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The most common cause of a massive hematemesis in alcoholics is
acute hemorrhagic pancreatitis.
esophageal varices, are extremely dilated submucosal veins in the lower third of the esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding.
Removal of the capsule from an encapsulated bacterium is likely to result in:
1. loss of viability.
2. decreased generation time.
3. failure of the cell to gram stain.
4. increased susceptibility to mutation.
5. increased susceptibility to phagocytosis.
- increased susceptibility to phagocytosis
- The capsule—which can be found in both Gram-negative bacteria and Gram-positive bacteria, should not be confused with the second lipid membrane (or bacterial outer membrane), which contains lipopolysaccharides and lipoproteins and is found only in Gram-negative bacteria.
- The capsule can protect cells from engulfment by eukaryotic cells, such as macrophages
The major factor in the production of inflammatory edema is
1. venous obstruction.
2. arterial dilatation.
3. generalized kidney damage.
4. increased capillary permeability.
- increased capillary permeability.
- At the onset of an infection, burn, or other injuries, these cells undergo activation (one of their PRRs recognize a PAMP) and release inflammatory mediators responsible for the clinical signs of inflammation. Vasodilation and its resulting increased blood flow causes the redness (rubor) and increased heat (calor). Increased permeability of the blood vessels results in an exudation (leakage) of plasma proteins and fluid into the tissue (edema), which manifests itself as swelling (tumor).
Left-sided heart failure or shock may be associated with
3. pulmonary edema.
4. pulmonary emboli.
- pulmonary edema
- Can be cardiogenic or non-cardiogenic
- Left ventricular failure may be due to a heart attack leading to arrhythmias (tachycardia/fast heartbeat or bradycardia/slow heartbeat) and fluid overload, e.g., from kidney failure or intravenous therapy which may cause dilatation and failure of the left ventricle or may cause pulmonary edema in the absence of heart failure.
Which of the following diseases is characterized by painful vesicles that occur on the skin or a mucosal surface along the distribution of a sensory nerve?
3. Cat-scratch fever
4. Recurrent varicella
5. Infectious mononucleosis
- Recurrent varicella (herpes zoster)
- REMEMBER: the virus will always remain in the ganglia
- REMEMBER: Smallpox (variola)
The renal lesion most commonly associated with benign hypertension is
1. renal atresia.
2. acute pyelonephritis.
3. chronic pyelonephritis.
- arteriolonephrosclerosis (from the name)
- Sclerosis - hardening of a tissue
The most likely diagnosis for a patient with dysphonia, dysphagia, weight loss and a history of heavy cigarette smoking is:
carcinoma of the lungs.
carcinoma of the larynx.
- carcinoma of the larynx
- REMEMBER: the smoking indicates cancer
- REMEMBER: dysphonia and dysphagia can indicate that there is s problem in the throat.
A benign neoplasm of the myometrium of the uterus is a:
leiomyoma is a benign smooth muscle neoplasm that is very rarely premalignant. They can occur in any organ, but the most common forms occur in the uterus, small bowel and the esophagus.
The primary function of SlgA is to:
1. promote phagocytosis by monocytes.
2. prevent ingress of antigen through mucosa.
3. activate complement in secretory fluids
4. activate K/NK cells in the gingival crevice
- prevent ingress of antigen through mucosa.
- SigA (is igA) is an antibody that plays a critical role in mucosal immunity. More IgA is produced in mucosal linings than all other types of antibody combined (even through breastmilk).
- It is a poor activator of the complement system.
The principal antibacterial action of the tetracyclines is inhibition of:
- DNA synthesis
- protein synthesis
- histone formation
- cell wall synthesis
- cell membrane function
- protein synthesis
- tetracyclines is a broad spectrum polyketide antibiotic produced by the Streptomyces genus of Actinobacteria, indicated for use against many bacterial infections. It is a protein synthesis inhibitor. It is commonly used to treat acne today, and, more recently, rosacea, and is historically important in reducing the number of deaths from cholera.
- Stain developing teeth (even when taken by the mother during pregnancy) and Discolor permanent teeth (yellow-gray-brown), from infancy and childhood to eight years old.
