Micro/Path Pt 2 Flashcards by Ch Mora

Which of the following occurs most ommonly in elferly women and is associated with postmenopausal state and estrogen deficiency?

osteogenesis imperfect
osteoporosis
myasthenia gravis
osteoarthritis

osteoporosis

FYI:
osteoarthritis is progressive erosion of articular cartilage
osteogenesis imperfetca - brittle bone, AD, poor teeth
myasthenia gravis - autoimmune, auroAB to ACh receptors at neuromuscular jct

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All are features of Albers-Schonberg dz except:

anemia
multiple bone fractures
decreased bone density
blindness
deafness

decreased bone density

this is osteopetrosis
anemia is result of decreased marrow space
blindness, deafness and cranial nn involvement due to narrowing of neural foramina
multiple fractures

osteomalacia - vit D deficienct in adults

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head of femur osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg

Perthes’ dz

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tibial tuberosity osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg

Osgood-Schlatter

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tarsal navicular bone tuberosity osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg

Kohler

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intervertebral jts osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg

Scheuermann

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metatarsal head osteochondrosis

Perthes'
Osgood-Schatter
Kohler
Scheuermann
Freiberg

Freiberg

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Osteitis deformans present as a mized radiopaque and radiolucent lesion BECAUSE the mized stage of the dz features primnent osteolysis and osteogenesis

both true and related

osteitis deformans = Paget’s

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Rickets occurs only in children; its typical adult counterpart is called:

osteitis fibrosa cystica
osteitis deformans
osteopetrosis
osteomalacia
osteomyelitis

osteomalacia

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Order histologic stages of fracture healing:
A. Replacement of callus by lamellar bone
B Remodeling of bone to normal contour
C. Fracture
D. Replacement of granulation tissue by callus
E. Formation of granulation tissue around fractured bone cells

C E D A B

fat embolism often sequel of fractured bones

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Most common viral cause of pericarditis:

mumps
influenza
herpes
HIV
coxsackie B and echo

coxsackie B and echo

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Most common cause of right-sided heart failure:

left-sided heart failure
hypertension
ischemic heart disease
aortic and mitral valvular disease

left-sided heart failure

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Causes of left heart failure:

ischemic (esp MI)
hypertension
aortic and mitral valve disease
myocardial disease

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Which type of angina is characterized by prolonged or recurrent chest pain at rest?

stable angina
unstable angina
prinzmetal’s angina
variant angina

unstable

classic symptom of coronary artery disease

stable: repeated, doesn’t change in character, intensity, frequency or duration for several weeks. Predictable. Relieved by rest or vasodilators (like nitroglycerin).
unstable: variable, irregular, prolonged and recurrent at rest.

Prinzmetal’s: vasospasm, intermittent chest pain at rest.

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Which is the first cardiac marker to increase after myocardial infarction?

creatine kinase
troponin
myoglobin
lactate dehydrogenase

myoglobin

MI most commonly caused by CAD.

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Approximately 50% of cases of subacute (bacterial) endocarditis are caused by:

serratia
pseudomonas
staph aureus
strep viridans

strep viridans

infectious endocarditis is inflammation of heart valves

staph is most common in IV drug users

acute endocarditis - 50% is Staph
subacute - 50% is Strep viridans
fever in both

mitral valve most frequently involved

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acute vs subacute endocarditis

acute is staph, subacute is strep viridans

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most commonly encountered neck space infection is:

angioedema
Vincent’s angina
Ludwig’s angina
hereditary angioedema

Ludwig’s angina - extension from mandibular lower teeth into floor of mouth

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Tetanospasmin is a neurotoxin that inactivates proteins that regulate the release of which of the following neurotransmitters?

glycine and 5-HT
NE and epi
GABA and 5-HT
5-HT and epinephrine
glycine and GABA

glycine and GABA

unregulated excitatory synaptic activity, spastic paralysis, no inhibition

botulotoxin prevents release of ACh –> flaccid paralysis

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Eosinophilia is often associated with

acute infx
viral infx
tuberculosis
parasitic infx

parasitic infx

also allergies

n/ph: acute bacterial infx

lymphocytes: TB, viral
monocytes: TB, malaria, ricketsia

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lymphocytosis associated with

viral and TB

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monocytosis assoc with

TB, malaria, ricketsia

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n/ph associated with

acute bacterial infx

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Link between Reye’s Syndrome and use of:

ibuprofen
aspirin
acetaminophen
amoxicillin
diphenhydramine

aspirin

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Symptoms of TB include all except: ``` bad cough for 3 wks or longer pain in chest coughing up blood or sputum weakness or fatigue weight gain no appetite chills fever sweating at night ```

wt gain primary TB: Gohn focus secondary: activation of Ghon; favors upper lobe; tubercle formation (caseous granulomas, cavitary lesions) secondary may be spread via lymph --> military or disseminated TB

