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Questions and Answers
What is a characteristic finding of congenital cytomegalovirus infection?
Which of the following is NOT a marker for Hepatitis B?
What complication can arise from chronic overproduction of gastric acid?
Which first-generation antipsychotic is most likely to cause extrapyramidal symptoms?
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What is a common consequence of an influenza infection on the respiratory system?
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In a fasting state, which hormones are primarily responsible for preventing hypoglycemia?
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Which type of pleural effusion is characterized by high protein and LDH levels?
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Which congenital infection is associated with sensorineural hearing loss and heart defects?
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What alteration in blood supply do the lungs receive to help protect against infarction?
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What structural abnormality is most commonly associated with congenital syphilis?
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Which embryological layer gives rise to the kidneys?
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What type of hypersensitivity reaction is primarily involved in serum sickness?
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What is the primary mechanism of mycobacterial resistance to isoniazid?
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Which of the following best describes paranoid personality disorder?
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What is a common clinical manifestation of niacin toxicity?
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What is the greatest risk factor for developing cervical cancer?
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In which part of the midbrain are the structures responsible for the pupillary light reflex located?
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What does the Hawthorne effect describe?
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What complication can result from pudendal nerve injury during vaginal delivery?
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Which of the following best differentiates vasovagal syncope from anaphylaxis?
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Which of the following statements accurately describes the changes in phospholipids during pregnancy?
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What is the initial consequence of the genetic defect in T cell development seen in severe combined immunodeficiency?
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What characterizes the late phase of a type 1 hypersensitivity reaction?
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What is a consequence of HcG secretion by testicular germ cell tumors?
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In bipolar disorder, how does Bipolar II differ from Bipolar I?
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What indicates advanced lung maturity during pregnancy?
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Which characteristic is associated with chronic granulomatous disease?
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Which of the following conditions is a result of a mutation in the VHL gene on chromosome 3p?
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What symptom might indicate the presence of a pituitary tumor?
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What differentiates typhoidal from nontyphoidal salmonella infections?
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Which of the following features is associated with congenital toxoplasmosis?
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What laboratory marker indicates persistent Hepatitis B infection for more than six months?
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Which type of pleural effusion is typically associated with lower levels of protein and LDH?
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What is the main effect of glucagon and epinephrine during fasting?
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Which of the following is a feature of congenital rubella syndrome?
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Which anatomical feature protects the lungs from infarction during pulmonary artery occlusion?
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Which of the following findings is typical during an infection with influenza?
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What symptom is indicative of chronic gastric acid overproduction?
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What common side effect occurs due to D2 receptor blockade by first-generation antipsychotics?
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What is the primary consequence of increased HBeAg in Hepatitis B infection?
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What is the hallmark duration of symptoms required for a diagnosis of cyclothymic disorder?
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Which condition is most likely to cause bradycardia during a vaccine administration?
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What is the primary embryological origin of the lungs?
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What is the mechanism by which lead time bias occurs in screening tests?
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Which factor is most commonly associated with serological immune complexes in serum sickness?
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Which neurotransmitter system is primarily involved in the pathophysiology of schizophrenia?
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Which physiological change is commonly seen as a result of niacin toxicity?
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Which psychological trait is most characteristic of schizotypal personality disorder?
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Which outcome is primarily associated with pudendal nerve injury during vaginal delivery?
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What condition results from reductions in the catalase peroxidase enzyme in mycobacterial strains?
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What hormonal change occurs during prolonged fasting that affects gluconeogenesis, lipolysis, and proteolysis?
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What does the presence of phosphatidylglycerol in the amniotic fluid during the third trimester indicate?
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What is a characteristic symptom of agammaglobulinemia caused by B cell dysfunction?
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In which condition is the defective enzyme NADPH oxidase implicated?
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What type of hypersensitivity reaction is triggered by an intradermal injection of candida?
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What is the genetic mutation associated with Li-Fraumeni syndrome?
