Block 9 Pace 2 Part 1

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  • 1/21 Questions

    Pharmacology (Dr B) Metoprolol was given IM to several dogs during a lab experiment. One hour later each dog received an autonomic drug and the effects of that drug were recorded. Which of the following drug-induced effects was most likely best counteracted by metoprolol pretreatment?

    • Dobutamine-induced tachycardia
    • Isoproterenol-induced hyperglycemia
    • Albuterol-induced bronchodilation
    • Dopamine-induced renal vasodilation
    • Atropine-induced mydriasis
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Block 9 Pace 2 Part 1 - Quiz
About This Quiz

Block 9 Pace 2 part 1 assesses understanding of pharmacological and microbiological concepts through clinical scenarios. It covers drug effects, antibiotic properties, immune responses, viral infection symptoms, and appropriate decontamination methods, preparing learners for practical and theoretical applications in medical fields.

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  • 2. 

    A 69-year-old man recently diagnosed with a Proteus mirabilis infection started a treatment with a daily IM injection of gentamicin, an aminoglycoside antibiotic. Which of the following pairs of properties best explains why the drug is usually administered once daily despite gentamicin short half-life (about two hours)?

    • Time-dependent killing and bactericidal effect

    • Extensive plasma protein binding and bactericidal effect

    • Dose-dependent renal impairment and bacteriostatic effect

    • Time-dependent killing and long postantibiotic effect

    • Concentration-dependent killing and long postantibiotic effect

    Correct Answer
    A. Concentration-dependent killing and long postantibiotic effect
    Explanation
    Gentamicin exhibits concentration-dependent killing, meaning that higher drug concentrations are more effective in killing bacteria. Additionally, it has a long postantibiotic effect, which means that even after the drug has been cleared from the body, it continues to inhibit bacterial growth. These two properties allow for once-daily administration of gentamicin, as a single high dose can achieve sufficient drug concentration and maintain effective bacterial killing for an extended period of time.

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  • 3. 

    Microbiology (Dr Be) Individuals affected by viral infections often go through a febrile state marked by nonspecific symptoms such as fever, malaise, headache, and nausea, followed by more specific symptoms associated with the presence of the virus (e. g. the flu starts with an abrupt onset of fever, malaise, headache and myalgia, quickly followed by respiratory symptoms such as a cough and sore throat). What cytokines would most likely be responsible for the systemic symptoms associated with the prodromal stage of the viral infection?

    • IL-8, IFN-y and IL-10

    • IL-2, IL-4 and IL-13

    • IL-1, IL-4 and IFN-y

    • IL-6, IL-8 and IL-10

    • IL-1, IL-6 and TNF-a

    Correct Answer
    A. IL-1, IL-6 and TNF-a
    Explanation
    During the prodromal stage of a viral infection, the body's immune response is activated, leading to the release of pro-inflammatory cytokines. IL-1, IL-6, and TNF-a are pro-inflammatory cytokines that play a crucial role in initiating and amplifying the immune response. They are responsible for the systemic symptoms such as fever, malaise, headache, and nausea that are commonly seen during this stage. IL-8, IFN-y, IL-10, IL-2, IL-4, and IL-13 are not typically associated with the prodromal stage of viral infections.

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  • 4. 

    A 22-year-old male presents to an outpatient clinic with greyish, hyperkeratotic, firm, exophytic papules on his penis for which he is prescribed Aldara (a 5% imiquimod topical cream that induces IFN-a) three times a week for twelve weeks.   Which immune defense mechanism is stimulated by this treatment?

    • INFAR synthesis down-regulation

    • INOS-derived nitric oxide down-regulation

    • RNase L-derived protein translation down-regulation

    • IFN-a synthesis down-regulation

    • Fas/FasL down-regulation

    Correct Answer
    A. RNase L-derived protein translation down-regulation
    Explanation
    The correct answer is RNase L-derived protein translation down-regulation. Aldara, a 5% imiquimod topical cream, stimulates the immune defense mechanism by inducing IFN-a. IFN-a, in turn, activates RNase L, an enzyme that degrades viral RNA and inhibits protein translation, thus down-regulating protein synthesis. This helps to eliminate the viral infection and resolve the hyperkeratotic papules on the patient's penis.

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  • 5. 

    Micro Dr Drum An outbreak of acute vomiting and diarrhea occurred on a cruise ship in the middle of a transatlantic crossing. The company running the cruise immediately decided to institute a stringent cleaning protocol, using a product containing benzalkonium chloride (a quaternary ammonium compound), to try to contain the outbreak. Later, it was discovered that the outbreak was due to Norovirus, a calicivirus. What method of decontamination would have been more appropriate in preventing transmission of the virus from sick to healthy passengers?  