Rebound tenderness in lower right quadrant of abdomen is characteristic of: cholelithiasis ulcerative colitis hepatocellular carcinoma acute appendicitis

acute appendicitis

Chlamydial cervicitis, the most common sexually transmitted infection, is caused byL C. diff c. perfringens c. trachomatis c. suis c. muridarium

trachomatis gonorrhea is caused by neisseria

Characteristic lesion of secondary syphilis is known as: chancre gumma condyloma lata condyloma acuminatum

condyloma lata syphilis caused by treponema pallidum primary: chancre secondary (highly infectious): maculopapular rash and condyloma lata (flat gray) on skin and mucosal surfaces tertiary: gumma (focal nodular mass) condyloma acuminaum is caysed by HPV

Encephalitis is most common caused by: bacterial infx viral infx fungal infx parasitic infx

viral

An infection is pandemic if: it has a worldwide distribution it is constantly present at minimal levels within a population it occurs more frequently than normal within a population it is highly communicable

worldwide epidemic: more frequently than normal endemic: minimal levels highly communicable = contagious

Acute lymphoblastic leukemia equally affects young children and adults. This acute leukemia is most responsive to tx.

1 false, 2 true. acute lymphoblastic - most common in children, ost responsive to tx. acute myeloid leukemia is most malignant; 90% of adult acute leukemias. chronic lymphocytic - least malignant, slow.

ALL vs AML vs CLL vs CML leukemias

ALL - children, responsive to tx AML - adults, 90% of leukemias, most malignant CLL - slow CML - Philadelphia chromosome

Principal organ(s) involved in acute leukemia is/are the: bone marrow brain lungs kidneys

bone marrow

Philadelphia chromosome and low levels of leukocyte alkaline phosphatase are common characteristics of: AML ALL CML CLL

CML

No definitive causes have been identified for leukemia. Possible risk factors include genetic predisposition, environmental exposure to chemicals and radiation, and viruses.

both true viruses: HTLV, EBV

All about immunoglobulins are true except: ``` secreted by activated plasma cells also known as antibodies have enzymatic activity activate complement are glycoproteins ```

have enzymatic activity this is false

Injection of med to someone with allergy to it leads to: low levels of histamine hyperglobulinemia systemic anaphylaxis localized anaphylaxis

