Block 9 Pace 2 Part 2

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Block 9 Pace 2 Part 2 - Quiz


oct 2011


Questions and Answers
  • 1. 

    Pathology: Dr Jo   This section of heart shown was taken during an autopsy from a 45 year old man with a history of familial hypercholesterolemia.  Which of the following is most consistent with the section shown?

    • A.

      Healing by regeneration and repair

    • B.

      Healing by repair via secondary union

    • C.

      Healing by repair via primary intention

    • D.

      Healing by regeneration via primary union

    • E.

      Healing by regeneration via secondary intention

    Correct Answer
    B. Healing by repair via secondary union
    Explanation
    The section shown in the pathology slide indicates healing by repair via secondary union. This is suggested by the presence of fibrous tissue and scar formation, which is a characteristic feature of secondary intention healing. In this type of healing, the wound is left open and healing occurs through the formation of granulation tissue and subsequent scar formation. This is commonly seen in large, open wounds or wounds with significant tissue loss, as opposed to primary intention healing where the wound edges are brought together and healing occurs with minimal scar formation.

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  • 2. 

    A 65 year old alcoholic man is diagnosed with cirrhosis after 40 years of heavy drinking.  Which of the following is most likely associated with his diagnosis?

    • A.

      Fibrosis

    • B.

      Regeneration

    • C.

      Repair

    • D.

      Regeneration & repair

    • E.

      Repair & Fibrosis

    Correct Answer
    E. Repair & Fibrosis
    Explanation
    The correct answer is "Repair & Fibrosis". When the liver is damaged, it undergoes a process called repair, where it attempts to heal itself. However, in the case of cirrhosis, this repair process is accompanied by the formation of scar tissue, known as fibrosis. Therefore, repair and fibrosis are both likely to be associated with the diagnosis of cirrhosis in this alcoholic man.

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  • 3. 

    Behavioral: Dr Fo During your inquiry of his past medical history, your new patient, a 35-year-old male, reports that you are the 5th primary care doctor he has had during the past 7 years. Upon further inquiry, the patient informs you that, at first, he likes his doctors, but eventually they frustrate him by not listening to him, at which point he confronts them. Such confrontation inevitably results in him firing his physician and finding another one. Which of the following most accurately describes this patient’s interpersonal process with his physicians?

    • A.

      Counter-transference

    • B.

      Emotionally corrective experience

    • C.

      Evenly hovering attention

    • D.

      Parapraxis

    • E.

      Repetition-compulsion

    Correct Answer
    E. Repetition-compulsion
    Explanation
    The patient's pattern of repeatedly firing his physicians and finding new ones after feeling frustrated and unheard suggests a repetition-compulsion. This term refers to the unconscious tendency to repeat past experiences or patterns of behavior, even if they are negative or harmful. In this case, the patient may be unconsciously seeking out situations where he can reenact his past experiences of feeling unheard and confront his physicians. This repetition-compulsion may stem from unresolved issues or traumas from his past, leading him to recreate similar dynamics in his current relationships with doctors.

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  • 4. 

    behav Dr Rick   A comparison of clinically diagnosed versus autopsy-confirmed gastric and peptic ulcers was performed on 100,000 consecutive diseased patients in several large hospitals as shown in the following table. From these data, the sensitivity of clinical diagnosis was

    • A.

      2,500/4,000

    • B.

      1,500/1700

    • C.

      200/96,000

    • D.

      95,800/96,000

    • E.

      1,500/4,000

    Correct Answer
    E. 1,500/4,000
    Explanation
    The sensitivity of clinical diagnosis refers to the proportion of true positive cases that are correctly identified by the clinical diagnosis. In this case, the numerator represents the number of clinically diagnosed gastric and peptic ulcers (1,500) and the denominator represents the total number of autopsy-confirmed cases (4,000). Therefore, the sensitivity of clinical diagnosis is 1,500/4,000.

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  • 5. 

    H_BHS: Validity of screening tests The strength of the association between smoking and coronary heart disease is best demonstrated by:

    • A.

      Incubation period

    • B.

