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CLINICAL SCIENCES Flashcards

1
Q

drugs CONTRAINDICATEDin breastfeeding

A

All Cautious Mothers Take Care Suckling Little Babies

Aspirin/Amiodarone
Cytotoxics/Carbimazole/Clozapine
Methotrexate
Tetracycline
Ciprofloxacin/Chloramphenicol
Sulphonamides/Sulphonylureas
Lithium
Benzodiazepines

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2
Q

what type of lab investigation used to edetect mutated oncogenes

A

PCR

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3
Q

exception to MR DS inheritance rule

A

freidreichs ataxia is the opposite

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4
Q

way to remember where steroids secreted from

A

GFR- ACD
zona glomerulosa-aldosterone

fasciculata- corticosteroid

reticularis- dexamethasone

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5
Q

Sensitivity = calculation

A

Sensitivity = TP / (TP + FN )

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6
Q

where is growth hormone secreted from

A

anterior lobe pituitary gland

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7
Q

where does majority of glucose reabsorption take place in nephron

A

proximal convoluted tubule

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8
Q

downsyndrome commonest gene error

A

maternal non dysjunction

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9
Q

Wilson and hunger key criteria

A

The condition should be potentially curable

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10
Q

early-onset breast cancer, sarcoma and leukaemia

A

Li fraumeni syndrome

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11
Q

Li fraumeni syndrome inheritance

A

P53 and autosomal dominant

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12
Q

Most common cause of Down’s syndrome

A

Non disjunction

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13
Q

Fastest conduction in the heart?

A

Purkinje fibres

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14
Q

RCT level of evidence

A

Ib

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15
Q

Which statistical test for comparing before and after on a single sample

A

Wilcoxon signed rank test

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16
Q

Interferon gamma assd which lung condition

A

TB

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17
Q

Kearns-Sayre syndrome

A

mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
retinitis pigmentosa

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18
Q

Behçet’s disease chromosome

A

Chromosome 6

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19
Q

Vincristine acts in what stage of cell cyecle

A

Metaphase

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20
Q

Hat does insulin bind to on cell membrane

A

Tyrokinase receptor

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21
Q

how long to keep in anaphylaxis patients and monitor

A

6 hours

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22
Q

which HLA for narcolepsy

A

hLA DR 2

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23
Q

fabry disease inheritance

A

x linked recessive

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24
Q

optic neuritis caused by which TB medication

A

ethambutol – causes optic neuritis

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25
Q

what are interferons

A

interferons are cytokines
Beta by Blasts
Alpha Antiviral
Gamma Granulomatous diseases

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26
Q

characteristics of a negatively skewed distribution?

A

Skewed distributions
alphabetical order: mean - median - mode
‘>’ for positive, ‘<’ for negative

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27
Q

fabry disease
inheritance
cfs

A

x linked recessive
FABRY’S
Fever
Angiokeratomas / Alpha-galactosidase A
Burning pain
Renal
YX (x linked recessive)
Stroke / Cardiovascular

CORNEAL WHIRLS

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28
Q

how can digoxin affect vision

A

green - yellow tinge

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29
Q

her 2 positive breast ca treatment

A

trastuzumab

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30
Q

aspirin MOA

A

irreversible inhib of cox1 cox2

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31
Q

ondansetron MOA

A

5ht3 antagonist

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32
Q

cyanidepoisoning treatment

A

hydroxycobalamin

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33
Q

levothyroxineMOA

A

nuclear receptors

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34
Q

allopurinol moa

A

inhibits xanthine oxidase

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35
Q

Hypersensitivity reactions:
type 1
2
3
4

new added- type 5

A

1- anaphylaxis and atopy (asthma, hayfever, eczema— IgE

  1. HAEM: haemolytic anaemia, ITP, goodpastures, pernicious anaemia, rheumatic fever ,pemphygoid
    IgG, IgM
  2. IgG, IgA
    serum sickness, SLE, glomerulonepritis , EEA

4- T cell mediated :
delayed hypersensitivity
TB, Graft vs host disease, allergic contact dermatitis , MS, Guillan barre

5
Graves
Myasthenia gravis

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36
Q

wernickes encephalopathy cause by ?? vit def ??

A

Vit B1 def= THIAMINE

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37
Q

BRCA= TSG or oncogene ?

