OptoPrep Systemic Flashcards
Of the four major variants of leukemia, which type typically presents in children and has the BEST prognosis following proper treatment? A. Chronic lymphocytic leukemia B. Acute myelocytic leukemia C. Chronic myelocytic leukemia D. Acute lymphocytic leukemia
Answer: D
Explanation - Acute lymphocytic (lymphoblastic) leukemia (ALL): This type of leukemia predominantly affects children but can affect adults as well (typically over the age of 65). The standard treatment for ALL involves chemotherapy and radiotherapy. Survival rates for children are very high, as about 85-90% of cases respond to treatment and close to 70% of patients become cured. Prognosis is more guarded in older populations, with an observed survival rate of about 50%.
An easy way to remember the answer to this question is that “ALL kids survive” (in ALL cases, the prognosis for children is very good).
Acute myelocytic (myeloblastic) leukemia (AML): AML is most frequently found in older populations and rarely affects children. The treatment of choice in these cases is chemotherapy, and remission rates are about 30% (for those under the age of 60).
Chronic lymphocytic leukemia (CLL): CLL typically affects adults over the age of 55. It may rarely affect younger adults, but almost never occurs in children. There is no cure for this type of leukemia, but there are many effective treatments. CLL has a very chronic course and is not typically fatal.
Chronic myelocytic leukemia (CML): CML more frequently affects older populations more frequently than younger adults or children. It has a progressive, chronic course with a less favorable prognosis. The mainstay of treatment for these patients is imatinib (a tyrosine-kinase inhibitor).
The type of juvenile idiopathic arthritis in which five or more joints are affected during the first six months of the disease is known as which of the following? A. Oligoarticular onset B. Extra-articular onset C. Systemic onset D. Polyarticular onset E. Pauciarticular onset
Answer: D
Explanation - Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA), is a type of inflammatory arthritis that occurs in children under the age of 16, for a duration of at least 6 weeks. It is the most common form of arthritis in children and adolescents, as well as the most common systemic disease associated with childhood anterior uveitis. JIA is classified based upon the extent of joint involvement in the first 6 months of the disease. These subtypes are as follows:
- Pauciarticular (aka Oligoarticular): JIA in which 4 or fewer joints are affected within the first 6 months. This type accounts for 50-60% of all cases of JIA, and uveitis affects about 20% of these children. Large joints are most commonly affected in these patients.
- Polyarticular: JIA in which 5 or more joints are affected within the same time period. This type accounts for 20% of cases of JIA, and uveitis occurs in about 5% of these cases. Usually the smaller joints are affected in these children.
- Systemic: In addition to polyarticular JIA, children with systemic JIA also experience symptoms such as fever and a salmon pink rash in conjunction with the arthritic conditions. This type of JIA typically involves both the small and large joints.
Brown hair is a dominant trait while blond hair is recessive. If a person who is heterozygous for this trait mates with a person who is homozygous recessive for this trait, what is the probability that their first child will have blond hair? A. 1/4 (25%) B. 4/4 (100%) C. 3/4 (75%) D. 1/2 (50%)
Explanation - A simple Punnett square can be used to help solve this question. One mate is heterozygous for the trait and is represented as Bb. The other person is homozygous recessive with the notation of bb. The Punnett square is as follows:
B b
---------------------------------
B { Bb } bb
b { Bb } bb
Therefore, the probability of their first child having blond hair is 1/2 or 50%, and the probability of the child having brown hair is also 50%.
A 34-year old patient walks into your office concerned with distance blurry vision. During review of her case history, she also reports that she cannot stand cold temperatures, her skin is very dry, she feels sluggish, depressed and her heart rate is slowed. Which of the following conditions do you suspect is the culprit of her systemic concerns? A. Myasthenia gravis B. Grave's disease C. Hypothyroidism D. Hyperthyroidism E. Cretinism
Answer: C
Explanation - The above case history is a textbook case of hypothyroidism. People who suffer from hypothyroidism are intolerant of the cold, have a slowed heart rate, display dry skin, possess dry, brittle nails and hair, have unintentional weight gain, and have feelings of sluggishness, fatigue, and depression. The most common treatment includes increasing TSH levels via medication (Levothyroxine).
Individuals who suffer from hyperthyroidism often complain of increased heart and metabolic rates, heat intolerance, weight loss, trouble sleeping, and excessive nervousness. Hyperthyroidism can also lead to Grave’s condition, an autoimmune disorder that attacks the thyroid gland and results in increased levels of thyroxine. A common sign of Grave’s disease is proptosis caused by inflammation of orbital fat and the extraocular muscles. Treatment includes radioactive iodine to destroy thyroid function.