The class of antibodies first detected in serum after primary immunization is usually
- REMEMBER: MADGE (is the order)
- REMEMBER: GAMED: is the size
Production of bone in scar tissue occurs by:
- Anaplasia: (structural differentiation loss within cell or group of cells)
- Aplasia: (organ or part of organ missing)
- Hypoplasia: (congenital below-average number of cells, especially when inadequate)
- Hyperplasia: (proliferation of cells)
- Neoplasia: (abnormal proliferation)
- Dysplasia: (change in cell or tissue phenotype)
- Metaplasia: (conversion in cell type)
- Prosoplasia: (development of new cell function)
- Desmoplasia: (connective tissue growth)
- Atrophy: (reduced functionality of an organ, with decrease in the number or volume of cells)
- Hypertrophy: (increase in the volume of cells)
Which of the following diseases is characterized by an extremely high level of alkaline phosphatase, normal levels of calcium and phosphorus, enlargement of the skull, and an increased incidence of osteogenic sarcoma?
Paget's disease of bone
Paget's disease of bones is a chronic disorder that can result in enlarged and mis-shapen bones. Paget's is caused by the excessive breakdown and formation of bone, followed by disorganized bone remodelling. This causes affected bone to weaken, resulting in pain, misshapen bones, fractures and arthritis in the joints near the affected bones. Rarely forms Paget's sarcoma and is localized to some bones.
A very high percentage of cases of hepatitis A are found in:
1. young people
2. recent recipients of gamma globulin
3. recent recipients of blood transfusions
4. persons with histories of recurrent respiratory infections
- young people
- Hepatitis A is caused by consumption of food or water infected with feces.
- It often occurs in outbreaks in moderately developed countries where children are not exposed when young and there is not widespread vaccination.
The etiologic basis of Hashimoto's thyroiditis is:
2. bacterial infection.
3. hereditary enzyme deficiency.
4. premalignant diffuse hyperplasia.
5. secondary to hyperpituitarism.
- Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an autoimmune disease in which the thyroid gland is attacked by a variety of cell- and antibody-mediated immune processes. It was the first disease to be recognized as an autoimmune disease.
Long-standing gradual ischemia of an organ or a tissue most likely results in:
A disease caused by the interaction of antigen and IgE on the surface of mast cells with release of histamine is:
- bronchial asthma
- REMEMBER: IgE (allergy), mast cells (histamine)
- Asthma: chronic inflammatory disease of the airways
Which of the following identifies the cell that produces interleukin-1 and the cell affected by interleukin-l, respectively?
1. T cell-B cell
2. Macrophage-T cell
4. Dendritic cell-B lymphocyte
- Macrophage-T cell
- Interleukins are a group of cytokines (secreted proteins and signaling molecules) that were first seen to be expressed by white blood cells (leukocytes). The function of the immune system depends in a large part on interleukins, and rare deficiencies of a number of them have been described, all featuring autoimmune diseases or immune deficiency.
- The majority of interleukins are synthesized by helper CD4 T lymphocytes, as well as through monocytes, macrophages, and endothelial cells. They promote the development and differentiation of T and B lymphocytes, and hematopoietic cells.
Patients with Bruton's agammaglobulinemia
principally suffer from infections caused by
4. pyogenic bacteria.
5. tubercle bacilli.
- pyogenic bacteria.
- is a rare X-linked genetic disorder, that affects the body's ability to fight infection. XLA is an X-linked disorder, and therefore is much more common in males. XLA patients do not generate mature B cells, which manifests as a complete lack of antibodies in their bloodstream.
Which of the following is diagnosed by karyotyping?
Sickle cell anemia
- Turner's syndrome
- Karyotyping is the number and appearance of chromosomes in the nucleus of a eukaryotic cell. The term is also used for the complete set of chromosomes in a species, or an individual organism
- Abnormalities in chromosome number usually cause a defect in development. Down syndrome and Turner syndrome are examples of this.
Neoplasms of which of the following organs
have been shown to be hormonally
- The prostate glands require male hormones, known as androgens, to work properly. Androgens include testosterone, which is made in the testes; dehydroepiandrosterone, made in the adrenal glands; and dihydrotestosterone, which is converted from testosterone within the prostate itself.
Chronic passive congestion of the lung is characterized by:
1. hyaline membranes.
2. chronic bronchitis.
3. giant cell arteritis.
4. interstitial infiltration of PMN's
5. edema of alveolar walls and "heart
- Edema of alveolar walls and "heart failure" cells.
- Hyperemia: represents the increase of blood in a territory, due to dilatation of small vessels. According to the mechanism, it may be active or passive.
- Active hyperemia: is a result of arteriolar distension (e.g., skeletal muscle activity, inflammation, local neuro-vegetative reaction).
- Passive hyperemia: also termed stasis, is a consequence of an impaired venous drainage (heart failure, compression or obstruction of veins), followed by dilatation of venules and capillaries.
