CLINICAL SCIENCES Flashcards
drugs CONTRAINDICATEDin breastfeeding
All Cautious Mothers Take Care Suckling Little Babies
Aspirin/Amiodarone
Cytotoxics/Carbimazole/Clozapine
Methotrexate
Tetracycline
Ciprofloxacin/Chloramphenicol
Sulphonamides/Sulphonylureas
Lithium
Benzodiazepines
what type of lab investigation used to edetect mutated oncogenes
PCR
exception to MR DS inheritance rule
freidreichs ataxia is the opposite
way to remember where steroids secreted from
GFR- ACD
zona glomerulosa-aldosterone
fasciculata- corticosteroid
reticularis- dexamethasone
Sensitivity = calculation
Sensitivity = TP / (TP + FN )
where is growth hormone secreted from
anterior lobe pituitary gland
where does majority of glucose reabsorption take place in nephron
proximal convoluted tubule
downsyndrome commonest gene error
maternal non dysjunction
Wilson and hunger key criteria
The condition should be potentially curable
early-onset breast cancer, sarcoma and leukaemia
Li fraumeni syndrome
Li fraumeni syndrome inheritance
P53 and autosomal dominant
Most common cause of Down’s syndrome
Non disjunction
Fastest conduction in the heart?
Purkinje fibres
RCT level of evidence
Ib
Which statistical test for comparing before and after on a single sample
Wilcoxon signed rank test
Interferon gamma assd which lung condition
TB
Kearns-Sayre syndrome
mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
retinitis pigmentosa
Behçet’s disease chromosome
Chromosome 6
Vincristine acts in what stage of cell cyecle
Metaphase
Hat does insulin bind to on cell membrane
Tyrokinase receptor
how long to keep in anaphylaxis patients and monitor
6 hours
which HLA for narcolepsy
hLA DR 2
fabry disease inheritance
x linked recessive
optic neuritis caused by which TB medication
ethambutol – causes optic neuritis
what are interferons
interferons are cytokines
Beta by Blasts
Alpha Antiviral
Gamma Granulomatous diseases
characteristics of a negatively skewed distribution?
Skewed distributions
alphabetical order: mean - median - mode
‘>’ for positive, ‘<’ for negative
fabry disease
inheritance
cfs
x linked recessive
FABRY’S
Fever
Angiokeratomas / Alpha-galactosidase A
Burning pain
Renal
YX (x linked recessive)
Stroke / Cardiovascular
CORNEAL WHIRLS
how can digoxin affect vision
green - yellow tinge
her 2 positive breast ca treatment
trastuzumab
aspirin MOA
irreversible inhib of cox1 cox2
ondansetron MOA
5ht3 antagonist
cyanidepoisoning treatment
hydroxycobalamin
levothyroxineMOA
nuclear receptors
allopurinol moa
inhibits xanthine oxidase
Hypersensitivity reactions:
type 1
2
3
4
new added- type 5
1- anaphylaxis and atopy (asthma, hayfever, eczema— IgE
- HAEM: haemolytic anaemia, ITP, goodpastures, pernicious anaemia, rheumatic fever ,pemphygoid
IgG, IgM - 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
wernickes encephalopathy cause by ?? vit def ??
Vit B1 def= THIAMINE
BRCA= TSG or oncogene ?
Tumour suppressor gene
cushings, conns , thiazide use== VBG finding
metabolic alkalosis
x linked dominant syndromes
rett
parametric vs non parametric statistical tests
parametric
students T test (paired or unpaired)
Pearson’s correlation coefficient
Non Parametric
Spearman rank
Wilcoxon
Mann Whitney U
Chi Squared
before and after comparison test
wilcoxon
compare % improved after intervention stat test
chi squared
X linked recessive syndromes
Hunters disease
Lesch-Nyhan syndrome
coeliac HLA
HLA -DQ2/DQ8
Q2 CUTIE DATE D8 DQ
C3 deficiency associated with ??
incr recurrent bacterial infections
The usual outcome measure is the relative risk=== ? type of study
cohort study
GFR - ACD)
zona glomerulosa (on outside): mineralocorticoids, mainly aldosterone
zona fasciculata (middle): glucocorticoids, mainly cortisol
zona reticularis (on inside): androgens, mainly dehydroepiandrosterone (DHEA)
Activation of B cells- which Ig?
