Clin Integ Quiz 2 case 1

After a full-term delivery, a mother notices a slight yellowing of her baby's skin. Test results come back which show high levels of bilirubin. The doctor orders phototherapy and the jaundice improves. What type of bilirubin was causing the symptoms and why was phototherapy effective?

A. Unconjugated, chemical changes increasing the water solubility of bilirubin

A child of Mediterranean descent presents to the clinic with fatigue, facial bone deformities, slowed development and hepatosplenomegaly. After examining lab results along with observed signs and symptoms, the physician diagnosed the child with a type of hereditary anemia. What is the general pathogenesis of this blood disorder?

Autosomal codominant disorders caused by mutations in α- or β-globin that reduce hemoglobin synthesis

Alexa, A 19-year-old female of Mediterranean decent seeks advice from her doctor after feeling abnormally fatigued. Upon physical examination, the doctor notices Alexa is more pale than usual. Previously, she had not sought medical attention because she had attributed her fatigue to working tirelessly to become Valedictorian in high school. Before high school, Alexa claims she was asymptomatic. Her doctor orders a CBC, hemoglobin electrophoresis, and molecular genetic testing. Lab results find that she has microcytic, hypochromatic RBCs due to decreased b-chain synthesis. What other lab result can be attributed to why Alexa was previously asymptomatic?

Elevated HbF

A 34 year old male presented to his local emergency department for a severe bacterial infection of his upper respiratory tract. To combat the infection, the attending physician started the man on a 14 day intravenous cephalosporin treatment. However, after 10 days of receiving this treatment, he began developing symptoms not typical for pharyngitis. The patient displayed signs of fatigue, severe weakness, shortness of breath and pale, cold skin to the touch. A Direct Coombs Antiglobulin test was then performed which ultimately resulted in significant clumping of the blood. Based on the patient's presentation and the diagnostic test performed, what is the most likely mechanism of action causing the patient's symptoms?

Extravascular hemolysis due to IgG antibodies binding to the host's red cells at 37°C

A 24-year-old male presented to his primary care physician with lower neck pain, migraines, and cutaneous nodules on his genitalia. After further examination, the physician diagnosed the patient with primary syphilis. After treating the patient for two weeks with Benzathine penicillin, the nodules turned into painless granulomatous lesions. After further discussing the history of the patient, the physician had learned that the patient recently traveled to Australia on a mission trip 3 months ago. What bacterial infection does this patient have?

Klebsiella granulomatis

A 27-year-old female presents to the emergency room complaining of dysentery, severe stomach pain, and low-grade fever (99.5 F). She explains that she recently went to the cider mill with her roommate 3 days prior to her symptoms developing. She recalls drinking apple cider and having a few donuts while there. What is the causative agent, and which of the following agars would help differentiate what the causative agent is?

STEC, MacConkey-Sorbitol agar

A 19-year-old female presents to her primary care physician complaining of easy bruising on her arms and frequent nosebleeds. Her physician orders a CBC blood test, which shows a low platelet count. Which of the following platelet secretions is responsible for reducing blood flow to areas of blood vessel injury.

Serotonin

A 44-year-old female presents to her gynecologist with malaise, fatigue, shortness of breath, and severe pain in the pelvic area. Although her menstrual cycles are regular, and she suffers from dysmenorrhea and menorrhagia. Lab tests primarily reveal a hemoglobin level of 10 g/dL (normal: 12-16 g/dL female), a hematocrit level of 34% (normal: 37-47% female), and an MVC level of 73 fL (normal: 80-95 fL). An ultrasound reveals a benign mass in her uterus that is exerting pressure on her urethra and bladder, leading to difficulty and pain in emptying urine, thus causing frequent UTIs. Before resorting to surgical options to remove the fibroid, the gynecologist wants to try other treatment methods to help the patient's symptoms. Which of the following treatments is best for this patient?

A diet rich in meat and dark, leafy greens

A 21-year-old male from Northern Europe presents to the ER complaining of fatigue, lightheadedness, and appears jaundiced. Upon physical examination there appears to be tenderness in the right upper quadrant of his abdomen. He claims the lightheadedness comes and goes, but it has become more debilitating over the last few days. An ultrasound is ordered along with a CBC. Ultrasound shows the presence of gallstones and CBC indicates slightly lowered hemoglobin and hematocrit. These lab findings point to a diagnosis of Hereditary Spherocytosis. What is responsible for the morphology of red blood cells in patients with Hereditary Spherocytosis?

A frameshift mutation that results in the failure to produce proteins, resulting in destabilization and the shedding of membrane fragments

A 50 year old man returns from a business trip to a developing country, where bacterial diarrheal diseases are common. Upon returning to the United States, the man starts feeling symptoms of watery diarrhea and abdominal cramps 1-2 days later. The man is informed by his PCP that he has an Enterotoxigenic E. coli infection and most likely contracted it from his recent travel. How is this bacterial infection primarily acquired?

A. Consumption of fecally contaminated food or water

A patient comes to the ER with complaints of pelvic/abdominal pain, odor, and blood when urinating. She explains that she might have a recurring UTI from which she has been suffering from on and off for the past 2 years. After physical examination, the physician decides to obtain a bodily fluid swab. After viewing the swabs contents microscopically, it was confirmed that she had a UTI infection based on the increased levels of a certain cell type that initiates respiratory bursts which create oxygen radicals that rapidly destroy foreign particles. What physical characteristics might have the physician seen under a microscope to confirm his findings?

