Medical Quiz on Hepatitis and Alzheimer’s Genetics

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Questions and Answers

HepB surface antigen must coat HepD viral particles to enter what type of cells?

hepatocytes

Which gene mutations are associated with early-onset familial Alzheimer's?

APP (correct)

Presenilin 1 (correct)

ApoE4

Presenilin 2 (correct)

Pulmonary vascular resistance is lowest at ______.

FRC (functional residual capacity)

Prolonged total parenteral nutrition (TPN) is often complicated by what condition?

gallstones Signup and view all the answers

What cell wall component does carbolfuchsin stain bind to in acid-fast bacteria?

mycolic acid Signup and view all the answers

What is the first-line drug treatment for narcolepsy?

Modafinil Signup and view all the answers

Individuals who are slow acetylators are at greater risk for developing what condition?

drug-induced lupus erythematosus Signup and view all the answers

What is the first-line treatment for depression that does not cause sexual dysfunction or weight gain?

bupropion Signup and view all the answers

Which carotid artery feeds the retina?

Internal carotid artery Signup and view all the answers

Fall onto an outstretched, dorsiflexed hand leads to a __________ fracture.

scaphoid Signup and view all the answers

What three substances does tetrahydrobiopterin (BH4) help synthesize?

tyrosine, dopamine, serotonin Signup and view all the answers

What is the first-line treatment for Lyme disease?

Tetracyclines Signup and view all the answers

What two ketogenic amino acids can provide energy in the form of acetyl-CoA without producing lactic acid?

lysine, leucine Signup and view all the answers

Antibodies against what are present in most patients with Hashimoto thyroiditis?

TPO Signup and view all the answers

Which drug overdose produces a triad of fever, tinnitus, and tachypnea?

aspirin Signup and view all the answers

What is the mechanism of action (MOA) of nifedipine and amlodipine?

calcium channel blockers that affect arterial smooth muscle Signup and view all the answers

Ecchymosis is also known as a __________.

bruise Signup and view all the answers

Why does a pregnant woman's blood pressure drop when she lies supine?

compression of IVC Signup and view all the answers

Calcineurin is important for the activation of which interleukin?

IL-2 Signup and view all the answers

What serotonin receptor antagonist is effective for treating nausea and vomiting?

ondansetron Signup and view all the answers

Fragile X syndrome is caused by an increase in CGG repeats leading to __________.

hypermethylation Signup and view all the answers

Where is the medial longitudinal fasciculus (MLF) located?

dorsal pons Signup and view all the answers

The short gastric veins drain blood into which vein?

splenic vein Signup and view all the answers

What is the most common side effect of opioids?

constipation Signup and view all the answers

Most renal cell carcinomas originate from which part of the kidney?

proximal renal tubules Signup and view all the answers

Amphotericin B is most toxic to which organ?

kidneys Signup and view all the answers

What is the mechanism of action of colchicine in treating gout?

inhibits leukocyte migration and phagocytosis Signup and view all the answers

What is Nitroglycerin primarily used for?

Symptomatic relief in chronic stable angina Signup and view all the answers

What is the first-line treatment for essential tremor?

Propranolol Signup and view all the answers

What is the active form of RAS signaling protein?

GTP Signup and view all the answers

What is Mullerian Aplasia associated with?

No upper vagina and variable uterine development Signup and view all the answers

In a domestic violence case, what is a physician's priority?

Safety Signup and view all the answers

A stroke in which brain area would cause complete contralateral sensory loss?

Thalamus Signup and view all the answers

What causes lacunar infarcts?

Small vessel occlusion due to lipohyalinosis and microatheroma formation Signup and view all the answers

What is the treatment of choice for behavioral symptoms of delirium?

Low dose antipsychotic (haloperidol) Signup and view all the answers

What do adenosine and dypyridamole selectively dilate?

All coronary vessels Signup and view all the answers

What is the treatment of choice for status epilepticus?

IV benzodiazepine (like lorazepam) Signup and view all the answers

What deficiency causes Pellagra?

Vitamin B3 (Niacin) Signup and view all the answers

Which nerve, when stimulated, moves the bulky tongue in obstructive sleep apnea?

Hypoglossal Signup and view all the answers

Where should a femoral nerve block be performed?

Inguinal crease at lateral border of femoral artery Signup and view all the answers

Where is the pudendal nerve block injected for delivery?

Ischial spine tip Signup and view all the answers

What mediates the changes seen in Gigantism due to hypersecretion of growth hormone?

Insulin-like growth factor 1 (IGF-1) Signup and view all the answers

What is the toxic component of LPS?