systemic anaphylaxis most common cause - allergy to penicillin

``` Cellular immunity is immunity mediated by: B-lymphocytes T-lymphocytes both B and T-lymphocytes neither B not T-lymphocytes ```

Of the anaphylatoxins, C3a is more stable and potent than C5a. Only mast cells have receptors specific for C5a and C3a.

both false C5a is more stable and potent phagocytes, endothelial cells and mast cells have receptors for both anaphylatoxins increase blood flow and vascular permeability only IgG and IgM fix complement anaphylaxis by complement components is less common than that caused by Type I (IgE-mediated) hypersensitivity

Exaggerated IgE response to environmental allergen (= atopy) manifests in all except: dermatitis rhinitis jaundice asthma

jaundice atopic = localized Type I atopic dermatitis = eczema in asthma, leukotrienes rhinitis: histamine

Which is most frequently used diagnostic technique for detection of antigens in tissue secretions or cell suspensions? ``` immunofluoresecence agglutination radioimmunoassay precipitation enzyme-linked immunosorbent assay ```

immunofluorescence ELISA - for pt specimens, both antibodies or antigens

Which of the following major pathways of complement activation is triggered by the presence of infection, but does not involve antibody? classical pathway alternative pathway lectin pathway all of the above

alternative lectin only specific mannose-containing PGs of bacteria all pathways converge to C3

classical pathway of complement

Ag + AB --> C1, C4, C2 --> C3 + C5

alternative pathway of complement

infx but no AB

lectin pathway of complement

mannose in peptidoglycan

type I hypersensitivity

atopic, IgE, degranulation of mast

type II hypersensitivity

IgG-mediated cytotoxicity (--> complement or T killer) drug allergies

type III hypersensitivity

IgG --> complement | serum sickness

type IV hypersensitivity

T-helpers (mostly Th1) sensitized, recruit destroyers

In passive immunity, antibodies are preformed in another host. Passive immunity lasts as long as active immunity.

1 true, 2 wrong active is slow onset but long term

Small molecule, not antigenic by itself, that can react with antibodies is called: epitope hapten plasmid immunogen

hapten too small to eb immunogenic epitope - specific portion of antigen to which antibody binds

Whicg of the following types of immunity os conferred by transferring lymphoid cells from actively immunized donor to a naïve or immunocompromised host? ``` acquired immunity humoral immunity passive immunity active immunity adoptive immunity ```

adoptive immunity

Complement system is a group of plasma proteins that attack pathogens. These proteins are primatily synthesized by kidney.

First true, second wrong mainly made by liver; C1 is made in GI epithelium C-reactive protein - binds to bacterial in classical pathway membrane attack complex comes after C5

Each of the following are associated with an anaphylactic hypersensitivity reaction except: ``` histamine heparin plt-activating factors serotonin dopamine ```

dopamine

IgM, IgA, and IgG are main antibodies present in blood, lymph and intercellular fluid in connective tissues. IgA is also made in lymphoid tissues underlying mucosa and then selectively transported across mucosal epithelium to bind extracellular pathogens and their toxins on mucosal surfaces.

both true

Type II hypersensitivity rxns result from binding of antigen to antigen-specific IgE bound to its Fc receptor, principally on mast cells. Type III hypersensitivity rxns are caused by small soluble immune complexes formed by soluble protein antigens binding to IgG made against them.

1 false, 2 true

THREE items associated with humoral immunity provides immunity against extracellular pathogens provides immunity against intracellular pathogens mediated by T cells mediated by antibodies produced by B cells antibodies neutralize and eliminate pathogens and toxins

extracellulae B cells antibodies neutralize and eliminate in contrast, cell-mediated is T against intracellular Th activate m/ph and T-killers

All about MHC are true except: plays a role in acute rejection of transplanted tissue assist T-cells in recognition of intracellular pathogens glycoprotein secreted by activated plasma cells able to interact with T-cell receptor coded by group of highly polymorphic genes

glycoprotein secreted by activated plasma cells this is wrong not secreted at all MHCI - all cells - recognized by CD8+ - from cytosolic proteins MHCII - only professionals (APC, m/ph, B) - CD4+ - from endocytosed proteins

Although many substances and preparations are know to be adjuvants, the only adjuvants approved for use in human vaccines are: Freund's complete adjuvant and Alum Freund's incomplete adjuvant and MF59 Immune stimulatory complexes and Alum Alum and MF59

Alum and MF59 adjuvants allow smaller and rarer doses

Bacterial toxin that has been weakened until it is no longer toxic but is strong enough to induce formation of antibodies and immunity to the specific dz caused by the toxin is called: antitoxin antivenin antiserum toxoid

toxoid antitoxin = antibody to toxin

Human HBIG to prevent Hep B in those not actively immunized with the Hep B vaccine is an example of naturally acquired passive immunity naturally acquired active immunity artificially acquired active immunity artificially acquired passive immunity

artificial passive

All contain attenuated virus except: ``` yellow fever measles rabies mumps rubella ```