Use of vaccines for preventing clinical symptoms after introduction of the virus is most likely to be effective against
4. herpes zoster.
- In those who have been exposed to rabies, rabies vaccine and sometimes rabies immunoglobulinare effective in preventing disease if given before the start of symptoms
Which of the following is characterized by a collapse of alveoli?
- Atelectasis is a complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. It is one of the most common breathing (respiratory) complications after surgery.
- Atelectasis is also a possible complication of other respiratory problems, including cystic fibrosis, inhaled foreign objects, lung tumors, fluid in the lung, severe asthma and chest injuries.
An oral lesion that may appear as an ulcer, a nodule or a vegetative process and is often mistaken for squamous cell carcinoma is a manifestation of:
- Histoplasmosis (a disease caused by the fungus Histoplasma capsulatum) is common among AIDS patients because of their suppressed immunity. In immunocompetent individuals, past infection results in partial protection against ill effects if reinfected.
- In the majority of immunocompetent individuals, histoplasmosis resolves without any treatment. Antifungal medications are used to treat severe cases.
Which of the following is the most common
initial sign or symptom in patients with
2. Weight loss
4. Chronic infection
5. Unexplained fever
Lymphadenopathy refers to lymph nodes which are abnormal in size, number or consistency and is often used as a synonym for swollen or enlarged lymph nodes. Common causes of lymphadenopathy are infection, autoimmune disease, or malignancy.
Which of the following bacteria has the
highest lipid content in the cell wall?
Mycobacterium tuberculosis has an unusual, waxy coating on its cell surface (primarily due to the presence of mycolic acid), which makes the cells impervious to Gram staining.
A complication of peptic ulcer disease that accounts for the majority of deaths is
3. surgical complication
4. malignant transformation
5. obstruction from edema or scarring
- Perforation and penetration are when the ulcer continues into adjacent organs such as the liver and pancreas.
- Perforation (a hole in the wall of the gastrointestinal tract) often leads to catastrophic consequences if left untreated. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity
Which of the following organs is the most
uncommon site for infarcts?
- Infarcts are uncommon because the liver has two blood supplies-portal venous system and hepatic arterial system.
Ten days after hospitalization for a large
incapacitating myocardial infarct, a 50-year-old man suddenly develops paralysis of the right side of his body. The best explanation for his brain damage is :
- rupture of a congenital aneurysm of the circle of willis
- brain abscess from necrosis of the myocardium.
- detachment of a bacterial embolus from the pulmonic valve.
- detachment of a mural thrombus from the right ventricle.
- detachment of a mural thrombus from the left ventricle.
- detachment of a mural thrombus from the left ventricle. OPPOSITE SIDE
- Mural thrombi are thrombi that adhere to the wall of a blood vessel. They occur in large vessels such as heart andaorta, and can restrict blood flow but usually do not block it entirely
Features of the herpes simplex virus type 1 virion surface include:
- no envelope.
- an envelope synthesized de novo.
- an envelope acquired by budding through the cytoplasmic membrane.
- an envelope acquired by budding through the nuclear membrane.
- none of the above.
an envelope acquired by budding through the nuclear membrane.
Hemorrhagic infarction and necrosis are characteristic of which of the following fungal diseases?
Mucormycosis (Phycomycosis): is a disease often characterized by hyphae growing in and around vessels. REMEMBER - INFARCTION
Detergents kill bacteria by interfering with
the function of the cell:
An Rh-negative mother delivered a normal first child. Her second child developed symptoms of erythroblastosis fetalis. Which of the following can be concluded?
1. The father is Rh-negative.
2. the first baby is Rh-negative
3. The first baby is girl, the second baby is a boy
4. The mother has very high levels of serum complement and anti-Rh IgE.
5. None of the above
- None of the above
- Erythroblastosis fetalis is an alloimmune condition that develops in a fetus, when the IgG molecules produced by the mother pass through the placenta. Among these antibodies are some which attack the red blood cells in the fetal circulation; the red blood cells are broken down and the fetus can develop reticulocytosis and anemia.
- This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood and so these forms of the disease can be called erythroblastosis fetalis
A summer illness that produces vesicular
lesions of the uvula, anterior pillars and the
posterior pharynx is:
Coxsackievirus is a virus that belongs to a family of non-enveloped, linear, positive-sense ssRNA viruses, Picornaviridae and the genus Enterovirus, which also includes poliovirus and echovirus.
