Micro
Clostridium spp., Bacteroides Fragilis, Fusobacterium, Actinomyces Israelii are all obligate anerobic organisms, and lack the enzyme Superoxide Dismutase, which normally functions to break down harmful oxygen molecules in cells. The mutation of this enzyme is also known to be associated with which of the following?
a. Absent pus and delayed separation of the umbilical stump in children.
b. Absence of the thymic shadow due to failed differentiation of the 3rd and 4th pharyngeal pouches.
c. Port wine stain of V1 & V2, Leptomeningeal angiomas, and “Tram-track” pattern brain calcifications.
d. Degeneration resulting in both upper and lower motor neuron symptoms.
e. Subacute Combined Immunodeficiency.
Clostridium spp., Bacteroides Fragilis, Fusobacterium, Actinomyces Israelii are all obligate anerobic organisms, and lack the enzyme Superoxide Dismutase, which functions to break down harmful oxygen molecules in cells. The mutation of this enzyme is also known to cause which of the following?
a. Absent pus and delayed separation of the umbilical stump in children. LAD1. Mutated CD18 -> impaired phagocyte migration and chemotaxis.
b. Absence of the thymic shadow due to failed differentiation of the 3rd and 4th pharyngeal pouches. 22q11.
c. Port wine stain of V1 & V2, Leptomeningeal angiomas, and “Tram-track” pattern brain calcifications. SWS
d. Degeneration resulting in both upper and lower motor neuron symptoms. ALS; SOD1 mutation. Tx Riluzole.
e. Subacute Combined Immunodeficiency. IL-2R gamma chain, ADA, RAG mutations.
A patient presents to the office with a tearing pain in the back. BP is 80/40 and they feel faint. Fluid resuscitation is not working and they lose consciousness. You palpate a pulsating mass where the Chapman’s points of the adrenal glands and kidneys are located. Which of the following risk factors have the highest association with this patient’s diagnosis?
a. Hypertension
b. Male smoker
c. Bicuspid aorta
d. Female smoker
e. Marfan’s syndrome
f. Tertiary syphilis
A patient presents to the office with a tearing pain in the back. BP is 80/40 and they feel faint. Fluid resuscitation is not working and they lose consciousness. You palpate a pulsating mass where the Chapman’s points of the adrenal glands and kidneys are located. Which of the following risk factors have the highest association with this patient’s diagnosis?
a. Hypertension. #1 risk factor for TAA.
b. Male smoker. #1 risk factor for AAA.
c. Bicuspid aorta. Risk factor for TAA.
d. Female smoker. Male smoker has higher risk than female smoker for AAA.
e. Marfan’s syndrome. Risk factor for TAA
f. Tertiary syphilis. Risk factor for TAA.
35yo female with HLA-DR3 & HLA-B8 presents with weight loss, diffuse goiter, and pretibial myxedema. You determine that she has the #1 cause of hyperthyroidism. What are you likely going to see on histology of her thyroid?
a. Tall, crowded follicular epithelial cells with scalloped colloid.
b. Empty-appearing nuclei with central clearing, psammoma bodies, and nuclear grooves.
c. Sheets of polygonal cells in an amyloid stroma.
d. Lymphoid aggregates with germinal centers.
e. Thyroid replaced by fibrous tissue and inflammatory infiltrate.
35yo female with HLA-DR3 & HLA-B8 presents with progressive weight loss, goiter, and pretibial myxedema. What are you likely going to see on histology of her thyroid?
a. Tall, crowded follicular epithelial cells with scalloped colloid. Graves. Autoantibodies against TSH receptors.
b. Empty-appearing nuclei with central clearing, psammoma bodies, and nuclear grooves. Papillary thyroid carcinoma.
c. Sheets of polygonal cells in an amyloid stroma. Medullary thyroid carcinoma.
d. Lymphoid aggregates with germinal centers. Hashimoto Thyroiditis.
e. Thyroid replaced by fibrous tissue and inflammatory infiltrate. Riedel Thyroiditis.
