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MRCP > Clinical Sciences > Flashcards

Clinical Sciences Flashcards

1
Q

Risk factors of statin myopathy

A

Female
Old
Low BMI
Multisystem disease

An old think woman with lots wrong

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2
Q

Statin mechanism of action

A

Inhibits HMG-CoA reductase.

This is the rate limiting enzyme in cholesterol synthesis

Lipophilic statins - simvastatin and atorvastatin- more myopathy

Hydrophilic- rosuvastatin, pravastatin, fluvavastin - less myopathy

Erythromycin/clarithromycin - increase CK

Stop statin if after 3/12 trbsaminases rise by 3x

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3
Q

Innate immune response

A

Neutrophil - primary phagocytise in acute inflammation. Contains myeloperoxidase + lysozyme. Multilobed nuclei

Basophils - histamine I’m allergic response m. Expresses IgE - bilobed nuckeus

Mast cells - similar to basophils function Present in tissues.

Eosinophils- defence vs protozoan and helminthic infect - bilobed nuclei

Macrophage - phagocytosis of vellular debris + pathogen. APC. Nah source of IL-1 (fat laden = FOAM. CELL)

Dendritic cell - APC

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4
Q

Helminths

A

Seen in poorer countries with ooor sanitation and communities. Eggs in soil from poo in soil.

Get in body from eating eggs - veg or meat infected with eggs

Grow inside —> anaemia, WL, malnutrition.

Can lead to Bowel obstruction —> surgery

To bendazoles mainly

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5
Q

Adaptive immune response cells

A

Helper T - cell mediated respond CD4 - recog MHC class 2 - acute + chronic organ rejection

Cytotoxic T cells - MHC class 1 recognition - Expresses CD8. Acute in chronic rejection

B cells - hyperacute rejection - humoral immune response

Plasma cells - differentiate from B cells. Specific

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6
Q

Endothelin

A

Bunds to target tissues —> ETA & ETb to coulek to Gq protein —> formation of IP3 —> calcium release from SR

Causes: vasoconstriction and Positivr inotropic. Causes aldosterone secretion, decreases renal
BF & eGfFR and release ANP

Stimulated by- ADH, AT2, thrombin, Hypoxia, shearing force

Inhibited by: prostacyclin and ANP(neg feedback)

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7
Q

Hungry bone syndrome

A

Rare

Follows parathyroidectomy for hyperPTH and a rapid decrease in PTH

Normal
To get trainsient hypoPTH for few weeks —> hypocalcaemia, but I’m hungry bone you get a rapid absorption of Ca into bones which prolongs hypocalcaemia.

Suppressed PTH and low Ca, PO4- and Mg

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8
Q

T helper cells

A

TH1 (think gamma (1)-2-3)

  • cell mediated response in Type 4 hypersensitivity
  • Secretes: IFN-gamma, Il 2 and Il3

Th2:

  • humoral immunity
  • eg stimulating IgE in asthma
  • IL4,5,6,10,13

TH-17

  • driven by IL17
  • unknown
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9
Q

HLA classes

A

HLA-A3 - haemochromatosis

HLA-B51: Bechets

HLA-B27 - Ank spond, Reiter’s, acute ant uveitis

HLA-DQ2/8 - Coeliac disease

HLA- DR2 - narcolepsy + goodpasteures

HLA - DR3 - dermatitis heroetiformis, sjrogrens, PBC

HLA-DR4 - DB type 1/RA

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10
Q

Standard deviations and percentage values

A

1 SD - 68.3%
2 SD - 95.4%
3 SD -99.7%

68.3–> 95.4 —> 99.7

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11
Q

Clopidogrek mexhsnism of action

A

Inhibits ADP binding to platelet, therefore inhibits activation of platelets

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12
Q

Pulmonary surfactant

A

Released by type 2 pneumocystis.