rabies - inactivated

Each are live attenuated bacterial vaccines except mycobacterium bovis salmonella typhi Yersinia pestis coxiella burnetti

Yersinia? has to be killed, for plague

Persons vaccinated against Hep B who have developed immunity are also immune to: Hep A Hep C Hep D Hep E

Hep D

THREE items associated with rheumatic fever ``` pancarditis Group B streptococci koplik spots bullous skin lesions aschoff bodies Sydenham chorea ```

pancarditis aschoff bodies Sydenham chorea acute rheumatoid fever - group A streps! manifestations: migratory polyarthritis, pancarditis, subcutaneous nodules, erythema, Sydenham chorea Aschoff bodies - foci of lymphocytes in heart

All are characteristics of Addison's excepts: hypertension increased pigmentation of skin hypoglycemia increased serum K

hypertension characterized by hypotension failure of adrenocortical

Osteoarthritis (degenerative joint dz) is the most common type of joint disease. Heberden nodes, bony swellings in the distal interphalangeal joints, are a characteristic morphological changes

both true bone polishing dislodged pieces of cartilage in joint space osteophytes (bony spurs) at distal (Heberden) or proximal (Bouchard) interphalangeal joints

All can be classified as type of Lagerhans cell histiocytosis except: Letterer-Siwe Bruton Hand-Schuller-Christian eosinophilic granuloma

Bruton disease is X-linked agammaglobulinemia

Primary hyperparathyroidism is most often caused by liver dz parathyroid adenoma bronchogenic squamous cell carcinoma hypoCa of chronic renal dz

parathyroid adenoma

Systemic vasculitis in which dz ``` polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis ```

polyarteritis nodosa

Skin rash in which dz ``` polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis ```

dermatomyositis

Widespread connective tissue fibrosis in which dz ``` polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis ```

scleroderma

butterfly rash ``` polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis ```

systemic lupus

stiffness of joints which dz ``` polyarteritis nodosa dermatomyositis scleroderma systemic lupus rheumatoid arthritis ```

rheumatoid arthritis

Most common demyelinating disorder? ``` Devic's dz Tabes dorsalis Optic neuritis Multiple sclerosis Guillain-Barre syndrome ```

multiple sclerosis female prevalence

In many cases of primary amyloidosis, the pts have some form of: m/ph dyscrasia erythrocyte dyscrasia hemoglobin dyscrasia plasma cell dyscrasia

plasma cell dyscrasia primary amyloidosis related to abnormal production of immunoglobulins

Urticaria (hives) is a common disorder of skin characterized by localized mast cell degranulation and resultant dermal microvascular hyperpermeability. This gives rise to pruritic edematous plaques called wheals. Angioedema is closely related to urticaria and is characterized by deeper edema of both the dermis and subcutaneous fat.

both true

Type 1 diabetes is caused by a reduction in sensitivity of insulin's target cells. Type 1 diabetes is more common than type 2 diabetes.

both false 1 is autoimmune, destruction of cells and absolute deficiency of insulin 2 is resistance to insulin and is more common (90-95%)

THREE items associated with rheumatoid arthritis: ``` joint effusions bouchard's nodes bacterial in nature fungal in nature Still-s dz osteophyte unknown cause ```

joint effusions Still's dz (RA in young ppl) unknown cause osteophytes - in osteoarthritis, not rheumatoid! RA: nonsuppurative proliferative

Which is the prototype of a systemic immune complex dz? ``` systemic lupus erythematosus acute serum sickness poststreptococcal glomerulonephritis reactive arthritis polyarteritis nodosa ```

acute serum sickness

______ hypersensitivity rxns are initiated by Ag-activated (sensitized) T lymphocytes, including CD4+ and CD8+. type I type II type III type IV

type IV

which of the following antibodies are specific for systemic lupus? anti-Sm Anti-Jo anti-Ro anti-centromere

anti-Sm particularly ANA and anti-Sm specific for SLE acrocyanosis (Raynaud's phenomenon) often associated with SLE

Raynaud's phenomenon

acrocyanosis., often associated with SLE

anti-Ro

Sjogren

Which of the following autoimmune disorders are caused by production of antibodies against ACh receptor which results in inhibition of neuromuscular transmission and eventual paralysis? ``` eaton-lambert syndrome myyastenia gravis graves disease Addison's disease hashomoto's throiditis ```

myasthenia gravis

In phenylketonuria, tyrosine cannot be synthesized in adequate amounts. Newborns with phenylketonuria don't have any symptoms.

both true phe is essential tyrosine from phe

Increased melanin pigmentation is seen in: ``` addison't dz jaundice albinism vitiligo hemosiderosis ```

Addison's dz albinism and vitiligo - decreased

Gout is caused by defect in metabolism that results in overproduction of: urea ammonia Bb uric acid

uric acid

Cholelithiasis may induce acute cholecystitis. Enteric bacteria is cultured more commonly in cases of chronic cholecystitis than in acute cholecystitis.

first is true, second is false Enteric bacteria can be cultured in 80% of acute cases. Chronic usually due to fibrosis.

Which of the following results from inadequate secretion of thyroid hormones during fetal life or early infancy? myxedema plummer dz gigantism cretinism

cretinism myxedema is hypothyroidism in adults, more common in women