Bacterial endotoxin exerts its pathologic effect, in part, by
1. stimulating production of IgA.
2. activating the complement cascade.
3. inactivating nonspecific lymphokines.
4. releasing transfer factor from B lymphocytes
5. releasing vasoactive lipopolysaccharides
from mast cells.
activating the complement cascade.
The host response to a malignancy is best reflected by:
- marked cellularity of the tumor.
- many mitotic figures in the tumor.
- lymphocytic infiltration at the edge of the neoplasm.
- a large number of blood vessels in the
- large areas of necrosis in the center of the neoplastic mass
- lymphocytic infiltration at the edge of the neoplasm.
- REMEMBER: if the neoplasm reaches the lymph, it will bring trouble!
Which of the following is most commonly associated with development of gastrointestinal cancer?
Duodenal peptic ulcer
Villous adenoma is a type of polyp that grows in the colon and other places in the gastrointestinal tract and sometimes in other parts of the body. These adenomas may become malignant (cancerous).
Which of the following characteristics of
enterobacteria is most important in hospital
High degree of invasiveness
Ability to become resistant to antibiotics
Production of enzymes destructive to
Ability to survive drying due to spore
- Ability to become resistant to antibiotics
- REMEMBER: MRSA (STAPH A., involved in food poisoning and develops a resistance against antibiotics)
In organisms sensitive to penicillin, this
antibiotic shows the greatest bactericidal
growing gram-negative bacteria.
growing gram-positive bacteria.
non-growing gram-negative bacteria.
non-growing gram-positive bacteria.
sporulating gram-negative bacteria.
- growing gram-positive bacteria
- All penicillins are β-lactam antibiotics and are used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms.
- Gram-positive bacteria are called protoplasts when they lose their cell walls.
- Gram-negative bacteria do not lose their cell walls completely and are called spheroplasts after treatment with penicillin.
Myasthenia gravis is caused by dysfunction of the
Myasthenia gravis is an either autoimmune or congenital neuromuscular disease that leads to fluctuating muscle weakness and fatigue. In the most common cases, muscle weakness is caused by circulating antibodies that block acetylcholine receptors at the postsynaptic neuromuscular (myoneural) junction, inhibiting the excitatory effects of the neurotransmitter acetylcholine on nicotinic receptors at neuromuscular junctions.
Which antibody type is resistant to hydrolysis
by microbial proteolytic enzymes?
- SlgA (Secretory IgA)
- The secretory component of sIgA protects the immunoglobulin from being degraded by proteolytic enzymes, thus sIgA can survive in the harsh gastrointestinal tract environment and provide protection against microbes that multiply in body secretions
Which of the following are rarely, if ever,
acquired from another individual?
- All but Neonatal candidiasis
- Blastomycosis: is an infection caused by breathing in the Blastomyces dermatitidis fungus. The fungus is found in wood and soil.
- Sporotrichosis: caused by the infection of the fungus Sporothrix schenckii, usually affects the skin, Because roses and soil can spread the disease, it is one of a few diseases referred to as rose-thorn disease.
- Histoplasmosis: found in soil and bird droppings usually affects immunocompromised patients.
Granulation tissue typically contains:
- fibroblasts and endothelial cells.
- GRANULOMA: contains fibroblasts, epithelioid cells, multinucleated giant cells (langhans) and inflammatory cells.
Significant functions of polymorphonuclear
leukocytes in inflammation are
replication of new cells.
phagocytosis of bacteria.
elaboration of antibodies.
elaboration of proteolytic enzymes.
- phagocytosis of bacteria and elaboration of proteolytic enzymes
- Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm.
Invasive staphylococcal infections of orofacial
structures are likely to result in
(a) brain abscess.
(c) cavernous sinus thrombosis.
(d) localized tissue abscesses.
ALL OF THE ABOVE
Which of the following diseases are commonly associated with pathogenic staphylococci ?
- Impetigo and Food poisoning
- REMEMBER: STAPH A. can cause food poisoning
- Impetigo: one of the most common skin infections among kids, usually produces blisters or sores on the face, neck, hands, and diaper area.This contagious superficial skin infection is generally caused by one of two bacteria: Staphylococcus aureus or Streptococcus pyogenes (also called group A streptococcus, which also causes strep throat). Methicillin-resistant Staphylococcus aureus (MRSA) is also becoming an important cause of impetigo.
Which of the following blood diseases are
red cell disorders?