A. Pink granules, polymorphonuclear

A 24 year old female presents with the following symptoms: watery diarrhea, abdominal cramps, and vomiting. The lab results from the cultures collected revealed the bacteria was a gram negative rod, lactose fermenter, and growth of pink colonies was observed on MacConkey Agar. These results confirmed that the pathogen was E.coli. Which of the following is the epidemiology of E.coli?

A. The most common gram-negative rods isolated from patients with sepsis B. Responsible for causing more than 80% of all community-acquired UTIs C. Prominent cause of gastroenteritis D. All of the above

A 29 year old female goes to the doctor to find out what her blood type is. She wants to see if she could donate blood to a sibling needing a transfusion. They tell her she has a B antigen and has anti-A serum antibodies. What blood type does the sibling need to be in order to be able to receive her blood?

AB

23-year-old female presents to her PCP with complaints of pelvic pain, increased urge to urinate, pain with urination, and blood in the urine for 2 days. She reports no recent travel or GI symptoms. Urine culture and lab tests reveal lactose positive, indole positive, gram negative rods. She is diagnosed with a bacterial UTI and treated with antibiotics successfully. Which virulence factors make these bacteria particularly virulent in regards to causing UTIs?

Adhesins and hemolysin HlyA

A 62-year-old male presents to the ED complaining of fever (101.5 degrees F), abdominal pain, and edema (swelling) to his lower extremities, most notably to the ankles and feet. The patient notes the edema is worse at the end of the day and admits to a history of alcohol abuse. The ER physician suspects liver damage and orders a series of blood tests including a liver function test (LFT). The results of the liver function test were abnormal including low plasma protein levels. What is the main protein constituent of plasma that causes swelling of the ankles due to lowered colloid osmotic pressure?

Albumin

A 27-year-old male presents to his primary care physician with a pale appearance and describes his symptoms as malaise, general weakness and becoming fatigued rather easily. After a few tests, it was determined that this patient has developed an immunohemolytic anemia. What test did the attending physician use to diagnose the patient's condition based on his desire to characterize the antigens target and temperature dependence?

An indirect coombs antiglobulin test where the patient's serum is tested for its agglutinating ability against commercial red blood cells with specific antigens

A 36-year-old female goes to her General Family Physician after complaining of feeling tired and short of breath during the week. She complains of difficulty concentrating and frequent headaches and having a hard time falling asleep although she cuts caffeine in her daily intake. Upon physical examination, the doctor noticed that the patient's skin was pale and so the doctor ordered for blood to be drawn and sent to the laboratory for CBC. Once the results arrived, it illustrated the patient has a low hemoglobin concentration of 10.3g/dL and further laboratory results showed that the patient had a low vitamin B12 as well. The result illustrates ...

Anemia

A 65 year old man presents to the ED due to chronic fatigue, pale skin, and shortness of breath. The patient had been recently discharged from the hospital a few days prior due to a remission of a malignant tumor. The physician on site suspects a nutritional deficiency and runs a blood test. Results indicate normal WBC and platelet count but a marked reduction in red blood cells. Suspecting anemia, the physician performs a bone marrow biopsy and notes an abnormally high ratio of adipocytes to hematopoietic cells. Which of the following disease conditions below best describes the patient's affliction?

Aplastic Anemia

A 4-year-old child presents to her primary care physician with nausea, vomiting, and diarrhea. Her mother claims she has not seen any blood in the diarrhea. She states that the symptoms started 12 hours ago, after her daughter attended an outdoor birthday party where the children were served chicken fingers. The mother also informs the physician that her daughter is not the only child who attended the party that is now feeling ill. When grown on MacConkey agar, this organism is seen to be lactose non-fermenting. Which of the following is NOT a characteristic of the causative organism?

Associated with chronic diarrhea and growth retardation in children

During the check in process at the clinic, a patient responds to the questionnaire by saying he had recently traveled to Eastern Europe. Before walking into the patient's room, the doctor glances at the patient's recent lab work and sees that all of his white blood cell counts are elevated. He remembers there is a new species of helminths that are rampant in Eastern Europe and begins to wonder if that is the cause of the patient's abnormal blood counts. Blood cells involved in protection from parasites, such as worms, are also involved in which of the following activities in the body?

Asthma and allergy responses

An 11 month old child presents to the clinic after the rapid development of watery diarrhea accompanied by fever and vomiting starting within hours after arriving home from daycare yesterday. The parents deny any blood in the patient's stool and also say they have not fed him any undercooked meat. It is determined that the illness was spread via fecal oral from another child attending daycare. After lab tests confirm the doctors diagnosis, it is known that this specific strain possesses a cluster of virulence genes located on a locus of enterocyte effacement (LEE). What is the likely mechanism this bacteria uses to initiate infection causing watery diarrhea?

Attachment to epithelial cells leading to effacement of microvilli (A/E histopathology)

A newborn male was admitted to the NICU upon birth due to apparent skeletal deformities and coarse facial features including a depressed nasal bridge and an elongated face. Months later the patient began exhibiting mental disabilities and clouded corneas. Laboratory testing revealed a decreased level of mannose 6-phosphate with elevated levels of lytic enzymes in the patient's plasma. It is determined that the physical deformities are a result of these lytic enzymes causing tissue damage. The patient also has an accumulation of undegraded molecules in his cells. Which of the following best describes this patient's condition?