Main component is dipalmitoyl phosphatidylcholine (DPPC)

1st detected at 28 weeks

Mechanism: as alveoli decrease in size it increases in conc, therefore making sure no collapse - by lowering elastic recoil

Reduces manic forces needed to expand lungs

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13
Q

Pellagra

A

Vitamin B3 deficiency - niacin

Get in alcoholism

3Ds

Dementia
Diarrhoea
Dermatitis

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14
Q

Likelihood ratios

A

LR+ = sensitivity/(1- specificity)

LR- = (1- sens)/spec

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15
Q

Common Tumour supressor genes.

A

APC - colorectal Ca

p53 - multipla Ca. Li Fraumeni

BRCA1 - Breast + Ovarian Ca

BRCA2 - Breast Ca

RB - Retinoblastoma

NF1 - Neurofibromatosis

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16
Q

Cell Cycle:

A

G0 - resting phase

G1 - Gap 1 - Cell increase in size - determines length of cell cycle (p53)

S - Synthesis phase - RNA + DNA + Histones form

G2 - Gap 2 - cell increase in Size

M - Mitosis = shortest phase

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17
Q

IFN

A

IFN - alpha:

  • think a for A - best antiviral acttion
  • Vs Hep B + C, Karposi sarcome, metestatic RCC

IFN - B:

  • antiviral
  • shown to decrease freq of exac. in R-R M.S.

IFN - G:

  • Immunomodulation
  • Chronic granulamtous dx & Osteopetrosis

IFN a + B = bind to type 1 receptor

IFN–gamma - binds type 2

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18
Q

Haldane vs Bohr Effect

A

Haldane:

O2 causes Hb to have a decreased affinity for CO2

Bohr:

CO2 + pH (acid) causes Hb to have a decreased affinity for O2

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19
Q

Organelles and their fn:

1) Endoplasmic reticulum
2) Golgi apparatus
3) Mitochondrion
4) Nucleus
5) Nucelous
6) Ribosome
7) Lysosome
8) Peroxisome
9) Proteasome

A

1) Rough ER - Translation and folding of proteins. Manafacturesn lysosomal enzymes
N-linked glycosylation
1) Smooth ER - steroid + lipid syntesis

2) Packaging of above for those that are destined to be secreted by cell. O-linked glycosylation
3) Aerobic resp. Contains mitochondrial circular DNA
4) DNA –>RNA
5) Produces ribosome
6) RNA –> protewin
7) B.D>. of proteins + polysaccharides
8) B.D. of long chain fatty acids –> forms hydrogen peroxide
9) B.D> of proteins

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20
Q

Common CDs

A

CD1 - MHC molecule that presents lipid molecules
CD2 - Found on thymocytes, T cells, and some natural killer cells
CD3 - The signalling component of the T cell receptor (TCR) complex
CD4 - Found on helper T cells.
Co-receptor for MHC class II
Used by HIV to enter T cells
CD5 Found in the majority of mantle cell lymphomas
CD8 Found on cytotoxic T cells.
Co-receptor for MHC class I
Found on a subset of myeloid dendritic cells
CD14 Cell surface marker for macrophages
CD15 Expressed on Reed-Sternberg cells (along with CD30)
CD16 Bind to the Fc portion of IgG antibodies
CD21 Receptor for Epstein-Barr virus
CD28 Interacts with B7 on antigen presenting cell as costimulation signal
CD45 Protein tyrosine phosphatase present on all leucocytes
CD56 Unique marker for natural killer cells
CD95 Acts as the FAS receptor, involved in apoptosis

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21
Q

Compliment deficiencies

A
  • C1 inhibitor – hereditary angioedema (remember 1 = A 1st letter alphabet)
  • C1q, C1rs, C2, C4 –> immune complex dx – HSP/SLE
  • C3 – Bacterial infections – 3 looks like a B
  • C5 – leinier disease – recurrent diarrhoea, wasting and seberrhoeic dermatitis.
  • C5-9 – MAC complex disorder – Neisseria meningitides
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22
Q

Chicken pox

A

Highly infectious:

  • Spread via reps route.
  • Infectivity – 4days before rash, until 5 days after
  • Incubation = 10-21 days

Mx symptoms– lotion + trim nails

Immunocompromised, newborns with periparrtum exposure –> VZIG

If chicken pox develop –> IV Aciclovir

Complications:

Pneumonia –> Giv IV Acicllovir – fine crackles bilaterally. Multiple itny opacities

Encephalitis

Arthritis

nephritis

pancreatits

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23
Q

GI Hormones

A

Gastrin

  • secreted by G cells of antrum
  • stimulus: vagus nerve activity vi distension. Luminal peptides + AA. Low Ph
  • secretes acid + digestive enzymes, increase motility

Somatostatin:

  • D cells of stomach + SI
  • stimulated by digestive prod - fat, bile salts + glucose
  • essentially opp of above: decrease acid + motility + digestive enzymes

CCK:

  • I cells of SI
  • stim: partially digested protein + TG
  • increases secretion of pancreas, contract GB relax sphincter of oddi. Decrease gastric emptying. Induces satiety

Secretin:

  • S cells of SI
  • acidic chyme + FA
  • increase BICARBONATE secretion + decrease acid

VIP:

  • secreted by cells SI
  • Naural
  • secretion if pancreas’s + intestine
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24
Q

Sigmificance tests and statistical

Errors:

A

Null
Hypothesis - two to see equally effective

Alternative hypotheses- is the opp null hypothesis

Type 1 statistical error: null hypothesis rejected when it’s true.

Type 2 statistical error: null hypothesis accepted when it’s fals

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25
Q

Respiratory physiology: control

A

Control of resp:

Central reg centres

  • medullary resp centre
  • apneustic centre- lowerpons
  • pneumotaxic Centre- upped pons

Central + peripheral chemoreceptors

  • central: raised (H+) ECF
  • perioheral; carotid + aortic bodies - respond to raised pCO2/(H+, lesser extent low pO2

Pulm receptors

  • stretch receptors. Distension —> slower RR (hering-bruer reflex)
  • irritant receptor —> bronchoconstriction
  • juxtacapillary - stretching of micro add
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26
Q

Clinical trial: phases

A

Phase 1

  • determines pharmokinetics, pharmodynamocd and side effects
  • healthy volunteers

Phase2:

  • 2a - optimal dosing
  • 2b - assessed efficacy
  • small number of dx patients

Phase 3:

  • assess effectiveness.
  • RCT

Phase 4:

  • post marketing surveillance
  • Lt effectiveness and side-effects
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27
Q

Immunoglobulins

A

IgG - most common - phagocytosis. Complement. Passes to foetal circulation

IgA - breast milk. Secreted by resp/digestive/urogenitak. Localised protection to mucous membrane

IgM - 1st secreted in response to infection. Complement. Doesn’t pass into foetal circ. BLOOD GROUPS.

IgD - activation of B cells

IgE - LEAST COMMON - type 1 hypersensitivity.

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28
Q

Hypersensitivity reactions

A B.C D E

A

Type 1 = A -

  • Allergic, Anaphylactic,Atopy.
  • IgE
  • Caused by cross linking of multiple IgE on mast cell/Basophils. —> mast cell granules —> histamine release. (Can be presensitised - happens V quick)

Type 2 - B

  • anti-B-ody, = IgG and IgM
  • antibody dependedant cytotoxicity. Same as humours immunity but targeted at own body cells.
  • examples include goodpasteures , haemolytic dx of newborns
  • GRAVES DISEASE

Type 3 - C

  • immune-C-omplex
  • increase Ag Ab ratio in body.
  • clumping —> inflammation by aCompement + attracting neutrophils.
  • SLE, rheumatoid, golmerulonephritis
  • hypoclompementaemia

Type 4 - D

  • D-elayed hypersensitivy
  • Th 1 attract and activate macrophages
  • cell mediated and antibody independent
  • GvH dx And BCG
  • contact dermatitis/ PPD - TB skin test/ MS

Type 5 - E

  • Ab that recognise cell surface or E-xternal receptors
  • graVEs or MG
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29
Q

Staph epididermis

A

Most common organism for central line infection

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30
Q

Standard error of the mean

A

Standard deviation/square root of number of patients

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31
Q

Acute phase proteins

A 
CRP 
Ferritin 
Complement 
Alpha - 1 antitrypsin
Procalcitonin 
Serum amyloid A & P 
Caeruloplasmkn 
Haptoglobin
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32
Q

Alkaptonuria

A

Lack of enzyme homogentisic dioxygenase.