      Incidence of coronary heart disease

    • C.

      Relative risk for smokers compared to non-smokers

    • D.

      Prevalence of smoking

    • E.

      Risk difference for smokers’ vs non-smokers

    Correct Answer
    C. Relative risk for smokers compared to non-smokers
    Explanation
    The strength of the association between smoking and coronary heart disease is best demonstrated by the relative risk for smokers compared to non-smokers. Relative risk measures the likelihood of developing a disease in one group compared to another. In this case, it compares the risk of developing coronary heart disease in smokers versus non-smokers. A higher relative risk indicates a stronger association between smoking and coronary heart disease, suggesting that smoking is a significant risk factor for the disease.

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  • 6. 

    H_BHS: Measures of effect The epidemic curve below is for an outbreak of fever and rash among school-children who were subsequently shown to have had exposure to a confirmed case of rubella on June 6. The minimum incubation period for rubella in this outbreak is

    • A.

      15 days

    • B.

      8 days

    • C.

      19 days

    • D.

      23 days

    • E.

      25 days

    Correct Answer
    A. 15 days
  • 7. 

    Microbiology: Dr Sl A 44-year-old man is given an intramuscular high dose of penicillin.  About 8 days later, he develops chills, fever  and a rash.  If his symptoms are due to an immune reaction to the drug, what type of reaction is this considered?

    • A.

      Type I Hypersensitivity reaction

    • B.

      Type II Hypersensitivity reaction

    • C.

      Type IV Hypersensitivity reaction

    • D.

      Anaphylactoid reaction

    • E.

      Type III Hypersensitivity reaction

    Correct Answer
    E. Type III Hypersensitivity reaction
    Explanation
    The symptoms of chills, fever, and rash occurring 8 days after receiving penicillin indicate a delayed immune reaction. Type III hypersensitivity reactions, also known as immune complex reactions, occur when antigen-antibody complexes are deposited in tissues, leading to inflammation and tissue damage. This reaction typically occurs a few days after exposure to the antigen. Therefore, the symptoms described in the question are consistent with a type III hypersensitivity reaction.

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  • 8. 

    The vaccine for Anthrax is a killed cell vaccine.  Because of the fact that this vaccine is comprised of killed organism, what is a disadvantage of the vaccine? 

    • A.

      There is a risk that the vaccine components will secrete the toxins that cause the disease.

    • B.

      The immunity to the organism will wane as soon as the vaccine components are cleared from the body.

    • C.

      This vaccine is not appropriate for use in immuncompromised persons

    • D.

      Immunity to this organism is not typically life-long and sustained immunity will require booster shots.

    • E.

      Maintaining viability of the vaccine is a concern.

    Correct Answer
    D. Immunity to this organism is not typically life-long and sustained immunity will require booster shots.
    Explanation
    The disadvantage of the Anthrax vaccine being a killed cell vaccine is that immunity to the organism is not typically life-long and sustained immunity will require booster shots.

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  • 9. 

    Micro Dr Sch   The virulence factor CagA encoded by a specific pathogen is associated with gastric adenocarcinoma. CagA is encoded within a pathogenicity island and transferred into host cells via a Type IV secretion system. Which of the following pathogens encodes CagA?

    • A.

      Candida albicans

    • B.

      Escherichia coli

    • C.

      Streptococcus lactis

    • D.

      Helicobacter pylori

    • E.

      MRSA – methicillin resistant Staphylococcus aureus

    Correct Answer
    D. Helicobacter pylori
    Explanation
    Helicobacter pylori is the pathogen that encodes CagA. CagA is a virulence factor associated with gastric adenocarcinoma and is encoded within a pathogenicity island. It is transferred into host cells via a Type IV secretion system. Candida albicans, Escherichia coli, Streptococcus lactis, and MRSA do not encode CagA.

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  • 10. 