B. I Cell Disease

A 25-year-old male patient presents to the clinic with complaints of fatigue, shortness of breath, and pale skin. Previous medical history reveal that the patient was diagnosed with Alpha Thalassemia. Further lab diagnostics were taken and indicated that the patient has a genetic deletion of two alpha-globin genes from chromosome 16. Based on the deletion of the two alpha-globin genes, what other lab results will be seen in the patient?

B. Microcytic Red blood cells and reduced hemoglobin concentration

Upon arrival to the ED, an 11-year-old male underwent anaphylaxis. His mother reported that she brought him to the ED due to an acute onset of hives on his left upper arm and difficulty breathing immediately after he was stung by a bee while climbing a tree with his friends. She stated that the patient had not been stung by a bee before until recently. The patient's vitals are as followed: BP 85/60 mmHg, HR 120 bpm, RR 32 breaths/min, and body temperature 98.6 °F. Which of the following leukocytes is responsible for this patient's symptoms?

Basophils

A family in the United States adopted a child from Africa at three months old. Now, three months later, the child is six months old, the family notices that their growth has stopped and their cheekbones have become large and malformed. A CBC shows that their HbF is elevated and the child is showing signs of hepatosplenomegaly. It is deduced that the child has some severe mutation/possible deletion in the gene of the synthesis of globin chains. What chains would be targeted in this condition?

Beta

A two-year-old of Mediterranean descent presented with enlarged, distorted cheekbones and signs of growth retardation. A CBC revealed low hemoglobin, low MCV, and excess iron. Additionally, her family's medical history showed a lineage of an autosomal homozygous genetic disorder. What kind of illness does this child have?

Beta-thalassemia major

A 19-year-old African American male presents to his family physician with complaints of fatigue and weakness. He appears uncharacteristically pale. This is the second trip to his family physician this week. In his visit 3 days ago, his physician diagnosed him with viral hepatitis. While suffering from liver pain during that visit, he had not been feeling fatigued. His physician suspects a type of hemolytic anemia brought on by the environmental trigger of a viral infection. Which of the following when viewed on a blood smear would confirm the diagnosis of this specific hemolytic anemia?

Bite Cells

A 54-year-old male reports to his new PCP with complaints of fatigue, weakness, and chest pain. In the appointment after reviewing the man's chart, the doctor finds that he had a transcatheter aortic valve replacement about a year ago. Suspecting the man to have anemia the physician orders for a blood smear to confirm. What cells in addition to RBCs would be found in the blood smear?

Burr/Helmet Cells

A 28-year-old male presents to the emergency department after suffering impalement to the abdomen during a car crash. The patient suffered from massive blood loss and presented to the primary care physician with symptoms of pale skin, weakness, and decreased blood pressure. The primary care physician orders a CBC and Differential and from further questioning and lab results during the patients week long recovery in the hospital, the primary care physician diagnoses the patient with Acute Blood Loss Anemia due to the trauma the patient encountered. What results from the CBC and Differential led to the primary care physicians diagnosis?

Decreased hematocrit and increased reticulocytes

A 50-year old man with a history of heavy alcohol use has presented to the Emergency Department citing increased thirst, nausea, and fatigue. Upon further inspection, it is found that he has cirrhosis of the liver as a result of secondary hemochromatosis. Which of the following changes inside of his body can likely be attributed to this condition?

Decreased hepcidin

A five year old girl of African descent presents to the emergency department with a low grade fever, cough, and chest pain. An x-ray is performed showing bilateral pulmonary infiltrates. The parents mention that the patient was diagnosed with sickle cell anemia at 8 months old. What factor is most likely increasing the rate of RBC sickling, leading to her symptoms?

Decreased transit time of RBC's through microvascular beds

A 24-year-old male presents to the clinic with complaints of extreme fatigue, weakness and pale skin appearance. Lab evaluation including CBC, reticulocyte count, ferritin test and peripheral blood smear indicate a normal RBC count with abnormally low ferritin in the blood. The red blood cells also appear to be small and pale indicating microcytic and hypochromic anemia. What is the cause of the microcytic red blood cells?

Developing red blood cells continue to divide past their normal stopping point

A 6 month-old male presents to the clinic because his parents have noticed he has been having difficulty eating, crawling and remaining in an upright position. The physician decided to run a serum test to measure enzymatic activity. The results showed no hexosaminidase A and hexosaminidase B activity. What type of glycolipid(s) are expected to be accumulated in lysosomes?

E. GM2 ganglioside and Globoside

A 35-year-old female presents to the clinic with unexplained bruising, shortness of breath, fatigue and an abnormal discoloration of her urine close to when she wakes up in the morning. A flow cytometry detects the absence of GPI-linked proteins therefore, diagnosing the paroxysmal nocturnal hemoglobinuria. What makes red blood cells deficient in GPI-linked factors more prone to lysis?

Genetic mutations that inactivate PIGA

A 30 y.o african male presents to his primary care physician with a fever, dark urine, fatigue, and pale skin. The patient explains to his physician that he started taking chloroquine, an antimalarial medication, in preparation for his trip to Asia, and it was shortly after that he started experiencing these symptoms. Physical examination is remarkable for splenomegaly. The clinical workup shows evidence of hemolysis, increased bilirubin, and anemia. Blood smear findings include darkly stained regions within the red blood cells also known as Heinz bodies. The physician suspects that his symptoms are being caused by a mutation in a gene. What is the most likely diagnosis in the patient?