A

Tumour suppressor gene

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38
Q

cushings, conns , thiazide use== VBG finding

A

metabolic alkalosis

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39
Q

x linked dominant syndromes

A

rett

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40
Q

parametric vs non parametric statistical tests

A

parametric
students T test (paired or unpaired)
Pearson’s correlation coefficient

Non Parametric
Spearman rank
Wilcoxon
Mann Whitney U
Chi Squared

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41
Q

before and after comparison test

A

wilcoxon

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42
Q

compare % improved after intervention stat test

A

chi squared

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43
Q

X linked recessive syndromes

A

Hunters disease
Lesch-Nyhan syndrome

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44
Q

coeliac HLA

A

HLA -DQ2/DQ8

Q2 CUTIE DATE D8 DQ

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45
Q

C3 deficiency associated with ??

A

incr recurrent bacterial infections

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46
Q

The usual outcome measure is the relative risk=== ? type of study

A

cohort study

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47
Q

GFR - ACD)

A

zona glomerulosa (on outside): mineralocorticoids, mainly aldosterone
zona fasciculata (middle): glucocorticoids, mainly cortisol
zona reticularis (on inside): androgens, mainly dehydroepiandrosterone (DHEA)

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48
Q

Activation of B cells- which Ig?

A

IgD

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49
Q

Molecular biology techniques

what is used to detect DNA, RNA, Protein

A

SNoW (South - NOrth - West)
DRoP (DNA - RNA - Protein)

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50
Q

nitric oxide secondary messenger

A

cGMP

if you do NOS= you are a G

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51
Q

which phase of cell cycle is the longest

and shortest

A

Interphase in G1

shortest- mitosis

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52
Q

stages of mitosis

A

PEE ON THE MAT:
PMAT

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53
Q

WHICH phase of determines length of cell cycle

A

G1

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54
Q

cherry red spot on macula and NO splenomegaly:

A

tay sachs= lysosomal storage disease
aut recessive

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55
Q

FGFR3 (fibroblast growth factor receptor) gene defect mutation

A

ACHONDRPLASIA

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56
Q

which B vitamin causes angular chelitis

A

B2- riboflavin
affects 2 corners of the mouth

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57
Q

exception condition to X LINked recessive inheritance only males are affected:

A

TURNERS SYNDROME

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58
Q

where does ADH act on

A

collecting duct

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59
Q

endothelin causes vaso constriction or dilation?

A

endothelin causes vasoconstriction

therefore in pulm HTN- endothelin antagonist is used

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60
Q

vitamin d resistant rickets inheritance and tx

A

x linked dominant
high dose vit d
oral phosphate supplements

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61
Q

45XO genotype =?

A

turners syndrome

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62
Q

how to remember ocular eye movements and their nn palsies

A

‘LR6SO4’

IPSILATERAL

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63
Q

X LINKED RECESSIVE conditions

A

Androgen insensitivity syndrome
Becker muscular dystrophy
Colour blindness
Duchenne muscular dystrophy
Fabry’s disease
G6PD deficiency
Haemophilia A,B
Hunter’s disease
Lesch-Nyhan syndrome
Nephrogenic diabetes insipidus
Ocular albinism
Retinitis pigmentosa
Wiskott-Aldrich syndrome

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64
Q

What molecule is responsible for binding and trafficking? in a cell organelle

A

Golgi adds mannose-6-phosphate to proteins for trafficking to lysosomes

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65
Q

what does adrenaline act on

A

g protein coupled

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66
Q

what type of Ig is synthesised by plasma cells

A

IgE

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67
Q

what is power

A

Power = 1 - the probability of a type II error

Power - the probability of detecting a statistically significant difference

68
Q

PTH ACTIONS - ca and phosphate and osteoclastic activity

A

Actions of parathyroid hormone
increases plasma calcium, decreases plasma phosphate
increases renal tubular reabsorption of calcium
increases osteoclastic activity*
increases renal conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol
decreases renal phosphate reabsorption

69
Q

actions of vit d (calcitriol- activated form)

A

Actions of 1,25-dihydroxycholecalciferol
increases plasma calcium and plasma phosphate
increases renal tubular reabsorption and gut absorption of calcium
increases osteoclastic activity
increases renal phosphate reabsorption