Lipid A Signup and view all the answers

What causes ACE-inhibitor induced angioedema and dry cough?

Bradykinin accumulation Signup and view all the answers

In a lateral ankle sprain, what ligament is most commonly involved?

Anterior talofibular ligament Signup and view all the answers

What is anti-cholinergic toxicity caused by?

Atropine and scopolamine Signup and view all the answers

How does timolol help treat glaucoma?

It diminishes secretion of aqueous humor by ciliary epithelium Signup and view all the answers

What is the defining feature of Ebstein anomaly?

Displacement of tricuspid valve leaflets downward into RV Signup and view all the answers

What is Zellweger syndrome characterized by?

Defective peroxisomal biogenesis Signup and view all the answers

What is pulsus paradoxus?

Exaggerated drop in systolic blood pressure during inspiration Signup and view all the answers

What is Beck's triad characteristic of?

Cardiac tamponade Signup and view all the answers

What is acute intermittent porphyria caused by?

Porphobilinogen (PBG) deaminase deficiency Signup and view all the answers

What are the common adverse effects of long-term lithium therapy?

Hypothyroidism and nephrogenic diabetes insipidus Signup and view all the answers

How to get substances out of the lungs: upper airway involves _____

coughing/sneezing Signup and view all the answers

How to get substances out of the lungs: bronchi to terminal bronchioles involves _____

mucociliary transport Signup and view all the answers

How to get substances out of the lungs: respiratory bronchioles to alveoli involves _____

phagocytosis by alveolar macrophages Signup and view all the answers

What are the specific features of Graves disease?

Ophthalmopathy and pretibial myxedema Signup and view all the answers

What are the signs of Gerstmann Syndrome?

Agraphia, acalculia, finger agnosia, and left-right disorientation Signup and view all the answers

What is the first-line treatment for Wilson Disease?

Copper chelator (penicillamine) Signup and view all the answers

What is the first-line treatment for iron overdose?

Iron chelator (Deferoxamine, Deferasirox, Deferipone) Signup and view all the answers

What is the first-line treatment for lead poisoning?

Edetate calcium disodium (CaNa2 EDTA) Signup and view all the answers

How is scabies typically described?

Highly contagious, rapidly spreading, intensely pruritic rash Signup and view all the answers

What factors drive angiogenesis?

VEGF and FGF Signup and view all the answers

What do Leydig and Sertoli cells secrete?

Leydig secretes testosterone, Sertoli secretes Inhibin B Signup and view all the answers

What is associated with t(15;17) in Auer rods?

Acute Promyelocytic Leukemia (APML) Signup and view all the answers

What does Potter Sequence result in?

Newborn with pulmonary hypoplasia and facial limb deformities Signup and view all the answers

What type of maneuvers are carotid sinus massage, valsalva, and cold water immersion?

Vagal maneuvers Signup and view all the answers

What nerve is commonly injured in fibular neck fractures?

Common peroneal (fibular) nerve Signup and view all the answers

What neurotransmitter do the raphe nuclei release?

Serotonin Signup and view all the answers

What happens during metyrapone stimulation test?

Patients will experience a reactive increase in ACTH Signup and view all the answers

What condition is associated with hydralazine, procainamide, and isoniazid?

Drug-induced lupus erythematosus Signup and view all the answers

What are two methods for reversing warfarin anticoagulation?

Fresh frozen plasma (rapid) and Vitamin K (slow) Signup and view all the answers

What condition is nonbacterial thrombotic endocarditis commonly associated with?

Advanced malignancy Signup and view all the answers

What is heteroplasmy?

Coexistence of distinct versions of mitochondrial genomes in a single cell Signup and view all the answers

Autosomal deficiency of adenosine deaminase is the second most common cause of _____

SCID Signup and view all the answers

Match the lymphatic drainage of the rectum above vs. below the anal dentate line:

Above the line = Inferior mesenteric & internal iliac Below the line = Superficial inguinal nodes Signup and view all the answers

Acoustic schwannomas arise from which cranial nerve?

CN VIII Signup and view all the answers

What vitamin is beneficial in treating measles?

Vitamin A Signup and view all the answers

What does desmopressin increase the release of?

vWF from endothelial cells Signup and view all the answers

What should patients be screened for before starting TNF-a inhibitors?

Latent tuberculosis Signup and view all the answers

What term refers to normal tissues found in an abnormal location due to maldevelopment?

Ectopy Signup and view all the answers

What deficiency can lead to Wernicke encephalopathy?

Thiamine (vitamin B1) Signup and view all the answers

What are the two main findings in Plummer-Vinson syndrome?

