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MRCP Part 1 > Important notes document > Flashcards

Important notes document Flashcards

1
Q

APC tumour suppressor gene lies on

A

chromosome 5
colonic cancer

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2
Q

HFE gene for haemochromatosis lies on

A

chromosome 6

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3
Q

ATP7B gene for Wilsons disease lies on

A

chromosome 13

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4
Q

Peutz jegher syndrome gene

A

serine threonine kinase LKB1 or STK11

autosomal dominant

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5
Q

test for haemochromatosis

A

transferrin saturation >55%, best marker to monitor tx response

2y osteoarthritis (hook like osteophytes at 2nd and 3rd MCP) and slate grey skin

also hypogonadotrophic hypogonadism due to pituitary gland involvement - typically presents as impotence in men and amenorrhoea in women - irreversible

diabetes due to pancreatic beta cells damaged

liver cirrhosis due to hepatic iron overload causing fibrosis

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6
Q

encapsulated bacteria in splenectomy

A

Strep pneumoniae, Hib, n meningitidis

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7
Q

HNPCC lynch gene

A

MSH2 and MLH1
involved in DNA mismatch repair leading to microsatellite instability

colorectal and endometrial cancers

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8
Q

elevated subtypes of Ig and corresponding hepatobiliary disease

A

alcoholic LD - IgA
PBC - IgM
autoimmune hepatitis - IgG

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9
Q

MEN1

A

parathyroid (hyper)
pituitary
pancreas (insulin/gastrinoma)
adrenal and thyroid

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10
Q

nicotinic acid test

A

confirms diagnosis of Gilbert’s syndrome - mutation in gene for enzyme glucuronyl transferase

prolonged increase in serum unconjugated bilirubin levels due to impairment of hepatic uptake and conjugation of bilirubin

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11
Q

ammonium chloride acidification test

A

to evaluate renal tubular acidosis rather than liver function

inability to adequately acidify urine

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12
Q

fulminant vs viral hepatitis

A

necrosis vs apoptosis

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13
Q

SBP most common organism

A

E Coli
Klebsiella

gram +
Strep pneumo, viridans and Staph

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14
Q

Diarrhoea, history of carcinoid tumour - treatment

A

octreotide

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15
Q

diarrhoea and history of scleroderma

A

suggestive of bacterial overgrowth

hydrogen breath test

rifaximin tx of choice
co-amox
metronidazole

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16
Q

diarrhoea and terminal ileal resection

A

bile salt malabsorption

treatment with cholestyramine

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17
Q

HCC management

A

Barcelona classification

no signs of portal htn, single lesion <2cm - surgical resection

2-3 tumours <3cm or 1 <5cm without vascular invasion or extrahepatic spread - liver transplant (treat with TACE/RFA)

good performance status and evidence of vasc, lymph, extrahep spread - sorafenib (tyrosine kinase inhibitor) prolongs survival

poor candidates - symptomatic tx

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18
Q

Verner-Morrison or WDHA syndrome (watery diarrhoea, hypokalaemia, achlorhydria)

A

VIPomas - non-beta islet cells of the pancreas

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19
Q

Fanconi syndrome

A

impaired renal tubular function.

anaemia - rare genetic disease leading to bone marrow failure and increased risk for leukaemia

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20
Q

Glasgow imrie criteria

A

paO2 <7.9
age >55
WBC >15
Ca <2
urea >16
LDH >600
albumin <32
glucose >10

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21
Q

laxative to avoid in IBS

A

lactulose

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22
Q

factors increasing risk of cancer in UC

A

disease >10 yrs
pancolitis
onset <15 yo
unremitting disease
poor compliance to tx

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23
Q

first symptom of carcinoid syndrome

A

facial flushing

due to release of serotonin and kallikrein into systemic circuliation

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24
Q

% of individuals with positive FOBT that have ca

A

10

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25
Q

biliopancreatic diversion with duodenal switch

A

primarily malabsorptive procedure, reserved for BMI >60

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26
Q

coeliac disease HLA assoc

A

DQ2 and DQ8

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27
Q

typical iron studies in haemochromatosis

A

transferrin saturation >55% in men or >50% in women

raised ferritin and iron

low TIBC

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28
Q

Dubin Johnson syndrome

A

conjugated hyperbilirubinaemia

defect in the canalicular multispecific organ anion transporter (MRP2)

benign course - no clinical impairment, intermittent jaundice only

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29
Q

marker of infectivity in hep B

A

HBeAg
antibodies only - vaccine only

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30
Q

colorectal ca with solitary liver lesion

A

surgical resection

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31
Q

pancreatic cancer risk factors

A

BRCA2 mutations
KRAS gene mutation

also BRCA 1, PALB2, MLH1/MSH2

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32
Q

how to prevent refeeding syndrome

A

provide 50% of normal energy and protein requirements for first 2 days

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33
Q

appendicitis score

A

Alvarado

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34
Q

prophylaxis of oesophageal bleeding

A

NSBB
propranolol - decreases portal venous pressure by reducing cardiac output and splanchnic blood flow

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35
Q

amoebiasis treatment

A

metronidazole
+ diloxanide furoate

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36
Q

human/animal bite pen allergy

A

doxy + metro

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37
Q

anthrax tx

A

ciprofloxacin

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38
Q

lower UTI

A

trimeth/nitro

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39
Q

acute pyelonephritis

A

broad spectrum cephalosporin/quinolone

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40
Q

acute prostatitis treatment

A

quinolone for 14d
trimethoprim

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41
Q

exacerbations of chronic bronchitis tx

A

amox
tetracycline
clarithromycin

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42
Q

uncomplicated CAP tx

A

amox

pen allergy - doxy/clari
staph spp - fluclox

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43
Q

atypical pneum rx

A

clari

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44
Q

HAP tx

A

<5d - coamox/cefuroxime
>5d - piptaz/ceftaz/cipro

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45
Q

impetigo rx

A

hydrogen peroxide
oral fluclox/erythromycin

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46
Q

cellulitis rx

A

fluclox

clari/eryth/doxy in pen allergic

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47
Q

cellulitis near eyes or nose

A

co-amox

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48
Q

erysipelas

A

fluclox

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49
Q

throat infections

A

phenoxymethylpenicillin (also for sinusitis)

pen allergy - erythromycin

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50
Q

otitis media vs externa

A

amox vs fluclox

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51
Q

gingivitis rx

A

metronidazole

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52
Q

gonorrohoea
chlamydia
PID
syphilis
BV

treatment

A

IM ceftriaxone
doxy/azithro
ofloxacin+metro OR IM cipro+doxy+metro
benzathine penicillin OR doxy OR erythromycin
oral/topical metro OR topical clindamycin

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53
Q

C diff
campy
salmonella (non typhoid)
shigella

A

vanc - fidaxo - oral vanc + IV metro
clarithromycin
ciprofloxacin
ciprofloxacin

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54
Q

Fite’s faraco stain

A

m leprae

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55
Q

cryptosporidium spread

A

farm animals and contaminated water

modified ZN stain

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56
Q

aerosolised pentamidine prophylaxis

A

often not effective
spontaneous pneumothorax

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57
Q

incubation period of giardia

A

3-40 days
chronic intermittent explosive diarrhoea without blood

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58
Q

campy incubation

A

2-4 days

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59
Q

HIV treatment process

A

2 NRTI + additional third (INI, PR or NNRTI)

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60
Q

maraviroc moa

A

entry inhibitor

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61
Q

examples of NRTI

A

emtricitabine
tenofovir disoprox

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62
Q

NNRTI examples

A

efavirenz
nevirapine

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63
Q

PI examples

A

ritonavir
lopinavir

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64
Q

rare complication in atypical pneumonia

A

cardiac conduction abnormalities due to autoimmune reactions

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65
Q

purpura fulminans

A

strep pneumo

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66
Q

high risk wounds for tetanus

A

> 6 hrs
1cm deep
foreign body
infection ischaemia necrosis

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67
Q

pregnancy VZV

A

susceptible in first 20 weeks - VZIG
susceptible in 20 weeks on - either VZIG or aciclovir from d7-14 post exposure
oral aciclovir if presenting within 24 hours of onset of rash and 20+ weeks

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68
Q

silver stain

A

PCP or fungi

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69
Q

rose bengal stain

A

fungal keratitis or acanthamoeba

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70
Q

LGV treatment

A

doxy or azithro/erythro and possible drainage/aspiration

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71
Q

Loefflers syndrome

A

larvae of strongy travel around the host body including reaching the lungs causing respiratory symptoms and eosinophilia

tx of strongy - ivermectin

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72
Q

causes of bloody diarrhoea
CASSE

A

campy
amoebiasis
salmonella
shigella
EHEC (supportive care)

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73
Q

scrub typhus

A

orientia tsutsugamushi
chigger

vasculitis like illness with regional or generalised lymphadenopathy and an eschar

hepatic and renal failure, myocarditis and meningoencephalitis

treatment - doxy

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74
Q

HHV3
HHV4
HHV5

A

VZV
EBV
CMV

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75
Q

JE typically affects

A

thalamus, basal ganglia, brainstem

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76
Q

how does TB cause hypoadrenalism

A

adrenalitis, haematogenous spread -> progressive destruction of the glands

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77
Q

dex in bacterial meningitis

A

purulent CSF
WCC >1000
raised WCC + protein count >1
bacteria on gram stain

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78
Q

schisto treatment

A

praziquantel

fever myalgia cough diarrhoea urticarial rash and hsmeg with eosinophilia and pulmonary isolates = Katayama fever

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79
Q

Klebsiella associations

A

cardiomyopathies
alcoholics
upper lobe involvement

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80
Q

visceral larva migrans
mucocutaneous larva migrans
larva currens

A

toxocara canis
anylostoma braziliense
strongyloides stercoralis

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81
Q

differentiate MRSA

A

with rapid PCR
vanc > teic > linez

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82
Q

clostridia

A

tetani - spastic paralysis
perfringens - skin inf and gas gangrene
difficile - diarrhoea
sordelii - post partum or termination sepsis

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83
Q

diagnosis of bartonella

A

serology
culture
histopath with Warthin-Starry stain

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84
Q

moa of trimethoprim

A

dihydrofolate reductase inhibitor

ADR - myelosuppression
transient rise in creatinine, blocks ENaC in distal nephron causing a hyperkalaemia distal RTA

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85
Q

treatment of HCV

A

PI (daclatasvir + sofosbuvir OR sofosbuvir + simeprevir) with or without ribavirin

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86
Q

screening for HIV

A

HIV 1/2 Ab/Ag immunoassay

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87
Q

pneumonia associations

A

Pneumonia + Alcoholic + Cavitation = Klebsiella
Pneumonia + cavitation = Staph, Klebsiella
Pneumonia + Prior Flu = Staph Pneumonia
Pneumonia + Chicken Pox Rash = Varicella
Pneumonia + Hemolytic Anemia = Mycoplasma
Pneumonia + Hyponatraemia + Travel History = Legionella
Pneumonia + Fleeting opacities = Cryptogenic Pneumonia
Pneumonia + Fits/LOC = Aspiration Pneumonia
Pneumonia + HSV oral lesion = Strep Pneumonia
Pneumonia + parrot = Chlamydia psitatssi
Pneumonia + farm animals = Q fever (coxillea brunetii)
Pneumonia + HIV = think pcp but if straight forward case strep
pneumonia is still most common
Pneumonia + Cystic fibrosis = consider pseudomonas/
Burkholderia
Pneumonia + COPD or exac = c1::Haemophilus Influenza
Commonest cause of CAP = Strep Pneumonia

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88
Q

shortest replication time of non falcip malaria

A

P knowlesi
-> 24 hour cyclical fever syndrome

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89
Q

erythema multiforme
erythema migrans
marginatum

A

mycoplasma pneumonia
lyme
rheumatic fever

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90
Q

IRIS

A

paradoxical worsening of pre-existing chronic or latent condition

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91
Q

Lyme disease test

A

ELISA for IgM or G if no rash

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92
Q

factors which reduce vertical transmission

A

maternal antiretroviral therapy
C section
neonatal ART
infant bottle feeding

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93
Q

neonatal ART

A

zidovudine infusion during C sec
if <50 then zidovudine orally to neonate
otherwise triple ART and cont for 4-6 weeks

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94
Q

disseminated gonorrhoea triad

A

dermatitis
migratory polyarthritis
tenosynovitis

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95
Q

New-delhi metallo-beta-lactamase 1 mutation that leads to

A

carbapenem resistance

mx - colistin, tigecycline

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96
Q

D alanyl D lactate variation

A

mechanism of VRE

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97
Q

penicillin binding protein 2 alteration

A

MRSA
MEC gene

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98
Q

Brucellosis

A

animals or unpasteurised dairy
serology (RBT) -> STA -> ELISA

fluctuating temperatures, transient arthralgia, myalgia and hypergidrosis with a wet hay smell

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99
Q

pus cells on urethral swab

A

NSU
doxy oral

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100
Q

echinococcus tx

A

albendazole

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101
Q

sodium stibogluconate

A

leish

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102
Q

Monod’s or air crescent sign

A

aspergilloma vs improving angioinvasive aspergilloma

mobile mass - prone position

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103
Q

lassa fever rx

A

ribavirin

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104
Q

ifn a
ifn b
ifn g

A

Hep B
MS
TB test

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105
Q

TB hypersens

A

Type 4 hypersensitivity

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106
Q

virus known to cause a CSF result with low glucose

A

mumps

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107
Q

severe transaminitis in the first trimester

A

Hep E infection

thrombocytopaenia and hx of undercooked meat

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108
Q

HHVs

A

herpes simplex virus 1 and 2 -> cold sores, genital herpes
—> VZV - HHV 3 -> chickenpox, shingles
—> CMV (HHV 5) -> Glandular fever, CMV retinitis / colitis /
oesophagitis in HIV
— >HHV 6 -> Glandular fever, roseola infantum
—> EBV (HHV 4) : Glandular fever, lymphoma, nasopharyngeal CA
—> HHV 7 -> Glandular fever, roseola infantum
—> HHV 8 -> Kaposi sarcoma