    Micro Dr Ber    Researchers discover a new molecule they think could be used as an antiviral against picornaviruses. To test their hypothesis, they perform the following experiment using a cell line permissive to picornavirus infection:   Condition 1: The cells are neither treated with the test compound nor exposed to the virus.   Condition 2: The cells are not treated with the test molecule but are infected with the virus.   Condition 3: The cells are treated with the test molecule but are not exposed to the virus.   Condition 4: The cells are treated with the test compound and exposed to the virus.   After a 5 minute incubation period, all cell cultures are thoroughly washed to eliminate the test molecule and virus. A fluorescent nucleic acid probe, complementary to the viral RNA, is then used to demonstrate the presence of viral RNA inside the cells by fluorescence microscopy.   Results are as follow: Which viral molecule is the most likely target of this potential antiviral?

    • A.

      RNA

    • B.

      RNA polymerase

    • C.

      Capsid protein

    • D.

      Envelope glycoprotein

    • E.

      Envelope lipid

    Correct Answer
    C. Capsid protein
    Explanation
    The most likely target of this potential antiviral is the capsid protein. This is because the experiment demonstrates the presence of viral RNA inside the cells, suggesting that the virus was able to enter the cells. Since the cells were treated with the test compound and exposed to the virus, the fact that viral RNA was still present suggests that the test compound did not prevent the virus from entering the cells. Therefore, it is more likely that the test compound interfered with the function of the capsid protein, which is responsible for protecting the viral RNA and facilitating its entry into host cells.

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  • 11. 

    An 8-year-old girl presents to the school nurse complaining of an itchy rash. The rash is composed of a mixture of erythematous macules, papules, vesicles, pustules, and crusts, mostly confined to the face and trunk. The prupritus and characteristic rash allows the nurse to conclude that the child has varicella (chickenpox). Human herpesvirus 3 (Varicella-zoster virus), the causative agent of chickenpox and shingles, interferes with the Jak/STAT pathway of antigen presenting cells thereby reducing IFN-g-mediated expression of MHC-II. Which cytokine necessary for defending against viruses would be inhibited in this case of viral immune evasion?

    • A.

      IL-12

    • B.

      IFN-y

    • C.

      IL-4

    • D.

      TNF-a

    • E.

      A & B

    Correct Answer
    E. A & B
    Explanation
    The correct answer is A & B. IL-12 and IFN-y are both cytokines that are necessary for defending against viruses. IL-12 promotes the differentiation of T cells into Th1 cells, which produce IFN-y. IFN-y, in turn, activates macrophages and enhances their ability to kill intracellular pathogens, including viruses. In this case of viral immune evasion caused by Varicella-zoster virus, the interference with the Jak/STAT pathway reduces the expression of MHC-II, which is important for antigen presentation to T cells. As a result, the production of IL-12 and IFN-y would be inhibited, compromising the immune response against the virus.

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  • 12. 

    Micro Dr Ad   A 15-month-old female child has a history of recurrent infections with multiple agents, including cytomegalovirus, Candida, and staphylococci.  Her mother takes her to the pediatrician concerned that she has not yet begun to walk.  Two months ago she was able to pull herself up to stand at the coffee table, but has not progressed beyond that stage.  A careful family history and pedigree analysis reveals this to be a genetic disorder that is inherited in an autosomal recessive pattern.   Of the laboratory tests listed (all of which are relevant), which one is likely to be the most useful in establishing the underlying mechanism of the immunodeficiency?

    • A.

      Adenosine deaminase levels in leukocytes

    • B.

      Test of neutrophil function

    • C.

      Enumeration of B cells in the blood

    • D.

      Enumeration of CD3 lymphocytes in the blood

    • E.

      Quantitative serum immunoglobulin levels

    Correct Answer
    A. Adenosine deaminase levels in leukocytes
    Explanation
    The most likely explanation for the correct answer is that adenosine deaminase (ADA) deficiency is a known cause of severe combined immunodeficiency (SCID), which is characterized by recurrent infections and impaired immune function. ADA is an enzyme involved in the breakdown of toxic metabolites in lymphocytes, and its deficiency can lead to the accumulation of these metabolites, causing lymphocyte dysfunction. Measuring ADA levels in leukocytes can help establish the underlying mechanism of the immunodeficiency by identifying ADA deficiency as the cause. This information can guide further diagnostic and management strategies for the patient.