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Which condition is characterized by accumulation of glucocerebroside due to decreased glucocerebrosidase activity?
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What is the primary manifestation of pituitary tumors in men?
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What signifies the distinction between typhoidal and nontyphoidal salmonella infections?
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What is indicated by asymmetric pupil reactions during light exposure?
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Study Notes
Congenital Infections
- Toxoplasmosis: Chorioretinitis, hydrocephalus, diffuse intracranial calcifications
- Syphilis: Rhinorrhea, skeletal anomalies
- Rubella: Cataracts, heart defects, sensorineural hearing loss
- Cytomegalovirus: Periventricular calcifications, microcephaly, sensorineural hearing loss
Rubella
- Typically presents as polyarthritis, rash, and postauricular lymphadenopathy
Collagen
- Glycine is the most abundant amino acid in collagen
Extrapyramidal Symptoms
- Acute extrapyramidal symptoms like dystonia, akathisia, and parkinsonism are due to D2 blockage in the nigrostriatal pathway.
- First-generation antipsychotics like haloperidol and fluphenazine block D2 receptors and are most likely to cause extrapyramidal symptoms.
Gastric Acid Neutralization
- Gastric acid is neutralized by bicarbonate from the submucosal (Brunner) glands of the duodenum and from pancreatic duct secretions.
- Chronic overproduction of gastric acid can lead to hyperplasia of the submucosal glands.
Lung Circulation
- The lungs are supplied by dual circulation from both the pulmonary and bronchial arteries.
- This collateral circulation can help protect against lung infarction due to pulmonary artery occlusion (PE).
- The bronchial circulation can continue to provide blood to the lung parenchyma.
Hepatitis B Markers
- HBsAg: Surface marker that is detectable during acute infection. Persistence of more than 6 months leads to chronic infection.
- HBeAG: Detectable during acute infection, indicates increased viral replication and infectivity.
- Anti-HBc IgM: Detectable during acute infection, present during the window phase between HBsAg and anti-HBs.
- Anti-HBs: Seen with cleared infection or vaccination.
- Anti-Hbe: Indicates decreased viral replication.
- Anti-HBc IgG: Seen during infection, not present after vaccination.
Influenza
- Influenza alters the respiratory epithelium, increasing the risk of infection with Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae.
Pleural Effusions
- Exudative pleural effusion: Infection, malignancy, and rheumatologic disease. An increase in protein or LDH is seen.
- Transudative pleural effusion: Caused by heart failure, cirrhosis, and nephrotic syndrome when protein and LDH are low.
Fasting and Metabolism
- In a fasting state, glucagon and epinephrine bind to transmembrane receptors and prevent hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis.
- Prolonged fasting increases secretion of cortisol, a steroid hormone that binds to an intracellular receptor and acts to increase transcription of enzymes involved in gluconeogenesis, lipolysis, and proteolysis.
Lung Maturity
- Phosphatidylcholine and sphingomyelin increase equally until the middle of the third trimester.
- After the middle of the third trimester, phosphatidylcholine concentration increases sharply, while sphingomyelin levels remain low, reflecting the production of more mature surfactant.
- Phosphatidylglycerol increases late in the third trimester, indicating advanced lung maturity.
Immunodeficiency
-
Severe combined immunodeficiency: Caused by a genetic defect in T cell development, leading to loss of both cellular and humoral immunity (B cell dysfunction).
- These patients are infected by opportunistic infections, experience failure to thrive, and have diarrhea.
- Agammaglobulinemia: B cell defect that manifests with recurrent sinopulmonary bacterial infections.
-
Chronic granulomatous disease: Disorder of phagocyte dysfunction due to defective NADPH oxidase.
- Presents as skin abscesses, pneumonia, and osteomyelitis.
- Primary ciliary dyskinesia: Sinopulmonary infections and decreased fertility.
Type IV Hypersensitivity Reaction
- Intradermal injection of Candida triggers a type IV hypersensitivity reaction, enabling a cell-mediated immune response.