Which is associated with esophageal varices? hemoptysis hematuria hemophilia hematemesis

hematemesis

Which vessels are particularly prone to tearing along their ourse through the subdural space and are the source of bleeding in most cases os subdural hematoma? MMA middle cerebral arteries berry aneurysm in circle of Willis bridging vv

bridging veins epidural is MMA subdural - between inner of dura and outer of arachnoid subarachnoid is berry in Willis

Which is a clinical manifestation of vit A deficiency? rickets neurological disorders coagulation defects night blindness

night blindness D - rickets, osteomalacia E - neurological disorders K - coagulation

neurological disorders which vitamin?

E (= tocopherol)

Pathologic calcification is the abnormal tissue deposition of Ca salts, together with smaller amounts of Fe, Mg, and other mineral salts. There are two forms of pathologic calcification: dystrophic and metastatic.

both true dystrophic - necrosis metastatic - when hyperCaemia

THREE items associated with vitamin B6 ``` component of NAD and NADP component of FAD and FMN wet beriberi cheilosis pellagra required for porphyrin synthesis required for hydroxylation of proline and lysine anemia ```

cheilosis required for porphyrin anemia

thiamine, beriberi, Wernicke-Korsakoff in alcoholics

beriberi

B1 = thiamine

Wernicke-Korsakoff

B1 in alcoholics

riboflavin FAD and FMN cheilosis, glossitis, dermatitis

FAD and FMN

B2 (riboflavin)

niacin, NAD and NADP glycolysis pellagra

niacin

pellagra

pyridoxine transmination porphyrin synthesis cheilosis glossitis anemia

porphyrin synthesis

cheilosis, flossitis - vitamins?

B2 and B6

folic and B12 deficiency

megaloblastic anemia! | in B12 also neurologic

Trachoma is an eye infection caused by chlamydia trachomatis bacteroides fragilis prevotella intermedia leptospira interrogans

chlamydia conjunctivitis

Severe mid-abdominal pain suspect acute pancreatitis elevated lipase What other would likely be elevated? alkaline phosphatase amylase glu-6-phosphatase acid phosphatase

amylase

Neurofibromatosis Type 1 is characterized by all except ``` multiple skin neurofibromas gliomas of optic nerve mupltiple meningiomas pigmented nodules of iris cutaneous hyperpigmented macules ```

multiple meningiomas Type 1 is pretty common. Neurofibromatosis Type 2 is bilateral VIII schwannomas and multiple meningiomas both AD

Most common cause of hypothyroidism in adults is Graves' disease. Hypothyroidism can be caused by iodine deficiency.

first wrong, second true most common cause of hypothyroidism in adults is Hashimoto thyroiditis (autoimmune) Graves is hyperthyroidism myxedema and cretinism hypothyroidism is caused by I deficiency

Somatotyopic adenoma with hypersecretion of growth hormone that develops before epiphyseal closure results in cretinism acromegaly gigantism myxedema

gigantism after fusion - acromegaly

Pathognomonic lesion of erythema multiforme is butterfly rash target lesion pasten-on plaque hill-sachs lesion

target often in Stevens-Johnson

Vesicles on mucosa ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

pemphigus autoAB against desmosomes between keratinocytes pemphigoid - larger bullae

large red nose ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

rosacea

honey colored crust, superficial skin infection ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

impetigo caused by Staph aureus or group A streps

herald patch ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

pityriasis

irregular pigmentation ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

vitiligo

hyperlipidemia in skin ``` pemphigus rosacea impetigo pityriasis vitiligo xanthoma ```

xanthoma

Recurrent peptic ulcers in aberrant sites such as jejunum is suggestive of cushing syndrome acromegaly sipple syndrome zollinger-ellison syndrome

ZES

vasopressin is produced in which of the following: ``` paraventricular of HT suprachiasmatic of HT arcuate supraoptic preoptic ```

supraoptic diabetes insipidus - deficiency in ADH polyuria

Infx mono is a benign, self-limiting disorder caused by: VZV HSV1 CMV EBV

EBV also Burkitt hairy leukoplakia nasopharyngeal carcinoma

Half of first cases of asthma occur in middle age adults teenagers elderly children <10

children <10

Which is characterized by breakdown in self tolerance to thyroid auto-antigens, most importantly the TSH receptor? Graves thyroiditis muxedema cretinism

Graves thyrotoxicosis, overproduction, more frequent in F with protruding eyeballs it is autoimmune, autoAB to TSH receptor --> no negative feedback Plummer is v similar but without protruding eyes, toxic goiter, never in children

First WBCs during acute or early stage of inflammation are basophils eosinophils neutrophils monocytes

n/ph

Abscesses are localized collections of purulent inflammatory tissue caused by suppuration that buries in a tissue, an organ, or a confined space. Abscesses are produced by deep seeding of pyogenic bacteria into a tissue

both true

Gas gangrene occurs as result of infection by Clostridium perfringens Clostridia are obligate aerobes, G- bacteria capable of endospore production

1 true, 2 false anaerobes!

Which of the following types of necrosis is the most basic and most common? ``` coagulation liquefaction caseous gangrenous fibrinoid ```

coagulation

Epithelioid cells and giant cells are derived from m/ph and are important in development of initial inflammation granulomatous inflammation acute inflammation subacute inflammation