This class of antiarrhythmics is clasically known to decrease phases 0, 3, and 4 of the myocardial action potential. Which medication listed is in this class?
a. Amiodarone
b. Propranolol
c. Propafenone
d. Mexiletine
e. Verapamil
This class of antiarrhythmics is clasically known to decrease phases 0, 3, and 4 of the myocardial action potential. Which medication listed is in this class?
a. Amiodarone
b. Propranolol. Class II, decerases slope of Phase 4, prolongs PRi.
c. Propafenone. Class IC, decreases slope of Phase 0, CI in CHF.
d. Mexiletine. Class IB, decreases slope of Phase 0, indicated in ischemic HF.
e. Verapamil. Class IV. AE includes constipation, flushing, edema, and Hyperprolactinemia.
Which of the following organisms is Obligate Intracellular?
a. Rickettsia
b. Salmonella
c. Listeria
d. Francisella
e. Mycobacterium
Which of the following organisms is Obligate Intracellular?
a. Rickettsia. All others listed are facultative intracellular
b. Salmonella
c. Listeria
d. Francisella
e. Mycobacterium
Kid comes into office with barking cough and inspiratory stridor. Which virulence factor for this virus promotes viral entry by binding onto sialic acid residues?
a. Neuraminidase
b. Hemagglutinin
c. Heparin Sulfate Integrins
d. P Antigens
e. CCR5
Kid comes into office with barking cough. Which virulence factor for this virus promotes viral entry by binding onto sialic acid residues?
a. Neuraminidase. Promotes progeny virion release of Parainfluenza.
b. Hemagglutinin. binds onto sialic acid residues.
c. Heparin Sulfate Integrins. Receptor used by CMV.
d. P Antigens. Receptor used by Parvo B19.
e. CCR5. Receptor on macrophages used by HIV.
Atherosclerosis is characterized by which of the following in the large and medium sized arteries?
a. Cholesterol plaques in the adventitia.
b. Cholesterol plaques in the tunica media.
c. Fibromuscular hyperplasia of the arterioles caused by fibrinoid necrosis.
d. Degeneration of the cystic media.
e. Cholesterol plaques in the tunica intima.
Atherosclerosis is characterized by which of the following?
a. Cholesterol plaques in the adventitia.
b. Cholesterol plaques in the tunica media.
c. Fibromuscular hyperplasia of the arterioles caused by fibrinoid necrosis. Hyperplastic Arteriolosclerosis.
d. Degeneration of the cystic media. Thoracic aortic aneurysm.
e. Cholesterol plaques in the tunica intima. Large and medium sized arteries -> hardening. Most common locations: A Copy cat named Willis. Lower Abdominal Aorta > Coronary Artery > Popliteal artery > Carotid artery > Circle of Willis.
Which genetic anomaly most likely caused "Orphan-Annie Eyes"?
a. RAS mutation
b. PAX8-PPAR-gamma translocation
c. Tp53 mutation
d. GNAS1 mutation
e. RET/PTC & BRAF mutation
f. MEN2
Kid presents to the office with the following thyroid histology. What genetic anomaly likely led to this?
a. RAS mutation. Follicular carcinoma. Histo: invasion into tumor capsule
b. PAX8-PPAR-gamma translocation. Also Follicular carcinoma.
c. Tp53 mutation. Anaplastic carcinoma.
d. GNAS1 mutation. Pseudohypoparathyroidism
e. RET/PTC & BRAF mutation. Papillary carcinoma. Orphan Annie. Children.
f. MEN2. RET, chromosome 10.
Patient has minor Latent TB and is started on the classic TB monotherapy regimen. Which of the following best describes this medication?
a. Catalase-Peroxidase enzyme confers resistance to this medication.
b. This medication is a CYP Inducer that may cause red-orange urine
c. This medication inhibits fatty caid synthase I and may cause gout and hyperuricemia.
e. This medication may cause optic neuritis and red-green color blindness.