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  • 13. 

    Micro Dr Drum In May 2011, an outbreak of foodborne illness, presenting with bloody diarrhea and complicated in many cases by hemolytic uremic syndrome, was seen in Germany. In thousands of patients, the causative agent was identified as a lactose-fermenting, Gram-negative, oxidase-negative rod of the novel O104:H4 serotype. Interestingly, while the pathogen causes a disease similar to that caused by the O157:H7 strain, it does not have the attaching/effacing genes found in this latter organism. What virulence factor is most likely responsible for the similarities in clinical presentation between the new strain and the O157:H7 strain?

    • A.

      Intimin

    • B.

      Endotoxin

    • C.

      Exotoxin A

    • D.

      Shiga toxin

    • E.

      Alpha hemolysin

    Correct Answer
    D. Shiga toxin
    Explanation
    The bloody diarrhea/HUS is due to Shiga toxin production, which is also produced by O157:H7 EHEC. The strain described here is not actually an EHEC, as it does not carry the LEE (eae genes, tir, etc), but actually appears to be an enteroaggregative strain (EAggEc) which has acquired the stx-carrying bacteriophage. EAggEc has not yet been taught, but this knowledge is not needed to answer the question. This outbreak actually spread too many countries, but everyone affected had travelled in or near Germany, and the food implicated was not unequivocally identified—it was not meat, it was more likely a plant product (cucumbers, sprouts?). This is actually common in the case of EHEC also, in that veggies are often the source, via being washed in contaminated water.

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  • 14. 

    An 18-year-old college student presents with fever, headaches, photophobia, nuchal rigidity, and petechiae. Gram-staining of both blood cultures and cerebrospinal fluid reveals red pairs of kidney bean-shaped bacterial cells. One of the ways this organism is able to survive in the bloodstream is by evading phagocytosis. What is the general structure of the virulence factor most responsible for this ability?

    • A.

      Trimeric protein embedded in the outer membrane

    • B.

      Short surface protein filaments

    • C.

      Surface-anchored polysaccharide

    • D.

      Crystalline layer of self-assembling surface proteins

    • E.

      Polymer of sugars cross-linked via peptides

    Correct Answer
    C. Surface-anchored polysaccharide
    Explanation
    Patient has septicemia and meningitis due to meningococcus. The question is referring to the capsular polysaccharide produced by the organism, which is a surface-anchored polysaccharide (anchored in outer membrane). The other answers are referring to S-layer, pili, OMPs, and peptidoglycan.

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  • 15. 

    Pharmacology: Dr B  A new synthetic drug X was studied for its cardiovascular effects. The drug was given IV to four laboratory animals while the heart rate was recorded. The animals had received either no pretreatment or an effective dose of the drugs indicated below. The NET CHANGES (+ or -) induced by drug X (not by the pretreatment) are shown in the following table. Which of the following drugs did the new agent most resemble?

    • A.

      Propranolol

    • B.

      Acetylcholine

    • C.

      Albuterol

    • D.

      Norepinephrine

    • E.

      Isoproterenol

    Correct Answer
    D. Norepinephrine
    Explanation
    The new synthetic drug X most resembles norepinephrine based on the net changes induced by drug X. Norepinephrine is a neurotransmitter and hormone that is involved in the body's stress response. It increases heart rate and blood pressure, which is consistent with the cardiovascular effects observed with drug X in the study. Propranolol, acetylcholine, albuterol, and isoproterenol have different pharmacological effects and do not produce similar changes in heart rate as observed with drug X.

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  • 16. 

    A 35-year-old man admitted to the hospital because of a car accident, started a blood transfusion. Few minutes later he complained of nausea and pruritus and developed dyspnea with audible wheezing. His skin was mottled and cold, heart rate was 120 bpm and blood pressure fell to 80/50 mm Hg. An injection of epinephrine was given. Which of the following actions most likely contributed to the therapeutic efficacy of the drug in the in the patient’s disease?

    • A.

      Inhibition of mast cell degranulation

    • B.

      Stimulation of eicosanoid biosynthesis

    • C.