granulomatous granulomatous infxs: TB, leprosy, syphilis, sarcoidosis, Crohn

In response to an injury, mononuclear inflammatory cells couple with the production of fibrous connective tissue are indicative of acute inflammation chronic inflammation edema gangrene

chronic inflammation

In response to an injury, capillary permeability increases resulting in formation of plasma serum exudate transudate

exudate --> edema transudates are non-inflammatory conditions

Acute inflammation is an early defense mechanism to contain an infx, prevent its spread from the initial focus and signal subsequent specific immune receptors. Tissue damage is caused to some extent by complement and macrophages but mostly by neutrophils.

both true m/ph are transition from acute to chronic

THREE items associated with biotin ``` ataxia beriberi seborrheic dermatitis nervous disorders anemia scurvy can be induced by avidin ```

seborrheic dermatitis nervous disorders can be induced by avidin B12 malabsorption also occurs in Crohn's!

Which malabsorption syndrome is caused by a sensitivity to gluten in cereal? tropical sprue celiac dz whipple dz autoimmune enteropathy

celiac dz

Which is characterized by presence of numerous polyps along with skin and bone tumors? Turcot Gardner Peutz-Jeghers familial adenomatous polyposis

Gardner Turcot - polyps + brain tumors Peutz-Jeghers: non-neoplastic polyps, melanin hyperpigmentation

Pts with Down syndrome are at increased risk for osteosarcoma lymphoblastic leukemia berry aneurysm fabry dz

lymphoblastic leukemia

Each are symptoms of Sjogren except xerostomia keratoconjunctivitis sicca sarcoidosis associated CT dz

sarcoidosis dx of Sjogren - at least two antiRo and antiLa

Chvostek's sign and Trousseau's sign are reliable indicators of bell's palse botulism rickets tetany

tetany also hypoCa

DiGeorge syndrome adversely affects development of 3 and 4 pharyngeal pouches. Result on immune syste, will most likely be deficiency in B cells T cells complement innate immunity

T cells also hypoCa (because no parathyroids) --> tetany

Which immunodeficiency disorder features incompetent or absent T and B cells? wiskott-aldrich sever combined immunodeficiency ataxia-telangiectasia hyper-IgE syndrome

SCID

THREE items associated with Klinefelter's ``` extra 21 XO XXY extra 18 affects 1 in 500 men affects women hypergonadism hypogonadism ```

XXY 1 in 500 men hypogonadism

X-linked agammaglobulinemia is characterized by failure of T cell precursors to develop into mature T cells. Usually not apparent until 6 mo, as maternal Igs are depleted.

First false, second true X-linked agammaglobulinemia = Bruton's failure of B T are normal

Right sided heart failure results in pulmonary edema peripheral edema lymphedema cirrhosis of liver

peripheral edema left sided failure --> pulmonary edema pitting edema - acute non-pitting - chronic

Which thrombi from as result of damage to ventricular endocardium (usually left ventricle following myocardial infarct)? ``` agonal white red fibrin mural ```

mural agonal - in fyind after long heart filure mural - damage to ventricular endotheliu, white - blood plts red - coagulation of stagnant blood

Intracellular anaerobic glycolysis and subsequent buildup of lactic acid occur in which stage of shock? non-progressive progressive irreversible cardiogenic

progressive beginning of failure after attempts to compensate glycolysis and anaerobic not enough, cells begin to die refractory - point of no return

Most common type of shock: cardiogenic septic neurogenic hypovolemic

hypovolemic

Standard prophylactic regimen for prevention of bacterial endocarditis: penicillin VK tetracyclin erythromycin amoxicillin

amoxicillin if allergy: clindamycin, azithromycin, clarithromycin

Nystatin and Clindamycin are the two antifungals used as "swish and swallow" tx for oral candidiasis. Nystatin is taken as a troche (lozenge) that is slowly in the mouth and swallowed.

both false nystatin (suspension) + clotrimazole (lozenge) are for swish and swallow of oral candida

Which Abx is used cautiously due to its side effects (pseudomembranous colitis, sever GI upset)? azithromycin clindamycin penicillin VK cephalexin

clindamycin

Pt allergic to penicillin is mot likely to have cross allergy with ``` carbapenem macrolide quinolone cephalosporin glycopeptide ```

cephalosporin beta-lactam Abx: penicillins, cephalosporins, and newer: carbapenems and monobactams

Each affects bacterial cell wall except: ``` bacitracin azithromycin penicillin vancomycin aztreonam ```

azithromycin cell wall: penicillins, cephalosporins, bacitracin, vancomycin, aztreinam, imipenem protein synthesis: tetracycline, aminoglycosides, chloramphenicol, -mycins (except vanco) biosynthetic pathways: sulfonamides, trimethoprim, quinolones (floxacins)

cell wall abx

penicillins, cephalosporins, carbapenems, monobactams vancomycin, aztreonam = bacitracin

protein synthesis abx

-mycins, tetracycline, aminoglycosides + chloramphenicol

synthetic pathways

quinolones (floxacins), sulfonamides +trimethoprim

Tetracyclines are first choice in all except: mycoplasma pneumonia chlamydia infx rickettsial infx staphylococcal infx

staphs

Which penicillin is prescribed for sever penicillinase-producing staphylococcal infxs? methicillin ampicillin penicillin VK carbenicillin

methicillin (MRSA)

Which is antifungal? bacitracin amphotericin B polymyxin B neomycin

amphotericin B