Patient has minor Latent TB and is started on the classic TB monotherapy regimen. Which of the following best describes this medication?
a. Catalase-Peroxidase enzyme (KatG) confers resistance to this treatment. Isoniazid. Inhibits mycolic acid synthesis. Hepatotoxicity, sideroblastic anemia (depletes Vit B6). Relatively CI in alcoholics. Supplement with B6.
b. CYP Inducer that may cause red-orange urine. Rifampin, inhibits DNA-dependent RNA polymerase. Rifabutin: less effects on CYP.
c. Inhibits fatty caid synthase I and may cause gout and hyperuricemia. Pyrazinamide
e. May cause optic neuritis and red-green color blindness. Ethambutol: inhibit arabinosyl transferase.
Which of the following chemicals is a sterilizing agent?
a. Alcohol
b. Chlorhexidine
c. Ammonium and other quatenary amines
d. Hydrogen Peroxide
Which of the following chemicals is a sterilizing agent?
a. Alcohol
b. Chlorhexidine
c. Ammonium and other quatenary amines.
d. Hydrogen Peroxide. Also autoclaving, iodine, and chlorine. Everything else is a disinfectant.
Your patient has the #1 cause of lobar pneumonia. Which of the following microbial characteristics would you observe?
a. Failure of growth in the presence of bile salts.
b. Produces dextrans from sucrose substrate, allowing adherence to tooth enamel.
c. Grows in hypertonic saline.
d. Complete hemolysis of hemoglobin
e. Requires oxygen to sporulate.
f. Growth in the presence of bile salts.
Your patient has the #1 cause of lobar pneumonia. Which of the following microbial characteristics would you observe?
a. Failure of growth in the presence of bile salts. S. Pneumo is bile soluble (no hydroxylation of esculin).
b. Produces dextrans from sucrose substrate, allowing adherence to tooth enamel. Viridans
c. Grows in hypertonic saline. Enterococcus.
d. Complete hemolysis of hemoglobin. Beta-hemolysis (Staph Aureus, Strep Agalactiae)
e. Requires oxygen to sporulate. B. Anthracis
f. Growth in the presence of bile salts. S. Viridans
A patient has muffled heart sounds, hypotension, and JVD. Further evaluation shows a pulse that is undetectable on inspiration. What changes will you likely see on JVP tracing?
a. Absent a wave
b. Absent x descent
c. Prominent y wave
d. Absent y wave
A patient has muffled heart sounds, hypotension, and JVD. Further evaluation shows a pulse that is undetectable on inspiration. What changes will you likely see on JVP tracing?
a. Absent a wave. AFib.
b. Absent x descent. Tricuspid regurgitation.
c. Prominent y wave. Constrictive pericarditis.
d. Absent y wave. Cardiac tamponade.
A patient with Type II DM is started on a medication, then they later develop an nasopharyngitis and a sinus infection. Which medication were they likely started on?
a. Proglitazone
b. Glipizide
c. Enexatide
d. Linagliptin
e. Canagliflozin
f. Acarbose
A patient with Type II DM is started on a medication, then they later develop an upper respiratory tract infection. Which medication were they likely started on?
a. Proglitazone. PPAR-y. Weight gain, edema, HF, Fractures.
b. Glipizide. Sulfonylureas. Hypoglycemia.
c. Enexatide. GLP-1 analog. N&V, Pancreatitis.
d. Linagliptin. DPP IV Inhibitors.
e. Canagliflozin. SGLT-2 Inhibitors. UTI, candidiasis.
f. Acarbose. Inhibit intestinal brush border. AE: GI upset, bloating.
Patient went on a 1 month vacation through Africa, India, and Southwest Asia and then a few weeks later developed dark spots, a spiking fever, pancytopenia, and hepatosplenomegaly. The vector was determined to be sandflys. What’s your treatment?
a. Fluconazole / Metronidazole
b. Suramin / Melarsoprol
c. Pentamidine / Nifurtimox-Eflornithine Combination Therapy (NECT)
d. Stibogluconate / Milteforsine / Amphotericin B
e. Ivermectin
f. Pyrantel Pamoate
Patient went on a 1 month vacation through Africa, India, and Southwest Asia and then a few weeks latere developed dark spots, a spiking fever, pancytopenia, and hepatosplenomegaly. The vector was determined to be sandflys. What’s your treatment?