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109
Q

needle stick transmission

A

Hep B 20-30%
HIV 0.2%
Hep C - 2%
Vertical transmission Hep C - 6%
Sexual intercourse Hep C - 2%

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110
Q

oseltamavir moa

A

neuraminidase inhibitor
flu A and B

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111
Q

tetanospasmin

A

GABA

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112
Q

exclude HIV seroconversion illness

A

p24 antigen

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113
Q

meningitis with pen allergy

A

chloramphenicol

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114
Q

MAC infection

A

clari + ethambutol
rifampicin as third
azithro

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115
Q

which film identifies parasite burden in malaria

A

thick films

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116
Q

cold agglutinin disease

A

Mycoplasma pneumoniae

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117
Q

fever headaches rash on trunk and limbs with sparing of palms and soles
exposure to vermin

A

typhus
doxy

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118
Q

non keratinised vs keratinised warts

A

podophyllum vs cryotherapy

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119
Q

listeriosis

A

diarrhoea
flu like illness
meningoencephalitis, ataxia, seizures

tumbling motility in blood cultures
pleocytosis in CSF, predom lymphocytes

amox/ampi
IV amox + gent in elderly

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120
Q

p450 ART

A

nevirapine induces
PI inhibit

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121
Q

IVDU with descending paralysis, diplopia and bulbar palsy, slurred speach, dysphagia, ptosis and facial muscle weakness

no fever or loss of sensation or loss of awareness

A

C botulinum

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122
Q

spiramycin

A

reduces risk of toxo transmission from mother to foetus

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123
Q

rhabditiform larvae

A

strongy

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124
Q

orf

A

contagious ecthyma
Parapoxvirus

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125
Q

tularaemia

A

zoonotic infection involving F tularensis
rodents and ticks
papulo-ulcerative lesion at site of bite with reactive and ulcerating regional lymphadenopathy
doxycycline rx

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126
Q

typhoid

A

abdo pain
constipation
delirium/encephalitis
abdo perf
leukopenia
rose spots
relative bradycardia (Faget sign)

test of choice - large volume blood culture
Widal test

IV ceftriaxone empirical therapy

chronic carrier status in the gallbladder

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127
Q

adjunctive therapy for mod-severe PCP (po2 <8 or Aa gradient >35)

A

steroids

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128
Q

multibacillary lep

A

rifamp+dapsone+clofazimine

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129
Q

yellow fever vaccine contraindication

A

egg protein

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130
Q

conjugate vaccine examples

A

Men ACWY
Men B
Pneumococc
HIB
Meningococc

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131
Q

most common infective cause of diarrhoea in HIV

A

cryptosporidium

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132
Q

vancomycin AEs

A

oto and nephrotoxicity
red man syndrome - flushing and maculopapular rash due to non IgE mediated mast cell degranulation -> antihistamines

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133
Q

most effective intervention for MRSA in hospitals

A

hand washing

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134
Q

genital ulcers STIs

A

painless ulcer painless LN = syphilis
Single painless ulcer painful LN = LGV
Indolent painless ulcers ‘regional lymphadenopathy is rare’&raquo_space;
Granuloma inguinale

Multiple painful ulcer with ragged edges painful LN = chancroid H.
ducreyi
Multiple painful blisters/ulcers with tingling pain neuropathic type
pain and tender inguinal lymph nodes + systemic symptoms=
Genital herpes simplex

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135
Q

cause of erysipelas

A

GAS - pyogenes

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136
Q

acute toxo detection

A

serology with IgM rising 5-14 d, peak at 2-3mo

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137
Q

vaccines always contraindicated in HIV

A

2 GI infection -> cholera, polio
2 lung infection -> BCG (TB), intranasal Influenza

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138
Q

contraindicated at CD4 <200 in HIV

A

yellow fever
MMR
chicken pox

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139
Q

drug causes of thrombocytopaenia

FANQAAH

A

furosemide
antibiotics (PSR)
NSAIDs
Quinine
abciximab
anti-convulsants (carb, valp)
heparin

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140
Q

drugs causing impaired glucose tolerance

A

thiazides, furosemide
steroids
IFNa
tacrolimus
cyclosporin
nicotinic acid

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141
Q

drugs causing urinary retention

A

opioids
NSAIDs
anti-cholinergics
dipyridamole
TCAs

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142
Q

alpha 1 agonists

A

phenylephrine
oxymetazoline

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143
Q

alpha 2 agonists

A

brimonidine

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144
Q

alpha 1a antagonist

A

tamsulosin

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145
Q

alpha 1 antagonist

A

doxazosin

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146
Q

beta 1 agonist

A

dobutamine

non sel - aten/bisop

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147
Q

beta 2 agonist

A

salbutamol

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148
Q

dopamine agonists

A

bromocriptine
cabergoline
ropinirole

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149
Q

dopamine antagonists

A

haloperidol
metoclopramide
domperidone

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150
Q

GABA agonist

A

BZD
baclofen

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151
Q

GABA antagonist

A

flumazenil

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152
Q

histamine-1 antagonist

A

antihistamines - loratadine, urticaria, DRESS

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153
Q

histamine-2 antagonist

A

ranitidine

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154
Q

muscarinic agonist

A

pilocarpine

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155
Q

muscarinic antagonist

A

atropine
ipratropium/tiotropium
oxybutynin

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156
Q

nicotinic agonist

A

varenicline
suxamethonium

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157
Q

nicotinic antagonist

A

atracurium

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158
Q

oxytocin agonist

A

syntocin

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159
Q

oxytocin antagonist

A

atosiban

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160
Q

serotonin agonist

A

triptan

ergotamine - partial agonist

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161
Q

serotonin antagonist

A

ondansetron

pizotifen
methesergide
cyproheptadine (control of diarrhoea in carcinoid)

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162
Q

drugs causing lung fibrosis

A

amiodarone
bleomycin, busulphan
nitrofurantoin
ergot derived dopamine agonists - bromocriptine, cabergoline, pergolide

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163
Q

drugs causing ocular problems

A
  • Cataracts - Steroids
  • Corneal opacities - Amiodarone (vortex keratopathy, night time glare), Indomethacin
  • Optic neuritis - Ethambutol (anti TB), Amiodarone,
    Metronidazole
  • Retinopathy - Chloroquine (anti malarial), Quinine (anti malarial)
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164
Q

Drugs causing photosensitivity

A
  • Thiazides
  • Tetracyclines, sulphonamides, ciprofloxacin
  • Amiodarone - hypothyroidism, hyperthyroidism type 1 (antithyroid drugs),
    hyperthyroidism type 2 (corticosteroids), photosensitivity, corneal opacities, lung
    fibrosis, optic neuritis
  • NSAIDs - Piroxicam
  • Psoralen’s
  • Sulphonylureas - Metformin
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165
Q

clinical features of ecstasy overdose

A

CNS symptoms - agitation, anxiety, confusion, ataxia, dilated pupils, lock jaw, bruxism

hyponatraemia
hyperthermia
rhabdomyolysis
seizures
acute renal failure
acute psychosis

supportive mx -> dantrolene

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166
Q

ethylene glycol poisoning

A

stage 1 - confusion, slurred speech, dizziness
stage 2 - metabolic acidosis with high anion gap and high osmolar gap, tachycardia, hypertension
stage 3 - AKI

mx - fomepizole -> inhibits alcohol dehydrogenase

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167
Q

methanol poisoning

A

intoxication, nausea
visual problems - blindness, optic neuropathy

fomepizole
ethanol
haemodialysis
folinic acid to reduce visual complications

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168
Q

monoclonal antibodies

A
  • Infliximab : anti TNF - Rh arthritis, Crohn’s
  • Rituximab :anti CD20-Rh arthritis, Non-Hodgkin’s Lymphoma
  • Cetuximab : Epidermal growth factor receptor antagonist -
    Metastatic colon cancer, Head & Neck cancer
  • Trastuzumab : HER2/neu receptor antagonist - metastatic
    breast disease
  • Alemtuzumab : anti CD52 - Chronic lymphocytic leukaemia
  • Abciximab : Glycoprotein IIb/IIIa receptor antagonist -
    Percutaneous coronary interventions
    Abiciximab - can cause thrombocytopenia
  • OKT3 : anti CD3 - used to prevent organ rejection
    Cetucoxib & Panitumumba - metastatic colon cancer
    Infliximab and Adalimumab - Crohn’s disease
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169
Q

mercury poisoning
albacore tuna

A

visual field defects
sensorineural hearing loss
paraesthesia
peripheral neuropathy
hyperchloraemic metabolic acidosis consistent with RTA
irritability

avoid
chelation

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170
Q

lead poisoning

A

peripheral neuropathy
constipation
vomiting
blue lines on gums (Burtons)

lead paint in house

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171
Q

manganese poisoning

A

visual hallucinations and anxiety
later -> mimics Parkinson’s disease
fume inhalation working with steel

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172
Q

zinc poisoning

A

GI distress, abdo pain, nausea
chronic - spastic gait, sensory ataxia

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173
Q

octreotide moa

A

somatostatin analogue

used in acute variceal bleeding treatment, acromegaly, carcinoid
syndrome, VIPomas, refractory diarrhoea, following pancreatic
surgery

causes biliary stasis -> gallstones

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174
Q

treatment of oculogyric crisis

A
  • Benztropin / Procyclidine / Trihexiphenidyl
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175
Q

zero order kinetics

A

warfarin
aspirin
alcohol
theophylline
tolbutamide
phenytoin
salicylates
heparin
ethanol

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176
Q

first pass metabolism

A
  • Aspirin
  • Isosorbide dinitrate, Isosorbide trinitrate
  • Glyceryl trinitrate
  • Lignocaine AKA Lidocaine
  • Propranolol
  • Verapamil
  • Isoprenaline
  • Testosterone
  • Hydrocortisone
  • Morphine
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177
Q

Phase 1 reactions

A

oxidation
reduction
hydrolysis
deamination
dealkylation

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178
Q

Phase 2 reactions

A

conjugation

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179
Q

drugs affected by acetylator status

A
  • Isoniazid (slow - per neur, rapid - hepatitis)
  • Dapsone
  • Procainamide
  • Hydralazine
  • Sulfasalazine
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180
Q

PDE5 inhibitors

A

causes vasodilation through increase in cGMP leading to smooth muscle
relaxation
Sildenafil - Viagra : short acting, 1 hour before sexual activity
Tadalafil - Cialis : longer acting than Sildenafil, once daily

Contraindications :
1. Patient taking nitrates and related drugs such as Nicorandil
2. Hypotension
3. Recent stroke or MI - wait period of 6 months

Uses - Erectile dysfunction, Pulmonary Hypertension

Adverse - blue discolouration, non arteritic anterior ischemic optic
neuropathy
nasal congestion
flushing
GI side effects
headache
Priapism

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181
Q

cause of hepatocellular damage in paracetamol OD

A

depletes glutathione stores causing accumulation of
NAPQI

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182
Q

medications and receptors

A

G protein coupled receptor - Opioid receptor, Beta receptors

Ligand gated ion channels - nicotinic acetylcholine, GABA
receptors

Tyrosine kinase - Insulin

Nuclear receptors - Hydrocortisone, Levothyroxine

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183
Q

types of potassium sparing diuretics

A
  • Epithelial Sodium Channel Blockers
    A.Amiloride : blocks the Epithelial Na channel in DCT; weak
    diuretic, usually given in combination with thiazide or
    loop to counter hypokalaemia
    B.Triamterene
  • Aldosterone antagonists - Spironolactone, Eplerenone
    a) Spironolactone : acts in cortical collections duct
    i) Ascites - patients with cirrhosis develop
    secondary hyperaldosteronism
    ii) Heart failure
    iii)Nephrotic syndrome
    iv)Conn’s syndrome
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184
Q

drugs to avoid in renal failure

A

antibiotics - tetra, nitro
NSAIDs
lithium
metformin

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185
Q

quinine toxicity

A

tinnitus, visual blurring, flushed dry skin,
abdominal pain, visual defects

arrhythmia - prolonged QRS and QT -> VF
hypoglycaemia
flash pulmonary oedema

supportive mx, bicarc, CPAP

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186
Q

cipro ECG

A

QT prolongation

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187
Q

salicylate overdose

A

A.Hyperventilation
B.Tinnitus
C.Lethargy
D.Sweating, pyrexia
E. Nausea, vomiting
F. Hyperglycaemia & hypoglycaemia
G.Seizures
H.Coma

mixed respiratory alkalosis + metabolic
acidosis
Early stimulation of respiratory centre - rest. Alkalosis
Direct renal effect of salicylates with acute renal failure - acidosis

MX : charcoal if within 1 hour, urinary alkalisation with IV HCO3, hemodialysis

Indications for hemodialysis in salicylate overdose -
* Serum concentration >700 mg/L
* Metabolic acidosis resistant to treatment
* Acute renal failure
* Pulmonary edema
* Seizures
* Coma

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188
Q

serotonin syndrome

A
  • Neuromuscular excitation - hyperreflexia, myoclonus, rigidity
  • ANS excitation - hyperthermia, sweating
  • AMS - confusion
  • Increased reflexes, clonus, normal pupil size