Major cariogenic property of S. mutans appears to be its ability to produce which of the following enzymesL lactase beta-glucosidase cellulose glucosyltransferase

glucosyltransferase (make dextrans) Strep mutans is primary cariogenic

Which has been shown to be most effective antimicrobial agent for reducing plaque and gingivitis long-term? stannous fluoride phenolic compounds chlorhexidine quaternary ammonium compounds

chlorhexidine fluorides - anticavoty phenolic - listerine ammonium - for bad breath

Principal oral site for growth of spirochetes, fusobacteria and other G- negative anaerobes is saliva calculus gingival margin gingival sulcus

sulcus for stagnation and bacterial proliferation

Order stages in plaque formation: A. Streps colonize acquired pellicle B. Filamentous bacteria colonize acquired pellicle C. Formation of pellicle D. Rod-shaped microorganisms colonize acquired pellicle E. Calcification of crystalline structure

C A D B E pellicle - primarily salivary proteins colonization: streps --> rods --> filamentous (actinomyces) eventually calcifies --> calculus

Organic constituents of plaque include polysaccharides, proteins, glycoproteins, and lipid material. Inorganic components of plaque are predominantly Ca and P with trace amts of other minerals.

both true

Calculus is mainly organic. It is covered by a layer of bacterial plaque.

First wrong, second true. Calculus is mineralized plaque.

All are true about supragingival and subgingival plaque except subgingival plaque can be attached or loosely adherent supragingival plaque is attached or tooth associated subgingival plaque is dominated by G- supragingival is domninated by G- supragingival plaque has more anaerobes than subgingival

last is wrong subgingival has more anaerobes

Which is commonly implicated with etiology of acute necrotizing gingivitis? S. sanguis Actinomyces israeilii prevotella intermedia strep uberis

prevotella also generalized aggressive perio other ANUG is treponema

Quaternary ammonium compounds are cationic detergents. They can be used for skin antisepsis.

both true soaps are anionic

Which is a powerful oxidizing agent that inactivates bacteria and most viruses by oxidizing free sulfhydrul groups? alcohol chlorine formaldehyde phenol

chlorine phenol too caustic formaldehyde denatures protein and nucleic acids disinfectants kill; not safe on living tissue (antiseptics are).

How long does it take to kill bacterial endospores when a dental instrument is immersed in a chemical sterilant such as 2% glutaraldehyde, hydrogen peroxide or peracetic acid? 10-30 minutes 1-2 hours 10-12 hours 24 hours

10-12 hours alcohols, chlorhexidine, ammonium - disinfectants, less powerful

alcohol - steril or disinf?

disinf

examples of sterilants?

glutaraldehyde, peroxide

Effectiveness of autoclaving is best determined by culturing bacterial spores. Spore testing on autoclave units is recommended monthly.

first true, second false testing should be weekly

Proper time and temperature for dry heat sterilization 160C for 2 hours 121 C for 20-30 minutes 232 for 5 minutes 31 for 30 minutes

160 for 2 hours (or 170 for 1 hour)

Which is minimum required temperature to positively destroy all living organisms? 100 121 134 250

121 steam autoclaves: 121 for 15-20 270 for 3 minutes

Ethylene oxide sterilization is faster than moist heat autoclave. Ethylene oxide sterilization can be used to sterilize heat sensitive instruments.

first false, second true sterilization with ethylene ozide is 10-16 hours (vs 2 hours)

Killing or removal of all microorganisms, including bacterial spores, is called disinfection cleaning sterilization wiping

sterilization - absence of all living forms disinfection - killing of many but not all (does not include spores)

All are advantages of using alcohols as surface disinfectants except: they are bactericidal they are sporicidal they are tuberculocidal they are economical

sporicidal they are not iodine - most effective skin antiseptic (oxidizing agent)

Greatest occupational health care worker risk for bloodborne infx is hep C HIV hep B TB

hep B

Antimicrobial chemical agents which destroy microorganisms when applied on to inanimate surfaces, such as counter tops or lights, are called ``` antiseptics sterilants disinfectant microbicides antibacterials ```

disinfectant

Which of these antiseptics does NOT exhobot persistent activity? isopropyl alcohol chlorhexidine gluconate triclosan quaternary ammonium compounds

isopropyl alcohol persistent activity - ability to prevent after being applied

Bactericidal agents work best during which phase of bacterial growth? lag log stationary death

log

marker microorganism for intermediate surface disinfection is bacillus stearothermophilus pseudomonas aeruginosa hepatitis B virus myco TB

myco TB | - significant benchmark criterion

Antigens most responsible for immediate Type I reaction to natural rubber latex are proteins accelerators corn starch powders anti-oxidants

proteins

Cleaning surfaces prior to disinfection in clinical settings is required to destroy all pathogens inhibit pathogen growth reduce concentration of pathogens weaken the virulence of pathogens

reduce concentration

Most efficient way to kill microbes is: cold sterilization proper handwashing with sterilizing antiseptics heat sterilization immersion of contaminated items in chemical sterilants

heat