70
Q

recurrent meningitis- complement deficiency

A

C5-9

71
Q

pathognomic of hodgkins lymphoma

A

reed sternberg cells= cd 15

72
Q

how does hypoxia affect pulm arteries

A

constrict

73
Q

marker of poor prognosis RA

A

anti ccp antibodies
positive rheumatoid factor

74
Q

p53 gene function

A

Tumour suppressor gene

preventing entry into the S phase until DNA has been checked and repaired

Encodes proteins which regulate the cell cycle

75
Q

what % of data lies within 3 SDs if normally distrubuted

A

99.7%

68.3% of values lie within 1 SD of the mean
95.4% of values lie within 2 SD of the mean
99.7% of values lie within 3 SD of the mean

76
Q

what is the measured out come in case control study and cohort study

A

case control study= odds ratio

cohort study= relative risk

77
Q

homocysteinuria
inheritance
cfs
mx

A

aut recessive

long fingered
tall
fine fair hair
kyphosis
recurrent DVT
downwards dislocation of his lens

Tx= vit B6 PYridoxine

78
Q

A study is designed to compare the calcium levels of males and females who have Crohn’s disease. The investigators aim to discover whether there is a difference between the average calcium level in males compared to females. From previous studies it is known that the calcium levels are normally distributed. Which one of the following statistical tests is it most appropriate to use?

PAIRED OR UNPAIRED

A

UNPAIRED

79
Q

pre test probability in simple terms = ?

A

prevalence

80
Q

how to calc down sydnrome risk

A

One way of remembering this is by starting at 1/1,000 at 30 years and then dividing the denominator by 3 (i.e. 3 times more common) for every extra 5 years of age

81
Q

what type of graph shows publication bias in meta-analyses

A

funnel plot

treatment effect (odds ratio of in-hospital mortality due to COVID-19) on the horizontal axis and the standard error of the effect estimate on the vertical axis.

82
Q

complement deficiencies in SLE

A

C1q, C1rs, C2 and C4

83
Q

P value

A

the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true

84
Q

how do leptin and ghrelin affect appetite

A

Leptin Lowers appetite
Ghrelin Gains appetite

85
Q

type 1 vs type 2 error

A

type I: the null hypothesis is rejected when it is true

type II: the null hypothesis is accepted when it is false

86
Q

power of a study = ?

A

the probability of (correctly) rejecting the null hypothesis when it is false

the probability of detecting a statistically significant difference

87
Q

what do these treat:
interferon alpha
interferon beta
interferon gamma

A

Beta by Blasts

Alpha Antiviral (hep b and c, kaposi sarc, met RCC, hair cell leukaemia)

Gamma Granulomatous diseases
Interferom gamma= activates macrophages

88
Q

anakinra = ?

A

stops IL1 production ( IL1 antagonist) therefore blocks macrophages

89
Q

which Ig is responsible for haemolytic reaction post blood transfusion

A

IgM

90
Q

WHERE does ADH work and how

A

Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels

COLLECTING DUCT

91
Q

radial nn damage :

A

causes
wrist drop
sensory loss between 1st and 2nd fingers dorsal aspect
triceps pararlysis

92
Q

Which one of the following types statistical measures is it most appropriate to compare survival time with?

A

Hazard ratio
Typically used to analyse survival over time

93
Q

mitochondrial inheritance

A

eg affected man= children will not inherit disease

affected woman: all her children will inherit disease

94
Q

what clotting factors does warfarin act on

which of these factors depends on vit k

A

1972
10
9
7
2

clotting factor 2 depends on vit k

95
Q

oncogene for neuroblastoma

A

n-MYC

96
Q

which stage of sleep is associated with deep sleep and dreamig

A

REM

97
Q

what is the hering bruer effect

A

Hering Bruer reflex terminates inspiration and initiates expiration when stretch receptors are activated

lung distension causes slowing of resp rate

98
Q

drugs inhibit folate metabolism

A

methotrexate
trimethoprim
pyrimethamine

phenytoin= reduces folate reabsorption

99
Q

how does hypoxia affect arteries

A

HYPOXIA causes vasoconstriction of the pulmonary arteries.

100
Q

diabetic nephropathy findings= histological findings

A

Kimmelstiel-Wilson lesions, nodular glomerulosclerosis

histological changes include: basement membrane thickening, capillary obliteration, mesangial widening

101
Q

number needed to treat (NNT) of 20 for the prevention of the primary end-point. ==?