      Beta-2 receptor mediated vasodilation

    • D.

      Inhibition of insulin secretion

    • E.

      Stimulation of platelet aggregation

    Correct Answer
    A. Inhibition of mast cell degranulation
    Explanation
    The patient's symptoms, including nausea, pruritus, dyspnea, wheezing, mottled and cold skin, tachycardia, and hypotension, are consistent with anaphylaxis, a severe allergic reaction. Epinephrine is the treatment of choice for anaphylaxis because it acts as a potent vasoconstrictor, bronchodilator, and cardiac stimulant. In this case, the patient's symptoms improved after receiving an injection of epinephrine, suggesting that the drug was effective in reversing the allergic reaction. One of the main mechanisms by which epinephrine exerts its therapeutic effects in anaphylaxis is by inhibiting mast cell degranulation, which reduces the release of histamine and other mediators that contribute to the allergic response.

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  • 17. 

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

    • A.

      Isoproterenol-induced hyperglycemia

    • B.

      Albuterol-induced bronchodilation

    • C.

      Dopamine-induced renal vasodilation

    • D.

      Atropine-induced mydriasis

    • E.

      Dobutamine-induced tachycardia

    Correct Answer
    E. Dobutamine-induced tachycardia
    Explanation
    Metoprolol is a beta-blocker medication that works by blocking the effects of adrenaline on the heart. Dobutamine is a medication that stimulates the heart to beat faster. Therefore, dobutamine-induced tachycardia, or an abnormally fast heart rate caused by dobutamine, would be best counteracted by metoprolol. Metoprolol would block the effects of dobutamine on the heart, helping to reduce the heart rate and bring it back to a normal level.

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  • 18. 

    A 35-year-old farmer was brought to the emergency room complaining of severe abdominal cramps, vomiting and excess salivation. His skin was flushed, warm, and moist to the touch. He stated that he was working in his field with an organophosphate pesticide. Which of the following molecular actions most likely mediated the flushed skin in this patient?

    • A.

      Increase in intracellular Ca ++

    • B.

      Increased cGMP synthesis

    • C.

      Opening of Na+ channels

    • D.

      Increased cAMP synthesis

    • E.

      Increased IP3/DAG synthesis

    Correct Answer
    B. Increased cGMP synthesis
    Explanation
    The correct answer is "Increased cGMP synthesis." Organophosphate pesticides inhibit acetylcholinesterase, leading to an accumulation of acetylcholine. Acetylcholine acts on muscarinic receptors, which are coupled to G proteins. Activation of these receptors leads to the activation of phospholipase C, which hydrolyzes phosphatidylinositol 4,5-bisphosphate (PIP2) into inositol trisphosphate (IP3) and diacylglycerol (DAG). IP3 then binds to receptors on the endoplasmic reticulum, causing the release of calcium ions (Ca++) into the cytoplasm. Increased cytoplasmic Ca++ activates nitric oxide synthase, leading to increased synthesis of cyclic guanosine monophosphate (cGMP). Increased cGMP levels cause vasodilation and flushing of the skin.

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  • 19. 

    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 the short half-life of gentamicin (about two hours)?

    • A.

      Time-dependent killing and bactericidal effect

    • B.

      Extensive plasma protein binding and bactericidal effect

    • C.

      Dose-dependent renal impairment and bacteriostatic effect

    • D.

      Concentration-dependent killing and long postantibiotic effect

    • E.

      Time-dependent killing and long postantibiotic effect

    Correct Answer
    D. Concentration-dependent killing and long postantibiotic effect
    Explanation
    The reason why gentamicin is usually administered once daily despite its short half-life is because it exhibits concentration-dependent killing and has a long postantibiotic effect. Concentration-dependent killing means that the effectiveness of the drug is dependent on achieving a certain concentration in the body. By administering a higher dose once daily, it allows for higher drug concentrations in the body, which is more effective in killing the bacteria. Additionally, gentamicin has a long postantibiotic effect, meaning that it continues to inhibit bacterial growth even after the drug has been cleared from the body. This further supports the rationale for once daily dosing.

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