    • Autoclaving the entire ship

    • Disinfecting with 0.5% bleach (hypochlorite)

    • Sterilizing the hands of those with the illness

    • Disinfecting with 50% alcohol

    • Washing all surfaces with a detergent

    Correct Answer
    A. Disinfecting with 0.5% bleach (hypochlorite)
    Explanation
    Disinfecting with 0.5% bleach (hypochlorite) would have been more appropriate in preventing transmission of the Norovirus from sick to healthy passengers. Norovirus is highly resistant to many disinfectants, but it is susceptible to bleach. Bleach is effective in killing the virus and preventing its spread on surfaces. Autoclaving the entire ship may not be feasible or practical, sterilizing the hands of those with the illness may not be sufficient to prevent transmission through other means, disinfecting with 50% alcohol may not be as effective as bleach against Norovirus, and washing all surfaces with a detergent may not be enough to fully eliminate the virus.

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  • 6. 

    A child presents with a very sore throat. Physical examination reveals a tough, grayish, adherent membrane in the back of the throat. Cell culture of the swab on tellurite agar grows brown colonies with halos. The bacterial exotoxin produced by this pathogen is an ADP-ribosyltransferase which affects eukaryotic elongation factor 2. What are the characteristics of another bacterial species that produces an exotoxin with the identical enzymatic mechanism of action (but different cell target)?  

    • Gram-negative, oxidase-positive, nonfermenting bacilli

    • Gram-positive, catalase-negative cocci in chains

    • Gram-positive, endospore-forming, anaerobic bacilli

    • Gram-negative, oxidase-negative, lactose-fermenting bacilli

    • Gram-positive, catalase-positive cocci in clusters

    Correct Answer
    A. Gram-negative, oxidase-positive, nonfermenting bacilli
  • 7. 

    Immune Dr Sl A 65-year-old alcoholic, homeless man presents to the emergency department with fever and a cough productive of green, foul-smelling sputum.  A chest x-ray is positive for a lung abscess.  What organism(s) is(are) likely the cause of the abscess?  

    • Mycobacterium tuberculosis

    • Coxiella brunetii and Legionella pneumophila

    • Streptococcus pneumoniae

    • Fusobacterium nucleatum and Petptosteptococcus intermedius

    Correct Answer
    A. Fusobacterium nucleatum and Petptosteptococcus intermedius
    Explanation
    The likely cause of the lung abscess in this 65-year-old alcoholic, homeless man presenting with fever and foul-smelling sputum is Fusobacterium nucleatum and Petptosteptococcus intermedius. These organisms are commonly associated with lung abscesses, particularly in individuals with poor oral hygiene and compromised immune systems. The presence of green, foul-smelling sputum is consistent with an anaerobic infection, which is commonly caused by Fusobacterium nucleatum. Petptosteptococcus intermedius is another anaerobic organism commonly found in lung abscesses.

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  • 8. 

    Micro Dr Ha A 7-year-old patient presents to your southern California family practice with pneumonia in July. No other family member is sick (mother 31, father 29, sister 14). Recent travel history included a family trip to visit his paternal grandparents in Iowa and that father and son did do some cave exploring in caves along the Mississippi River about 3 weeks ago. The child has asthma and had increased the usage of his inhaler. He has been on antibacterial therapy for 2 days and is not getting better. Gram stain of sputum continues to be negative for bacteria. Because of this and the cave activity you now suspect Histoplasma pneumonia. If you were to order cultures for suspected Histoplasma, what would grow out a couple of weeks later?  

    • Yeasts on both the 30°C and 37°C Mycosel medium

    • Hyphal forms on both the 30°C and 37°C Mycosel medium

    • Hyphal forms on 30°C and yeasts on 37°C Mycosel medium

    • Yeasts on the 30°C and hyphal forms on37°C Mycosel medium

    Correct Answer
    A. Hyphal forms on 30°C and yeasts on 37°C Mycosel medium
    Explanation
    The correct answer is "Hyphal forms on 30°C and yeasts on 37°C Mycosel medium." This is because Histoplasma is a dimorphic fungus, meaning it can exist in two different forms depending on the temperature. At 30°C, it grows as a mold with hyphal forms, while at 37°C, it grows as a yeast. Therefore, if cultures were ordered for suspected Histoplasma, the presence of hyphal forms at 30°C and yeasts at 37°C would confirm the diagnosis.

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  • 9. 

    Biochemistry (Dr Sa) 29) The DNA for an H chain in a B cell making IgG2 antibody for diphtheria toxoid has the following structure:   5’-V17D5J2Cγ2-Cγ4-Ce-Cα2-3’ How many individual rearrangements were required to go from the embryonic DNA to this B cell DNA?  