- Candida is taken up by antigen-presenting cells (APCs) and presented on MHCII to naïve CD4 cells.
- The cells differentiate into Th1 cells that secrete TNF-alpha and recruit macrophages.
Exercise Physiology
- During physical exercise, increased skeletal muscle CO2 increases the CO2 content of venous blood.
- Arterial O2 and CO2 content remain constant via alveolar ventilation and gas exchange efficiency.
- Venous O2 content remains constant or is decreased due to increased O2 extraction by tissues that matches or exceeds the rate of oxygen delivery.
Alzheimer's Disease
- The amyloid precursor protein (APP) gene is on chromosome 21 and can lead to early-onset Alzheimer's disease.
Salmonella
- Nontyphoidal Salmonella: Comes from poultry/eggs. Presents as self-limited watery diarrhea. Can progress to osteomyelitis, mycotic aneurysm.
- Typhoidal Salmonella: Due to water/food contamination. Presents with progressive fever, rose spots, GI bleeding, and perforation.
Type I and IV Hypersensitivity Reactions
- Late-phase type I hypersensitivity reactions: Manifest as an indurated skin lesion hours after exposure to the allergen due to local tissue damage caused by major basic protein released from eosinophils.
- Type IV hypersensitivity reactions: Develop over days due to the time needed to produce a cell-mediated immune response.
Pituitary Tumors
- Pituitary tumors can present with headaches, bitemporal hemianopsia, and hypopituitarism.
- In women, prolactinomas can cause galactorrhea and amenorrhea.
- In men, they often present with hypogonadism.
Gaucher Disease
- Gaucher disease is a lysosomal storage disease in which decreased activity of glucocerebrosidase leads to the buildup of glucocerebroside.
- Accumulation of this substrate within lysosomes in the mononuclear phagocyte system results in hepatosplenomegaly, cytopenia, and bone involvement.
- CNS involvement can also lead to neurologic manifestations, such as spasticity.
Testicular Germ Cell Tumors
- Secretion of hCG by testicular germ cell tumors impairs testosterone production in Leydig cells while increasing aromatase activity and conversion of androgens to estrogens.
- The resulting increase in the estrogen/androgen ratio can cause gynecomastia.
Renal Cell Carcinomas
- Sporadic and hereditary (associated with von Hippel-Lindau disease) renal cell carcinomas are associated with mutations involving the VHL gene on chromosome 3p.
Cancer Syndromes
-
Li-Fraumeni syndrome: Associated with sarcomas, breast cancer, brain tumors, and adrenocortical carcinoma.
- Due to a TP53 mutation.
-
MEN1: Mutation in MEN1.
- Parathyroid adenomas, pituitary adenomas, pancreatic adenomas (inactivation of tumor suppressor genes).
-
MEN2: RET mutation.
- Medullary thyroid cancer, pheochromocytoma.
- Gain-of-function mutation in a proto-oncogene.
Pupil Asymmetry
- Asymmetry that increases in dim light indicates that the smaller pupil is unable to dilate due to loss of sympathetic nerve output.
- Asymmetry that increases under bright light indicates that the larger pupil is unable to constrict due to loss of parasympathetic nerve input.
Bipolar Disorders
- Bipolar I: Manic episodes with depressive episodes common but not required for diagnosis.
- Bipolar II: Hypomanic episodes (no psychotic features and less severe symptoms), one or more major depressive episodes.
- Cyclothymic disorder: 2 years or more of fluctuating, mild hypomanic and depressive symptoms that do not meet the criteria for hypomanic or major depressive episodes.
Serum Sickness
- Serum sickness is an immune complex-mediated type III hypersensitivity reaction that forms 5-14 days after exposure to foreign proteins in an antitoxin, antivenom, or monoclonal antibody.
- Patients show rash, fever, and arthralgia that resolves spontaneously due to immune complexes being cleared by the mononuclear phagocyte system.