Dysphagia and iron deficiency anemia Signup and view all the answers

What residues must be phosphorylated for proteins to transit through the Golgi apparatus?

Mannose residues Signup and view all the answers

What brain area is damaged in hemiballism?

Subthalamic nucleus Signup and view all the answers

What is a common side effect of phenytoin?

Gingival hyperplasia Signup and view all the answers

Match the heart leads with their corresponding arteries:

Lateral leads = Left circumflex artery Anterior leads = Left anterior descending artery Inferior leads = Right coronary artery Signup and view all the answers

What is the drug of choice to manage unwanted muscarinic overstimulation in Myasthenia Gravis treatment?

Selective muscarinic antagonist (glycopyrrolate) Signup and view all the answers

What bacterium commonly causes meningitis in immunocompromised adults or neonates?

Listeria monocytogenes Signup and view all the answers

What two substances can be increased in production due to small intestinal bacterial overgrowth (SIBO)?

Vitamin K and folate Signup and view all the answers

Which sugar-alcohol accumulates in cells during hyperglycemia?

Sorbitol Signup and view all the answers

What insulin-sensitive glucose transporter is expressed in skeletal muscle and adipocytes?

GLUT-4 Signup and view all the answers

What causes pityriasis (tinea) versicolor?

Malassezia Signup and view all the answers

What condition leads to direct hyperbilirubinemia and transient jaundice?

Dubin-Johnson syndrome Signup and view all the answers

What happens to Positive Predictive Value (PPV) as disease prevalence increases?

PPV increases Signup and view all the answers

What class of antifungal drugs inhibits ergosterol synthesis?

-azoles Signup and view all the answers

What does DRESS syndrome stand for?

Delayed drug reaction with eosinophilia and systemic symptoms Signup and view all the answers

Concentric LV hypertrophy is due to __________ overload.

pressure Signup and view all the answers

Eccentric LV hypertrophy is due to __________ overload.

volume Signup and view all the answers

What type of chemotherapy often causes acute nausea?

Systemic chemotherapy Signup and view all the answers

How does Hepatitis B virus assist Hepatitis D virus?

Provides envelope proteins for Hepatitis D to replicate Signup and view all the answers

Study Notes

Nitroglycerin and Angina

Nitroglycerin acts primarily as a venodilator, reducing preload and afterload while maintaining stroke volume.
Mechanism of action involves increasing nitric oxide (NO) which enhances cGMP, decreasing intracellular calcium, and relaxing vascular smooth muscle.
Common adverse effects include headaches, flushing, lightheadedness, hypotension, and reflex tachycardia.
Nitroprusside may lead to cyanide toxicity.

Essential Tremor Treatment

First-line treatment for essential tremor is Propranolol.

RAS Signaling

RAS signaling is activated by binding to GTP; KRAS mutations can lead to colon cancer.

Müllerian Aplasia

Characterized by agenesis of the upper vagina and variable uterine development; 46,XX females typically have normal ovaries and secondary sexual characteristics.

Domestic Violence Cases

Physician priority is ensuring safety for the patient; do not confront denial or pressure them to disclose abuse.

Stroke and Sensory Loss

Complete contralateral sensory loss occurs with damage to the thalamus.

Lacunar Infarcts

Caused by small vessel occlusions due to lipohyalinosis and microatheromas; typically affect lenticulostriate arteries.

Delirium Management

Behavioral symptoms of delirium are best treated with low-dose antipsychotics like haloperidol.

Coronary Vasodilators

Adenosine and Dypyridamole act as selective vasodilators for all coronary vessels; potential for coronary steal syndrome exists.

Status Epilepticus Treatment

Treat with IV benzodiazepines (e.g., lorazepam) to halt seizures; follow with phenytoin to prevent recurrence.

Pellagra

Caused by Vitamin B3 (Niacin) deficiency leading to diarrhea, dermatitis, and dementia; can develop in nutrient-poor diets.

Obstructive Sleep Apnea

Stimulation of the hypoglossal nerve helps displace a bulky tongue in obstructive sleep apnea.

Femoral Nerve Block

Administered at the inguinal crease, lateral to the femoral artery; numbs anterior thigh, including quadriceps.

Pudendal Nerve Block

Performed at the ischial spine tip for vaginal deliveries; can result in decreased perineal sensation and possible fecal/urinary incontinence.

Gigantism and Growth Hormone

Gigantism involves hypersecretion of growth hormone, mediated by insulin-like growth factor 1 (IGF-1) from the liver.

LPS Toxic Component

Lipid A is the toxic component of lipopolysaccharides, primarily involved in gram-negative sepsis.