A

For 1000 patients treated with active therapy, there would be 50 fewer strokes

102
Q

x linked recessive inheritance

A

Affected males can only have unaffected sons and carrier daughters.

103
Q

what indicates haematuria is of glomerular origin

A

Dysmorphic red blood cells if found in urine sediment indicates a glomerular origin of hematuria

104
Q

which type of interferon activates macrophages

A

interferon gamma

105
Q

deficiency causes:
B3

A

B3 niacin DEFiciency= pellagra

106
Q

dry vs wet beri ber

and what is it caused by

A

beri beri caused by thiamine b1 deficiency
Dry beri beri= dry surfaces eg skin,

wet beri beri affects wet parts eg heart, pulm oedema eg

CFs:
progressive weakness of both lower limbs.
lethargy and muscle loss in the lower limbs.
marked loss of fine touch and proprioception in a stocking distribution bilaterally.

107
Q

retro peritoneal organs -
organs in direct contact w kidneys

A

Retroperitoneal Organs: SADPUCKER
S: supearenal (adrenal) gland
A: aorta
D: duodenum
P: pancreas
U: ureter
C: colon
K: kidneys
E: Esophagus
R: rectum

108
Q

how do age and emphysema affect lung compliance

A

they increase lung compliance

109
Q

primary site of action empagliflozin

A

SGLT2) proteins are responsible for the resorption of approximately 90% of filtered glucose.

The majority of glucose reabsorption in the nephron occurs within the proximal convoluted tubule

110
Q

where does most glucose reabsorption take place in the nephron

A

PCT

111
Q

power calculation

A

1- type 2 error
Is the probability of rejecting the null hypothesis when it is false

112
Q

what is the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true

A

P VALUE

113
Q

WHAT TYPE of problem mainly in case control studies

A

recall bias

114
Q

what is type 1 statistical error

A

the null hypothesis is rejected when it is true

115
Q

what is type 2 statistical error

A

type II: the null hypothesis is accepted when it is false

116
Q

which HIV peptide is used for HIV to enter cells

A

GP41`

117
Q

what causes hungry bone syndrome

A

post parathyroidectomy

XR lytic lesions
This process can be uncomfortable and also result in systemic hypocalcaemia.
Mx= IV calcium

118
Q

patient taking lithium and needs anti HTN med== which one

A

beta blocker and dyhydropyridine ca channel antag

eg felodipine, amlodipine ( especially if pt has poor glucose control, beta blockers worsen glucose)

ACEi and ARB are contraindicated in lithium use

119
Q

Factors stimulating renin secretion

A

Factors stimulating renin secretion
hypotension causing reduced renal perfusion
hyponatraemia
sympathetic nerve stimulation
catecholamines
erect posture

120
Q

which cells mediate organ transplant rejection

A

B cells IGG

121
Q

nitric oxide function

A

Nitric oxide - vasodilation + inhibits platelet aggregation

122
Q

You have collected data as part of a study into a new suture being used as part of a hysterectomy. In the study, patients are randomised into 2 groups. One group receives a newly developed suture, and the other receives the usual suture. The main outcome measure is the length of hospital stay.

Initial analysis of the data reveals that the lengths of stay in the intervention group are positively skewed and do not follow a normal distribution.

Which of the following statistical tests should be used to compare whether the average length of hospital stay differed between the two groups?

A

Mann-Whitney U test

123
Q

WHAT DOEs negatively skewed data mean

A

negatively skewed apparently means most of the data is to the right hand side of the graph…

124
Q

what is tertiary hyper parathyroidism and what situation is it common in

A

Tertiary hyperparathyroidism is an important differential in hypercalcaemia post renal replacement therapy

125
Q

How is the left ventricular ejection fraction calculated?

A

Stroke volume / end diastolic LV volume

126
Q

where is phosphate reabsopbed in nephron

A

proximal convoluted tubule

127
Q

HLA antigens are encoded by WHICH CHR

A

chromosome 6

128
Q

ANP :
where is it secreted
in response to what

effects

A

Basics
secreted mainly from myocytes of right atrium and ventricle in response to increased blood volume
secreted by both the right and left atria (right&raquo_space; left)
28 amino acid peptide hormone, which acts via cGMP
degraded by endopeptidases

Actions
natriuretic, i.e. promotes excretion of sodium
lowers BP
antagonises actions of angiotensin II, aldosterone

129
Q

Which part of an antibody do immune cells bind to?