IgD
Molecular biology techniques
what is used to detect DNA, RNA, Protein
SNoW (South - NOrth - West)
DRoP (DNA - RNA - Protein)
nitric oxide secondary messenger
cGMP
if you do NOS= you are a G
which phase of cell cycle is the longest
and shortest
Interphase in G1
shortest- mitosis
stages of mitosis
PEE ON THE MAT:
PMAT
WHICH phase of determines length of cell cycle
G1
cherry red spot on macula and NO splenomegaly:
tay sachs= lysosomal storage disease
aut recessive
FGFR3 (fibroblast growth factor receptor) gene defect mutation
ACHONDRPLASIA
which B vitamin causes angular chelitis
B2- riboflavin
affects 2 corners of the mouth
exception condition to X LINked recessive inheritance only males are affected:
TURNERS SYNDROME
where does ADH act on
collecting duct
endothelin causes vaso constriction or dilation?
endothelin causes vasoconstriction
therefore in pulm HTN- endothelin antagonist is used
vitamin d resistant rickets inheritance and tx
x linked dominant
high dose vit d
oral phosphate supplements
45XO genotype =?
turners syndrome
how to remember ocular eye movements and their nn palsies
‘LR6SO4’
IPSILATERAL
X LINKED RECESSIVE conditions
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
What molecule is responsible for binding and trafficking? in a cell organelle
Golgi adds mannose-6-phosphate to proteins for trafficking to lysosomes
what does adrenaline act on
g protein coupled
what type of Ig is synthesised by plasma cells
IgE
what is power
Power = 1 - the probability of a type II error
Power - the probability of detecting a statistically significant difference
PTH ACTIONS - ca and phosphate and osteoclastic activity
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
actions of vit d (calcitriol- activated form)
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
recurrent meningitis- complement deficiency
C5-9
pathognomic of hodgkins lymphoma
reed sternberg cells= cd 15
how does hypoxia affect pulm arteries
constrict
marker of poor prognosis RA
anti ccp antibodies
positive rheumatoid factor
p53 gene function
Tumour suppressor gene
preventing entry into the S phase until DNA has been checked and repaired
Encodes proteins which regulate the cell cycle
what % of data lies within 3 SDs if normally distrubuted
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
what is the measured out come in case control study and cohort study
case control study= odds ratio
cohort study= relative risk
homocysteinuria
inheritance
cfs
mx
aut recessive
long fingered
tall
fine fair hair
kyphosis
recurrent DVT
downwards dislocation of his lens
Tx= vit B6 PYridoxine
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
UNPAIRED
pre test probability in simple terms = ?
prevalence
how to calc down sydnrome risk
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
what type of graph shows publication bias in meta-analyses
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.
complement deficiencies in SLE
C1q, C1rs, C2 and C4
P value
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
how do leptin and ghrelin affect appetite
Leptin Lowers appetite
Ghrelin Gains appetite
type 1 vs type 2 error
type I: the null hypothesis is rejected when it is true
type II: the null hypothesis is accepted when it is false
power of a study = ?
the probability of (correctly) rejecting the null hypothesis when it is false
the probability of detecting a statistically significant difference
what do these treat:
interferon alpha
interferon beta
interferon gamma
Beta by Blasts
Alpha Antiviral (hep b and c, kaposi sarc, met RCC, hair cell leukaemia)
Gamma Granulomatous diseases
Interferom gamma= activates macrophages
anakinra = ?
stops IL1 production ( IL1 antagonist) therefore blocks macrophages
which Ig is responsible for haemolytic reaction post blood transfusion
IgM
WHERE does ADH work and how
Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels
COLLECTING DUCT
radial nn damage :
causes
wrist drop
sensory loss between 1st and 2nd fingers dorsal aspect
triceps pararlysis
Which one of the following types statistical measures is it most appropriate to compare survival time with?
Hazard ratio
Typically used to analyse survival over time
mitochondrial inheritance
eg affected man= children will not inherit disease
affected woman: all her children will inherit disease
what clotting factors does warfarin act on
which of these factors depends on vit k
1972
10
9
7
2
clotting factor 2 depends on vit k
oncogene for neuroblastoma
n-MYC
which stage of sleep is associated with deep sleep and dreamig
REM
what is the hering bruer effect
Hering Bruer reflex terminates inspiration and initiates expiration when stretch receptors are activated
lung distension causes slowing of resp rate
drugs inhibit folate metabolism
methotrexate
trimethoprim
pyrimethamine
phenytoin= reduces folate reabsorption
how does hypoxia affect arteries
HYPOXIA causes vasoconstriction of the pulmonary arteries.
diabetic nephropathy findings= histological findings
Kimmelstiel-Wilson lesions, nodular glomerulosclerosis
histological changes include: basement membrane thickening, capillary obliteration, mesangial widening
number needed to treat (NNT) of 20 for the prevention of the primary end-point. ==?
For 1000 patients treated with active therapy, there would be 50 fewer strokes
x linked recessive inheritance
Affected males can only have unaffected sons and carrier daughters.
what indicates haematuria is of glomerular origin
Dysmorphic red blood cells if found in urine sediment indicates a glomerular origin of hematuria
which type of interferon activates macrophages
interferon gamma
deficiency causes:
B3
B3 niacin DEFiciency= pellagra
dry vs wet beri ber
and what is it caused by
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.
retro peritoneal organs -
organs in direct contact w kidneys
Retroperitoneal Organs: SADPUCKER
S: supearenal (adrenal) gland
A: aorta
D: duodenum
P: pancreas
U: ureter
C: colon
K: kidneys
E: Esophagus
R: rectum
how do age and emphysema affect lung compliance
they increase lung compliance
primary site of action empagliflozin
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
where does most glucose reabsorption take place in the nephron
PCT
power calculation
1- type 2 error
Is the probability of rejecting the null hypothesis when it is false
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
P VALUE
WHAT TYPE of problem mainly in case control studies
recall bias
what is type 1 statistical error
the null hypothesis is rejected when it is true
what is type 2 statistical error
type II: the null hypothesis is accepted when it is false
which HIV peptide is used for HIV to enter cells
GP41`
what causes hungry bone syndrome
post parathyroidectomy
XR lytic lesions
This process can be uncomfortable and also result in systemic hypocalcaemia.