ACE-Inhibitors and Side Effects

Angioedema and dry cough from ACE inhibitors are due to bradykinin accumulation, which can also increase prostaglandin production.

Ankle Sprains

Inversion of a plantar-flexed foot typically injures the anterior talofibular ligament.

Anticholinergic Toxicity

Characterized by symptoms summarized as "blind as a bat, mad as a hatter," and can be reversed with cholinesterase inhibitors.

Timolol for Glaucoma

A non-selective beta-blocker that reduces aqueous humor secretion to lower intraocular pressure.

Ebstein Anomaly

Involves downward displacement of tricuspid valve leaflets, causing right heart failure; associated with lithium teratogenicity.

Zellweger Syndrome

Characterized by defective peroxisomal biogenesis causing symptoms like craniofacial abnormalities and death from accumulated very long chain fatty acids.

Pulsus Paradoxus

Notable drop in systolic blood pressure during inspiration, frequently observed in cardiac tamponade.

Beck's Triad

Classic signs of cardiac tamponade include hypotension with pulsus paradoxus, elevated jugular venous pressure, and muffled heart sounds.

Acute Intermittent Porphyria

Caused by porphobilinogen deaminase deficiency, leading to abdominal pain and neuropsychiatric symptoms; worsens with alcohol or smoking.

Lithium Therapy Side Effects

Long-term lithium therapy can lead to hypothyroidism and nephrogenic diabetes insipidus.

Mucociliary Transport

Mucociliary transport removes debris from bronchi to terminal bronchioles; phagocytosis handles material in respiratory bronchioles and alveoli.

Graves Disease Features

Characterized by ophthalmopathy (proptosis) and pretibial myxedema.

Gerstmann Syndrome

Results from damage to the angular gyrus, presenting with agraphia, acalculia, finger agnosia, and left-right disorientation.

Wilson Disease Treatment

First-line treatment includes copper chelation with penicillamine.

Iron Overdose Treatment

Treat with iron chelators like Deferoxamine, Deferasirox, or Deferiprone.

Lead Poisoning Symptoms and Treatment

Symptoms include blue "lead lines," abdominal pain, and neurotoxicity; treat with edetate calcium disodium.

Scabies Presentation

Caused by Sarcoptes scabiei, leading to a highly pruritic rash, particularly in wrist and finger areas.

Angiogenesis Factors

Driven by vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF).

Leydig and Sertoli Cells

Leydig cells respond to LH to produce testosterone; Sertoli cells respond to FSH and produce inhibin B.

Acute Promyelocytic Leukemia

Relates to a t(15;17) translocation and Auer rods; treated with all-trans retinoic acid.

Potter Sequence

Results from renal anomalies causing oligohydramnios; involves pulmonary hypoplasia and facial deformities.

Vagal Maneuvers

Techniques like carotid sinus massage that increase parasympathetic tone; useful for treating paroxysmal supraventricular tachycardia.

Common Peroneal Nerve Injury

Vulnerable in fibular neck fractures, leading to dorsiflexion weakness and sensory loss in the dorsum of the foot.

Raphe Nuclei Function

Release serotonin, a target for various antidepressants (SSRIs, SNRIs).

Metyrapone Test

Leads to decreased cortisol synthesis; a functional HPA axis shows elevated ACTH due to loss of negative feedback.

Drug-Induced Lupus Erythematosus

Associated with drugs like hydralazine, procainamide, and isoniazid; characterized by anti-histone antibodies.

Warfarin Reversal

Achieved via fresh frozen plasma (rapid) and vitamin K (slow).

Nonbacterial Thrombotic Endocarditis

Commonly linked to advanced malignancies and can involve sterile platelet thrombi on heart valves.

Heteroplasmy

Refers to varying mitochondrial genomes within a single cell, potentially leading to diverse disease manifestation.

SCID Causes

Autosomal deficiency of adenosine deaminase is the second most common cause of severe combined immunodeficiency, following X-linked IL-2R gamma chain defects.

Rectal Lymphatic Drainage

Above the anal dentate line drains to the inferior mesenteric and internal iliac nodes; below it drains to superficial inguinal nodes.

Acoustic Schwannomas

Arise from CN VIII; can affect CN V and CN VII, presenting with hearing loss, tinnitus, and potential facial paralysis.

Vitamin A and Measles

Beneficial in managing measles to reduce ocular complications.

Desmopressin Function

Increases von Willebrand factor release, aiding in bleeding disorders and also used in diabetes insipidus.

Screening for Tuberculosis

Necessary prior to starting TNF-alpha inhibitors, due to risk of reactivation.

Ectopy

Refers to tissue found in abnormal locations due to developmental anomalies; differs from metaplasia, which is an adaptive response.