Cretinism is a severe form of hypothyroidism that occurs in children due to a genetic defect that affects the thyroid gland of the fetus. Proper and early treatment is of essence; otherwise, the child’s growth is stunted and mental retardation occurs.
Myasthenia gravis is an autoimmune disorder that results in a weakness of skeletal muscles. Muscle weakness worsens with activity but will improve with rest.
A contracting muscle that develops tension but does not shorten displays which type of muscle tension? A. Isometric B. Isovelocity C. Isotonic D. Isovolume
Answer: A
Explanation - Isometric contraction occurs when a muscle is contracting but is not shortening. This type of muscle tension is used for load-bearing situations such as holding a plate of food in front of you. Muscles that shorten but maintain the same amount of tension are said to display isotonic contraction. An isovelocity contraction follows when the force of the contraction varies while the velocity remains constant.
A neuron is stimulated 12 points above threshold, resulting in an action potential. The same neuron is stimulated a few minutes later 60 points above threshold; how will the neuron respond?
A. It will generate an action potential involving a greater number of sodium channels
B. It will generate an action potential equal to the first
C. It will generate an action potential of longer duration
D. It will generate an action potential of greater magnitude
E. It will generate an action potential that involves more potassium channels
Answer: B
Explanation - Action potentials fire based upon an all-or-none principle. That is, once threshold is reached, an action potential will ensue, and its signal will not decay along the length of the axon. The magnitude and length of the action potential is always the same, regardless of the strength of the stimulus. However, in order to code for the strength of the stimulus, more action potentials will be generated with increased frequencies, which in turn determines the amount of neurotransmitter released by the pre-synaptic terminals.
hich 2 of the following systemic conditions are NOT considered HLA-B27 associated diseases? (Select 2) A. Behcet's disease B. Ankylosing spondylitis C. Sarcoidosis D. Psoriatic arthritis E. Crohn's Disease F. Reiter's syndrome
Answer: A, C
Explanation - Of the above systemic conditions, all are considered HLA-B27 related diseases except for sarcoidosis and Behcet’s disease. HLA-B27 refers to a specific genotype related with chromosome 6. These disorders have a strong association with anterior uveitis; however, the trigger mechanism for acute uveitis in patients demonstrating this genotype remains unknown.
Which type of epithelium lines the throat, nasal passages, sinuses and trachea? A. Pseudostratified B. Stratified C. Simple squamous D. Simple
Answer: A
Explanation - The throat, nasal passages, sinuses, and trachea are lined with pseudostratified columnar epithelium. This type of tissue is actually a type of modified simple epithelium. It is actually a single layer but resembles stratified tissue due to the placement of its nuclei. Pseudostratified epithelium generally possesses cilia to help sweep mucous or fluid across its surface.
Simple epithelium is found lining the body’s cavities, tubes, and ducts. It is composed of a single layer of cells which is important for its function of absorption, secretion, filtering or diffusion. Stratified epithelium comprises two or more layers of cells and serves an important role in protection.
Epithelium always has one free surface whether it faces a lumen, cavity, or the environment. The other surface is anchored to a basement membrane.
The nerve tract that serves to maintain communication between the cerebral hemispheres is named which of the following? A. The ventricles B. The red nucleus C. The thalamus D. The corpus callosum
Answer: D
Explanation - The brain is divided into two hemispheres, both of which are capable of functioning independently. In terms of function, the left hemisphere is thought largely to govern spoken language skills while the right houses the centers for math, music and other nonverbal, abstract thinking. The two hemispheres are connected by a nerve tract called the corpus callosum which facilitates communication between the two sides.
The exact purpose of the red nucleus is still not fully understood but it is widely believed to be involved in motor function.
The thalamus serves as a relay for sensory information; it projects sensory signals to the appropriate destination.
The ventricles total four in number and function to synthesize and secrete cerebrospinal fluid (CSF).
Where is the sinoatrial node of the heart located? A. The upper left atrium B. The lower left ventricle C. The upper right atrium D. The lower right ventricle
Answer: C
Explanation - Think in terms of function to help determine and remember the answer to this question. The first area to contract is the right atrium (only briefly, before the left atrium). Logically, it therefore would make sense for the pacemaker of the heart to be located at the site of contraction origin. The atria contract first, followed by contraction of the ventricles.