    • 1

    • 2

    • 3

    • 4

    • None

    Correct Answer
    A. 3
    Explanation
    The given DNA sequence indicates that there were three individual rearrangements required to go from the embryonic DNA to this B cell DNA. This can be determined by counting the number of different gene segments present in the sequence. In this case, there are three different gene segments: V17, D5, and J2. Each of these gene segments represents a separate rearrangement event. Therefore, the correct answer is 3.

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  • 10. 

    Behavioral (Dr Fo)   As you reflect upon your life, you come to the disconcerting realization that there exists a pattern that results in you not attaining what you believe you want in this life. It seems that, as you approach success with important activities, you undermine yourself by losing motivation thereby compromising a positive outcome. This has occurred as recently as your performance on the MCAT exam and as far back as when you auditioned for your 4th grade Christmas pageant. What is this phenomenon?

    • Counter-transference

    • Repetition-compulsion

    • Emotionally corrective experience

    • Evenly hovering attention

    • Parapraxis

    Correct Answer
    A. Repetition-compulsion
    Explanation
    The phenomenon described in the scenario is repetition-compulsion. This refers to a pattern where an individual unconsciously repeats certain behaviors or experiences that are detrimental to their goals or well-being. In this case, the person consistently undermines themselves and loses motivation when they are close to achieving success. This pattern can be seen in various aspects of their life, such as their performance on the MCAT exam and their audition for the Christmas pageant. Repetition-compulsion suggests that there may be underlying psychological factors at play, causing the individual to repeat self-sabotaging behaviors.

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  • 11. 

    Dr Rick Following the White Coat Ceremony at the beginning of the new semester at a prominent medical school a group of dignitaries – senior administrators of the school and officials from the local community – gather to have  refreshments.            The local caterer was complemented for the fine array of hors d’oeuvres  – sushi, mini beef patties, barbecued chicken drumsticks, tuna sandwiches and “fruit-on-a-stick”.  The drink selection included freshly squeezed orange juice, passion fruit juice and iced tea as well as bottled water.  Later that evening, several of the dignitaries called the school doctor to report that they had developed vomiting and diarrhea.  The alert doctor recognized that the people who were calling in were all diners at the function and called the local epidemiologist to report the situation.   While the school doctor collects specimens to identify the etiological agent for this outbreak, the epidemiologist sets out to identify the source.  Based on the information from the school doctor, the epidemiologist suspects that the ‘fruit-on-a-stick’ is the source of the infection. What should the epidemiologist do to confirm his suspicion?

    • Conduct a cohort study of all dignitaries who ate at the reception

    • Initiate surveillance among all asymptomatic dignitaries

    • Perform a case-control study in which the cases are those dignitaries who ate ‘fruit-on-a-stick’ and controls are those who did not

    • Perform a case-control study in which the cases are those who became ill and the controls are those who did not

    Correct Answer
    A. Perform a case-control study in which the cases are those who became ill and the controls are those who did not
    Explanation
    The epidemiologist should perform a case-control study in which the cases are those who became ill and the controls are those who did not. This study design allows for a comparison between those who were exposed to the suspected source (fruit-on-a-stick) and those who were not. By comparing the two groups, the epidemiologist can determine if there is a significant association between consuming the fruit-on-a-stick and developing illness. This study design is appropriate for investigating an outbreak and confirming the suspected source of infection.

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  • 12. 

    A systematic review and meta-analysis of all randomized controlled trials on the effect of statins on the risk of cardiovascular events published since 1997 was conducted.  The study determined that for all-cause mortality the odds ratio (OR) was 0.76 (95% confidence interval (CI), 0.67-0.86).  What conclusion can you draw from this report?

    • Statins have no significant effect on death from cardiovascular disease

    • Statins reduce mortality from cardiovascular disease

    • The sample size in this study was inadequate

    • There is no possibility of bias

    • This effect can be explained by concurrent use of other cardio-protective drugs such as aspirin

    Correct Answer
    A. Statins reduce mortality from cardiovascular disease
    Explanation
    The systematic review and meta-analysis of randomized controlled trials showed that the odds ratio for all-cause mortality with statins was 0.76, indicating a lower risk of death from cardiovascular disease. This suggests that statins have a significant effect in reducing mortality from cardiovascular disease.

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  • 13. 

    A systematic review and meta-analysis of all randomized controlled trials on the effect of statins on the risk of cardiovascular events published since 1997 was conducted.  The study determined that for all-cause mortality the odds ratio (OR) was 0.76 (95% confidence interval (CI), 0.67-0.86).  What conclusion can you draw from this report?

