycemia and neurologic and hepatic dysfunction a period of fasting or increased metabolic stress.
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| When and how is Primary Ovarian insufficiency presented? | Occurs in women 40 < years of age and presents with amenorrhea and an elevated FSH level.
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| What does a negative result represent in Agglutination inhibition test? | By the presence of agglutination
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| What are the signs of increased estrogen level in cirrhotic patients? | 1. Spider angiomas
2. Palmar erythema
3. Gynecomastia
4. Testicular atrophy
5. Dupuytren's contractures, and
6. Decreased body hair
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| What does an endoscopy in a patient with UC will reveal? | Erythematous, friable mucosa being a the anal verse and extending proximally
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