IV fluids
cyproheptadine
chlorpromazine

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189
Q

NMS

A
  • Tachycardia, hypertension, pyrexia, diaphoresis
  • Increased Creatine kinase
  • Slower onset
  • Decreased reflexes, lead pipe rigidity, normal pupils
  • Mx - Dantrolene
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190
Q

side effects of anti-anginal drugs

A
  1. CCB - Headache, flushing, ankle oedema; Verapamil -
    constipation
  2. Beta blockers : bronchospasm (asthma), fatigue, cold
    peripheries, sleep disturbances
  3. Nitrates - headache, postural hypotension, tachycardia
  4. Nicorandil - headache, flushing, anal ulceration
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191
Q

side effects of diabetes drugs

A

a) Metformin - GI side effects (diarrhoea, nausea), lactic
acidosis
Page 61
b) Sulfonylureas (glimepiride) - hypoglycaemia, increased
appetite, weight gain, SIADH, liver dysfunction
(cholestatic)
c) Glitazones (Pioglitazone) - weight gain, fluid retention,
liver dysfunction, fractures (CI in heart failure)
d) Gliptins - pancreatitis

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192
Q

QT shortening

A

Hypercalcemia, Hypermagnesemia, Digoxin,
Thyrotoxicosis

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193
Q

QT Prolongation - MATCHES OPQ

A

M - Methadone/Metocloprmaide
A - Amiodarone
T - TCA (Citalopram, Escitalopram); Tefenadine/Tramadol,
C - Chloroquine/Clarithromycin
H - Haloperidol
E - Erythromycin
S - Sotalol

O - Ondansetron
P - Procainamide
Q - Quinolones

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194
Q

illegal drugs ODs

A

Cocaine overdose - palpitations, agitation, chest pain,
mydriatic pupils, elevated pulse rates
Cocaine - sympathomimetic drug which stimulates the release of
Noradrenaline and dopamine.
Causes increased HR, increased BP and vasoconstriction.
Coronary vasospasm - acute chest pain

Cannabis overdose - relaxation, euphoria, slowed reaction time,
red eyes

LSD overdose - mydriasis, altered mental state

Heroin - respiratory depression, mitosis, sedation, hypotension,
bradycardia

Ketamine - dissociative anaesthetic agent by antagonist to NMDA
receptors in brain

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195
Q

motion sickness preferred meds

A

hyoscine > cyclizine > promethazine

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196
Q

calcineurin

A

IL-2 release

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197
Q

tamoxifen ADR

A
  • Menstrual disturbances - vaginal bleeding, amenorrhea
  • Hot flushes
  • Venous thromboembolism
  • Endometrial cancer (due to partial agonist activity on oestrogen
    receptors causing endometrial hyperplasia and increased risk of
    neoplasia)
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198
Q

teratogens

A

A.ACE inhibitors - renal dysgenesis, crania-facial abnormalities
B.Alcohol - cranio-facial abnormalities
C.Aminoglycosides - ototoxicity
D.Carbamazepine - Neural tube defects, craniofacial
abnormalities
E. Chloramphenicol - Gray baby syndrome
F. Cocaine - IUGR, preterm labor
G.Lithium - Ebstein anomaly (atrialized right ventricle)
H.Maternal DM - Macrosomia, Polyhydramnios, Preterm labor,
caudal regression, neural tube defects
I. Diethylstilbestrol - vaginal clear cell adenocarcinoma
J. Smoking - preterm labor, IUGR
K.Tetracylines - discoloured teeth
L. Thalidomide - limb reduction defects
M.Valproate - neural tube defects
N.Warfarin - craniofacial abnormalities

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199
Q

monitoring for ADRs

A

Retinopathy - Hydroxychloroquine, Ethambutol, Vigabatrin,
AMiodarone

BP monitoring - Cyclosporin

Urine analysis - Gold, Penicillamine (both to look for protein due to
increased risk of membranous glomerulonephritis)

Urine analysis - Cyclophosphamide (blood due to risk of hemorrhagic cystitis & bladder cancer)

Therapeutic levels - Tacrolimus, Cyclosporin

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200
Q

HIT diagnosis

A

serotonin release assay
or Hep-PF4 ab ELISA

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201
Q

macrolides AE

A
  • QT prolongation
  • GI side effects are common
  • Cholestatic jaundice
  • P450 inhibitor
  • Azithromycin - hearing loss, tinnitus
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202
Q

PDGFR ab

A

imatinib
dasatinib

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203
Q

carbon monoxide poisoning oxygen dissociation curve

A

shifts to the left
downward

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204
Q

amitriptyline

A

increase serotonin and noradrenaline

Blocks histamine, cholinergic and alpha 1 receptors
TCA - cardiotoxic prolongs QT internal and widened QRS
complexes leading to ventricular arrhythmia and seizures.

Also causes metabolic acidosis.

Overdose of amitriptyline - anti cholinergic effects
* Dilated pupils
* Dry skin
* Confusion
* Uriary retention
* Tachycardia

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205
Q

organophosphate poisoning

A

over-activation of the parasympathetic nervous system - excessive urination, defaecation, borderline bradycardia, miosis, diaphoresis

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206
Q

drugs worsening heart failure

A
  1. Pioglitazone
  2. NSAIDs
  3. Non Dihydropyridene CCB - Verapamil, DIltiazem
  4. Non cardio selective Beta blockers
  5. Alpha blockers used for urological problems
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207
Q

Cholinergic overdose symptoms - DUMBBELLS

A
  • D - diarrhoea
  • U - Urination
  • M - Miosis
  • B - Bradycardia
  • B - Bronchospasm
  • E - Emesis
  • L - Lacrimation
  • L - Lethargy
  • S - Salivation, Sweating

SLUDGE - Salivation, Lacrimation, Urination, Defecation, GI Upset,
Emesis

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208
Q

drugs causing photosensitivity

A

P - phenothiazines
Q - Quinine, Quinolones, Quinidine
R - Retinoids
S - Sulphonamides, Sulfonylureas
T - Tetracyclines, Thiazides

A - Amiodarone
N - NSAIDs - Piroxicam, Celecoxib
D - Dapsone

C - Chloroquine, Chlorpromazine
N - Nalidixic acid
G - Griseofulvin

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209
Q

tacrolimus glucose

A

NODAT

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210
Q

Flecainide moa

A

vaughan williams class 1c anti-arrhythmic

blocks Nav1.5 sodium channel

widened QRS and prolonged PR

not to be used in structural heart

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211
Q

precipitating factors for digoxin tox

A
  • Hypokalaemia
  • Increasing age
  • Renal failure
  • Myocardial ischaemia
  • Hypomagnesemia
  • Hypercalcemia
  • Hypernatremia
  • Acidosis
  • Hypothermia
  • Hypothyroidism
  • Drugs - Amiodarone, Quinidine, Verapamil, Diltiazem,
    Spironolactone, Ciclosporin, Thiazides, Loop diuretics
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212
Q

drug causes of low Mg

A
  • Drugs - diuretics, PPI
  • TPN
  • Diarrhoea
  • Alcohol
  • Hypokalaemia
  • Hypercalcemia - secondary to hyperparathyroidism
  • Metabolic disorders - Gitelman’s and Bartter’s.
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213
Q

osmolar gap formula

A

2xNa + glucose + urea (<10)

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214
Q

thallium poisoning

A

GI upset
delirium
convulsions
coma
MODS

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215
Q

iron poisoning

A

vomiting
diarrhoea
hepatotoxicity
bowel obstruction
multi organ failure
myocardial siderosis
metabolic acidosis (lactic)

Diagnosis :
* Serum iron levels >500 micro gram/dL - aggressive
* Abdominal X ray may reveal radiopaque pills
* Glucose - elevated due to hepatic dysfunction - can cause
hypoglycaemia later
* FBC - anemia
* LFT - hepatic dysfunction
Serum iron levels >90 —> moderate to sever toxicity
Management :
* Mld GI symptoms with serum concentration < 500 —> Observe
* IV Fluids
* IV Deferroxamine : binds ferric iron and promotes urinary
excretion.

Indications of Deferroxamine :
1) severe symptoms - AMS, hemodynamic instability, persistent
diarrhoea and vomiting
2) Anion gap metabolic acids
3) Serum iron >500
4) Significant number of pills on radiography

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216
Q

drugs precipitating AIP

A
  • Barbiturates
  • Halothane
  • Benzodiazepines
  • Alcohol
  • Oral contraceptive pill (by increasing synthesis of porphyrin
    precursors, as they increase demand for hepatic cytochrome
    P450 enzyme system which in turn increases heme
    synthesis and depletes heme stores to provoke an attack of
    acute intermittent porphyria)
  • Sulphonamides
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217
Q

nivoluman moa

A

PD-1 inhibitor

hypophysitis, hypothyroidism

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218
Q

EGFR
PDGR
VEGF
ALK-1
CTLA-4

A

erlotinib
olaratumab
bevacizumab
crizotinib
ipilimumab

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219
Q

adrenaline induces

A

hyperglycemia, hyperlactatemia and hypokalaemia

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220
Q

monoclonal ab constant region

A

Fc

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221
Q

drugs cleared by haemodialysis

A

BLAST
B - barbiturate
L - lithium
A - alcohol
S - salicylates
T - theophyllines

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222
Q

erythromycin effect on stomach

A

motilin receptor agonist - stimulates gastric emptying

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223
Q

agranulocytosis drug causes

A
  • Anti thyroid drugs - Carbimazole, Propylthiouracil
  • Anti psychotics - atypical anti psychotics
  • Anti epileptics - Carbamazepine
  • Antibiotics - Penicillin, Chloramphenicol, Co-trimoxazole
  • Anti depressant - Mirtazapine
  • Cytotoxic drugs - Methotrexate
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224
Q

normal anion gap metabolic acidosis

A

Addison’s
Bicarbonate loss: GI (e.g. diarrhoea) or renal (e.g. renal tubular
acidosis)
Chloride excess
Diuretics (e.g. acetazolamide)

Diarrhoea, vomiting
* Pancreatic fistula
* Renal bicarbonate loss
* Kidney disease
* Hypoaldosteronism
* Acetazolamide - causes renal sodium and HCO3 loss
* Renal tubular acidosis

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225
Q

allopurinol hypersensitivity

A

HLAB*5801 allele

RFs - diuretic use, ethnicity, CKD

DRESS syndrome

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226
Q

ethambutol ocular SE

A

neuritis
central scotoma
red-green clind

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227
Q

finasteride moa

A

5 alpha reductase inhibition

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228
Q

NSAID overdose

A

seizures
acidosis
renal impairment
GI haemorrhage
CNS effects

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229
Q

digoxin loading dose

A

volume of distribution

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230
Q

warfarin loading dose

A

rapid onset of action

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231
Q

what increases the risk of heart valve regurgitation in patients who use fluoroquinolones

A

RA

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232
Q

raised anion gap metabolic acidosis

A
  • Methanol poisoning
  • Uraemia
  • Diabetic ketoacidosis
  • Paraldehyde
  • Isoniazid, iron overload
  • Lactic acidosis (can be due to metformin)
  • Ethylene glycol intoxication
  • Salicylate overdose
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233
Q

effects of anabolic steroids

A

BP elevation
increased LDL
decreased HDL

prolonged -> haematocrit increase, prothrombotic + plasma fibrinogen decreases

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234
Q

heroin withdrawal sx

A

Sweating; diarrhoea; nausea; vomiting; irritability; restlessness;
muscle ache

MX : methadone or buprenorphine maintenance programs to
prevent dangers of heroin withdrawal

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235
Q

meds and cancers

A

Ethanol - fetal alcohol syndrome
Diethylstilbestrol - vaginal carcinoma
Phenobarbital - cleft lip
Thalidomide - phocomelia
Androgen - deformities

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236
Q

drugs contraindicated during breast feeding

A
  • Amiodarone
  • Anti neoplastics
  • Chloramphenicol
  • Ergotamine
  • Iodides
  • Methotrexate
  • Lithium
  • Tetracyclines
  • Cabergoline
  • Pseudoephedrine
  • All recreational drugs
  • Clozapine (fetal agranulocytosis)
  • BZD - cleft lip, cleft palate
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237
Q

fungal infections

A

— Oral candidiasis - Miconazole oral gel or nystatin mouthwash ;
severe infection - oral fluconazole
— Oesophageal candidiasis - ketoconazole
— tinea infection : Terbinafine topical
— invasive aspergillosis - Amphotericin B (nephrotoxic)
— Aspergilloma : oral voriconazole
— cryptococcal meningitis : amphotericin B

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238
Q

drugs increasing concentration of ciclosporin

A
  • FLuconazole
  • Ketoconazole
  • Itraconazole
  • Voriconazole
  • Methyl prednisolone high dose
  • Allopurinol
  • Protease inhibitors
  • Colchicine
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239
Q

doxorubicin moa

A

anti tumor activity derives from triggering of
topoisomerase II dependent DNA breakage

Cardiotoxicity
* Cardiomyopathy
* Acute arrhythmia
* Congestive heart failure
* Dose dependent impairment of LVEF
* Myocardial dysfunction.

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240
Q

eplerenone adrs

A

hyperkalaemia
dizziness
hypotension
diarrhoea
nausea

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241
Q

vigabatrin ADRs

A

aggression, alopecia, retinal atrophy, reduced
peripheral vision

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242
Q

vincristine features

A

Peripheral neuropathy - neurotoxic feature
C/F : Foot drop, parenthesis, loss of ankle jerks, wrist drop.
Vincristine - biochemical picture resembling syndrome of
inappropriate antidiuretic hormone (SIADH) & hyponatremia.