    • Statins have no significant effect on death from cardiovascular disease

    • Statins reduce mortality from cardiovascular disease

    • The sample size in this study was inadequate

    • There is no possibility of bias

    • This effect can be explained by concurrent use of other cardio-protective drugs such as aspirin

    Correct Answer
    A. Statins reduce mortality from cardiovascular disease
    Explanation
    The conclusion that can be drawn from the report is that statins reduce mortality from cardiovascular disease. This is based on the odds ratio of 0.76, which indicates a lower risk of death from cardiovascular events in individuals who take statins compared to those who do not. The 95% confidence interval also suggests that this finding is statistically significant. Therefore, the evidence from the systematic review and meta-analysis supports the conclusion that statins have a beneficial effect on reducing mortality from cardiovascular disease.

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  • 14. 

    Researchers report that adjusted cancer mortality rates in the USA were 52 percent higher for men and 62 percent higher for women with a body-mass index (BMI) of 40 or greater as compared to men and women of normal BMI.  What is the most appropriate interpretation of this information?

    • Higher cancer mortality rates among individuals with BMI 40 or greater are likely due to high fat diets

    • Higher mortality rates among individuals with BMI 40 or greater is due to less access to cancer treatment

    • Having controlled for other potential cancer risk factors allows for acceptance of this finding

    • Higher smoking rates among obese individuals could account for this finding

    • This finding proves that obesity is associated with increased risk of death from cancer

    Correct Answer
    A. Having controlled for other potential cancer risk factors allows for acceptance of this finding
    Explanation
    The most appropriate interpretation of the information is that having controlled for other potential cancer risk factors allows for acceptance of this finding. This means that the researchers have taken into account other factors that could contribute to cancer mortality rates, such as smoking or high fat diets, and have still found a significant increase in mortality rates among individuals with a BMI of 40 or greater. Therefore, this finding suggests that obesity is indeed associated with an increased risk of death from cancer.

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  • 15. 

    behav Dr Sa Willie is a 14-year-old junior high student who has been disciplined frequently at school for failure to comply with his teachers’ instructions. He often says to them, “You can’t tell me what to do.” Willie’s parents also report that he is difficult to manage at home, as he refuses to do chores or treat them with respect. According to both his parents and teachers, Willie is smart enough to succeed, but it appears that he would rather fail a grade than comply with adults’ demands. Despite these behavioral difficulties, Willie has never been violent towards others. Given this limited information, which of the following is the most likely DSM-IV-TR diagnosis?

    • ADHD, Predominantly Inattentive Type

    • ADHD, Predominantly Hyperactive-Impulsive Type

    • Oppositional Defiant Disorder

    • ADHD, Combined Type

    • Conduct Disorder

    Correct Answer
    A. Oppositional Defiant Disorder
    Explanation
    Needs a swift ass-kickin! That ALWAYS cures "Defiant Disorders" :)

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  • 16. 

    IME (Dr Ma) You are asked to participate in a case-control study as part of your clinical clerkship rotation in Internal Medicine, of whether a history of herpes simplex is associated with lip cancer. A brief pilot study finds that about 30% of persons without lip cancer have had herpes simplex. The main investigator is interested in detecting whether the odds ratio (O.R.) for lip cancer associated with herpes simplex infection is 2.5 or more. Which of the following estimates will most likely provide investigators the best result of interest in the study?  

    • P value

    • Relative risk

    • Confidence intervals

    • Risk ratio

    • Prevalence ratio

    Correct Answer
    A. Relative risk
    Explanation
    The relative risk is the ratio of the risk of developing lip cancer in individuals with a history of herpes simplex infection compared to those without the infection. It provides a measure of the strength of the association between the two variables. In this case, the main investigator is interested in detecting whether the odds ratio for lip cancer associated with herpes simplex infection is 2.5 or more. Therefore, the relative risk would be the most relevant estimate as it directly measures the association between the two variables.

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  • 17. 

    behav Dr Bu 7 year old Norman has an imaginary friend named George. Norman says that George is always with him; he speaks to him and loves to play with him. Norman’s parents are worried about this behavior and brought Norman for medical evaluation. His examination was normal. A correct response by the doctor to the parents would be:

    • This is normal at his age and should disappear by 10 years.

    • I need to do some cognitive testing to rule out developmental delay

    • He needs to be with children so he doesn’t make imaginary friends

    • This is a sign of regression. Is there any problem at home?

    • This is usually seen in 3year olds; he should not behave in this way.