You are performing a blood pressure measurement on your 61 year-old male patient in which the reading is 168/124mmHg. You repeat the measurement and it reads 166/126. Which of the following BEST describes the time period in which the patient should be referred out for a hypertension evaluation?
A. The patient should see his primary care doctor within 1 month
B. The patient should seek immediate emergency medical treatment
C. The patient should see his primary care doctor within 1 day
D. The patient should see his primary care doctor within 2 weeks
E. The patient should see his primary care doctor within 1 week
Answer: B
Explanation - Blood pressure measurements that have a systolic reading above 180mmHg OR a diastolic reading higher than 120mmHg are indicative that the patient is experiencing a hypertensive crisis and must seek immediate emergency medical treatment.
Blood pressure categories as defined by the American Heart Association are as follows:
- Normal: Systolic less than 120 Diastolic less than 80
- Prehypertension Systolic 120-139 Diastolic 80-89
- Stage 1 HTN Systolic 140-159 Diastolic 90-99
- Stage 2 HTN Systolic 160 or higher Diastolic 100 or higher
- HTN crisis Systolic higher than 180 Diastolic higher than 120
When determining a newborn's APGAR score, which 2 of the following are NOT included in the 5 items that the physician evaluates? (Select 2) A. Color B. Weight C. Heart rate D. Length E. Muscle tone F. Respiratory effort G. Reflex irritability
B and D. Explanation - The APGAR scoring system is a quick and accurate way of evaluating a baby’s physical status directly after delivery. A physician or nurse will observe 5 signs and record a score for each on a scale of 0-2 based upon the degrees to which the sign is present (0-poor, 1-fair, 2-good). The 5 scores are then added together and range from 0-10. A score of 10 implies that the baby is in the best possible condition. A score of 8 or 9 indicates that the baby is in good condition, 4-7 indicates a fair condition, and 0-3 indicates a poor condition and the need for prompt diagnosis and treatment. The 5 signs are:
- Heart rate: 0-not detectable, 1-slow (less than 100), 2-Above 100
- Respiratory effort: 0-absent, 1-slow, irregular, 2-good; crying
- Muscle tone: 0-flaccid, 1-some flexion of extremities, 2-active motion
- Reflex irritability: 0-no response, 1-grimace, 2-cry, cough, or sneeze
- Color: 0-blue, pale, 1-body pink, extremities bluish, 2-completely pink or absence of cyanosis
Weight and length of the baby are not related to the APGAR score.
Progressive narrowing of the arterial lumen is BEST known as which of the following terms? A. Angina pectoris B. Arteriosclerosis C. Arrhythmia D. Atherosclerosis
D. Explanation - When excess cholesterol or other lipids build up on the inside of the arterial wall, the lumen of that blood vessel narrows. This narrowing can become aggravated if a platelet becomes stuck on the rough edges of the plaque stimulating a blood clot. The artery may become so clogged that blood flow is impeded and the tissue or organs normally supplied by the vessel may become ischemic. If a coronary artery is affected, chest pains (angina pectoris) or a heart attack may ensue. Atherosclerosis is a type of arteriosclerosis.
Arteriosclerosis results from thickened and hardened arterial walls. Arteriosclerotic blood vessels have lost much of their elasticity.
Arrhythmias are irregular heartbeats. Remember, not all arrhythmias are evil. Endurance athletes can exhibit bradycardia (low cardiac rate).
During case history, your patient reports that he has a family history of Gardner's syndrome. Which of the following ocular conditions is MOST closely associated with this disease? A. Congenital hypertrophy of the RPE B. Chorioretinal atrophy C. Anterior uveitis D. Optic disc drusen E. Choroidal nevi F. Melanocytoma
A. Explanation - Congenital hypertrophy of the retinal pigmented epithelium (CHRPE) has been associated with some inherited gastrointestinal polyposis disorders such as familial adenomatous polyposis, Gardner’s syndrome, and Turcot’s syndrome. These diseases are autosomal dominant syndromes that have a very high risk of developing adenocarcinoma of the colon. An observation of multiple CHRPE lesions upon fundus evaluation may provide very useful diagnostic information as they often precede the polyposis of the gastrointestinal tract, and therefore can be considered a marker for the disease.
A typical sperm contains how many chromosomes? A. 23 B. 21 C. 32 D. 46
A. Explanation - A typical sperm and a normal egg each contain 23 chromosomes. During reproduction the two join, eventually resulting in the creation of a baby with 46 chromosomes.