a. Fluconazole / Metronidazole. Cutaneous Leshmaniasis; L. Braziliensis.
b. Suramin / Melarsoprol. T. Brucei Gambiense. Slowly progressing sleeping sickness.
c. Pentamidine / Nifurtimox-Eflornithine Combination Therapy (NECT). T. Brucei Rhodesiense. Rapidly progressing sleeping sickness.
d. Stibogluconate / Milteforsine / Amphotericin B. Visceral Leshmaniasis; L. Donovani. Kala-azar
e. Ivermectin
f. Pyrantel Pamoate
A patient has Multifocal Atrial Tachycardia. Which of the following is classically associated with this diagnosis?
a. Arrhythmogenic activity from the pulmonary vein ostia
b. Reentry circuit around the Cavotricuspid isthmus.
c. COPD that results in CHF.
d. Reentry circuit around the AV node.
e. Autosomal dominant mutation causing loss of function of Na+ channels.
A patient has the following ECG. Which pathology is most commonly associated with this diagnosis?
a. Arrhythmogenic activity from the pulmonary vein ostia. AF. No P waves.
b. Reentry circuit around the Cavotricuspid isthmus. A Flutter. Sawtooth.
c. COPD that results in CHF. MAT classic association. 3+ distinct P waves due to multiple ectopic foci in atria.
d. Reentry circuit around the AV node. SVT; AVNRT. Short PRi, wide QRS.
e. Autosomal dominant mutation causing loss of function of Na+ channels.
During the summer, a patient presents with progressivly worsening, chronic arthralgias of the hand, worsening arthritis, and a maculopapular rash. Neuroimaging of the brain is unremarkable. Which virus is most known the cause?
a. Eastern Equine Encephalitis Virus
b. Western Equine Encephalitis Virus
c. Dengue Fever
d. Yellow Fever
e. West Nile Virus
f. Chikungunya Virus
g. Zika Virus
During the summer, a patient presents with progressivly worsening, chronic arthralgias of the hand, worsening arthritis, and a maculopapular rash. Neuroimaging of the brain is unremarkable. Which virus is most known the cause?
a. Eastern Equine Encephalitis Virus: Encephalitis, meningitis in the summertime.
b. Western Equine Encephalitis Virus: infants with severe encephalitis
c. Dengue Fever: bone marrow suppression -> thrombocytopenia, hemorrhagic fever, sepsis.
d. Yellow Fever: muscle pain, jaundice, thrombocytopenia.
e. West Nile Virus: Aseptic meningitis, asymmetric flaccid paralysis, tremor, parkinsonian features.
f. Chikungunya Virus: Distorted joints, chronic arthrlagias, maculopapular rash.
g. Zika Virus: vertical/sexual transmission -> Microcephaly, deficient brain tissue in the newborn.
You notice a "pan-systolic pan-diastolic" continuous murmur in a neonate. Which of the following structures are derived from the same anatomic structure that is causing this patient’s murmur?
a. Neural Crest Cells
b. Pulmonary a.
c. Septum primum & secundum fusion
c. Subclavian a.
d. Stapedial a.
e. Maxillary a.
You notice a pan-systolic pan-diastolic murmur in a neonate. Which of the following structures are derived from the same anatomic structure that is causing this patient’s murmur?
a. Neural Crest Cells
b. Pulmonary a. 6th aortic arch derivative forms pulmonary arteries & Ductus arteriosus. Patent Ductus Arteriosus -> machine like murmur aka a continuous pan-systolic pan-diastolic murmur.
c. Septum primum & secundum fusion
c. Subclavian a.
d. Stapedial a.
e. Maxillary a.
A 9yo boy comes into the office with Tanner Stage 5 development. Vitals: HR 88, RR 14, BP 166/92. Subsequent lab-work shows markedly increased serum androstenedione. It is determined that the underlying issue is due to the adrenal cortex. Which of the following serum values are most representative of the underlying pathology?
a. Hypokalemia, high aldosterone, low cortisol.
b. Hyperkalemia, low aldosterone, low cortisol.
c. Hypokalemia, low aldosterone, low cortisol.
d. Hypokalemia, low aldosterone, normal cortisol.
e. Hyperkalemia, low aldosterone, normal cortisol.