- ALL OF THE ABOVE
- Spherocytosis: is an auto-hemolytic anemia (a disease of the blood) characterized by the production of red blood cells (RBCs), or erythrocytes, that are sphere-shaped, rather than bi-concave disk shaped.
Basal cell carcinoma and squamous cell
carcinoma are similar in that both
(a) are invasive.
(b) readily metastasize.
(c) exhibit mitotic figures.
(d) are cured by early excision.
(e) commonly occur in the oral cavity.
- are invasive
- exhibit mitotic figures.
- are cured by early excision.
The secondary stage of syphilis may be manifested in which of the following forms?
(a) Hard chancre
(b) Soft chancre
(c) Maculopapular rash
(d) Extensive CNS involvement
(e) Mucous patches in the oral cavity
Maculopapular rash and Mucous patches in the oral cavity
Ascites, which is often a complication of
alcoholic liver disease, develops as a result of:
(b) esophageal varices.
(c) portal hypertension.
(d) decreased protein production by the liver.
- - cirrhosis- portal hypertension- decreased protein production by the liver.
- Ascites is a gastroenterological term for an accumulation of fluid in the peritoneal cavity. Although most commonly due to cirrhosis, severe liver disease or metastatic cancer, its presence can portend other significant medical problems,
Cells of which of the following retain a latent capacity for mitotic division?
(b) Bone marrow
(c) Cardiac muscle
(d) Salivary glands
Liver, Bone marrow and Salivary glands
In healing of a fracture, which of the following will prevent favorable reconstruction and alignment of bone?
(a) Formation of pseudoarthrosis
(b) Functional remodeling of the procallus by osteoblasts and osteoclasts
(c) Formation of new bone at the site of fracture
(d) Presence of sequestrum
(e) Organization of a hematoma at the site of fracture
- - Formation of pseudoarthrosis and Presence of sequestrum
- - Sequestrum is a piece of dead bone that has become separated during the process of necrosis from normal or sound bone.
Abnormalities in cell growth that cause cells, tissues or organs to be smaller than normal include
atrophy and hypoplasia
Right-sided heart failure affects the kidneys by
(a) renal hypoxia
(b) venous congestion.
(c) retention of H2O and NaCI.
(d) decreased glomerular filtration rate.
All of the above
A soft tissue infection rather diffusely spread along the mandible and into the floor of the mouth would likely involve which of the following organisms?
(a) Eikenella corrodens
(b) Staphylococcus aureus
(c) Streptococcus pyogenes
(d) Peptostreptococcus anaerobius
All of the above
Bacteria of which of the following genera have a limited range of habitats in the oral cavity?
Treponema and Bacteroides
Which of the following will NOT promote fluid retention in the interstitial compartment?
- Lymphatic obstruction
- Increased capillary permeability
- Decreased osmotic pressure of the blood
- Increased hydrostatic pressure of the blood
- Decreased osmotic pressure of the interstitial fluid
Decreased osmotic pressure of the interstitial fluid
Each of the following may be seen in multiple myeloma EXCEPT
2. plasma cell neoplasia.
4. light-chain proteinuria.
5. punched-out areas of bone.
hypoproteinemia is a condition where there is an abnormally low level of protein in the blood. There are several causes and all result in edema once serum protein levels fall below a certain threshold.
Which of the following is NOT a feature of infectious mononucleosis?
2. Necrotizing pharyngitis
3. Depressed heterophile titer
4. Abnormal lymphocytes in peripheral blood
5. Marked increase in the number of circulating lymphocytes
Depressed heterophile titer is a rapid test for infectious mononucleosis due to Epstein–Barr virus (EBV). It is an improvement on the Paul-Bunnell test.
A primary tumor of which of the following organs is least likely to give rise to skeletal metastasis?
Which of the following is NOT mediated by immunoglobulins?
Contact dermatitis is a localized rash or irritation of the skin caused by contact with a foreign substance (nickel, gold, poison ivy). Only the superficial regions of the skin are affected in contact dermatitis. Inflammation of the affected tissue is present in the epidermis (the outermost layer of skin) and the outer dermis (the layer beneath the epidermis). Contact dermatitis results in large, burning, and itchy rashes.
A patient with which of the following diseases is least likely to show "clubbing" of fingers and cyanotic nail beds?
2. Congenital heart disease
3. Chronic pulmonary disease
4. Congestive heart failure
5. Systemic lupus erythematosus
Systemic lupus erythematosus is a disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage. It is both a type II and a type III hypersensitivity reaction in which bound antibody-antigen pairs (immune complexes) precipitate and cause a further immune response.