Cervical Cancer
- The greatest risk factor for cervical cancer is lack of barrier contraception.
Embryological Derivatives
- Mesoderm: Muscle, spleen, kidney, adrenal cortex, peritoneum.
- Endoderm: Lungs, liver, pancreas, parathyroid, bladder, urethra, parafollicular C cells.
Vasovagal Syncope
- Vasovagal syncope is a known complication of vaccine administration.
- Can be differentiated from anaphylaxis based on skin findings (pallor vs. urticaria), absence of respiratory symptoms, and presence of bradycardia (vs. tachycardia).
Isoniazid Resistance
- Mycobacterial resistance to isoniazid (INH) is primarily mediated by reductions in the catalase peroxidase enzyme or through genetic modification of the INH binding site of the mycolic acid synthesis enzyme.
Pupillary Light Reflex
- The upper midbrain contains neural structures like the optic nerve, pretectal nuclei, Edinger-Westphal nuclei, and oculomotor nerve that mediate the direct and consensual pupillary light reflex.
Personality Disorders
- Paranoid personality disorder: Suspicious, distrustful.
- Schizoid personality disorder: Prefers to be a loner, detached, and unemotional.
- Schizotypical personality disorder: Magical thinking.
Niacin Toxicity
- Niacin (vitamin B3) is the precursor for NAD and NADP.
- Niacin toxicity leads to increased prostaglandin production, which causes cutaneous vasodilation, flushing, and pruritus.
- May be avoided by pretreating with NSAIDs.
Hawthorne Effect
- The Hawthorne effect (observer effect) is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied.
Lead Time Bias
- Lead time bias refers to the apparent prolongation of survival after applying a screening test that detects a disease earlier than it would have been otherwise detected, but without any real effect on prognosis.
Pudendal Nerve Injury
- Pudendal nerve injury during vaginal delivery leads to gradual denervation and weakness of the pelvic floor muscles.
- This injury can lead to pelvic organ prolapse (cystocele).
Congenital Infections
- Toxoplasmosis can lead to chorioretinitis, hydrocephalus, and diffuse intracranial calcifications.
- Syphilis may cause rhinorrhea and skeletal anomalies.
- Rubella can result in cataracts, heart defects, and sensorineural hearing loss.
- Cytomegalovirus can present with periventricular calcifications, microcephaly, and sensorineural hearing loss.
Rubella
- Rubella typically presents with polyarthritis, a rash, and postauricular lymphadenopathy.
Collagen
- Glycine is the most abundant amino acid in collagen.
Extrapyramidal Symptoms
- Acute extrapyramidal symptoms, such as dystonia, akathisia, and parkinsonism, are caused by D2 blockage in the nigrostriatal pathway.
- First-generation antipsychotics, like haloperidol and fluphenazine, block D2 receptors and are more likely to cause extrapyramidal symptoms.
Gastric Acid Neutralization
- Gastric acid is neutralized by bicarbonate from the submucosal (Brunner) glands of the duodenum and from pancreatic duct secretions.
- Chronic overproduction of gastric acid can lead to hyperplasia of the submucosal glands.
Dual Circulation of the Lungs
- The lungs are supplied by dual circulation from both the pulmonary and bronchial arteries.
- This collateral circulation can help protect against lung infarction due to pulmonary artery occlusion (PE).
- The bronchial circulation can continue to provide blood to the lung parenchyma.
Hepatitis B Markers
- HBsAg (surface marker): detectable during acute infection, persistence for more than 6 months leads to chronic infection.
- HBeAg: detectable during acute infection, indicates increased viral replication and infectivity.
- Anti-HBc IgM: detectable during acute infection, present during the window phase between HBsAg and anti-HBs.
- Anti-HBs: seen with cleared infection or vaccination.
- Anti-Hbe: indicates decreased viral replication.
- Anti-HBc IgG: seen during infection, not present after vaccination.
Influenza
- Influenza alters the respiratory epithelium and increases the risk of infection with Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae.