A 9yo boy comes into the office with Tanner Stage 5 development. Vitals: HR 88, RR 14, BP 166/92. Subsequent lab-work shows markedly increased serum androstenedione. It is determined that the underlying issue is due to the adrenal cortex. Which of the following serum values are most representative of the underlying pathology?
a. Hypokalemia, high aldosterone, low cortisol.
b. Hyperkalemia, low aldosterone, low cortisol. 21-Hydroxylase deficiency. No buildup of 11-deoxycortisterone -> no mimicking of aldosterone. Therefore these patients classically present as Precocious puberty + Hypotension.
c. Hypokalemia, low aldosterone, low cortisol. 11B-Hydroxylase deficiency has severe HTN due to buildup of 11-deoxycortisterone, mimics the effects of aldosterone -> Hypokalemia and increased BP. These patients classically present as Precocious puberty + severe HTN.
d. Hypokalemia, low aldosterone, normal cortisol.
e. Hyperkalemia, low aldosterone, normal cortisol.
Which medication is most likely to cause TdP?
a. Lidocaine
b. Flecainimide
c. Carvedilol
d. Sotalol
e. Propafenone
Which medication is most likely the causal agent of this patient’s ECG?
a. Lidocaine
b. Flecainimide
c. Carvedilol. Class II.
d. Sotalol. Class III -> tdP. Antiarrhythmics 1a and III.
e. Propafenone
2yr boy brought in, mom says he “turns blue” whenever he cries and eats. You listen to the upper left sternal border and observe a soft systolic component. XR shows right ventricular hypertrophy. What is the most likely pathogenesis of this congenital heart disease?
a. Aorticopulmonary septum failing to form.
b. Aorticopulmonary septum failing to spiral, resulting in parallel pulmonary and systemic circuits.
c. Anterosuperior displacement of the infundibular septum.
d. A pulmonary vein draining into the right heart, as well as an atrial septal defect.
e. Ostium secundum and primum fail to fuse.
2yr boy brought in, mom says he “turns blue” whenever he cries and eats. You listen to the upper left sternal border and observe a soft systolic component. XR shows right ventricular hypertrophy. What is the most likely pathogenesis of this congenital heart disease?
a. Aorticopulmonary septum failing to form. Truncus Arteriosus. One large trunk, commonly accompanied with VSD.
b. Aorticopulmonary septum fails to spiral. Transposition of Great Arteries. Narrowed mediastinal shadow, Eggs-on-a-string XR, parallel pulmonary and systemic circuits.
c. Anterosuperior displacement of the infundibular septum. TOF: Overriding aorta -> pulmonary stenosis -> RV Hypertrophy (Boot shaped heart). Tet spells caused by crying/fever/feeding, relieved by squatting (increasing SVR).
d. A pulmonary vein draining into the right heart, as well as an atrial septal defect.
e. Ostium secundum and primum fail to fuse. ASD. A L->R shunt; doesn’t present with congenital cyanosis (only in Eisenmenger; shunt reversal).
College kid has nuchal rigidity, (+) Brudzinski & (+) Kernig sign. Patient is started on Ceftriazxone, while his roommates were started on Rifampin. Which of the following virulence factors produced by this microbe allows for nasopharngeal colonization?
a. Capsular Polysaccharide
b. IgA Protease
c. Lipooligosaccharide
d. Factor H
College kid has nuchal rigidity, (+) Brudzinski & (+) Kernig sign. Patient is started on Ceftriazxone, while his roommates were started on Rifampin. Which of the following virulence factors produced by this microbe allows for nasopharngeal colonization?
a. Capsular Polysaccharide: resists phagocytosis and complement activation. Type B: poor immunogenicity.
b. IgA Protease: mediates nasopharyngeal epithelial colonization (contains type IV Pili; responsible for attachment to nasopharyngeal mucosa; epithelial cells).
c. Lipo-oligosaccharide (LOS): causes disease severity; severe DIC & Hemorrhagic necrosis.