Most common form of adverse epithelial reaction noted for healthcare professionals is irritation dermatitis type I immediate latex allergy type IV delayed latex allergy superficial fingal infx of fingers

irritation dermatitis (20-30%)

Pt develops immediate Type I to latex. From now on you can wear vinyl or nitrile gloves wear hypoallergenic latex gloves get an exemption and not wear gloves refuse to treat him

wear vinyl or nitrile

Which is killing all microorganisms on an object or in a material? standardization sanitization disinfection sterilization

sterilization sanitization lowers total microbial load

Most likely route for dentist to be infected with Hep C from patient is from inhalation of aerosols. There is no vaccination for Hep C.

1 false 2 true

Infx caused by normally non-pathogenic microorganism in a host whose resistance has been decreased or compromised is known as nosocomial infx secondary infx opportunistic infx medical infx

opportunistic

It is recommended that face masks be changed between pts daily twice per day twice in the morning and twice in the afternoon

between pts

Latex allergy risk factors include all except: ``` persons with multiple surgeries atopy rubber industry workers persons w allergy to pollen persons w allergy to bananas ```

persons w allergy to pollen

Instrument that contacts mucous membranes or non-intact skin is classified into which of the following categories? critical semicritical subcritical noncritical

semicritical critical - penetrate semicritical - contact noncritical - intact skin

Each are advantages of rapid heat sterilization except very fast cycle time no dulling or cutting edges dry instruments after cycle does not require precleaning

does not require precleaning preclean everything!

Personal protective equipment clinic jackets should be short sleeve, high neck short sleeve, turtle neck long sleeve, high neck long sleeve, turtle neck

long sleeve, high neck

In healthcare what is the primary disease prevention measure? wipe-wipe spray-wipe-spray handwashing vaccines

handwashing (at least 10 seconds)

Because ________ are the hardest icrobes, their destruction is required before defined parameters/levels of sterilization have been met Hep B bacterial endospores mycobacteria vegetative bacteria

bacterial endospores some G+ but NEVER G- are spore formers high concentration of Ca and dipicolinic acid

Thermometer is an example of which of the following Spaulding classifications? critical semicritical subcritical noncritical

semicritical

Each is characteristic of alcohol-based hand hygiene antiseptics except: broad antimicrobial spectrum removal of organic debris from contaminated hands rapid antibacterial action greater antibacterial effect than anionic detergents

removal of organic debris from contaminated hands must be washed with soap

Which is considered regulated medical waster and cannot be disposed of with general office trash? gauze soiled with blood, plaque, and saliva used in a dental prophy procedure blood-saturated gauze used in oral surgical procedures visibly contaminated environmental surface barriers plastic saliva ejectors and high-volume evacuator tips

blood saturated - considered infectious ``` also microbiological waste tissues and extracted teeth (w/o amalgam) blood and by products sharps anesthetic carpules ```

Iatrogenic infx in dental setting may be induced by failure to perform hand hygiene between pt procedures by performing tx pocedures in pts with debilitated or compromised immune defenses all

all

Occupational exposure incidents involving saliva and/or intact skin in dental settings typically: require special evaluation and prophylaxis by a qualified health care professional have a low risk of transmitting HIV dz have a >20% risk for subsequent HCV transmission have a >15% risk for subsequent HBV transmission

have a low risk of transmitting HIV

Using automated cleaning equipment is more time efficient, improves cleaning effectiveness, and is safer than hand-scrubbing. Cleaned instruments need not be wrapped not heat sterilized prior to use on subsequent patients

1 true 2 wrong

According to OSHA bloodborne pathogen standard, disposable glovea that have been contaminated shall be replaced immediately as soon as possible as soon as feasible as soon as practical

as soon as practical as soon as feasible when torn

One major difference between current "standard" infection control precautions and previous "universal" precautions recommendations, is that "universal" precautions: primarily targeted protection against respiratory infx provided specific precautions to protect against all known microbial pathogens was designed to primarily protect against bloodborne pathogens addressed inection control precautions to eliminate opportunistic pathogen risks

was designed to primarily protect against bloodborne pathogens standard: added all body fluids, moist body surfaces etc

Using cassettes to process and re-circulate instruments in clinical settings can make instrument processing more efficient increase organization of dental instruments decrease handling of contaminated instruments during cleaning procedures reduce the potential for accidental sharps injuries all of the above

all of the above

Using latex gloves, masks, and gauze that are contaminated with saliva and blood after pt care should always be placed in a medical waste container. Contaminated waste is routinely considered infectious.

both false contaminated waste can be discarded with office trash