Pleural Effusions
- Exudative pleural effusion is associated with infection, malignancy, and rheumatologic disease; increased protein or LDH levels are observed.
- Transudative pleural effusion is caused by heart failure, cirrhosis, and nephrotic syndrome, with low protein and LDH levels.
Fasting and Glucose Regulation
- In a fasting state, glucagon and epinephrine bind to transmembrane receptors, preventing hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis.
- Prolonged fasting increases secretion of cortisol, a steroid hormone that binds to an intracellular receptor and increases transcription of enzymes involved in gluconeogenesis, lipolysis, and proteolysis.
Pulmonary Surfactant
- Phosphatidylcholine and sphingomyelin increase in equal amounts until the middle of the third trimester.
- Phosphatidylcholine concentration increases sharply while sphingomyelin levels remain low, reflecting a more mature surfactant.
- Phosphatidylglycerol increases late in the third trimester, indicating advanced lung maturity.
Immunodeficiency Disorders
- Severe combined immunodeficiency is a genetic defect in T cell development, resulting in loss of both cellular and humoral immunity.
- Patients with severe combined immunodeficiency are susceptible to opportunistic infections, failure to thrive, and diarrhea.
- Agammaglobulinemia is a B cell defect manifested by recurrent sinopulmonary bacterial infections.
- Chronic granulomatous disease is a disorder of phagocyte dysfunction, caused by defective NADPH oxidase, leading to skin abscesses, pneumonia, and osteomyelitis.
- Primary ciliary dyskinesia causes sinopulmonary infections and decreased fertility.
Type IV Hypersensitivity
- Intradermal injection of Candida triggers a Type IV hypersensitivity reaction, eliciting a cell-mediated immune response.
- Candida is taken up by APCs and presented on MHCII to naïve CD4 cells.
- These cells differentiate into Th1 cells, secreting TNF-alpha and recruiting macrophages.
Physical Exercise and Gas Exchange
- During physical exercise, increased skeletal muscle CO2 increases the CO2 content of venous blood.
- Arterial O2 and CO2 content remain constant due to alveolar ventilation and gas exchange efficiency.
- Venous O2 content remains constant or decreases due to increased O2 extraction by tissues.
Alzheimer's Disease
- Amyloid precursor protein (APP) gene is located on chromosome 21 and is implicated in early-onset Alzheimer's disease.
Salmonella Infections
- Nontyphoidal Salmonella is typically acquired from poultry or eggs and presents as self-limited watery diarrhea. It can progress to osteomyelitis or mycotic aneurysm.
- Typhoidal Salmonella is transmitted through contaminated water or food. It causes progressive fever, rose spots, GI bleeding, and perforation.
Type I and Type IV Hypersensitivity Reactions
- The late phase of Type I hypersensitivity reactions manifests as an indurated skin lesion hours after exposure to the allergen, due to local tissue damage caused by major basic protein released from eosinophils.
- Type IV hypersensitivity reactions develop over days due to the time needed to produce a cell-mediated immune response.
Pituitary Tumors
- Pituitary tumors can present with headaches, bitemporal hemianopsia, and hypopituitarism.
- Prolactinomas can cause galactorrhea and amenorrhea in women and hypogonadism in men.
Gaucher Disease
- Gaucher disease is a lysosomal storage disease characterized by decreased glucocerebrosidase activity, leading to gluccocerebroside buildup.
- Accumulation of this substrate within lysosomes of the mononuclear phagocyte system causes hepatosplenomegaly, cytopenia, bone involvement, and potential neurologic manifestations.
Testicular Germ Cell Tumors
- Secretion of hCG by testicular germ cell tumors impairs testosterone production in Leydig cells while increasing aromatase activity and conversion of androgens to estrogens.
- The resulting increase in the estrogen/androgen ratio can cause gynecomastia.
Renal Cell Carcinoma
- Sporadic and hereditary renal cell carcinomas are associated with mutations involving the VHL gene on chromosome 3p.