Glucose 6 phosphate dehydrogenase deficiency

A 5 year old male patient was brought to the clinic because his parents are concerned about bloody diarrhea. The patient was previously healthy but started developing symptoms after attending a birthday party at a petting zoo. Lab test revealed that the microbe responsible for the GI infection is a gram-negative rod that belongs to the Enterobacteriaceae family. Which of the following lab results are expected for bacteria of this family?

Glucose fermenter, Catalase +, oxidase -

Glycoproteins are key structural components of the Extracellular matrix. Formation of Glycosaminoglycans (GAGs) requires that a sugar undergo conversion to an amino-sugar and subsequent acetylation to form GAGs such as Hyaluronic Acid. Which of the following is responsible for the addition of an amino group onto Fructose 6-Phosphate to form Glucosamine 6-Phosphate?

Glutamine

A patient presents to the emergency room with fatigue, rapid heart rate, dizziness, and jaundice. After completing numerous lab tests, the physician diagnosis the patient with G6PD Deficiency. The oxidative phase of the pentose phosphate pathway is necessary for the reduction of an important antioxidant called?

Glutathione

A 30 year old female presents to her family physician with cramps, fever, nausea, and complaints of watery and bloody diarrhea. The physician notes that the patient also decided to self-medicate with leftover antibiotics right after she returned from goat yoga with her friends. After immediately being referred to the ER for dialysis, later lab tests show presence of oxidase negative, indole positive, lactose fermenting, Sorbitol negative organism in her stool. Which of the following best describes the bacteria's classification and structure?

Gram negative bacteria, thin peptidoglycan layer with lipid A component

A 22-year-old female patient visits the emergency department due to having a "pain crises." Her history shows that she suffers from sickle cell disease and is presenting today with severe body pains. Upon examination of her peripheral blood smear, irreversibly sickled cells can be visualized. Her blood work is indicative of hemolytic anemia, and reticulocytosis. This patient has increased susceptibility of which of the following?

Haemophilus influenzae

A 44-year-old male patient who has been diagnosed with diabetes mellitus for 6 months visits his primary care physician for a follow-up appointment regarding his blood work. The male insists he has been limiting his sugar intake but has not been consistent with his diabetes medication, Glucophage. Which of the following elevated levels in the patient's blood work reveals that his diabetes has not been effectively controlled?

HbA1c

A 1 y.o. male child presents to his PCP with general weakness, fatigue, loss of appetite, and irritability. Parents have been supplementing diet with PediaSure mix. Normal diet is well balanced. Upon testing, his red blood cells appear microcytic and hypochromic. Further questioning reveals that he has been teething and currently uses a newly thrifted 80 year old antique crib. What deficiency is causing the patient's symptoms?

Heme

A 21-year old female presents to her university's Student Health Center with unusual tiredness and pale skin. She claims that she has been sleeping regularly and maintaining a healthy diet. Her PA believes that she may have iron deficiency and suggests taking an iron supplement. However, she returns to the Student Health Center within a month expressing the same concern. After completing a routine blood test, her PA discovers hypochromia, microcytosis, basophilic stippling, and target cells in the patient's peripheral blood smear. She has reason to believe that the patient has 𝛃-Thalassemia minor. Which of the following is diagnostically useful?

Hemoglobin electrophoresis revealing increased HbA2 levels

A Mediterranean patient presents to the emergency room with jaundice and discolored urine. Upon taking his history, it is found that he has recently eaten fava beans. The physician diagnosed the patient with G6PD deficiency. Which of the following occurs when this patient eats fava beans?

Hemoglobin will denature

A 3-year-old female presents to the ER with initially watery diarrhea that has become bloody, abdominal pain, and signs of severe dehydration. The patient's parents state that symptoms started about 3 days after they gave the child fruit juice from a local farm. If the family refuses treatment, what condition still remains a risk for the patient?

Hemolytic Uremic Syndrome

A 25 year old female presents to the clinic with anemia, splenomegaly, and jaundice. She has an inherited disorder that reduces the assembly of the red cell skeleton and destabilizes the plasma membrane. Which of the following disorders does she present with?

Hereditary Spherocytosis

A 32 year old female presents to her PCP with fatigue, shortness of breath, and lightheadedness. She mentions she recently visited the ED two weeks ago due to a UTI and was treated with a cephalosporin. Upon examining the left upper abdomen, the physician notices moderate splenomegaly. The PCP suspects immunohemolytic anemia. Which of the following antibodies would be the most probable causative agent and under what temperature would it most stably bind to red blood cells?

IgG; 37 degrees celsius

New parents bring their 1 month old to the ER. Baby has not stopped crying for 24 hours. Patient history shows baby was in the ER two weeks ago for an ear infection. Upon examination white spots on babies' tongues are observed. Laboratory testing reveals the patient has oral thrush. Given the patients history, genetic testing is ordered and shows baby has severe combined immunodeficiency disease (SCID), an X-linked disorder that neither parent presents with. By what mechanism is the babies immune system compromised?

Inactive B-lymphocytes fail to activate JAK3 due to lack production of T-lymphocytes

A 27-year-old female has a blood smear and a complete blood count (CBC) preformed as a part of her routine physical. The patient's vitals are also recorded: BP 120/90, HR 90, and Temperature 98.7°F. The results reveal that the patient has a hemoglobin mutation. This mutation is located at the same position as the HbS hemoglobin mutation. The mutation the patient is diagnosed with is characterized by an amino acid change from Glu to Lys. The patient is clinically unaffected by this hemoglobin mutation. What effect is the hemoglobin mutation having on the patient's hemoglobin concentration within the cells?