Get build up of homogentisic acid in urine

Blue sclera and black urine
Intervertebral disc calc —> back pain
Renal stones

Tx:

  • high dose vitamin C
  • diet: restrict phenylalanine and tyrosine
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33
Q

HIV immunology

A

Progressive HIV you se:

  • reduced CD4
  • reduced IL2
  • increase B2-microglobulin
  • polyclonal activation of B cells
  • decrease Nkcells
  • reduced delayed hypersensitivity rxn
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34
Q

Proto-oncogenes

A

Gain of function via:

  • mutation
  • translocation
  • increased protein expressions

ABL - CML

c-MYC - burkitts lymphoma

n-MYC - neuroblastoma

BCL-2 - follicular lymphoma

RET - MEN 1 & 2

RAS - many cancers

Erb- B2 (HER2) - Brest and ovarian ca

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35
Q

Innate

Immune response

A

PRRs on phagocytic cells recognise PAMPs —> complement/chemokines/ cytokines —> phagocytosis —> release pathogenic peptides —> APCs

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36
Q

Complement pathway triggers

A

Classic - Anyibody activated

Alternative and leptin - polysaccharide component of cell wall.

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37
Q

Hereditary A-ngioedema

A

Think C-1 and letter -A-

Increase in classic pathway and kallikerin

Kallikerin —> bradykinin driven angioedena

Distinguish from anaphylaxis as

  • NO URTICARIA
  • NO HYPOTENSION
38
Q

Cytokines

A

IL-1 - proinflamm of innate - seen in autoinflamm dx - periodic fever syndrome

Il-2 - T cell driven response - inhibition useful
In Transplant rejection - calcineurin inhib, ciclosporin, tacrolimus - s.e. HIV LIKE

Il-6 - proinflamm - ACUTE PHASE RESPONSE CRP - inhibition used in RA - therefore falsely reassuring low CRP

Il-10 - decreases cytokines and inhib HLA —> ANTINFLAMM

Il-17 —> TH17

TNF

  • pro inflamm —> Tcell recruitment.
  • prod by Mac
  • s.e of TNF-I —> granuloma reactivation

IFN:

  • proinflamm
  • seen in VIRAL infection
  • used to tx chronic viral Infection
  • SE —> FLU LIKE SX
39
Q

Adaptive immunity —> cellular and humoral response

A

Humoral:

  • circulating B cells recognise circulating antibodies
  • Initial IgM response —> memory cells which produce IgG
  • re-exposure —> rapid specific IgG response

Cellular:

  • some pathogens hide in cells
  • therefore cells present intracellular material using HLA system (APCs)
  • interact with Tcells
  • this system recognised self vs non-self
40
Q

Cryoglobulin

A

Ig that precipitate out at low temp

3 types:

Type1 - monoclonal IgM - Walldenstroms macroglobuniaemia —> hypervsicosity

Type 2 - mixed - chronic infection - Hep C

Type 3 - polyclonal - mixed CT dx

41
Q

Cold agglutin

A

Different from
Cryoglobulin

A form of haemolytic anaemia

Seen in lymphoproliferative dx and mycoplasma pneumonia

42
Q

Rituximab

A

Causes complement mediated lysis of CD20 express cells - B CELLS

43
Q

Transplantation

A

Hyperacute:

  • humoral
  • Min’s —> hrs
  • pre-existing ab bs donor HLA1

Acute:

  • <6/12
  • mismatched HLA / CMV
  • reversible with IS

Chronic:

  • > 6/12
  • ab & cell mediated —> fibrosis
44
Q

Neutrophil deficiency

A

Recurrent bacterial or fungal
Skin infection

Causes:

  • primary - chronic granulmatous dx
  • secondary -DB
45
Q

B cell deficiency

A

Get spinopulmonary infection/bronchiectasis

Primary:

  • common variable immunodeficiency
  • IgA deficiency
  • bruttons agammaglobulinaemia
  • Wishkott Aldrich - eczema + Thrombocytopaenia

Secondary:

  • CLL
  • Rituximab
  • Gold
  • Phenytoin
46
Q

T cell deficiency

A

results in HIV like syndromes —> PCP CMV SALMONELLA MYCOBACTER

Causes

Primary:

  • di George
  • SCID
  • Ataxia telangectasia

SEcondary:
- HIV
- Ciclosporin / calcineurin inhib /
Tacrolimus

47
Q

IL-1

A

Secreted by macrophages/monocytes

Causes T and B cell prolif

48
Q

Layers of the epidermis

Come Lets Get Some Beers

A 
Corneum 
Lucidum
Granukosum
Spinosum - swuamous cells
Germinatavum - deepest - columnar cells. Produce keratinocytes and has melanocytes
49
Q

Molecular biology techniquss

SNoW DRoP

A

S-outhern - detects D-NA

  • N-othern - detexts - R-NA
  • W- est - detects - P-rotein
50
Q

Carcinomas and their cancers

A

Aflatoxin - liver - hepatocellular carcinoma

Aniline dyes - bladder - transitional cell carcinoma

Asbestos - mesothelioma and bronchial carcinona

Nitrosamines - oesophageal and gastric ca

Vinyl chloride - hepatic angiocarcinoma

51
Q

Positive vs NFlegative skewed data

A

Positively skewed data = Nailed down and pullled to the right –> so the right had is longed out and lower

NEgatively = opposite

in normal distribution median and mean = the same.

In skewed data - Median still the same as this its the apex, but the mean is pulled into the tail.
- Neg skew - MEan Med

52
Q

Muscle relaxants

A

Suxamethonium:

  • Depolarising musc relaxant
  • Inhibits Ach at NMJ
  • Fastest onset and shortest duration of all musc relax - RSI
  • PRod gen contraction –> Relaxation
  • s.e.: HyperK+ / MAlignant hyperthermia and AcH lack.

Atracurium:

  • Non-depolarising
  • Duration 30-45 mins
  • Histamine release –> Flushing, tachy, hypotensive
  • Not BD by kidneys/liver (hydrolysis)
  • Reversed by NEostigmine

VEcuronium:

  • Non depolarision
  • duration = 30-40 mins
  • B.D> by kidney/liver –> therefore dysfn –> acccumulatuin
  • Reversed by neostigmine

Pancuronium:

  • Non-depolarising
  • long duration 2 hours
  • effects partially revered by nestigmine
53
Q

pre and post test odds

A

pre-test probability = prevelance
Post-test probability = post test odds/ 1+post test odds

Pre test odds = pretest probability / 1 - pretest prob
Post test odds = pre-test odds x likelihood ratio

54
Q

Most common gene disorder in down syndrome ?

A

NON-DYSJUNCTION

55
Q

Significance tests

A

Parametric data (measureable and normally distrivuted)

  • Students - paired or unpaired
  • Pearsons - CORRELATION
non=paramterict 
- Chi-squared - PROPORTIONS AND PERCENTAGES or Fisheres exact (small sample size)
]- Mann -whitney - unpaired 
- Spearman-kendal rank - CORRELATION
- Wilcoxon signed 
PAired = data from single group
unpaired = data from 2 diff groups
56
Q

Adrenoreceptors

A

alpa-1

  • activates phopholipase C –> IP3 –> DAG
  • VC
  • Relax Gastic SM
  • salivary secretion

alpha - 2 :

  • Inhibits pre-synaptic NT
  • Inhibits adenyl cyclase
  • Inhibit insulin secretion
  • Platelet aggregation

Beta 1 =

  • Stim Adenyl cyclase
  • Heart –> +chronotrope +ionotrope

Beta 2

  • Stim AC
  • Bronchodilation
  • vasodilation
  • Relax gastric SM

Beta 3

  • Stim AC
  • Lipolysis
57
Q

What is gthe power of a study

A

1 - probablity of a type 2 error

58
Q

Types of error

A

Type 1: - null hypothesis is rejected when its true
(Type 1, what people doing study want)

Type 2 - accepting null hypothesis when it is false.