Other adverse effects - mucositis of GIT and bleeding

Bleomycin - interstitial pneumonia
Cyclophosphamide - hemorrhagic cystitis
Doxorubicin and Daunorubicin - cardiomyopathy
Methotrexate - hepatic and pulmonary fibrosis

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243
Q

actions of insulin

A
  • Promotes glucose uptake
  • Inhibits glucose generation or release
  • Inhibits glucose converstion into storage molecules - glycogen
    and triglycerides
  • Increases protein synthesis
  • Promotes glycogen synthesis
  • Inhibits gluconeogenesis
  • Promotes lipogenesis
  • Decreases serum potassium levels.
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244
Q

amphetamine misuse

A

C/F : enhanced mood, excessive speech, increased energy,
insomnia

Sign : hypertension, dilated pupils, dry mucous membranes

Complication : Paranoid psychosis with prolonged use

Clinical uses - treating narcolepsy and ADHD

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245
Q

tx for psychedelic OD

A

distorted sensory perception, hallucination, out of body
experiences, panic/agitation in severe cases

Mx - BZDs

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246
Q

what Ca channels do CCBs work on

A

L type

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247
Q

HIV lipodystrophy

A

insulin resistance pattern
loss of fat on face
increasing abdominal fat
deposition of subcut fat on back

1) low HDL and High triglyceride levels
2) hypertension 3) impaire glucose tolerance precedes the
development of type 2 DM.

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248
Q

PNH mechanism

A

clonal red cell
abnormality, leaves erythrocytes open to complement mediated
attack.

Can occur in paroxysms resulting in hemolysis.

Eculizumab - orphan drug for PNH which inhibits C5 - stops
complement mediated erythrocyte destruction

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249
Q

TCA overdose

A

Side effects -
Anti cholinergic - dry mouth, tachycardia, mydriasis
Sodium channel blockade - QRS prolongation, arrhythmia, seizures
Others - grossly abnormal reflexes, loss of consciousness,
divergent eye movements

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250
Q

theophylline adverse effects

A

nausea, vomiting, hypokalaemia, metabolic acidosis

Regular smoking - u-pegulates hepatic enzyme activity and
cessation of smoking causes increased theophylline
concentrations.

Other factors that increase theophylline concentrations - heart
failure, liver cirrhosis, acute viral infection, increased age, enzyme
inhibitor or inducer.

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251
Q

polymorphic VT

A
  • Broad complex tachycardia - numerous ventricular foci that leads
    to polymorphic QRS complexes
  • Most common type - tornadoes de pointes
  • Aetiology :
    A.Inherited
    B.MI
    C.Drug induced
    D.Congenital Long QT syndrome - Romano Ward, Jervell and
    Lange-Nielson syndrome
    E. Electrolyte disturbances - low K, low Mg, Low Ca
  • Torsades de pointes : prolonged QT interval indicates longer time
    needed for myocytes to repolarise due to channelopathy -
    causing premature after-depolarisations.
  • C/F : light headedness, palpitations, dizziness, sudden cardiac
    death. Can progress to VF or cardiac arrest.
  • Bidirectional VT - DIGOXIN
  • MX : IV Magnesium is the drugo choice : 1-2g in 30 to 60
    seconds, repeated in 5-10 minutes.
  • Avoid these drugs
    A.Anti arythmie - Amiodarone, Sotalol, Procainamide
    B.Anti psychotics - Haloperidol
    C.Antidepressants - Citalopram
    D.Antibiotics - Erythromycin, Trimethoprim
    E. Antihistamines - Terfinadine
    F. Antifungals - Ketoconazole, Fluconazole
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252
Q

digoxin specific antibodies

A

digoxin tox with severe hyperkalaemia

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253
Q

diagnosis of SIADH

A

Confirming requires serum osmolality <275
and urine osmolality >100 and Urine sodium >30
- concentrated urine Na >20
- hyperosmolality >100 mOsm/k
- hyponatremia plasma Na <125 mmol/L
- absence of hypovolemia/edema/diuretics

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254
Q

warfarin decreased efficacy

A

Pharmacokinetic factors :
* Cholestyramine - decreased absorption
* CY450 inducers - St Johns Wort

Pharmacodynamic factors :
* Excess dietary vitamin K
* Oestrogen’s
* Griseofulvin
* 6-mercaptopurine (Azathioprine)

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255
Q

tumour lysis syndrome

A
  • Metabolic disorder - complication of malignant diseases
  • Hyperuricaemia + hyperkalemia + hyperphosphotemia
  • Hypocalcemia
  • Raised urea and creatinine levels due to acute renal failure
  • Hyperuricemia - crystallisation of uric acid in renal tubules -
    obstructive uropathy
  • Associated with steroid administration, monoclonal antibodies,
    biologics - Thalidomide, Paclitaxel, Zoledronic acid
  • Hypocalcemia - arrhythmia, tetany, seizures
  • C/F :
  • Dyspnea, orthopnea, tachypnea
  • Dyusira, flank pain, hematuria
  • Nausea, vomiting, seizures, tetanic spasms
  • Abdominal distension
  • Facial edema
  • Palpitations
  • Lethargy
  • Management : Rapid expansion of intravascular volume - IV
    fluids started 48 hours before initiation of chemotherapy
  • Allopurinol - can decrease production of uric acid - used in low
    risk patients
  • Recombinat urate oxidase : Rasuricase - treats hyperuricemia
    associated with leukaemia and lymphoma - used in high risk
    patients
  • Sodium Bicarbonate - for urine alkalinisation
  • Calcium - Calcium chloride, calcium glutinate
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256
Q

drugs causing nephrogenic DI

A
  • Lithium
  • Demeclocycline
  • Amphotericin
  • Glibenclamide
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257
Q

methaemoglobinaemia cause

A

isosorbide mononitrate

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258
Q

coronary artery vasospasm in cocaine OD

A

nitrates or CCB

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259
Q

drugs causing hyperprolactinaemia

A
  • Dopamine receptor antagonists - Domperidone, Metoclopramide
  • Antidepressants - TCA, MAO inhibitors, SSRI
  • CCB - Verapamil
  • Opiates
  • Protease inhibitors
  • Bezafibrate
  • H2 receptor antagonists
  • Oestrogens, anti androgens
  • Cocaine
  • Cyproheptadine
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260
Q

drug induced hepatitis

A
  • Febofibrate
  • Anti TB drugs
  • Methyldopa
  • Carbamazepine
  • Nitrofurantoin
  • Isoniazid
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261
Q

Inhibitors of CYP 3A4 with CIclosporin - increased risk of
nephrotoxicity

A
  • Verapamil
  • Diltiazem
  • Imidazole anti fungals
  • Macrolide antibiotics
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262
Q

green blue urine

brown urine

A
  • Pseudomonas urinary tract infection
  • Amitriptyline
  • Indigo carmine
  • IV cimetidine
  • IV promethazine
  • Methylthioninium Chloride
  • Triamterene
  • Levodopa
  • Metronidazole
  • Nitrofurantoin
  • Fava beans
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263
Q

drugs associated with intracranial HTN

A

tetracyclines amiodarone OCP withdrawal of steroid

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264
Q

carbimazole ADR

A

Carbimazole — converts into Methimazole —> inhibits iodination
of tyrosine and blocks the coupling of Iodotyrosine.
Methimazole : minor immunosuppressive action —> leading to
reduction in serum thyroid stimulating hormone antibody (TRAb).

Adverse effects - 7 to 28 days after starting treatment - stop the
drug if they develop any fever or sore throat.

Other rare complications : hepatitis, cholestatic jaundice

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265
Q

gp2b/3a inhibitors

A

Abciximab, Eptifibatide, Tirofiban
The receptor mediates platelet aggregation.

Inhibited by these drugs - leads to decreased thrombus formation.

ADP receptor antagonism - Clopidogrel, Prasugrel, Ticagrelor

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266
Q

statin-drug interactions

A
  • Antacid and anti fungal agents interact with Atorvastatin.
  • All statins interact with Cyclosporine and Nicotinic acid.
  • All statins should be used in caution with patients on fibrate
    therapy as the risk of rhabdomyolysis is increased.
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267
Q

cytotoxic drug resistance

A

P-glycoprotein encoded by MDR1

MRP

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268
Q

chemotherapy SEs

A
  1. Ciclosporin - nephrotoxicity, hepatotoxicity, increased K, Na,
    hypertrichosis, gum hypertrophy, increased BP, fluid retention
  2. Cyclophosphamide - bone marrow suppression
  3. Methotrexate - pulmonary fibrosis, pancytopenia, bone
    marrow suppression, mucositis
  4. Vincristine - neurotoxicity
  5. Doxorubicin - cardiotoxicity
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269
Q

SEs of salmeterol

A

hypokalaemia
liver disease
not used in breast feeding and preg

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270
Q

phenytoin is a highly protein bound drug

A
  • Toxicity happens when proportion of free to bound drug are
    increased.
  • Factors which increase this proportion -
  • States of hypoalbuminemia - pregnancy, malnutrition,
    nephrotic syndrome, malignancy
  • Uraemia
  • Neonates
  • Elderly individuals
  • Hyperbilirubinemia
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271
Q

cytochrome pathways

A

CYP2CB - pioglitazone
3A4 - simvastatin
2C9 - NSAID and warfarin
2D6 - antipsychotics
3A2 - conversion of testosterone

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272
Q

common drugs adrs

A

Methotrexate - pneumonitis, pulmonary fibrosis, hepatic fibrosis,
folate deficiency
Ciclosporin - nephrotoxic, cholestasis, hypertrichosis, gingival
hyperplasia, tremor, nausea, vomiting
Prednisolone - used as treatment for fibrosing alveoli’s
Sulfasalazine - can cause pulmonary fiborisi, myelosuppression,
decreased sperm count, hepatitis, oral ulcers, rash, haemolytic
anemia.
Azathiprine - dose related myelosuppression, hair loss,
hypotension, cholestatic jaundice, arrhythmia, hypersensitivity
reactions

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273
Q

theophylline metabolic disturbance

A
  • Metabolic disturbances - hypokalaemia, metabolic acidosis
  • Theophylline toxicity - hypotension, hypokalaemia, ventricular &
    supra ventricular arrhythmia
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274
Q

AED effects on OCP

A
  • Lamotrigine - most correct choice as it does not interfere with
    effectiveness of OCP
  • Carbamazepine - powerful enzyme inducer and decreased OCP
    effectiveness, and increased risk of unintended pregnancy
  • Clonazepam - causes sedation
  • Topiramate - decreases Estrogen levels - reduces pill
    effectiveness; also has a ten-fold risk of cleft lip compared to
    other people
  • Phenytoin - causes weight gain, powerful enzyme inducer - can
    cause congenital malformations - cleft lip, cleft palate, neural
    tube defects
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275
Q

digoxin overdose

A

Cardiac features :
* A and AV block
* Premature ventricular contractions
Slowed ventricular response
* PR prolongation
* scooped ST depression

Non cardiac features :
* GIT - nausea, vomiting, diarrhoea
* Vision - blurred, yellow green discoloration
* CNS - weakness, dizziness, confusion, apathy, malaise,
headache, depression, psychosis
* Haematological - thrombocytopenia, agranulocytosis
* Gynecomastia

MX : Digoxin specific antibody fragments (Fab) fragments
Symptomatic bradycardia - atropine
Hypotension - fluid replacement

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276
Q

rosuvastatin metabolism

A

substrate for hepatic uptake transporter
OATP1B1 and efflux transporter breast cancer resistance
protein (BCRP)

CYP3A4 inhibitors impact metabolism of Simvastatin &
Atorvastatin - which are affected by CYP3A4 inhibitors like
Itraconazole and Clarithromycin

ciclosporin inhibitor of OATP1B1

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277
Q

cranberry juice

A

increase in INR due to 2c9 metabolism

liver/brassica - decrease INR

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278
Q

beta agonists and AT2 lead to

A

promote photo oncogene
expression - which then Stimulates protein synthesis and induces
synthesis of fetal forms of actin and myosin, leading to hypertrophy
of smooth muscle

Beta blockers, ACE inhibitors, ARBs can be used for
reversal of hypertrophy

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279
Q

drug fever

A

penicillins,
phenytoin, hydralazine, and Quinidine

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280
Q

acetazolamide ADs

A

A.Metabolic acidosis due to HCO3 loss in PCT and DCT
through inhibition of reabsorption
B.Hypokalaemia
C.Acute interstitial nephritis
D.agranuloytosis
E. Thrombocytopenia

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281
Q

paracetamol metabolism key pathways

A

1) glucuronidation
2) sulfation

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282
Q

drug induced haemolysis

A
  • G6PD - Quinolones, dapsone, primaquine, Aspirin
  • Acquired autoimmune haemolytic anaemia - Methyldopa,
    Penicillin, Quinine, Quinidine
  • Lead exposure - can cause direct red cell toxicity
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283
Q

antifungals

A
  • Symptomatic patients - hemoptysis - surgical management by
    lobectomy
  • Alternative treatments - bronchial arterial embolisation & long
    term oral Itraconazole.
  • Pre and post operative systemic anti fungal treatment is also
    preferred.
  • Treatment options include - amphotericin with flucytosine/
    itraconazole / voraconazole.

Fluconazole - candidiasis and CNS infections with Cryptococcus
neoformans

Griseofulvin - tinea capitis in adults and children; effective against
infections caused by Trichophyton tonsurans and Microsporum
spp.

