Anaphylaxis

Question 1

Adverse drug reactions – Rawlins Thompson classification

Answer 1

Type A – (augmented pharmacological) – predictable, dose-dependent, common

Type B – (bizarre or idiosyncratic) – not predictable and not dose-dependent

Type C – (chronic) – osteoporosis and steroids

Type D – (delayed) – malignancies after
immunosuppression

Type E – (end of treatment) – occurs after abrupt drug withdrawal.

Type F – (failure of therapy) – failure of the oral contraceptive pill in the presence of enzyme inducer

Question 2

What is an example of an adverse drug reaction

Answer 2

• Beta-blockers
• Bradycardia and heart block are the primary adverse effects
• Bronchospasm is a secondary pharmacological adverse effect

Question 3

Define side effects

Answer 3

an unintended effect of a drug-related to its pharmacological properties and can include unexpected benefits of treatment

Question 4

Define adverse drug reaction

Answer 4

unwanted or harmful reactions following the administration of drugs or combination of drugs under normal conditions of use and is suspected to be related to the drug

Question 5

What does adrenaline do once administered regarding anaphylaxis

Answer 5

1. Vasoconstriction – increase in peripheral vascular resistance, increased BP and coronary perfusion
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2. Stimulation of beta1-adrenoceptors positive ionotropic and chronotropic effects on the heart
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3. Reduces oedema and bronchodilates via beta2-adrenoceptors

Question 6

What is anaphylaxis

Answer 6

acute allergic reaction to an antigen to which the body has become hypersensitive

a most severe form of type 1 hypersensitivity

Answer 7

• Margination Slowing of blood velocity to allow neutrophils to line up along endothelium.
• Adhesion “Sticking” of neutrophils to endothelium via adhesion molecules
• Emigration Neutrophils move through the walls of small blood vessels
• Diapedesis Where red cells passively escape the circulation due to hydrostatic pressure
• Chemotaxis Where neutrophils follow a concentration gradient of certain compounds

Question 8

Tumour

Answer 8

Papilloma – benign tumour of non-glandular, non-secretory epithelium.
* Adenoma – benign tumour of glandular or secretory epithelium
*Carcinoma- malignant tumour of non-glandular, non-secretory epithelium
*Adenocarcinoma – malignant tumour of glandular or secretory epithelium
*Sarcoma – malignant tumour of connective tissue (e.g. liposarcoma, rhabdomyosarcoma)

Question 9

Pharmacodynamics vs Pharmacokinetics

Answer 9

• Pharmacodynamics – what the drug does to your body
• Pharmacokinetics – what your body does to the drug

Question 10

Gram-positive vs Negative

Answer 10

• Gram positive – thick peptidoglycan
• Gram negative – 2 phospholipid membranes. Also has lipopolysaccharides

Question 11

list of the structures/processes which antibiotics interact with

Answer 11

Cell wall - Beta lactams, vancomycin
* DNA gyrase – quinolones
* Folate synthesis – sulphonamides, trimethoprim
* 30s subunit – tetracyclines, aminoglycosides
* 50s subunit – macrolides, clindamycin

Question 12

Mycobacteria are

Answer 12

Mycobacteria are slow growing, and predominantly immobile (A), rod shaped (B), intracellular (C) and gram positive

Question 13

SIADH causes a state is known as

Answer 13

euvolaemic hyponatraemia –
● Hyponatraemia – low blood sodium concentration due to excess water reabsorption.
● Euvolaemic meaning no signs of hypervolaemia (fluid overload) or hypovolaemia (dehydration). The extra water reabsorbed is not usually significant enough to cause fluid overload.

Question 14

Tolvaptan is a

Answer 14

vasopressin antagonist

Question 15

Hypo vs hypercalcaemia

Answer 15

Question 16

Haemodymaically stable vs unstable for Atrial fibrillation

Answer 16

● Haemodynamically unstable – cardioversion with synchronised DC shock + anticoagulation.
● Haemodynamically stable – either:
○ Rate control (Beta blockers / CCBs) + anticoagulation
○ Rhythm control (cardioversion) -> beta blockers + anticoagulation

Question 17

How does C.diff spread

Answer 17

Faecal oral route

Question 18

What is Meckels diverticulum

Answer 18

The vitelline duct is an embryonic structure providing communication from the yolk sac to the midgut during foetal development. It is located proximal to the ileocaecal valve (within the ileum).
It usually obliterates spontaneously and separates from the intestine between approximately the 5th and 9th weeks of gestation. If the vitelline duct remains it can form a Meckel diverticulum. This can present with rectal bleeding in children.

Question 19

1st line investigation for coeliac

Answer 19

The 1st line investigation is the IgA-tissue transglutaminase blood test

Question 20

Internal rotation of shoulder

Answer 20

Subscapularis is responsible for shoulder internal rotation.

Question 21

SLE hypersenstivity reaction

Answer 21

1

Question 22

mechanism by which alcohol consumption causes polyuria.

Answer 22

Ethanol suppressing ADH secretion from the posterior pituitary gland.

Question 23

Which of the following is not a well-recognised type of renal stone?
A) Monosodium Urate.
B) Calcium Oxalate.
C) Struvite.
D) Cystine.
E) Calcium Pyrophosphate.

Answer 23

Calcium Pyrophosphate.

Question 24

nimodipine action

Answer 24

A calcium channel blocker which reduces cerebral artery spasm thus preventing ischaemia

Question 25

Which of the following blood test abnormalities can be explained by the chronic hypoxia seen in COPD?

Answer 25

Polycythaemia