    Correct Answer
    A. This is normal at his age and should disappear by 10 years.
    Explanation
    It is common for children around Norman's age to have imaginary friends, and this behavior is considered normal. Many children develop imaginary friends as a way to explore their imagination and practice social interactions. It is expected that Norman will eventually outgrow this phase by the time he is 10 years old.

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  • 18. 

    behav Dr Ri In the field of Criminal Law many standards have been put forward as reasons for use of the Insanity Defense, where the patient claims that his action was a result of insanity. Which of these standards below is accepted as law in the United States?  

    • Because of the Mental Illness, the patient did not know the difference between right and wrong

    • The patient did not know the nature of, and consequences of his act

    • The patient labored under a mental disease such that he was incapable of realizing his acts were wrong.

    • The patient is not guilty of unlawful act if the unlawful act was the product of mental disease or defect

    • Patient is not responsible for criminal conduct as a result of mental disease; he lacked substantial capacity to appreciate the wrongfulness of such conduct.

    Correct Answer
    A. Patient is not responsible for criminal conduct as a result of mental disease; he lacked substantial capacity to appreciate the wrongfulness of such conduct.
    Explanation
    The accepted standard for the Insanity Defense in the United States is that the patient is not responsible for criminal conduct if it was a result of a mental disease and they lacked substantial capacity to appreciate the wrongfulness of their actions. This means that the individual's mental illness impaired their ability to understand that their actions were morally wrong.

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  • 19. 

    A 20 year old single medical student in her third trimester (last three months) of pregnancy requests an abortion. She was unaware of her pregnancy because she had never missed a period. Is it permissible to perform the abortion at this late stage because?

    • The law in the US states that you may perform under any circumstances at any stage of pregnancy.

    • If the abortion is not performed, the patient, because of severe medical problems might die before reaching term (40 weeks pregnant)

    • The woman is autonomous and is free to have an abortion at any time.

    • Even at this stage of pregnancy the decision is between the patient and yourself.

    • The Physician is free to perform the abortion if the husband requests it.

    Correct Answer
    A. If the abortion is not performed, the patient, because of severe medical problems might die before reaching term (40 weeks pregnant)
    Explanation
    Perhaps this is what they are going for:

    Bleeding during pregnancy, often an early pregnancy complication, can be a sign of trouble. Yet, it is not uncommon for a woman to report that she had her period while she was pregnant. Although it may seem like you are menstruating, there are often other causes for the blood, which are outlined in Periods During Pregnancy. However, bleeding in the ninth month may signify placenta previa or placental abruption. As for your morning sickness, if it seems far worse than you ever expected it to be, you could be suffering from hyperemesis gravidarum.

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  • 20. 

    Pathology (Dr 9) Police are called to a scene where a 32-year-old man has been "acting crazy", swinging a baseball bat and breaking things in his neighbor’s yard.  Upon arrival the police have to Taser the man to disable him, then it takes 4 police officers to restrain the man and get handcuffs on him.  One of the police officers has to sit on the man's lower back to help with the restraint.  What is the "crazed man" most at risk of dying from during this altercation?

    • Physical exhaustion

    • Heat stroke

    • Asphyxia

    • Electrical burn injuries

    • Cardiac arrhythmia

    Correct Answer
    A. Cardiac arrhythmia
    Explanation
    During the altercation, the "crazed man" is at the highest risk of dying from cardiac arrhythmia. The physical exertion, stress, and the use of a Taser can all contribute to an increased heart rate and irregular heart rhythm, potentially leading to cardiac arrhythmia. This can be a life-threatening condition if not promptly treated.

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  • 21. 
    behav Dr Co You are asked to examine the patient shown in the image.  What is the most likely explanation for the lesions on this patient’s back? - ProProfs

    behav Dr Co You are asked to examine the patient shown in the image.  What is the most likely explanation for the lesions on this patient’s back?

    • Accumulation of excessive amounts of granulation tissue in wound healing

    • Accumulation of excessive amounts of collagen in wound healing

    • Accumulation of excessive amounts of extracellular matrix in wound healing

    • Accumulation of excessive amounts of myofibroblasts in wound healing

    • Accumulations of excessive amounts of abnormal cells and extracellular matrix proteins

    Correct Answer
    A. Accumulation of excessive amounts of collagen in wound healing
    Explanation
    The most likely explanation for the lesions on this patient's back is the accumulation of excessive amounts of collagen in wound healing. Collagen is a protein that is essential for wound healing, but an excessive buildup can lead to abnormal scarring and the formation of lesions.

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  • Current Version
  • Mar 21, 2023
    Quiz Edited by
    ProProfs Editorial Team
  • May 18, 2012
    Quiz Created by
    Chachelly

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