Thiamine Deficiency

Leads to Wernicke encephalopathy, affecting the mammillary bodies; characterized by ataxia and confusion; thiamine should always be given with glucose.

Plummer-Vinson Syndrome

Characterized by dysphagia and iron deficiency anemia, often accompanied by spoon-shaped nails and a shiny red tongue.

Mannose Phosphorylation

Necessary for lysosomal transit of proteins; defective in certain lysosomal storage diseases.

Hemiballism

Involuntary flinging movements caused by damage to the subthalamic nucleus, indicative of basal ganglia modulation issues.

Phenytoin Side Effects

Commonly causes gingival hyperplasia due to elevated platelet-derived growth factor.

EKG Lead Associations

Lateral leads correspond to the left circumflex artery, anterior leads to the left anterior descending artery, and inferior leads to the right coronary artery.

Myasthenia Gravis Treatment

Cholinesterase inhibitors improve muscle strength but may cause muscarinic side effects, managed with selective muscarinic antagonists.

Listeria Monocytogenes

A gram-positive rod causing meningitis, especially in vulnerable populations; transmitted via food.

Gastric Bypass Complications

Can lead to small intestinal bacterial overgrowth, increasing the production of vitamin K and folate.

Sorbitol Accumulation in Diabetes

Sorbitol accumulates in hyperglycemia due to ald### Pharmacology and Drug Effects
Slow acetylators: Impair liver metabolism for certain drugs (e.g., procainamide, hydralazine, isoniazid), increasing toxicity risk; exhibits bimodal distribution in drug concentration.
Bupropion: First-line treatment for depression, doesn't cause sexual dysfunction or weight gain; a norepinephrine and dopamine reuptake inhibitor; high doses may increase seizure risk; contraindicated in patients with seizure disorders.
Mirtazapine: Alternative antidepressant that also avoids sexual side effects.

Cardiovascular and Neurological Health

Internal carotid artery: Supplies blood to the retina via the ophthalmic artery; occlusion leads to acute, painless monocular vision loss.
Compression of IVC: When a pregnant woman lies supine, it reduces venous return, decreases preload, and causes hypotension.
Calcineurin: Important for IL-2 activation, vital for T cell growth and differentiation; inhibited by immunosuppressants like cyclosporine and tacrolimus.

Musculoskeletal and Neurological Injuries

Fall onto an outstretched hand: Can lead to scaphoid fracture (tenderness in the snuff box, avascular necrosis risk), lunate dislocation (risk of carpal tunnel syndrome), and distal radius fracture.
Medial longitudinal fasciculus (MLF): Located in dorsal pons; MLF lesions can result in internuclear ophthalmoplegia.

Biochemical Pathways and Genetic Disorders

Tetrahydrobiopterin (BH4): Cofactor for hydroxylase enzymes synthesizing tyrosine (from phenylalanine), dopamine (from tyrosine), and serotonin (from tryptophan).
Fragile X syndrome: Caused by increased CGG repeats on FMR1 gene, leading to gene hypermethylation and inactivation.

Renal Health

Renal cell carcinoma: Most commonly arises from epithelial cells of proximal renal tubules; clear cell carcinomas contain high lipid content.
Amphotericin B: Antifungal known for renal toxicity; watch for severe hypokalemia and hypomagnesemia.

Gastrointestinal and Endocrinological Insights

Ondansetron: Effective serotonin (5-HT) receptor antagonist for nausea/vomiting caused by GI upset or chemotherapy; well-tolerated.
Acute gout treatment: Colchicine inhibits leukocyte phagocytosis by blocking microtubular polymerization; side effects include nausea and diarrhea.

Common Conditions and Symptoms

Ecchymosis: Also termed a bruise; indicates deep hemorrhage or extravasated blood; changes color from blue/red to green then yellow.
Opioid use: Most common side effect is constipation; individuals do not develop tolerance to this effect.

Drug Overdose Indicators

Aspirin overdose: Characterized by a triad of fever, tinnitus, and tachypnea; leads to respiratory alkalosis and anion gap metabolic acidosis; treatment includes sodium bicarbonate to alkalinize urine.

Miscellaneous

Short gastric veins: Drain blood from the stomach into the splenic vein; pancreatic inflammation may cause clots in this area, increasing pressure and leading to varices in the fundus.

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Description

Test your knowledge on the key concepts of Hepatitis B and the genetic factors involved in Alzheimer's disease. This quiz covers the role of HepB surface antigen, the genetic mutations associated with early and late-onset Alzheimer’s, and pulmonary vascular resistance. Challenge yourself with important definitions and concepts in the field of medicine.