Cancer Syndromes
- Li Fraumeni syndrome is associated with sarcomas, breast cancer, brain tumors, and adrenocortical carcinoma, caused by a TP53 mutation.
- MEN1 is caused by a mutation in the MEN1 gene and involves parathyroid adenomas, pituitary adenomas, and pancreatic adenomas.
- MEN2 is associated with a RET mutation, leading to medullary thyroid cancer, pheochromocytoma, and a gain-of-function mutation in a proto-oncogene.
Pupillary Dilation and Constriction
- Asymmetry that increases in dim light indicates the smaller pupil is unable to dilate due to loss of sympathetic nerve output.
- Asymmetry that increases in bright light indicates the larger pupil is unable to constrict due to loss of parasympathetic nerve input.
Bipolar Disorders
- Bipolar I disorder is characterized by manic episodes, with depressive episodes common but not required for diagnosis.
- Bipolar II disorder involves hypomanic episodes (without psychotic features and less severe symptoms) and one or more major depressive episodes.
- Cyclothymic disorder is characterized by 2 or more years of fluctuating, mild hypomanic and depressive symptoms that do not meet the criteria for hypomanic or major depressive episodes.
Serum Sickness
- Serum sickness is a Type III hypersensitivity reaction that occurs 5-14 days after exposure to foreign proteins in an antitoxin, antivenom, or monoclonal antibody.
- Patients with serum sickness exhibit rash, fever, and arthralgia that resolve spontaneously as immune complexes are cleared by the mononuclear phagocyte system.
Cervical Cancer Risk Factors
- The greatest risk factor for cervical cancer is lack of barrier contraception.
Embryological Derivatives
- Mesoderm gives rise to muscle, spleen, kidney, adrenal cortex, and peritoneum.
- Endoderm forms lungs, liver, pancreas, parathyroid, bladder, urethra, and parafollicular C cells.
Vasovagal Syncope
- Vasovagal syncope is a known complication of vaccine administration.
- It can be differentiated from anaphylaxis based on skin findings (pallor vs. urticaria), absence of respiratory symptoms, and the presence of bradycardia (vs. tachycardia).
Mycobacterial Resistance to Isoniazid (INH)
- Mycobacterial resistance to INH is primarily mediated by reductions in the catalase peroxidase enzyme or through genetic modification of the INH binding site of the mycolic acid synthesis enzyme.
Pupillary Light Reflex
- The upper midbrain contains neural structures like the optic nerve, pretectal nuclei, Edinger-Westphal nuclei, and oculomotor nerve that mediate the direct and consensual pupillary light reflex.
Personality Disorders
- Paranoid Personality Disorder is characterized by suspicion and distrust.
- Schizoid Personality Disorder is characterized by a preference for being alone, detachment, and lack of emotion.
- Schizotypical Personality Disorder is characterized by magical thinking.
Niacin (Vitamin B3)
- Niacin (vitamin B3) is the precursor to NAD and NADP.
- Niacin toxicity leads to increased prostaglandin production which causes cutaneous vasodilation, flushing, and pruritus.
- Pretreatment with NSAIDs can help prevent these side effects.
Hawthorne Effect
- The Hawthorne effect (observer effect) is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied.
Lead Time Bias
- Lead time bias refers to the apparent prolongation of survival after applying a screening test that detects a disease earlier than it would have been otherwise detected, without any real effect on prognosis.
Pudendal Nerve Injury
- Pudendal nerve injury during vaginal delivery leads to gradual denervation and weakness of the pelvic floor muscles.
- This injury can lead to pelvic organ prolapse (cystocele).
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Description
This quiz covers congenital infections and their symptoms, including Toxoplasmosis, Syphilis, and Rubella. It also explores extrapyramidal symptoms caused by antipsychotics, the role of collagen in the body, and the mechanisms of gastric acid neutralization. Test your knowledge on these important medical concepts.
