General medicine key notes Flashcards
what might occur after prolonged use of broad-spectrum antibiotics?
- vitamin k deficiency
- after prolonged use of broad spectrum antibiotics
- by eliminating gut flora
- vit K is a fat soluble vitamin
What is Epstein-barr virus?
- member of herpes virus family
achalasia
lower oesophageal sprinter fails to open during swallowing.
exomphalos
- weakness of baby’s abdominal wall where umbilical cord joins it
- allows protrusion of abdominal contents into loose sac surrounding umbilical cord
endoderm gives rise to
epithelium of gut
trophoblast gives rise to
extra-embryonic membranes
neural crest cells give rise to
- melanocytes
- odontoblasts
- schwann cells
mesoderm gives rise to
- connective tissue including muscles
ectoderm gives rise to
epidermis
A 16-year-old female presents to the GP. Five days ago she had unprotected intercourse and she is now five days pregnant. What stage is the fertilised tissue?
On about day 5 the blastocyst is formed and day 5-6 is when implantation occurs.
morula
16 cell stage.
day 4.
A young child with cystic fibrosis also suffers from malabsorption. Which of the following represent a possible state and consequence for such a child?
- CF patients have impaired pancreatic exocrine function
- reduced lipase secretion
- leads to reduced absorption of fat-soluble vitamins
- e.g. DEAK vitamines
vitamin A deficiency
night blindness
what cytokine involved in development of allergic inflammation?
Interleukin-4
bacterial vaginosis may be caused by…
- overgrowth of predominantly anaerobic organisms such as Gardeerlella vaginalis
receptor for epstein-barr virus
CD21
what is the cell surface marker found on macrophages?
CD14
type 1 hypersensitivity and mediator involved
- anaphylactic
- IgE
type 2 hypersensitivity
- cytotoxic, formation of autoantibodies against cell surface antigens
- IgG
type 3 hypersensitivity
- immune complex deposition
- IgG
- SLE
type 4 hypersensitivity
- delayed type
- T cells
An 88-year-old lady is brought to the emergency department from a care home. She has been complaining of a severe headache and general malaise for several days. The care home staff mention that she seems more confused than normal and had been complaining of a painful and stiff neck. On examination, she is pyrexic and tachycardic
what organism is most likely responsible?
indicative of meningitis
streptococcus pneumonias most likely in that age group.
———> gram positive
A 29-year-old female undergoes a sub total thyroidectomy. Five days post operatively the wound becomes erythematous and discharges pus. What is the most likely causative organism?
staph aureus.
common wound infection.
An 18-year-old female presents with an itchy rash around her umbilicus. She states that it started a few days after undergoing a belly button piercing. On examination there is a vesicular rash with an underlying erythematous base.
Which cells are key mediators of the disease which the patient is suffering from?
- key features of contact dermatitis
- type 4 delayed hypersensitivity reaction
- occurs due to activation of TH1 lymphocytes
- cell mediated
In a child with a single palmar crease, prominent supra-orbital ridge, brush spots, slanted ears and hypotonia, what is the most likely causative mechanism?
- trisomy 21
- Down’s syndrome
A 91-year-old lady presents to the emergency department following a fall. She is found to have a neck of femur fracture and a total hip replacement is performed. As part of her post-op care, she is prescribed vitamin D for her bones.
How would you expect this to affect the ions in her blood?
vitamin D increases plasma calcium and plasma phosphate
what is thromboxane and the roles?
- facilitating platelet aggregation
- potent v.constrictor
- hypertensive agent
- thromboxane mediated vasoconstriction reduces blood flow to site of a clot
prostacyclin
vasodilation
- decreased platelet aggregation
- decreased uterine tone
what defect is found in hereditary non-polyposis colorectal cancer?
- defect in mismatch repair
what antibody is involved in fighting of parasitic infections?
- IgE
- also triggers histamine release
what is the first immunoglobulin secreted in infections?
IgM
Where is IgA found?
- saliva
- tears
- breast milk
A 16-year-old female is brought to her primary care physician by her parents with a complaint of short stature and delayed puberty. Further questioning reveals primary amenorrhoea. The patient’s height is significantly shorter than her midparental height.
Which of the following cardiac pathologies is most commonly associated with this condition?
- classic features of Turner’s syndrome (45, XO)
- biscuspid aortic valve and aortic coarctation are common complications
( caused by either presence of one X chromosome or deletion of short arm of one of the X chromosomes )
Zac is a 14-year-old child who has presented with an uncomplicated urinary tract infection.
Which of the following correctly describes the characteristic of the most likely cause of this infection?
- uncomplicated thus common cause would be E.coli
- aerobic gram-negative rod
A 63-year-old female is referred to the surgical clinic with an iron deficiency anaemia. Her past medical history includes a left hemi colectomy but no other co-morbidities. At what site is most dietary iron absorbed?