Mx= IV calcium
patient taking lithium and needs anti HTN med== which one
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
Factors stimulating renin secretion
Factors stimulating renin secretion
hypotension causing reduced renal perfusion
hyponatraemia
sympathetic nerve stimulation
catecholamines
erect posture
which cells mediate organ transplant rejection
B cells IGG
nitric oxide function
Nitric oxide - vasodilation + inhibits platelet aggregation
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?
Mann-Whitney U test
WHAT DOEs negatively skewed data mean
negatively skewed apparently means most of the data is to the right hand side of the graph…
what is tertiary hyper parathyroidism and what situation is it common in
Tertiary hyperparathyroidism is an important differential in hypercalcaemia post renal replacement therapy
How is the left ventricular ejection fraction calculated?
Stroke volume / end diastolic LV volume
where is phosphate reabsopbed in nephron
proximal convoluted tubule
HLA antigens are encoded by WHICH CHR
chromosome 6
ANP :
where is it secreted
in response to what
effects
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»_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
Which part of an antibody do immune cells bind to?
crystallising region (Fc) of immunoglobulins
likelihood for a negative test result which is 0.1.
What does this result indicate?
There is a 10 fold decrease in the odds of the patient having malaria with a negative test result
layers of the epidermis
Come——-Corneum
Let’s——–Lucidum
Get ———Granulosum
Some ——Spinosum
Bananas / Grapes—–Basalis / Germinativum
where is majority of iron found in the body
haemoglobin
brown muddy casts= ?
Acute tubular necrosis is associated with granular, muddy-brown urinary casts
the chance that the patient has the condition if the diagnostic test is positive
positive predictive value
what is bohr effect
Increasing acidity (or pCO2) means oxygen binds less well to Hb
mos common type of renal stones
calcium oxalat e
which phase of trials looks at drug efficacy
2b
T-Helper cells of the Th1 subset typically secrete:
Th1 secretes IF GAMMA and Il 1 and IL2
Thor1 is from space (gamma) and is number 1
what is haldane effect
Increase in pO2 means CO2 binds less well to Hb
which study design would require the most patients to produce a significant result?
Speriority trial
what does adrenal medulla secrete
all of the body’s adrenaline
Where are G protein-coupled receptors located?
cell membrane
celecoxib MOA
sodium retention
beta blocker overdose== give?
IV glucagon
ciclosporin which cytokines
IL2 – T CELL growth factor
accidental adrenaline injection antidote
phentolamine
suxamethonium = ?
a depolarising muscle relaxant
which type of medication can increase stress fractures
bisphosphonates orla
most important antigen presenting cell during sensitisation
dendritic cell
overdose of WHAT causes pyrexia
salicylates eg aspirin
which UTI abx can cause peripheral neuropathy, diploia, ataxia
nitrofurantoin= Neuro
ciprofloxacin induced achilles rupture risk factors
incr age; >60
steroid use
renal impairment
solid organ transplant
prev tendon rupture
avoid SSRI use with which type of med due to incr risk serotonin syndrome?
AVOID TRIPTANS and SSRI
which beta blocker has largest volume of distrubution
metoprolol
which bacteria are the execptions of exotoxin production
cholera and some strains e coli
ALL OTHER GRAM positive bacteria secrete exotoxins
what type of cell causes SJS in chinese ppl after taking carbamazepine
T CELLS
how does tacrolimus and ciclosporin affect calcineurin
inhibit calcineurin thus decreasing IL-2
AMANTADINE moa
inhibits uncoating of virus in cell
AMANDA DOES NOT WANT TO TAKE OFF HER COATA
ingestion of corrosive substance FIRST INVESTIGATION
ENDOSCOPy = risk stratify
occurs during reverse transcriptase polymerase chain reaction?
RNA======> DNA
RECURRENT sinopulmonary/ GI infections ig cause
IgA deficiency
Absolute CI antibiotic in pregnancy UTI
ciprofloxacin
can give trimetho but just with folate supp
what type of opiate can incr serotonin syndrome if pt taking psych meds
tramadol
linezolid active against?? bacteria ?
ACTIVE AGAINST
MSRA, van resistant enterococcus and gylcoprotein
AVOID MAO tyosine foods
can cause thrombocytopenia
how does cranberry juice affect warfarin== and inr
INR increases
cranberry juice acts like an inhibitor
what type of pain medication can cause thrombocytopenia
NSAIDS