d. Factor H: cofactor for Factor I; cleaves C3b -> prevents opsonization of microbe
A male got into a severe MVC and now presents in the ED with a tearing sensation. BP Is 80/40, and XR shows a widened mediastinum. Where is the most likely location resulting in this patient’s drop in BP?
a. Ascending thoracic aorta
b. Proximal descending aorta just distal to the left subclavian vein
d. Descending aorta just proximal to the aortic hiatus
e. Descending aorta distal to the aortic hiatus
A male got into a severe MVC and now presents in the ED with a tearing sensation. BP Is 80/40, and XR shows a widened mediastinum. Where is the most likely location resulting in this patient’s drop in BP?
a. Ascending thoracic aorta
b. Proximal descending aorta just distal to the left subclavian vein. Aortic Isthmus. Dx Traumatic Aortic rupture.
d. Descending aorta just proximal to the aortic hiatus
e. Descending aorta distal to the aortic hiatus
Your patient at 40 weeks is being induced for labor. Which of the following chemicals acts using a similar signaling pathway (cAMP, cGMP, IP3, RTK, JAK/STAT) as the medication about to be used?
a. Insulin
b. Prolactin
c. BNP
d. Histamine (H1R)
e. Histamine (H2R)
f. TSH
g. Glucagon
Your patient at 40 weeks is being induced for labor. Which of the following chemicals acts using a similar signaling pathway (cAMP, cGMP, IP3, RTK, JAK/STAT) as the medication about to be used?
a. Insulin
b. Prolactin
c. BNP
d. Histamine (H1R). IP3: GOAT HAG. GnRH Oxytocin ADH (V1R) TRH Histamine (H1R) ATII Gastrin
e. Histamine (H2R). cAMP: FLAT ChAMPs CHuGG: FSH LH ACTH TSH CRH hCG ADH (V2R) MSH PTH Calcitonin Histamine (H2R) Glucagon GHRH
f. TSH
g. Glucagon
Patient with the Tuberculoid form of leprosy starts the drug-of-choice treatment. Which of the following best describes this medication?
a. Binds to DNA, inhibiting template function and may cause brownish-blue skin discoloration.
b. A CYP inhibitor that may cause QT prolongation and GI upset.
c. Inhibits folic acid synthesis and cause hemolysis in patients that lack reduced glutathione.
d. A medication that only works in aerobic conditions and inhibiting the 30s ribosomal subunit.
Patient with the Tuberculoid form of leprosy starts the drug-of-choice treatment. Which of the following best describes this medication?
a. Binds to DNA, inhibiting template function and may cause brownish-blue skin discoloration. Clofazimine. For Lepromatous Leprosy. MOA: inhibits DNA template function. AE: Brownish-blue skin discoloration.
b. A CYP inhibitor that may cause QT prolongation and GI upset. Macrolides (Azithromycin). For Mycobacterium Avium Complex.
c. Inhibits folic acid synthesis and cause hemolysis in patients that lack reduced glutathione. Dapsone. For Tuberculoid leprosy. Mechanism: inhibits folic acid synthesis. AE: Hemolysis in G6PD, Cyanosis, Methemoglobinemia.
d. A medication that only works in aerobic conditions and inhibiting the 30s ribosomal subunit. Aminoglycosides
20yo male comes in with tender inguinal lymphadenopathy. On exam you also notice multiple lesions on the thigh. Histology shows “railroad tracks” and “School of fish”. What’s your first-line treatment?
a. TMP-SMX
b. Metronidazole
c. Azithromycin
d. Fluconazole
e. Doxycycline + Ceftriaxone
20yo female comes in with tender inguinal lymphadenopathy. On exam you also notice multiple lesions on the thigh. Histology shows “railroad tracks” and “School of fish”. What’s your first-line treatment?
a. TMP-SMX
b. Metronidazole
c. Azithromycin. 1st line Tx for Chancroid (H. Ducreyi). 2nd Line: Cephalosporin, Ciprofloxacin/Erythromycin
d. Fluconazole
e. Doxycycline + Ceftriaxone