Nystatin - oral, vaginal and enteric candidiasis; only topical;
systemic route too toxic

Terbinafine - superficial mycoses - dermatophyte infections

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284
Q

site of action of diuretics

A
  • C - carbonic anhydrase inhibitors - proximal convoluted tubule
  • O - osmotic diuretics - at loop of Henle
  • L - loop diuretics - ascending limb of loop of Henle
  • T - thiazide diuretics - at proximal distal convoluted tubule
  • P - Potassium sparing - at distal portion of distal convoluted
    tubule
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285
Q

drugs causing mydriasis

A

1) drugs with sympathomimetic actions - cocaine, amphetamine,
pseudoephedrine
2) Anticholinergic drugs - antihistamines, atropine, tricyclic
antidepressants

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286
Q

ciclosporin moa

A

Two main modes of action -
1. Arrest the activity of resting lymphocytes in G0 or G1 phase of
growth cycle
2. Cytokine inhibition - IL-2
* Ciclosporin concetrations affected by renal function and coadministration of drugs that interfere with CYP3A4 enzyme
activity.
* Contraindicated drugs with Ciclosporin - Statin, Macrolides

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287
Q

carbamazepine autoinduction

A

CYP3A4

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288
Q

what drug protects against radiation therapy

A

amifistone

increase sens?
* Dactinomycin - radio sensitiser agent which increases cellular
response to radiation treatment
* Metronidazole
* 5-Fluorouracil
* Gemcitabine
* Cisplatin
* Hydroxyurea
* Paclitaxel
* Mitomycin C
* Topotecan

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289
Q

Gitelman syndrome metabolic

A
  • Low levels of chloride
  • Low levels of potassium
  • Low levels of magnesium
  • Decreased calcium excretion in urine
  • C/F : muscle cramps, weakness, numbness, thirst, waking up at
    night to urinate, salt cravings
  • Mx : potassium sparing diuretic - Amiloride or Spironolactone
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290
Q

loop and thiazide vs CA

A

metabolic alkalosis vs acidosis

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291
Q

drug induced cholestasis

A
  • Phenothiazines - Chlorpromazine
  • Erythromycin
  • Ciclosporin
  • Cimetidine
  • Nifedipine
  • Nitrofurantoin
  • Imipramine
  • Azathioprine
  • Dextro-propoxyphene
    Danazol - prolonged use - can hepatic adenomas or HCC
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292
Q

amoebic liver abscess

A
  • Routine Blood tests : raised TLC, deranged LFT; raised
    inflammatory markers
  • Amoebic serology : >90% sensitive
  • Most patients with Amoebic Liver abscess will have
    negative stool microscopy
  • Medical Rx : Metronidazole OR Tinidazole
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293
Q

coag negative staph

A

epidermidis

positive - aureus

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294
Q

rocky mountain spotted fever

A
  • RMSF : febrile illness - Rickettsia rickettsii
  • History of tick bite 65%, fever 100%, rash 90% of patients
  • C/F : fever, headache, malaise, myalgia
  • Macular rash - starts on hands and feet and progresses
    proximally towards trunk.
  • Macules evolves into papules, petechiae, ecchymoses.
  • Severe cases - necrosis & gangrene
  • Diagnosis - confirmed by 4-fold rise in titres over 2 week period
  • Treatment : Tetracycline
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295
Q

lyme disease tx

A

doxy/azithro

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296
Q

Acrodermatitis chronic atrophicans

A

dermal atrophy +
peripheral nerve involvement + dermal sclerosis

  • Rare manifestations - keratitis, uveitis
  • MX : early stages - oral Doxycycline
  • Later stage - IV Ceftriaxone
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297
Q

adverse effects of PI

A

Hypertrigyceridemia, diarrhoea, asthenia, oral paresthesia,
impaired glucose metabolism

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298
Q

actinomycosis

A
  • Cervicofacial actinomycosis - most commonly seen
  • Risk factors : dental extractions, jaw fractures, periodontal
    abscess, tonsillar crypts
  • C/F : acute, odontogenic abscess or cellulitis of the floor of
    mouth, (or) as a painless reddish swelling
  • Subacute to chronic course : regression of central suppurative
    foci while the infection progresses peripherally; can spread to
    other parts of head and neck, can involve meninges.
  • Actinomyces - sulfur granules, anaerobic conditions
  • Nocardiosis - sulfur granules +/- aerobic conditions
  • Prolonged courses of Amoxicillin >6 months
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299
Q

cutaneous nocardiosis

A
  • Following previous trauma to skin
  • Presents with a painless swelling allowed by an area of ulceration
  • Nocardia cultures - slow growing, does not grow under
    anaerobic conditions. USE PARAFFIN BAIT FOR GROWING
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300
Q

ribavirin common side effect

A

haemolytic anaemia
teratogenic

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301
Q

heterophile test

A

EBV/mono

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302
Q

fungal keratitis

A
  • Mycotic keratitis
  • Associated with trauma
  • Ulcerative lesion in cornea, base is raised with creamy infiltrate
  • Slough off the ulcer appears dry with a feathery border
    surrounded by a yellow line of demarcation.
  • R/F : patients with immunosuppression
  • Mx : antifungals such as Amphotericin B, Itraconazole, Natamycin
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303
Q

nightmares

A

efavirenz

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304
Q

peripheral neuropathy

A

stavudine

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305
Q

hyperlipidaemia

A

PIs

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306
Q

tenofovir

A

renal impairment
OP

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307
Q

epididymo-orchitis

A

Men >35 years, stable partner - caused by enteric bacteria : treat
with Ofloxacin

Men <35 years, multiple sexual partners, ?STI cause - treat with
Ceftriaxone

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308
Q

mefloquine toxicity

A

acute psychosis

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309
Q

hantavirus infection

A
  • Hemorrhagic fever with renal features
  • Endemic in Korean, Balkans, Scandinavia
  • C/F : fever, myalgia, shock, conjunctival haemorrhage with
    epistaxis, elevated creatinine, elevated urea

Haemolytic Uraemia syndrome will be associated with kidney
disease and thrombocytopenia + hypertension (NO SHOCK)

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310
Q

Q fever

A

Coxiella burnetii - transmission to humans by
inhalation of infected dust and aerosols, drinking unpasteurised
milk from cows
C/F - high fever, headache, malaise
Complications - pneumonia, hepatitis, myocarditis

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311
Q

M Tb replication time

A

18-24 hours

Escherichia coli - divides every 20 minutes
Staph aureus divides every 30 minutes
Treponema pallidum divides every 1-2 days
Mycobacterium leprae - divided every 14 days

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312
Q

trypanosomes

A
  • African Trypanosomiasis :
    A.Caused by protozoa transmitted by tsetse fly.
    B.West Africa - Trypanosome Brucei ambience
    C.East Africa - Trypanosome brucei rhodesiense
    D.Early C/F : fever, headaches, arthralgia, pruritis
    E. Later stages : meningoencephalitis, personality change,
    agitation, severely disordered sleep
    F. INV of choice : thick and thin blood fils. CSF M/C, serology
    G.MX : T. brucei ambiense —> Pentamidine
    H.MX : T. Brucei rhodisense —> Suramin
    I. CNS involvement Rx changes
    J. CNS T. brucei ambiense - Nifurtimox & Elfornithine
    K.CNS T.brucei rhodisense - Melasprolol
  • Trypanosome cruzi - South American Trypanosomiasis
  • Transmitted by reduviid bugs
  • Cardiac : cardiomyopathy dilated, myocarditis, cardiac
    arrhythmia - complete heart block
  • Mega oesophagus & megacolon - due to destruction of
    parasympathetic nerves; recurrent aspiration, bloating, sever
    constipation.
  • MX : Benznidazole or Nifurtimox
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313
Q

criteria for diagnosis of toxic shock syndrome

A
  1. Fever >38.9
  2. Hypotension
  3. Widespread erythematous, macular rash
  4. Subsequent desquamation of affected skin areas, palms
    and soles
  5. Involvement of at least 3 organ systems -
    - GIT - diarrhoea, vomiting
    - Muscular - severe myalgia, raised CK
    - Renal : raised urea, raised creatinine
    - Heaptic : impaired liver function
    - Blood : thrombocytopenia
    - CNS : disorientation, confusion without focal neurology
    - Mucous membranes : hyperaemia of conjunctiva,
    pharynx or vagina
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314
Q

loa loa treatment

A

diethycarbamazine

Sensitivity reactions to filarial antigen both local and systemic -
common and can stimulate acute manifestation reactions
* Treatment - 1mg/kg on first day - increasing over 3 or more days
to 6mg/kg in divide dose - dose is continued for 21 days
* Heavy filariasis - DEC can trigger encephalitis - treatment with
Albendazole is recommended

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315
Q

shiga toxin associated HUS

A

complement activation C3 and C9

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316
Q

dermatophyte infections

A

1) Micosporum - single microconidia or multiseptate macroconidia
2) Trichophyton spp. - multiple small microconidia
3) Epidermophyton spp. - do not produce conidia

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317
Q

brucella melitensis

A

niclosamide empty stomach

  • Doxycycline PO + Streptomycin IM
    OR
  • PO Quinolone + PO Rifampicin
    OR
  • PO Doxycycline + PO Rifampicin +/- Gentamicin/Cotrimoxazole
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318
Q

malignant otitis externa pathogen

A

pseud

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319
Q

sporotrichosis

A
  • Begins as reddish, non tender, macula-papular lesion at the site
    of inoculation.
  • Similar nodules forms along proximal lymphatic channels
  • These break to form a row of ulcers
  • Diagnosis - culture of biopsy samples of Saboraud dextrose agar
  • Treatment - Itraconazole - sever infections : IV Amphotericin B
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320
Q

infective endocarditis with an increasing PR interval

A

aortic root abscess

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321
Q

strep gallolyticus endocarditis

A

colon ca
biliary abnormality

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322
Q

Rx cryptococcal meningitis

A
  • IV Amphotericin B + Flucytosine/
    Fluconazole
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323
Q

cutaneous leish presentation

A
  • Incubation period - few days to several months
  • Erythematous nodules develops at the site of infected sandfly
    bite
  • Golden crust forms - sore reaches its final size - usually 1-5 cm in
    diameter; over weeks or months
  • Crust may fall away leaving a ulcer with raised edge; satellite
    papules are common
  • After months or years, lesion starts to heal; leaving behind a
    depressed, mottled scar.
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324
Q

diffuse infiltrative lymphocytic syndrome

A

weakness
due to peripheral motor neuropathy; ascetic meningits and cranial
palsies can occur too

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325
Q

quinine stimulates release of

A

insulin

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326
Q

culture negative IE

A

Coxiella, Brucella,
Bartonella
Non infective cause - malignancy, SLE (Libman Sacks endocarditis)

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327
Q

ART SEs

A
  • Indinavir - renal stones, asymptomatic hyperbilirubinemia
  • Ritonavir - P450 inhibitor
    Protease inhibitors - Indinavir, Ritonavir
  • Tenofovir - renal impairment, osteoporosis
  • Zidovudine - anaemia, black nails, myopathy, significant
    reduction in white cell count
  • Didanosine - pancreatitis
  • Abacavir - idiosyncratic hypersensitivity ass. With rash and fever;
    associated with HLA B5701 type
  • Lamivudine - skin rashes, arthralgia, peripheral neuropathy
    NRTIs - Zidovudine, Lamivudine, Stavudine, Tenofovir,
    Zalcitabione, Emtricitabine, Didanosine, Abacavir
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328
Q

jock itch

A

clotrimazole

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329
Q

most common organism in bronchiectasis

A

Hib

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330
Q

causes of transudative effusion (<30g protein)

A

heart failure (most common transudate cause)
hypoalbuminaemia
liver disease
nephrotic syndrome
malabsorption
hypothyroidism
Meigs’ syndrome

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331
Q

exudative effusion (>30g protein)

A

infection
pneumonia (most common exudate cause),
tuberculosis
subphrenic abscess
connective tissue disease
rheumatoid arthritis
systemic lupus erythematosus
neoplasia
lung cancer
mesothelioma
metastases
pancreatitis
pulmonary embolism
Dressler’s syndrome
yellow nail syndrome - lymphatic leak, chylothorax

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332
Q

causes of occupational asthma

A

isocyanates - foams and paints
soldering flux resin
flour
platinum salts

cadmium -> emphysema/COPD

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333
Q

PFTs

A
  • Obstructive Lung Disease -
    A.FEV1 - significantly reduced
    B.FVC - reduced or normal
    C.FEV1 / FVC - reduced
    D.Conditions - Asthma, COPD, Bronchiectasis, Bronchiolitis
    obliterans
  • Restrictive Lung Disease -
    1. FEV1 - reduced
    2. FVC - significantly reduced
    3. FEV1 / FVC - normal or increased
    4. Conditions - Pulmonary fibrosis, Asbestosis, Sarcoidosis,
    ARDS, Kyphoscoliosis, Ankylosing spondylitis,
    Neuromuscular disorders, Severe obesity, Interstitial Lung
    Disease
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334
Q

raised TLCO

A
  • Asthma
  • Pulmonary Hemorrhages - Goodpastures, Granulomatosis
    with microscopic polyangitis
  • Left to right cardiac shunts
  • Polycythemia
  • Hyperkinetic states
  • Male gender, exercise
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335
Q

reduced TLCO

A
  • Pulmonary fibrosis
  • Pulmonary emboli
  • Pulmonary edema
  • Pneumonia
  • Emphysema
  • Anaemia
  • Low Cardiac output
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336
Q

mesothelioma

A

chromosome 22 (TSG)
drainage not recommended
SV40 carcinogen

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337
Q

CF presentation

A

delayed puberty
nasal polyps
CFRD
rectal prolapse

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338
Q

mycoplasma

A

haemoptysis - rise in polyclonal anti-I IgM Abs in mycoplasma pneum

macrolides as no cell wall

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339
Q

causes of clubbing

A

bronchiectasis
abscess
empyema
malignancy
HPOA
fibrosing alveolitis
asbestosis

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340
Q

R heart strain

A
  • Normal CTPA - no contrast in IVC
  • ECG of right heart strain - ST segment depression and T wave
    inversion in V1-V4, and inferior leads leads II, III aVF
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341
Q

chest drain for infected effusion

A

A.Patients with frankly purulent or turbid/cloudy pleural fluid on
sampling
B.Pleural fluid pH < 7.2 with suspected pleural infection
C.Poor clinical progress despite antibiotic treatment
D.Presence of organisms identified by Gram stain and/or culture
from a non-purulent pleural fluid sample

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342
Q

Churg strauss syndrome

A
  • Eosinophilia + necrotising granulomatous inflammation
  • Involves respiratory tract, renal system, skin and peripheral
    nerves
  • Typically presents with history of asthma, with atopy, recurrent
    nasal polyps
  • 7 out of 10 patients - have mono neuritis multiplex
  • Renal involvement - hematuria, proteinuria, hypertension, raised
    creatinine levels.
  • Diagnostic investigation of choice - skin biopsy : granuloma
    formation with small vessel arteriopathy.