A

crystallising region (Fc) of immunoglobulins

130
Q

likelihood for a negative test result which is 0.1.

What does this result indicate?

A

There is a 10 fold decrease in the odds of the patient having malaria with a negative test result

131
Q

layers of the epidermis

A

Come——-Corneum
Let’s——–Lucidum
Get ———Granulosum
Some ——Spinosum
Bananas / Grapes—–Basalis / Germinativum

132
Q

where is majority of iron found in the body

A

haemoglobin

133
Q

brown muddy casts= ?

A

Acute tubular necrosis is associated with granular, muddy-brown urinary casts

134
Q

the chance that the patient has the condition if the diagnostic test is positive

A

positive predictive value

135
Q

what is bohr effect

A

Increasing acidity (or pCO2) means oxygen binds less well to Hb

136
Q

mos common type of renal stones

A

calcium oxalat e

137
Q

which phase of trials looks at drug efficacy

A

2b

138
Q

T-Helper cells of the Th1 subset typically secrete:

A

Th1 secretes IF GAMMA and Il 1 and IL2

Thor1 is from space (gamma) and is number 1

139
Q

what is haldane effect

A

Increase in pO2 means CO2 binds less well to Hb

140
Q

which study design would require the most patients to produce a significant result?

A

Speriority trial

141
Q

what does adrenal medulla secrete

A

all of the body’s adrenaline

142
Q

Where are G protein-coupled receptors located?

A

cell membrane

143
Q

celecoxib MOA

A

sodium retention

144
Q

beta blocker overdose== give?

A

IV glucagon

145
Q

ciclosporin which cytokines

A

IL2 – T CELL growth factor

146
Q

accidental adrenaline injection antidote

A

phentolamine

147
Q

suxamethonium = ?

A

a depolarising muscle relaxant

148
Q

which type of medication can increase stress fractures

A

bisphosphonates orla

149
Q

most important antigen presenting cell during sensitisation

A

dendritic cell

150
Q

overdose of WHAT causes pyrexia

A

salicylates eg aspirin

151
Q

which UTI abx can cause peripheral neuropathy, diploia, ataxia

A

nitrofurantoin= Neuro

152
Q

ciprofloxacin induced achilles rupture risk factors

A

incr age; >60
steroid use
renal impairment
solid organ transplant
prev tendon rupture

153
Q

avoid SSRI use with which type of med due to incr risk serotonin syndrome?

A

AVOID TRIPTANS and SSRI

153
Q

which beta blocker has largest volume of distrubution

A

metoprolol

154
Q

which bacteria are the execptions of exotoxin production

A

cholera and some strains e coli

ALL OTHER GRAM positive bacteria secrete exotoxins

155
Q

what type of cell causes SJS in chinese ppl after taking carbamazepine

A

T CELLS

156
Q

how does tacrolimus and ciclosporin affect calcineurin

A

inhibit calcineurin thus decreasing IL-2

157
Q

AMANTADINE moa

A

inhibits uncoating of virus in cell

AMANDA DOES NOT WANT TO TAKE OFF HER COATA

158
Q

ingestion of corrosive substance FIRST INVESTIGATION

A

ENDOSCOPy = risk stratify

159
Q

occurs during reverse transcriptase polymerase chain reaction?

A

RNA======> DNA

160
Q

RECURRENT sinopulmonary/ GI infections ig cause

A

IgA deficiency

161
Q

Absolute CI antibiotic in pregnancy UTI

A

ciprofloxacin

can give trimetho but just with folate supp

162
Q

what type of opiate can incr serotonin syndrome if pt taking psych meds

A

tramadol

163
Q

linezolid active against?? bacteria ?

A

ACTIVE AGAINST
MSRA, van resistant enterococcus and gylcoprotein

AVOID MAO tyosine foods
can cause thrombocytopenia

164
Q

how does cranberry juice affect warfarin== and inr

A

INR increases
cranberry juice acts like an inhibitor

165
Q

what type of pain medication can cause thrombocytopenia

A

NSAIDS

M R C P (18 decks)

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