Increase in water loss from the cell due to an activation of potassium transporter resulting in an increase in concentration of hemoglobin in the cells

A 35-year-old patient went to the hospital this morning because he is not feeling well. The patient appeared pale and often reported weakness, malaise, easy fatigability, dyspnea on mild exertion, and his urine came out dark colored. After several tests the patient was diagnosed with paroxysmal nocturnal hemoglobinuria. This type of anemia can be classified according to its underlying mechanism as one of the following:

Increased red cell destruction (hemolysis): Deficiency of phosphatidylinositol-linked-glycoproteins.

A 58-year-old male accountant arrives at the doctor for his routine physical. He offers complaints of fatigue and feeling lightheaded. He attributes this to working extra hours at a local gun range. What is an accurate explanation regarding his condition?

Increased δ-ALA, increased protoporphyrin IX

A 14 year girl comes into the ER with complaints of fatigue and shortness of breath. During the patient's physical examination, the physician finds a rash spread across the patient's back. Upon further testing, it is discovered that the patient has atopic dermatitis, causing extensive tissue damage. What would be the action of the first type of leukocyte to arrive at the site of infection?

Initiate a respiratory burst which creates oxygen radicals to destroy the foreign material

A 27-year-old male from Senegal presents to the clinic with complaints of occasional fatigue but no other symptoms. Lab results show increased MCHC with intracellular crystals seen on blood smear. Molecular analysis reveals the patient is homozygous for HbC mutation. What are the effects of this hemoglobin variant?

It promotes water loss from the cell by activating K+ transporter and lowers the hemoglobin solubility by replacing glutamate to lysine, resulting in the precipitation of the hemoglobin variant.

A 32 year old female presents to the Emergency Room with a 3 day history of explosive watery diarrhea, with sudden onset on her flight back from Mexico. The physician sends a blood sample to the lab, and 24 hrs later the culture results with growth on MacConkey Agar with lactose fermentation. The oxidase test is negative, and the catalase test is positive. The physician identifies the organism as Escherichia coli. Which virulence factor(s) of the causative organism is responsible for the symptoms exhibited by the 32 year old female?

LT-1, STa

A 31-year old woman has just given birth to a child and is having trouble breastfeeding. When tests are performed, results show a lack of lactose and an excess of glycoproteins. Which enzyme catalyzes the last step of the defective pathway, and which subunit appears to be missing from the enzyme?

Lactose synthase; α- lactalbumin

A 27-year-old male presents to his PCP with complaints of exhaustion, dizziness, episodes of anxiety, and dark colored urine. He explains that his symptoms started 4 days ago but have been getting progressively worse. When his doctor asks for any changes in diet, the man explains that he and his friends have gone out to dinner twice in the past week to a Mediterranean restaurant where they shared a family sized chicken kabob pita, lentil soup, fava bean appetizer, and baklava. The doctor orders a blood smear and notes the presence of bite cells among normal red blood cells. What is the cause of the red blood cell abnormality and where does it occur?

Macrophages plucking Heinz bodies from red blood cells as they pass through the splenic cords

A 2-year old male child presents to the clinic with symptoms of Tay Sach's Disease. However, the observed symptoms appear to be of a progressed stage of the disease. Enzyme assay reveals inactive hexosaminidase A, consistent with the initial diagnosis, but also indicates that hexosaminidase B is inactive in the child. What is responsible for the acceleration of the disease state in this child?

Mutation of the HexB gene, resulting in an accumulation of ganglioside GM2 and globoside

A new breastfeeding mother presents to her OB/GYN concerned that she is not producing breastmilk because of her low lactose intake. Is this a reasonable concern as to why the new mother has a low production of breastmilk?

No, because lactose in the mammary gland is derived from the epimerization of UDP-glucose.

A 3-yr old male presents to the ER with fever, chest pain, difficulty breathing, and bluish tinge on fingers. It is determined the patient is experiencing acute chest syndrome and needs an emergency blood transfusion. A blood culture is performed and high levels of Salmonella are found in their system. What would this cause in the patient?

Osteomyelitis

A 27 year old woman enters the Emergency Room with a fever, and non-specific complaints of a headache, constipation, and myalgia. The fever has developed over the past few days and is unresponsive to acetaminophen. She has no recent travel history, but she mentions that her mother is visiting from Brazil and arrived 12 days ago. Since arriving, her mom has cooked almost every night. The doctor samples the bacteria and concludes that this is an H2S positive bacteria that colonizes in the gallbladder. What is a trait associated with this bacteria?

Pathogenicity Island I and II

Ahmad, 33-year-old male, presents to the doctor with hemolytic anemia and yellowing of the sclera of his eyes. Eventually the doctor determined that the likely cause of his symptoms was an X-linked genetic defect in the gene that codes for glucose 6-P dehydrogenase. If the diagnosis is accurate, what is the pathway in which Glucose-6-Phosphate dehydrogenase is the rate limiting enzyme and what change in activity would be associated with this genetic defect?

Pentose phosphate pathway; Decreased NADPH levels and decreased Cytochrome P450 monooxygenase

A 32 year old woman has recently given birth to a seemingly healthy baby boy. 48 hours after delivery, the baby started to show signs of yellowing of the skin and sclerae of the eyes. A total bilirubin lab test shows elevated levels of total bilirubin and an indirect bilirubin lab test shows elevated levels of unconjugated bilirubin. The baby was diagnosed with neonatal jaundice. What is the most likely treatment for neonatal jaundice in this patient?