59
Q

Post-test odds =

A

Pre test odds x +ve likelihood ration

positive likelihood ratio = sensitivity/(1 - spec)

60
Q

Which cytokines involved in acute phase response

A

Tbf - alpha (a in acute phase)

Il-1 (1 for first phase)

Ik-6 (6 looks like upside down p)

61
Q

How does variance relate to standard deviation

A

Standard deviation is the square root of the variance

Remember 95% of normally distributed data will. Like between 2 SD bellow and above the mean

62
Q

Shock

A

Grade 1:

  • losss of 15% of blood vol - 750 ml
  • Not low BP
  • MAY nbe tach

GRade 2:

  • 15-30%
  • BP normal
  • Tachy

~GRade 3:

  • 30-40
  • Decreased UO

GRade 4:

  • > 40%
  • Anuria
63
Q

What is degranulation - in respect to eosinophils?

A

degranulation is where mast cells/eosinophils/basophils, release their lysosomes.

intracellular lysosomes fuse with plasma membrane and release their contents –> extracelllular

This maks them useful vs larger organisms such as helminths and protozoa

64
Q

Process of phagocytosis

A

chemotaxis –> ingestion –> intracellular enzymatic degradation –> exocytosis

65
Q

What is the product of a codon?

A

Codon is 3 adjacent nucletodies –> code for Amino acid

66
Q

Linear vs logistic regression

A

measures teh strength of a relationship between two variables.

y= a +b.X

X = input Y = ouput

if Y = continuus - linear (i.e. dose)

If Y = 2 x categories = logistic.

67
Q

Fisher exact test and chi2 test

A

Both sinificance tests

Essentially the same, but Fishers is Exact P-value and Chi2 is approximate P value

therefore fishers is better if SMALL SAMPLES

Chi2 is ok in BIG SAMPLES

68
Q

Number needed to treat

A

1/absolute risk reduction

69
Q

DNA - investigations - FISH:

A

FISH:

  • Microdeletion conditions - DiGEorge, Kallman, Williams
  • DNA denatured, Fluorescent probe added which is complimentary to DNA sequence you want to identify.
  • If that DNA is present –> binds and you detect signal

Metaphase FISH:
- Like above but cells need to be in GROWTH PHASE.

Interphase FISH:

  • Cells dont need to be in growth phase
  • USed in anueploid cells.
70
Q

Incidence vs prevelance

A

Incidence - number of NEW cases

Prevelance - number of ALL Cases

71
Q

Relative Risk

A

PRobability of event occuring in exposed / prob of event occuring in unexposed.

72
Q

Types of Analysis

A

Intention to treat}:

  • similar to clinical situation
  • Includes ALL participants , incl. those who drop out
  • good for compliance

Completer Analysis:

  • Only those that complete trial
  • Smaller smaple size and BIAS

Pre-protocol analysis :
- Even stricter than completer analysis

Severity analysis:
- look at how robust an assesment is by seeing if changing method –> Changes results.

73
Q

Absolute risk reduction

A

ARR = Relative Risk x Placebo event rate.

relative risk = experemential event rate/control event rate

74
Q

DNA investigations - Microarray analysis

A

Microarray analysis:

  • Looks at transcription activity by converting RNA –> DNA:
  • Compafres RNA
75
Q

DNA investiations - PRotein Aanlysis

A

Protein analysis:

  • Measures all protein in cell by Mass Spectometr.
  • compare healthy and disease tissues.
76
Q

DNA investigations - PCR

A

1) Primer + DNA Template + DNA polymerase
2) heat –> Single strand DNA
3) Coooled –> primers bind to template
4) HEat –> activated DNA polymerase –> amplification

Uses of PCR :

  • Mutation detection
  • detect bacteria/virus in tissues
  • Single cell genetic test of in-vitro fertilised embyos

Reverse transcription PCR:

  • ooks at only transcribed genes
    1) Reverse transcriptase used 1st
    2) mRNA –> DNA –> analysis as above
77
Q

Monoclonal Antibodies

A

Grown by injecting rat spleen with Antigen –> collect and combine with myeloma –> incrase antibody

Humanisation of Mab:

  • chimeric Antiboody = mouse variable region and Fc = human
  • decreased chane of recognised as foreign, btu still small chance
78
Q

Ligand gated ion channels

A

5 subunits 0 alpha-2/beta-2/gamma
binding to alpha –> conformational change

e. g:
- ACH-R/GABA/GLutamte/G;ycerione

79
Q

Tyrosine Kinase

A

Susbtrated –> binds receptor –> activates TK–> dimerisation –> autophosphorhylation

Insuline/IGF-1/PDGF

80
Q

GPCR

A

Couling of extracellular signal –> Second messenger.
3 subunits alpha/beta/gamma

in inactive state GDP is bound to alpha

Ligand binds –> GDP –> GTP –> alpha dissociates –> alpha-GTP or gamma –> activates 2nd messengers (Gi or Gs)

inactivation of alpha-GTP –> GTP –> GDP ( alpha-GTPase)

exampleS:

  • MUSCARINIC Achr
  • alpha + beta adrenergic-receptors
  • Rhodopsin

Dx assoc:

  • Cholera
  • pit adenoma
  • Mcune Albrights
  • Aldbrights hereditary osteroedystrophhy
81
Q

What fruit is associated with LAtex allergy

A

KIWI

82
Q

Calculating Clearance

A

(U x V)/P

U = Urine concentration of drg (mg/ml)
V = volume of urine in (ml/Min)
P = plasma concentration (mg/Ml)
83
Q

Cholera mechanism of action

A

GM-1 Agonism

84
Q

Study design and levels of evidence

A 
1a = meta-anaylsis of RCTs 
1b = at least 1 RCT 
2a = well designed controlled trial but not an RCT
2b = one well designed experiental trial 
3 = case/comparative/correlation studies
4= panel of experts
85
Q

Standard deviation and variance

A

Standard deviation = Square of the variance

Standard error = SD / square root of number in study

86
Q

What are seen in biopsies of sarcoid granulomas

A

Asteroid bodies

87
Q

Which HLA is seen in hyperacute rejection?

A

HLA-C

88
Q

Interleukina

A

IL-1 - prod by MAc - acute inflamm + fever

Il-2 - TH1 –> Growth + Tcell differentiation

IL-3 - TH1 –> myeloif progenitor cells

IL-4 - TH2 –> B cells

IL-5 = TH2 –> Eosinphils

IL-6 - TH2 + Mac –> B cells + fever

IL8 - MAc –> Neutrophil chemotaxos

IL-10 + TH2 - inhibits TH1

IL-12 - dendritic/MAc/Bcells –> activates NK and TH1 prod

IFN-gamma - TH1 –> aMAcrophage

TNFa - MAc –> Feveer + neutrophil chemotaxis

89
Q

Homocystinuria

A

Deficiency in cystathionine beta snthase

marfanoid
lens dislocation - downward

LEarning difficulty

Cyanide-nitroprusside test

Tx = pyridoxine

90
Q

raised anion gap metabolic acidosis

A

C - CO/Cyanide/ CHFx
A =- Aminoglyclosides
T - Toluene/Tehoophylline

M- MEthanol 
U - Uraemia 
D- DKA/Starvation Keto/ Alcoholic ketoacidosis 
P - Paraceetamol/
I - Inborn error/ Iron/ Isoniazid
L- lactic acidosis 
E- Ethanol/ Ethylene glycol
S - Salicylates/ASA/Aspirin
91
Q

Acute intermittent porphyria - drugs the precipitate attack

A 
BArbituates 
alothane 
BZD
EtOH 
OCP 
Suphonamides
92
Q

Variance and 95% confidence interval

A

S.D. - Square root of variance

Stander error = SD / sq root of.n

95% CI limit is mean +/- 2x SE

MRCP (20 decks)

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