Mx - steroids

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343
Q

Familial PAH

A

BMPR2

ECG may show P pulmonate, right axis deviation, RV
hypertrophy, RV strain, RBBB, ITC prolongation

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344
Q

step 2 of COPD treatment if no asthmatic features

A

LABA+LAMA

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345
Q

treatment of radiation pneumonitis

A

systemic corticosteroids
addition of azathioprine or cyclosporin

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346
Q

carcinoid tumour of lung

A
  • Tumor is normally vascular.
  • Histology - small polygonal cells with finely granular eosinophilic
    staining of cytoplasm and nuclei are small and round.
  • Bronchial carcinoid - derives from stem cells of bronchial
    epithelium - Kulchitsky cells.
  • 80-90% of them develop in bronchus of sub segmental size -
    patients often present with bronchial obstruction that has led to a
    lower respiratory tract infection.
  • Total surgical excision should be attempted if there is no evidence
    of metastasis.

recurrent haemoptysis with segmental collapse

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347
Q

lung ca appearances

A
  • Adenocarcinoma : forms a gland and produced mucin.
  • Bronchoalveola cell carcinoma : arises from type 2 pneumocytes
    and spreads rapidly.
  • Small cell carcinoma of bronchus : arises from neuroendocrine
    Kulchitsky cells - composed of sheets of small, round to spindled cells with dark nuclei, scanty cytoplasm, fine granular nuclear chromatin with indistinct nucleoli. ‘Salt and pepper appearance’
  • Squamous cell carcinoma : well differentiated contains keratin
    pearls. Poorly differentiated may stain positive for keratin, with
    large irregular nuclei and coarse nuclear chromatin with large
    nucleoli.
    Presence of intercellular bridging is diagnostic of squamous cell
    carcinoma
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348
Q

Langerhans cell histiocytosis

A

proliferaton of langerhans cells in
bronchiolar and bronchial epithelium, forming granulomas.
upper zone pulmonary fibrosis
C/F - cough, SOB on exertion, fever, fibrosis in mid to upper zones
CXR - bilaterally symmetrical reticulonodular pattern
Dx - incidentally on CXR
Spirometry - restrictive pattern

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349
Q

Macleod syndrome

A

unilateral emphysema following childhood bronchiolitis

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350
Q

empyema pleural fluid analysis

A

Macroscopic pus
* pH < 7.2
* Glucose < 3.3 mol/L
* LDH > 1000

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351
Q

haemoptysis massive

A

Massive hemoptysis + stable hemodynamics —> angiography + embolisation (step 1) later if needed —> lobar resection

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352
Q

legionella and penicillin allergy

A

levofloxacin

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353
Q

ARDS

A

low compliance, high elastic recoil, reduced transfer
factor, low pulmonary artery wedge pressure

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354
Q

primary pulmonary HTN

A
  • Presents with breathlessness, fatigue, angina (due to right
    ventricular ischaemia), pre syncope.syncope.
  • Autosomal dominant pattern with incomplete penetrance of
    inheritance in familial cases
  • Physical sings include -
    (1) elevated JVP
    (2) Left parasternal heave
    (3) Pansystolic murmur - tricuspid regurgitation
    (4) Right ventricular S4
    (5) peripheral edema
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355
Q

L hilar mass clinical sign

A

whispering pectoriloquy

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356
Q

mx of narcolepsy

A
  • CNS Stimulants - First line - Modafinil, Armodafinil
  • Second line - Methylphenidate, Dexamfetamine
  • Patients with cataplexy :
    1) first line - sodium oxybate
    2) second line - Fluoxetine, Paroxetine, Venlafaxine
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357
Q

hepatopulmonary syndrome

A

Hepatic disease can result in right-to-left shunting, secondary to
intrapulmonary vasodilation mainly in lower lobes.
* This is similar to Pulmonary AV malformations seen in hereditary
hemorrhagic telangiectasia.
* There is increase blood flow through the lower lobes when patient
moves from supine to standing position.
* This results in blood from the lower lobes which is poorly
oxygentated, entering the left side of heart, leads to oxygen
desaturation in the erect position.
* This phenomenon is called orthodeoxia.

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358
Q

PCP XR

A

normal X ray or b/l interstitial
shadowing - perihilar in distribution

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359
Q

Hypogammaglobulinemia in ataxia telangiectasia

A
  • Inherited in autosomal recessive fashion
  • Ataxic from an early age
  • Oculomotor apraxia and choreathetosis later in life
  • Alpha-fetoprotein can be raised.
  • Cell defects and deficiencies in humeral immunity with defective
    DNA repair and IgA and IgE deficiencies result in recurrent
    infections and tumour susceptibility.
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360
Q

hypoxia in primary pulmonary HTN

A

intra-pulmonary shunting, reduced diffusion capacity due to arterial fibromuscular hyperplasia

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361
Q

Hereditary spinocerebellar degeneration

A

autosomal dominant or
recessive. Associated with slowly progressive cerebellar
syndromes, tremors and ataxic gait.
Extrapyramidal features can be presents pyramidal signs, cortical
symptoms such as behavioural disturbance, epilepsy, cognitive
disturbances. NOT associated with bronchiectasis.

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362
Q

Mounier-Kuhn syndrome

A

congenital deficiency of bronchial
cartilage; tracheal and bronchial dilation and associated with
recurrent LRTIs

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363
Q

Williams-Campbell syndrome

A

deficiency of bronchial cartilage
particularly in sub segmental bronchi. Leads to bronchiectasis
distal to the affected bronchi.

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364
Q

idiopathic pulmonary haemosiderosis

A

occurs in younger
people and characterised by pallor, weakness, lethargy, dry cough
and occasional hemoptysis. No abnormal immunological features.
Gas transfer factor is elevated because of hemoptysis blood is
already in alveoli

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365
Q

bronchiectasis on HRCT

A

signet ring sign
dilation and thickening of affected bronchi

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366
Q

BHD syndrome

A

Pneumothorax + lung cysts + fibrofolliculoma of skin + renal cancer
Due to mutant of follicular gene
Family history of pneumothorax and renal cancer.

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367
Q

CF infiltration of

A

neutrophils

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368
Q

HAP mx

A

3rd gen cephalosporin + aminoglycoside

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369
Q

forced expiratory flow

A
  • Reflects the status of small airways
  • Effort independent
  • Impaired in smokers and in patients with graft v/s host disease
    with associated lung pathology
  • Impaired in bronchiolitis obliterans
  • Not useful for identifying large airway disease
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370
Q

elevated unilateral hemidiaphragm ix

A

fluoroscopy

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371
Q

cryptogenic pulmonary eosinophilia

A

malaise
fever
weight loss
raised ESR
asthma

rx - 1 year steroids

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372
Q

Caplan syndrome

A

RA + pneumoconiosis

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373
Q

acute asthma TLC

A

increased due to gas trapping

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374
Q

mendelson syndrome

A

acute pneumonia caused by
regurgitation of stomach contents and aspiration of chemical
material, usually gastric juices.
Can cause severe bronchospasm.
Pneumonia develops rapidly and within hours, patients become
tachypnoeic, hypoxic, and febrile.
Minimal sputum production.
Commonly seen after anaesthesia when the gag reflex is
depressed.

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375
Q

best predictor of OSA

A

neck size

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376
Q

jejunal biopsy in whipple’s disease

A

infection with gram-positive actinobacteria

deposition of macrophages containing PAS positive granules within villi

14 days of ceftriaxone of benzylpenicillin
+ year of co-trimox

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377
Q

gastrin hormone

A

G cells in antrum + duodenum

inhibited by low ph and somatostatin

increases acid secretion by gastric parietal cells, increased secretion of pepsinogen, increased IF section, increased gastric motility, parietal cell maturation

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378
Q

CCK

A

I cells in upper SI
secretion of enzyme rich fluid from pancreas, contraction of gallbladder and relaxation of sphincter of Oddi, decreases gastric emptying, trophic effect on pancreatic acinar cells, inducing satiety

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379
Q

what makes direct contact with L kidney

A

pancreas
L suprarenal gland

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380
Q

achalasia mx

A

short acting nitrates before meals
CCBs
Botox
heller myotomy

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381
Q

drug causes of pancreatitis

A

azathioprine
OCP
steroids
anti-retrovirals
fibrates
thiazides

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382
Q

Cullens and Gray Turners

A

umbilicus vs flanks

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383
Q

drug causes of chronic pancreatitis

A

thiazides
azathioprine
tetracyclines

hyperCa, hyperlipidaemia

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384
Q

exocrine insufficiency test in chronic pancreatitis

A

pancreolauryl and serum para-amino benzoic acid testing
fecal elastase

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385
Q

pre vs post sinusoidal portal htn

A

normal in pre
HVPG >= 5 - induced portal htn

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386
Q

Wilsons disease

A

autosomal recessive

ATP7B on chr13

high levels of free copper

fibrosis and CNS signs

reduced serum caeruloplasmin and total serum copper

mx
penicillamine
tridentine hydrochloride
liver transplant

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387
Q

malignancies in coeliac

A

T cell lymphoma
upper GI tract

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388
Q

Type 1 cryoglobulinaemia

A

IgG or IgM - monoclonal

MGUD, Waldenstrom, CLL, myeloma

Raynauds

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389
Q

Type 2 cryoglobulinaemia

A

mixture of polyclonal Ig with RF

Hep C, Sjogrens, SLE

positive RF

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390
Q

Type 3 cryoglobulinaemia

A

polyclonal

HCV, autoimmune disease

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391
Q

Meltzer’s triad

A

t2 and 3

purpura, arthralgia, weakness

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392
Q

advanced Parkinsons intestinal

A

pseudo-obstruction
prokinetics

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393
Q

NOD2 gene mutation

A

Crohns

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394
Q

HFE mutations

A

hctosis

C282Y
H63D

increased transferrin and ferritin

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395
Q

vitamin C deficiency

A

weak collagen

poor wound healing and recovery from burns

scurvy - haematological, abnormal osteoid and dentin formation

XR - generalised bone rarefaction, metaphyseal deformity of fractures and sebperiosteal hepatomas

co-factor for hydroxylation of proline and lysine

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396
Q

T1 vs 2 autoimmune hepatitis

A

most common, anti SMA and ANA, inc IgG
HLA DR3 and 4

children, anti LKM1 and ALC-1
HLA DQB1 and DRB

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397
Q

liver biopsy in AIH

A

piecemeal necrosis and mononuclear infiltration of portal and peri portal areas

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398
Q

AIH mx

A

pred
azathioprine

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399
Q

protein losing enteropathy dx

A

alpha 1 antitrypsin levels indicate plasma leakage of proteins in gut

due to sarcoid, IBD, pseudomemb colitis, CMV colitis, TB, CTD

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400
Q

bile salt malabsorption scan

A

SEHCAT

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401
Q

PSC

A

ALP raised, anti sma and ANA
MRCP dx

cholestyramine
UDO
abx if cholangitis

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402
Q

drugs causing hepatitis

A
  • Isoniazid
  • Rifampicin
  • Methyldopa
  • Atenolol
  • Enalapril
  • Verapamil
  • Nifedipine
  • Amiodarone
  • Ketoconazole
  • Cytotoxics
  • Halothane
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403
Q

drugs causing cholestasis

A
  • OCP
  • Ciclsporin
  • Azathioprine
  • Chloramphenicol
  • Cimetidine
  • Ranitidine
  • Erythromycin
  • Nitrofurantoin
  • Imipramine
  • Ibuprofen
  • Hypoglycaemics
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404
Q

Menetrier’s disease

A

giant gastric folds, in fundus and body

hyperplasia of gastric pits, gland atrophy, increase in mucosal thickness

hypochlorhydria - nil gastric production

hypoalbuminaemia

PPI

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405
Q

metformin can cause

A

bile acid malabsorption

similar to ileal resection, terminal ileal disease, cholecystectomy

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406
Q

PBC

A

ALP raised
cholestatic jaundice
AMA antibodies hallmark of PBC
portal htn and varices

anti mitochondrial antibody M2
raised IgM

cholestyramine
obeticholic acid

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407
Q

angiodysplasia 2x normal colonoscopies

A

capsule endoscopy

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408
Q

moa of lactulose in hepatic encephalopathy

A

acidic metabolites increase ionisation of freely diffusible ammonia into ammonium which cannot diffuse back into blood