Phototherapy

A 23 year old female visits the local Urgent Care because of recent pain and swelling in her axillary region. The patient informs the physician of her high fever that preceded the painful bubo. The physician asks the patient about the scratch on her arm, which she explains was the result of trying to put the stray cat she adopted almost a week ago in the carrier for its veterinarian appointment for a flea bath. What virulence gene allows this bacteria to prevent opsonization and phagocytic migration, and spread rapidly throughout the host?

Plasminogen activator protease gene

A 25-year-old, African American male presents to the Emergency Department with severe pain in his bones. It was later discovered that he was suffering from a vaso-occlusive pain crisis. His blood smear indicates needlelike fibers within red cells, and a lab evaluation shows increased MCHC levels which facilitates the formation of these needlelike fibers. Which of the following would be the most likely cause of this disease?

Point mutation in β-globin

A 5-year-old female child presents to her primary care physician as her parents are concerned about her being unusually fatigued over the past few days. Upon physical examination, it is noted that the child is pale and presents with bilateral icterus. The parents indicate that the child is adopted, and the family history of the birth parents is unknown. Lab evaluation and molecular analysis indicate hemolytic anemia caused by a disorder that is inherited in an autosomal recessive fashion. The disorder results in the mutation of an enzyme that leads to an increase in 2,3-BPG levels in the erythrocyte as a compensating mechanism. A deficiency in which of the following enzymes would explain the child's symptoms?

Pyruvate Kinase

A 43-year-old female presents to her local clinic with fatigue, shortness of breath, pale skin, and abdominal pain. The patient notifies her attending physician that she has had episodes of bright red blood appearing in her urine, at night. The physician orders a flow cytometry test, which reveals an abundance of red blood cells that are deficient in glycosylphosphatidylinositol-linked membrane proteins. Which of the following best explains the reason for the lack of such proteins?

Random inactivation of the X-linked PIGA gene

A 23-year-old male presents to the emergency department after training for a Marathon, with complaints of his urine being a red-brown color. Upon further examination it is also noted that the patient presents with signs of Jaundice. It is concluded that this patient is experiencing Intravascular hemolysis, what other clinical manifestations would you expect this patient to experience?

Renal Hemosiderosis

A Caucasian female of approximately 20 years of age arrives to the ER via ambulance. The EMTs inform the trauma surgeon on call that she was an innocent bystander at a college party where someone pulled a gun, unfortunately for her she took a bullet to the upper leg. She sustained heavy blood loss but fortunately the bullet passed through without impacting any bones or major nerves. Which of the following metrics would you expect to be greater than normal 3 days post-op?

Reticulocyte Count

An 8-year-old male was presented to his pediatrician with complaints of fatigue and shortness of breath. His pediatrician preformed a complete physical exam, including a CBC. His red blood cell count happened to be 5.7 x106/μL (normal RBC counts for children are 4.0 to 5.5 x106/μL of blood). It was later found that the child had a mutant erythropoietin (Epo) receptor that is unable to bind SHP-1. Erythropoietin is the hematopoietic cytokine that stimulates production of RBCs. What is true about SHP-1's role regarding RBC production?

SHP-1 binds to and deactivates the Epo receptor

A 19-year-old patient presents to the ED with cramps, vomiting, nausea, a low-grade fever, and watery, non-bloody diarrhea two days after returning home from a trip to Belize. PCR analysis of the fecal specimen suggests that the patient's diarrhea is due to inhibition of fluid absorption and an increase in chloride secretion in the small intestinal epithelium due to infection with enterotoxigenic E. coli (ETEC). The patient's diarrhea is caused by which of the following?

STa enterotoxin-mediated increase in cGMP as well as LT-I mediated increase in cAMP.

A 35-year-old male chef initially presents to the clinic with nausea, vomiting, and anorexia. Upon further examination, the patient has a fever and complains of headache, myalgia, and malaise. The patient also mentions he recently traveled to Cambodia. The clinic cultured the organism on MacConkey agar and noticed the colonies grew colorless and were resistant to bile salts. The patient was educated about chronic colonization of the gallbladder and prescribed antibiotics. What is the organism responsible for causing the patient's symptoms?

Salmonella Typhi

An 8-year-old girl is taken to her pediatrician because she is experiencing fluid loss, frequent non bloody diarrhea, and a fever. She had started experiencing these symptoms after receiving brand new livestock and animal feed at her family's farm. The provider knows that the patient is dealing with Salmonella, bacteria that invade through M Cells, but she does not want it to lead to a bacteremia. Which of the following is the correct serotype for this patient, so the provider can treat her correctly?

Salmonella enterica, serovar. Choleraesuis

A fifteen-year-old female is brought into the emergency room with symptoms of vomiting, abdominal pain and bloody diarrhea, but is afebrile. She mentions that she recently consumed tacos containing ground beef a few days prior but notes that the ground beef may have been slightly undercooked. Which of the following is most likely the pathogenesis of the organism that is causing her symptoms?

Shiga Toxins (Stx1 and Stx2) that cleave 28s rRNA to disrupt protein synthesis

A 30 year old female patient presents to her primary care physician with concerns of her constant watery and bloody diarrhea. Her diet has been normal for her with the exception of eating a rotisserie chicken that she picked up from the grocery store on her way home from work approximately two days ago. A culture has been done and growth on MacConkey agar shows the organism is a non-fermenter and resistant to bile salts. What is the most likely causative organism for the patient's symptoms?