- duodenum
A 35-year-old man attends the genetics clinic as he has started planning for a family with his partner and is concerned about the risk of ‘passing on an inherited disease’ which runs in his family. His partner is fit and well. He has a background of retinitis pigmentosa, and has a pacemaker in situ. On examination you note bilateral ptosis with reduced eye movements in all directions. The patient tells you that his mother and sister also have similar signs.
What will you advise the patient about the risk of his offspring inheriting this condition?
- classic signs of mitochondrial disease
- as mother and sister have similar signs
- none of this children will inherit the condition
A 50-year-old woman attends her GP presenting with insomnia, tachycardia and sweating, and unintentional weight loss. On examination she also has some degree of exophthalmos. Blood results are as follows:
low TSH
high T4
Grave’s disease
- autoimmune condition
- antibodies target self-antigen
- causing hyperthyroidism
lesion of the lateral corticospinal tract would result in?
- suboptimal motor function on neurological examination
gastrinoma
- increases HCl production
- increases gastric motility
Which tumour suppressor gene is most commonly associated with colorectal carcinomas?
APC gene
A 2-year-old boy presents to his GP for his annual check-up. The mother tells the GP that he has been having bone pain. You note that there are several bony deformities, curving of the humerus and frontal bossing. His growth is below what you would expect, however the length of his limbs are proportional to his height. His mother is a dedicated vegan and her son has also been eating a vegan diet.
- classic presentation of rickets
- vitamin D deficiency
- patient at risk due to diet
- bony deformities as result of reduced vitamin D levels
A 6-month old boy is diagnosed with phenylketonuria. He has started to develop mental retardation and reduced hair and skin pigmentation.
What is the term used to describe the presence of the variety of phenotypic traits in this patient?
Pleiotropy is a condition where a single mutation causes more than one observable phenotypic effect. A well known example is phenylketonuria.
Vitamin D increases serum calcium primarily through
aising its absorption via the small intestine
state phases of wound healing?
- haemostasis
- inflammation
- regeneration
- remodelling
what is the longest stage of wound healing?
Remodelling.
- may last up to a year or longer
- during phase: fibroblasts become differentiated to myofibroblasts
- ———————–> facilitate wound contraction
- collagen fibres remodelled
- micro vessel regression leaving pale scar
haemostasis phase of wound healing
- first
- vasospasm in adjacent vessels
- platelet plug formation
- fibrin rich clot
inflammation in wound healing involves
- neutrophils, Growth factors, fibroblasts, macrophages
regeneration stage of wound healing
- platelet derived growth factor
- fibroblasts produce collagen network
- angiogenesis occurs, wound will resemble granulation tissue
vitamin involved in formation of collagen
- vitamin c
side effect of iron supplements
- constipation
- iron deficiency anaemia common in younger females. Look at blood report
HLA-B27 is most commonly associated with several diseases, most commonly
ankylosing spondylitis
A 46-year-old female is referred to the dermatologist for a rash on both her elbows. The rash is red, is papulovesicular in nature, and looks like it has many small blisters.
Which HLA haplotype is this associated with?
- classic presentation of dermatitis herpetiformis
- associated with HLA-DR3
[ ] is associated with both type 1 diabetes mellitus and rheumatoid arthritis.
HLA-DR4
A mother brings her 6-month-old son to the GP. she is concerned that his left pupil looked white in all their holiday photos. The GP makes an urgent referral and a diagnosis of……..
RETINOBLASTOMA
- occurs via autosomal dominant inheritance of mutation in retinoblastoma gene
A known alcoholic is admitted with the Acute Admissions Unit (AMU) with confusion and symptoms of ataxia, confusion and ophthalmoplegia.
A deficiency in which vitamin is likely to be causing these psychological symptoms?
vitamin B1 (thiamine) deficiency may be caused by alcohol addiction.
key roles of folate
- helps in haemoglobin production
- prevents neural tube defects in unborn child
A 4-year-old female is brought to her paediatrician by mother with a sore throat and fever. On examination, she has a ‘sandpaper’ skin rash throughout her body. Her tongue is also red and bumpy. There is no history of allergy. Her paediatrician prescribes an antibiotic.
- presentation of scarlet fever
- penecillin treatment of choice
- penecillin binds transpeptidase blocking cross-linking of peptidoglycan cell walls
The combination of a fever, headache and photophobia are indicative of a presentation
MENINGITIS
what bacteria is classically associated with a rapidly spreading,non-blanching, purpuric rash.
neisseria meningitidis
describe difference between peroxisome and proteasome
peroxisome: catabolism of very long chain fatty acids and amino acids
proteasome: degradation of protein molecules tagged with ubiquitin