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409
Q

capecitabine advantage

A

oral administration
metabolised to 5FU

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410
Q

black pigment gallstones

A

irregular and radiolucent, bile pigments

hereditary spherocytosis, sickle cell, thalassaemia, cirrhosis

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411
Q

bleeding source of duodenal ulcer

A

posterior aspect of duodenum —>
posterior superior pancreaticoduodenal artery

Anterior duodenum + head of pancreas —> anterior superior
pancreaticoduodenal artery

Pylorus and primal duodenum —> proximal duodenal artery

Stomach —> gastroepiploic artery

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412
Q

fistulating crohns mx

A

anti TNF first line

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413
Q

acute fulminant hepatitis

A

A and E

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414
Q

can get IRIS after

A

Whipples tx

relapse tx-> penicillin, ceft, doxy, hcq

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415
Q

Gardner syndrome

A

AD

polyps, osteomas, soft tissue tumours

congenital hypertrophy of retinal pigment epithelium

APC gene on chr 5q21

total colectomy

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416
Q

juvenile polyposis

A

AD
hamartomatous polyps throughout GIT

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417
Q

Peutz-Jegher

A

AD

intestinal hamartomas and peri oral

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418
Q

Boyce’s sign

A

swelling on L side of cheek which gurgles on palpation

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419
Q

obstetric cholestasis

A

30-36 weeks of preg
pruritis of palms and soles
assoc with UTIs
risk of foetus prematurity
raised transaminases and bile acids

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420
Q

contraindications to liver transplant

A

untreated HIV
irreversible pulmonary disease
ongoing alcohol abuse
extra-hepatic malignancy

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421
Q

Crohn’s like enterocolitis

A

mmf adverse effect

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422
Q

contraindications for liver biopsy

A

increased INR >1.5
thrombocytopaenia <50
severe ascites
difficult body habitus
haemangiomas
echinococcus

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423
Q

Menkes disease

A

X linked recessive
ATP7A gene
copper deficiency

failure to thrive, seizures, hypotonia, neuro dys

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424
Q

Dubin johnson syndrome

A

AR
defective secretion of conjugated
high direct bili
dark granular pigments on liver biopsy

rotor same but biopsy n

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425
Q

criggler najar syndrome

A

familial unconjugated hyperbili
T1 - birth
2 - later

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426
Q

GIT polyps with highest malignancy potential

A

adenomas
serrated
villous

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427
Q

GAVE - gastric antral valvular ectasia

A

watermelon stomach
bleeds
RFA at endoscopy

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428
Q

UC indications for colectomy

A

stool >8x
colon diameter >5.5
CRP >45

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429
Q

systemic sclerosis diarrhoea

A

SIBO
E coli and bacteroides

vit B12 def

metro and cipro

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430
Q

acquired factor 8 def

A

phenytoin
penicillin
sulfa drugs
pregnancy
diabetes
psoriasis
SLE
MG
MS

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431
Q

drug causes of chronic hepatitis

A

ketoconazole
methyldopa
nitrofurantoin
isoniazid

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432
Q

which hep C genotype most difficult to treat

A

3

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433
Q

MALT

A

paraprotein and pseudohypoproteinemia

origin from B cells

eradicate with H pylori tx

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434
Q

liver drug SEs

A

1) Cholestatis liver injury - Chlorpromazine, Azathiprine, Captopril,
Cyclosporine, Penicillamine, Erythromycin, COCP, Flucloxacillin

2) Hepatitis picture : Paracetamol, Phenytoin, Ethanol, Rifampicin,
Allopurinol, Isoniazid

3) Mixed cholestasis / hepatitis : Co-Amoxiclav, Sulphonamides,
Sulfasalazine, Carbamazepine

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435
Q

Turcot syndrome

A

polyps and 1y brain tumour

HNPCC - glioblastoma

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436
Q

target cells

A

sickle cell
thalassaemia
IDA
hyposplenism
liver disease

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437
Q

tear drop poikilocytes

A

myelofibrosis

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438
Q

spherocytes

A

HS
AIHA

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439
Q

basophilic stippling

A

lead poisoning
thalassaemia
sideroblastic anaemia
myelodysplasia

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440
Q

schistocytes

A

cold AIHA
mechanical heart valve
DIC

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441
Q

pencil poikilocytes

A

IDA

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442
Q

burr cells

A

uraemia
pyruvate kinase deficiency

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443
Q

acanthocytes

A

abetalipoproteinemia

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444
Q

HSMNs

A

megaloblastic anaemia

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445
Q

irradiated blood products

A

depletion of T lymphocytes and used avoid transfusion-associated gvhd

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446
Q

breast cancer gene mutation

A

p53

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447
Q

Burkitt lymphoma

A

c-myc translocation
EBV - african form

starry sky appearance - lymphocyte sheets interspersed with macrophages containing dead apoptotic tumour cells

rasburicase

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448
Q

tumour lysis syndrome

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure

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449
Q

commonest UK cancers

A

breast > lung > colorectal > prostate > bladder

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450
Q

indications for CLL tx

A
  • Progressive marrow failure - development or worsening of
    anaemia and/or thrombocytopenia
  • Massive >10 cm or progressive lymphadenopathy
  • Massie > 6 cm or progressive splenomegaly
  • Progressive lymphocytosis : >50 % increase over 2 months or
    lymphocyte doubling time < 6 months
  • Systemic symptoms - weight loss >10 % in last 6 months,
    extreme fatigue, fever > 38 degree for > 2 weeks, night sweat
  • Autoimmune cytopenia - ITP
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451
Q

CLL mx

A

FCR
ibrutinib

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452
Q

cyclophosphamide

A

MOA : causes cross linking in DNA

Adverse effects : hemorrhagic cystitis, myelosuppression,
transitional cell carcinoma

Hemorrhagic cystitis - treated with Mesna and hydration;
cyclophosphamide toxic metabolite —> Acrolein which can cause
damage to urothelium; treatment with Mesna removes the Acrolein

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453
Q

bleomycin

A

degrades preformed DNA - lung fibrosis (lower zone)

  • Anthracyclines Doxorubicin - stabilises DNA-topoisomerase II
    complex which inhibits DNA & RNA synthesis
    Adverse : Cardiomyopathy
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454
Q

antimetabolites

A
  • Methotrexate : inhibits dihydrofolate reductase and thymidylate
    synthesis; Adverse - myelosuppression, mucositis, liver fibrosis,
    lung fibrosis lower zones
  • 5-Flurorouracil : Pyrimidine analogues inducing cell cycle arrest
    and apoptosis by blocking thymidylate synthase (works during S
    phase) ; adverse - myelosuppression, mucositis, dermatitis
  • 6-Mercaptopurine : purine analogue activated by HGPRTase
    decreasing purine synthesis; adverse - myelosuppression
  • Cytarabine : Pyrimidine antagonist - interferes with DNA synthesis
    at S phase and inhibits DNA polymerase
    Adverse - myelosuppression, ataxia
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455
Q

acts on microtubules

A
  • Vincristine, Vinblastine : inhibits formation of microtubules;
    Adverse - Vincristine —> Peripheral neuropathy ( reversible ),
    paralytic ileus
    Adverse - Vinblastine —>. Myelosuppression
  • Docetaxel - prevents microtubule depolymerisation &
    disassembly decrease free tubulin; adverse - neutropenia
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456
Q

topoisomerase inhibitors

A

Irinotecan : inhibits topoisomerase I which prevents relaxation of
supercoiled DNA - adverse : myelosuppression

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457
Q

other cytotoxics

A

Cisplatin - causes cross linking of DNA (MOA similar to
cyclophosphamide); adverse - ototoxicity, peripheral neuropathy,
hypomagnesemia
* Hydroxyura (hydroxycarbamide) - inhibits ribonucleotide
reductase, decreasing DNA synthesis; adverse -
myelosuppression

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458
Q

drug causes of pancytopaenia

A

cytotoxics
antibiotics - trimethoprim, chloramphenicol
anti-rheumatoid drugs - gold, penicillamine
carbimazole - agranulocytosis
anti-epileptics - carbamaz
sulphonylureas - tolbutamide

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459
Q

Fanconi anaemia

A
  • Autosomal recessive
  • Haematological - aplastic anaemia, increased risk of AML
  • Neurological
  • Skeletal : short stature, thumb/radius abnormalities
  • Cafe au lait spots
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460
Q

haematological malignancy genetics

A
  • t(9;22) - Philadelphia Chromosome
  • > 95% of patients with CML
  • ABL proto-oncogene fusion with BCR gene n chromosome 22
  • BCR-ABL fusion gene - fusion protein which has excessive
    tyrosine kinase activity
  • Poor prognostic factor in ALL
  • t (15 ; 17)
  • Seen in acute promyelocytic leukaemia AML-M3 subtype
  • Fusion of PML and RAR-alpha genes
  • t ( 8 ; 14 )
  • Burkitt’s lymphoma
  • MYC oncogene translocated into an immunoglobulin gene
  • t ( 11 ; 14 )
  • Mantle cell lymphoma
  • Deregulation of cyclin D1 (BCL-1) gene
  • t (14 ; 18)
  • Follicular lymphoma
  • Increased BCL-2 transcription
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461
Q

hereditary angioedema

A

AD

low C1INH during attack
low C2 and C4 levels during and between attacks

serum C4 - screening tool

mx
IV C1 inhibitor conc, FFP
danazol

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462
Q

histological classification of hodgkins

A
  • Nodular sclerosing : most common ~70%, good prognosis;
    associated with lacunar cells, F > M
  • Mixed cellularity : ~20%, good prognosis, associated wit high
    number of RS cells
  • Lymphocyte predominant : ~5% of total cases, BEST prognosis
  • Lymphocyte depleted - rare, WORST prognosis]

NC anaemia
eosinophilia (IL5)
raised LDH
RS - multinucleated or bilobed nucleus with prominent eosinophilic inclusion like nucleoli

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463
Q

Ann arbor staging

A
  • Stage I : single lymph node
  • Stage II : 2 or more lymph nodes / regions on same side of
    diaphragm
  • Stage III : nodes on both sides of diaphragm
  • Stage IV : spread beyond lymph nodes

Each stage divided into A or B -
* A = no systemic symptoms other than pruritus
* B = weight loss > 10% in 6 months / night sweats / fever > 38

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464
Q

chemo for Hodgkins

A

1) ABVD - Doxorubicin, Bleomycin, Vinblastine, Dacarbazine
2) BEACOPP - Bleomycin, Etoposide, Doxorubicin,
Cyclophosphamide, Vincristine, Procarbazine, Prednisone

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465
Q

methaemoglobinaemia

A

Congenital causes -
1) hemoglobin variants - HbH, HbM
2) NADH Methaemoglobin reductase deficiency

Acquired causes -
1) Drugs - Sulphonamides, Nitrates, Dapsone, Sodium
nitroprusside, Primaquine
2) Chemicals - aniline dyes

Aniline dyes - bladder cancer
Primaquine - G6PD

Features of Methaemoglobinemia -
1) chocolate cyanosis
2) Dyspnoea
3) Headache
4) Anxiety
5) Severe forms - acidosis, arrhythmia, seizures, coma
6) Normal pO2 but decreased oxygen saturations

Management :
- Enzyme deficiency of NADH Methaemoglobin reductase —>
ascorbic acid
- IV Methylthionium chloride (Methylene blue) for acquired
causes

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466
Q

causes of normocytic anaemia

A

chronic disease
CKD
aplastic anaemia
hyltic anaemia
blood loss

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467
Q

contra indications to platelet transfusion

A

chronic bm failure
autoimmune thrombocytopaenia
HIT
TTP

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468
Q

tx of PRV

A

aspirin
venesection
hydroxyurea and phosph-32
ruxolitinib

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469
Q

PCT tx

A

chloroquine

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470
Q

chronic granulomatous disease (neutrophils)

A

lack of NADPH oxidase reduces ability of phagocytes to produce ROS
recurrent pneumonias and abscess - S aureus and fungi
negative nitroblue-tetrazolium test
abnormal dihydrorhodamine flow cytometry test

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471
Q

Chediak higashi syndrome (neutrophils)

A

microtubule polymerisation effect -> decrease in phagocytosis
albinism and peripheral neuropathy
recurrent bacterial infections
giant granules in neutrophils and platelets

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472
Q

leukocyte adhesion deficiency (neutrophils)

A
  • defect of LFA-1 integrin (CD18) protein on neutrophils
  • Recurrent bacterial infections
  • Delay in umbilical cord sloughing may be seen
  • Absence of neutrophils/pus at sites of infection
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473
Q

common variable immunodeficiency (B cells)

A
  • low antibody levels - IgG, IgM, IgA
  • Recurrent chest infections
  • Can predispose to autoimmune disorders and lymphoma
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474
Q

Bruton’s congenital agammaglobulinaemia (B cells)

A
  • X-linked recessive
  • Defect in Burton’s tyrosine kinase (BTK) gene that causes severe
    block in B cell development
  • Recurrent chest infections
  • Absence of B cells with reduced immunoglobulins of all classes
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475
Q

selective IgA def (B cells)

A
  • maturation defect in B cells
  • Most common primary antibody deficiency
  • Recurrent sinus and throat infections
  • A/W coeliac disease and may cause false negative coeliac
    antibody screen
  • Sever transfusion reactions may occur due to anti-IgA antibodies
    —> anaphylaxis
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476
Q