Shigella dysenteriae

A 6 year old presents to the emergency room with her mother. The mother states her daughter started having watery diarrhea yesterday in addition to abdominal cramping and a fever. Both the mother and the daughter have never traveled outside of the U.S. and the daughter attends a day-care center after school. She is diagnosed with shigellosis. Based on the travel history, after school activities, and symptoms, which species of shigella is most likely causing the daughters symptoms?

Shigella sonnei

The parents of a 5-year-old boy walk into their primary care office and are worried about their son. Their child keeps holding onto his stomach, indicating some type of lower abdominal cramps and when he needs to defecate, he is straining to defecate. Parents have reported seeing pus and blood in his stool. While going over his history, his parents state that they work full time through the week and he is mostly at his daycare throughout the day. What type of bacterial infection is presumed to be in this boy based on his symptoms/history?

Shigellosis

A 35-year old male was recently diagnosed with a rare hemolytic disease, Paroxysmal Nocturnal Hemoglobinuria (PNH). A unique feature of this disease is the tendency for RBCs to lyse at night/during sleep. What biological feature is responsible for this event occurring?

Slight decrease in blood pH

After Frodo noticed that his 2 year-old son, Samwise was constantly fatigued, he brought him to their pediatrician. The physician noticed that the toddler had a pallor complexion and after the physician examination, she suspected that the toddler had splenomegaly. She decided to draw blood and ordered a Complete Blood Count with Differential. Later that evening, the Pathologist called her and said that he noticed that the erythrocytes were elliptical in shape. What two proteins are most commonly associated with the shape of the erythrocytes seen?

Spectrin & Protein 4.1

Researchers in a lab were comparing blood smear samples from five different patients. After staining each sample with H&E to observe the erythrocytes, they noticed one of the patients blood smear possessed abnormally shaped erythrocytes. Instead of a biconcave disc shape, they found spherical shaped erythrocytes. After further research and tests it was stated that the patient had hereditary spherocytosis. Why would a patient with hereditary spherocytosis be at risk for premature destruction of erythrocytes or hemolysis?

Spherocytosis occurs from defects in anchoring proteins causing the erythrocytes plasma membrane to detach and peel off, this leads to the inability of the erythrocyte to adapt to changes in the environment, ultimately resulting in hemolysis.

A young patient presents to a PCP with marked jaundice and is complaining of fatigue, weakness and dyspnea on mild exertion. The physician orders a blood smear, as well as other laboratory tests. The lab tests reveal anemia and the blood smear shows anisocytosis and several dark-appearing spherocytes with no central pallor. Upon further testing and review of the patient's family history the patient is diagnosed with Hereditary Spherocytosis. What medical procedure will be most beneficial for this patient and will help revert the anemia long term?

Splenectomy

A man of Middle Eastern descent is admitted to the emergency room with typhoid fever. The patient is found to have an X linked disorder that results in both intravascular and extravascular hemolysis. Which of the following is not observed in the patient?

Splenomegaly

A 50-year-old female presents to the clinic with abdominal pain and diarrhea that has been ongoing for 5 days. Symptoms began after a recent visit to a petting zoo. Her symptoms have progressively worsened with bloody diarrhea. She denies any recent travel or change in diet. Patient with pallor and jaundice on exam. A fecal culture was taken and grown on MacConkey Agar with pink colonies present. What toxin is associated with this pathogen?

Stx1 and Stx2

A 4 year old boy presents to the ER with abdominal pain and blood in his stools that started yesterday. Mom stated that since it is summer they went to a farm where the child drank fresh milk from a cow. The abdominal pain started 3 days ago and has been getting worse along with some vomiting but no fever. Lab tests showed that the organism that grows colorless on Sorbitol-MacConkey agar. The doctor is worried about complications from this organism. What would be the best treatment for this child?

Supportive treatment

The ER admits a 7 year old male with a suspected gastrointestinal obstruction. His patient history shows 6 admissions within the past year for repeated bacterial infections, 3 of which resulted in ICU care. His mother also reports he has frequent skin infections and diarrhea. Family history documents the mother as a carrier of the CYBB gene mutation affecting neutrophil function. What is the most probable defect in neutrophil function causing the boy's symptoms?

The NADPH oxidase system is unable to form cytochrome B558 on the phagolysosome plasma membrane

A patient with a prior cardiac history of a prosthetic valve placement comes to the emergency department for weakness and shortness of breath. The emergency department physician orders a CBC test to determine the patient's blood count. The patient is diagnosed with anemia and microscopic inspection of their blood is performed. What is the most likely cause of the patient's anemia and what shape would be present in the patient's RBCs?

The anemia is most likely caused by a mechanical valve and the RBCs would have schistocytes

A 57 year old male comes to the ER with abdominal cramps and constipation. He notices blood and pus in his stool. The bacteria stained pink on a gram stain and grew as yellow colonies when plated on MacConkey agar. The bacteria is also H2S negative. What best describes the virulence of the identified bacteria?

The bacteria invades the M cells in the Peyer's Patch and replicates in the host's cytoplasm.

A 37 year-old female presents to the emergency department with a 2-day history of fever, nausea, vomiting, and a swollen bug bite on her R ankle. She admits about 4 days ago she was hiking near Lake Tahoe and tried to pet some of the wildlife, mainly squirrels and rabbits. Physical exam was unremarkable apart from the stated bug bite near the patient's ankle with some lymphadenopathy. The attending physician suspects the patient has Yersinia pestis from a flea bite from one of the animals due to an increase in sylvatic plague in the area. A culture of the infected bite proved his suspicions. Which of the following is most likely the bacteria's virulence factor?

The bacteria's capsule, it is antiphagocytic and is resistant to serum killing.

A 29 year old female received a blood transfusion during a busy night at the hospital and is now showing signs of yellowing of the skin and sclera of the eye, hypotension, and renal failure. What would be the primary cause of these symptoms?

The patient was administered ABO-incompatible blood.

A 17-year-old male arrives to the ER following a large car accident on the freeway. During the accident a piece of metal sliced into the patient's thigh, cutting their femoral artery in the process and causing a massive amount of blood loss. Which of the following changes are not expected to occur during the patient's bodily response to the blood loss?

The patient's blood volume will initially be restored by a rapid increase of bone marrow activity

A researcher in a clinical lab is investigating the potential of the CRISPR system for possible gene therapeutics. In efforts to test the effectiveness of CRISPER/Ca9, the researcher decides to knockout the gene responsible for the transaldolase enzyme in the Hexose Monophosphate Shunt and monitor levels of Fructose 6-phosphate production. To the researchers' surprise, Fructose 6-phosphate was still produced. What enzyme in the Pentose Phosphate Pathway may be responsible for the production of Fructose 6-phosphate?

Transketolase

A 43-year-old man returned from a recent visit with his parents. He goes to his primary care physician with complaints of lesions. He mentions hunting in the woods of South Carolina with his parents and receiving many bug bites. After some testing, the physician found that the bacteria causing the lesions has a prominent capsule and a mucoid appearance of the colonies. The man is diagnosed with Donovanosis. What other disease has similar resemblance to this diagnosis?

Treponema pallidum

A 26 year old male presents to the emergency clinic with complaints of fatigue, pale skin, dizziness, and jaundice. A bilirubin blood test was ordered and shows elevated levels of indirect bilirubin. The patient was diagnosed with hemolytic anemia causing a buildup of unconjugated bilirubin within the blood. Which of the following answers below causes the conjugation and eventual excretion of bilirubin?

UDP-glucuronate transferase

Which of the following enzymes is correctly matched to the heme synthesis disorder most likely occurring in a patient who presents to the clinic with symptoms consisting of anxiety, light sensitivity, and increased facial hair?

Uroporphyrinogen decarboxylase, porphyria cutanea tarda

A 26-year-old male was exploring an old sewer when he discovered a pack of rats feeding on some garbage that had been left behind. He decided to pick up one of the rats but was unsuccessful as they ran away. As he was walking out of the sewer, he noticed that he had gotten a flea bite while in there. He did not think anything of it and continued on with his day. 5 days later, he went to the hospital with a high fever and painful bubo in his groin area. The patient was not treated quickly enough and developed bacteremia and later died. What is the pathogen that killed this patient?

Yersinia pestis

John Doe presents to the emergency department with complaints of abdominal pain, dysentery, lymphadenopathy, and a temperature of 100.1° F. Last week he was discharged from the hospital after having successfully completed invasive heart surgery during which he received a perioperative blood transfusion. After a physical exam, the physician notes acute lower right quadrant abdominal pain with point tenderness. A stool culture is ordered to confirm a diagnosis of Y. enterocolitica. Which of the following virulence factors is responsible for Yersinia spp. ability to secrete proteins into phagocytic cells that dephosphorylate proteins required for phagocytosis?

YopH gene product

A 30-year-old male presents to the emergency department with complaints of fatigue, generalized weakness, and shortness of breath. He recently started seeing a new primary care physician after moving to the area. He was diagnosed with sickle cell anemia as a child but has not had proper follow up since graduating from college. His prior diagnosis is likely causing his shortness of breath due to which of the following?

b. Inability of RBCs to maintain shape for proper oxygen transport

A 24-year-old female showed up to the emergency room with fever, abdominal cramps, and dysentery. She states that the illness originally started out as watery diarrhea. She was diagnosed with Enteroinvasive E. Coli. What has allowed the bacteria to invade the colonic epithelial cells?

pInv genes

A medical student presents to the primary care physician with complaints of general malaise and fatigue. She reports that yesterday she had been out drinking when she accidentally walked into a closed glass screen door and got a bloody nose that lasted about 30 minutes. She was celebrating because she had just finished taking an exam that she had studied extremely hard and had stressed over for about a week. The physician orders blood work and determines that the patient is suffering from chronic blood loss. What is most likely the cause of the blood loss and what test would the physician use to confirm the diagnosis?

peptic ulcer and stool sample

Describe the pathogenesis of encapsulated Enterobacteriaceae?

protection from phagocytosis

A 25 year old male presents to the clinic with complaints of a penile ulcer. The patient states this occurred 1 month after his vacation in São Paulo, Brazil. He further admits to having unprotected sexual intercourse multiple times during his time in Brazil. Lab results have narrowed down the causative agent to a species in the Enterobacteriaceae family. What is the shape of the causative agent and how will it present on a MacConkey agar ?

rod, pink/purple correct, as Klebsiella is part of the Enterobacteriaceae family, pink/purple [correct, as it is a lactose fermenter