Di George syndrome (T cells)

A
  • 22q11.2 deletion
  • Failure to develop 3rd and 4th pharyngeal pouches
  • C/F : congenital heart disease (TOF), learning difficulties,
    hypocalcemia, recurrent viral/fungal diseases, cleft palate
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477
Q

combined B and T cell disorders

A

1) Severe combined immunodeficiency
- X-linked defect due to defect in common gamma chain
- Common gamma chain : protein used in the receptor for IL-2 and
other interleukins
- Other causes : adenosine deaminase deficiency
- Recurrent bacterial, viral and fungal infections
- Reduced T cell receptor excision circle

2) Ataxic telangiectasia
- defect in DNA repair enzymes
- Autosomal recessive
- C/F : cerebellar ataxia, telangiectasia, recurrent chest infections
- 10% risk of developing leukaemia or lymphoma

3) Wiskott-Aldrich syndromes
- defect in WASP gene
- X linked recessive
- C/F : recurrent bacterial infections, eczema, thrombocytopenia
- Low IgM levels
- Increased risk of autoimmune disorders and malignancy

4) Hyper IgM syndromes
- mutations in CD40 gene
- Infections - Pneumocystic pneumonia
- Hepatitis
- Diarrhoea

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478
Q

AML

A

BM failure and thrombocytopaenia
accumulation/rapid proliferation of poorly differentiated myeloblasts in blood

anaemia, low WBC (infections, fever, lymphaden), thrombocytopaenia, hepatosplenomegaly, organ infiltration (spleen)

  • FBC - anaemia, macrocytosis, leukocytosis, neutropenia,
    thrombocytopenia
  • Peripheral smear - Auer rods, blasts
  • Increased uric acid, increased LDH
  • BM - hyper cellular bone marrow

Mx - cytarabine, idarubicin/daunorubicin
hydroxycarbamide, allopurinol, rasburicase

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479
Q

pancytopenia, liver
dysfunction, diarrhoea, rash after transfusion

A

GVHD

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480
Q

hairy cell leukemia

A

activating point mutation of BRAF
isoform of RAF (BRAF V600E) has been implicated in the
pathogenesis.
Hairy cell leukaemia expresses CD103.
HCL - can also express range of B cell markers - CD19, CD20,
CD22, CD25.

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481
Q

phases of trials

A

Phase I trial - pharmacokinetics, human toxicity of the drug
Phase II - to study optimal dosing, common adverse effects,
activity of drug, efficacy of drug against disease
Phase III - to compare new drug with conventional therapy
Phase IV - determines long term toxicity of the drug

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482
Q

mx of vwd

A
  • Tranexamic acid for mild bleeding
  • Desmopressin (DDAVP) - raises levels of vWF by inducing release
    of vWF from Weibel-Palade bodies in endothelial cells
  • Factor VIII concentrate
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483
Q

sickle crises

A

1) Thrombotic / vaso-occlusive / painful crises
* Precipitated by infection, dehydration, deoxygenation
* Infarcts occur in vaious organs including the bones (e.g.
avascular necrosis of hip, hand-foot syndrome in children, lungs,
spleen, brain).

2) Acute Chest syndrome
* Vase-occlusion within the pulmonary vasculature —> infarction in
lung parenchyma
* C/F : dyspnea, chest pain, pulmonary infiltrates on CXR, low PO2
* Mx - pain relief, oxygen therapy, antibiotics, transfusion which
improves oxygenation
-» most common cause of death after childhood

3) Aplastic crises
* Caused by sudden infection with Parvovirus B19
* Sudden fall in Hemoglobin
* Bone marrow suppression - reduced reticulocyte count

4) Sequestration crises
* Sickling within organs like spleen or lungs causes pooling of
blood and worsening of anaemia
* Increased reticulocyte count

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484
Q

commonest tumour in anterior mediastinum

A

thymoma

MG
red cell aplasia
dermatomyositis
SLE
SIADH

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485
Q

Waldenstrom’s macroglobulinaemia

A
  • Lymphoplasmacytoid malignancy characterised by secretion of
    monoclonal IgM paraprotein

(1)Systemic upset - weight loss, lethargy
(2)Hyperviscosiy syndrome - visual disturbance -
pentameric configuration og IgM increases serum
viscosity
(3)Hepatosplenomegaly
(4)Lymphadenopathy
(5)Cryoglobulinemia - Raynaud’s

  • Investigations - Monoclonal IgM paraproteinemia
  • BM biopsy —> diagnostic : infiltration of BM with
    lymphoplasmacytoid lymphoid cells
  • Mx : rituximab-based combination chemotherapy
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486
Q

maethaemoglobinaemia

A

metabolic acidosis due to lactic acid build-up due to tissue hypoxia

chocolate cyanosis

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487
Q

TTP

A
  • Abnormally large and sticky multimers of vWF causes platelets
    clumping in blood vessels
  • TTP - deficiency of ADAMTS13 which breakdown the large vWF
  1. Typically adult females
  2. Fever
  3. Fluctuating neurological signs due to micro emboli
  4. Microangiopathic haemolytic anaemia
  5. Thrombocytopenia
  6. Renal failure
  • Causes -
    (a)Post infection - urinary, gastrointestinal
    (b)Pregnancy
    (c)Drugs - cyclosporin, Cop, clopidogrel, aciclovir
    (d)Tumour
    (e)SLE
    (f) HIV
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488
Q

AIHA

A
  • Warm AIHA - antibody titre is usually IgG - extravascular
    hemolysis
  • Causes of Warm AIHA -
    1) idiopathic
    2) autoimmune disease - SLE
    3) neoplasia - lymphoma, CLL
    4) drugs - methyldopa
  • Cold AIHA - IgM - hemolysis at 4 degree; intravascular
    hemolysis; can have symptoms of Raynaud’s and acrocyanosis.
  • Causes :
  • Neoplasia : lymphoma
  • Infections, Mycoplasma, EBV
  • SLE and lymphoma : mixed warm-cold hemolytic anaemia
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489
Q

gram positive coagulase negative

A

staph epidermidis

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490
Q

haemolytic anaemia associated with mycoplasma

A

therapeutic plasmapheresis

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491
Q

duffy blood group antigen alleles

A

Fya and Fay

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492
Q

microcytic anaemia with
disproportionate MCH and MCV. Also associated with increase iron
and increased ferritin and increased TIBC.

A

BTT

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493
Q

Prolonged APTT = factor VIII deficiency —>

A

intrinsic

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494
Q

Factor VII deficiency = prolonged PT —>

A

extrinsic

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495
Q

Factor X deficiency

A

= prolonged PT and APTT

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496
Q

blood films

A

1) hyposplenism - post splenectomy, coeliac disease
a) Target cells
b) Howell Jolly bodies
c) Pappernheimer bodies
d) Sideritic granules
e) Acanthocytes

2) Iron deficiency Anaemia
A.Target cells
B.Pencil poikilocytes
C.Combined with B12 / folate —> mixed microcytic +
microcytic picture

3) Myelofibrosis - tear drop poikilocytes

4) intra vascular hemolysis - schistocytes

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497
Q

malignancies and associated infections

A

1) EBV - Hodgkin’s lymphoma, Burkkitt’s lymphoma,
Nasopharyngeal carcinoma
2) HTLV-1 : Adult T cell leukaemia/lymphoma
3) HIV-1 : High grade B cell lymphoma
4) H.pylori : MALT
5) Malaria : Burkitss’s lymphoma

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498
Q

leukemioid reaction

A
  • high leukocyte alkaline phosphatase score
  • Dohle bodies - toxic granulations in white cells
  • Left shift of neutrophils = three or fewer segments of nucleus
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499
Q

TACO vs TRALI

A

TA circulatory overload —> hypertension
TA acute lung injury —> hypotension

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500
Q

alteplase moa

A

tPA
reversal - FFP + IV TXA

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501
Q

CLL mx

A

FCR
ibrutinib
venetoclax

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502
Q

t9:22

A

philadelphia
good prog in CML
poor in AML/ALL

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503
Q

AT3 deficiency

A

AD
* Inhibits several clotting factors - thrombin, factor X, factor IX.
* It mediates the effect of heparin
* Heparin works by binding to antithrombin III - enhancing
anticoagulant effect of heparin by inhibiting formation of thrombin
and other clotting factors.
* C/F - recurrent venous thromboses
* Mx - lifelong warfarin, heparin during pregnancy, antithrombin III
concentrates during surgery or childbirth

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504
Q

where is BRCA2

A

chr 13

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505
Q

other useful mutations

A

ALK gene mutation - adenocarcinoma of lung; found on
chromosome 2
C-KIT mutation - GIST and AML; chromosome 4
EFGR mutation - renal cell carcinoma, non small cell lung
carcinoma; EFGR gene on chromosome 7
KRAS mutation - pancreatic cancer, chr 12

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506
Q

CALR

A

calreticulin
essential thrombocytosis

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507
Q

universal donor of FFP

A

AB RhD -ve

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508
Q

CA125

A

ovarian
primary peritoneal

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509
Q

sideroblastic anaemia

A
  • Delta aminolevulinate synthase 2 deficiency
  • Acquired causes -
    A.Myelodysplasia
    B.Alcohol
    C.Lead
    D.Anti TB medications
  • Investigations :
    (1)FBC - hypo chromic microcytic anaemia
    (2)Iron studies - high ferritin, high iron, high transferrin
    saturation
    (3)Blood film - basophilic stippling of red cells
    (4)Bone marrow - Prussian blue stain will show ringed sideroblasts
  • Management - supportive, Pyridoxine may help
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510
Q

Wald v MM

A

Waldenstrom’s macroglobulinaemia - Organomegaly with no
bone lesions
Multiple myeloma - Bone lesions with no organomegaly

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511
Q

aprepitant

A

anti-emetic NK1 receptor

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512
Q

bladder ca aromatic amines

A

benzidine and beta naphthylamine

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513
Q

Perl’s stain

A

ring sideroblasts

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514
Q

most common HL

A

nodular sclerosing

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515
Q

ALL prognosis

A

Good Prognosis -
1) FAB L1 type
2) Common ALL
3) pre-B phenotype
4) Low initial WBC
5) Del (9p)
6) Trisomy 4, 7 and 10
7) Hyper diploidy
8) t(12;21) - also known as TEL-AML1 fusion protein
9) Translocation (1;19)

Poor prognosis -
1. Hypodiploidy
2. FAB L3 type
3. T or B cell surface markers
4. Philadelphia translocation t(9;22)
5. Age < 2 years or > 10 years
6. Male sex
7. CNS involvement
8. High initial WBC >100,000
9. Non caucasian

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516
Q

testicular teratoma markers

A

AFP and bHCG

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517
Q

least likely ca to be inherited

A

gastric

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518
Q

most common bleeding disorder

A

VWD

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519
Q

most common hypercoag state

A

Factor V Leiden

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520
Q

Burkitts transloc

A

8:14

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521
Q

aflatoxin

A

HCC

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522
Q

nitrosamine

A

gastric and oesophageal ca

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523
Q

arsenic

A

lung and liver angiosarcoma

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524
Q

benzene

A

leukaemia

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525
Q

chromosome assocs

A
  • chromosome 4 = Huntington’s disease, PKD
  • Chromosome 8 = gamma globin genes in foetal HB synthesis
  • Chromosome 12 = Rett syndrome, bladder cancer
  • Chromosome 16 = alpha thalassemia, alpha globulin genes
  • Chromosome 20 = Creutzfeldt Jacob disease, Niemann Pick
    disease type C
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526
Q

tumour markers

A
  • CA 125 —> ovarian cancer
  • CA 19-9 —> pancreatic cancer
  • CA 15-3 —> breast cancer
  • PSA —> prostate cancer
  • AFP —> HCC, teratoma testicular
  • CEA —> colorectal cancer
  • S-100 —> melanoma, schwannoma
  • Bombesin —> Small cell lung carcinoma, gastric carcinoma,
    neuroblastoma
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527
Q

staging and prognosis of mm

A

beta 2 microglobulin

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528
Q

HIT

A
  • Caused by IgG antibodies that recognise multi molecular
    complexes of platelet factor 4 and heparin.
  • Received heparin within 100 days - at risk of fall in platelets.
  • DVT, PE, Major limb artery thrombosis, Stroke, MI, B/L adrenal
    hemorrhagic necrosis can occur
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529
Q

rasburicase

A

uric acid oxidation - it is an enzyme that breaks
down uric acid.
Urine testing for patients on Rasburicase - falsely elevated uric
acid levels - transport sample on ice cube to freeze action

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530
Q

febrile reaction due to

A

donor neutrophils

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531
Q

Cabot rings

A

megaloblastic anaemia, haemolytic anaemia, lead poisoning

Heinz bodies - haemolytic anaemia

Pappenheimer bodies - haemolytic anemia, sideroblastic anaemia, sickle cell disease

Russell bodies - Ig containing inclusion bodies found in plasma cells

Howell Jolly bodies - basophilic nuclear remnants in circulating RBCs

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532
Q

phases and drugs

A

S phase drug : MTX, 5-FU
G2 phase : Bleomycin
M phase : Docetaxel
G1 phase : Etoposide

vincristine - meta

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533
Q

aplastic anaemia

A

If a suitable HLA donor i.e., sibling present —> anti-thymocyte globulin is preferred treatment

If no mention of suitable donor —> haematopoietic stem cell
transplant

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534
Q

positive acute phase reactants

A

TNFa
IL6
ferritin

negative - albumin

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535
Q

protein C deficiency

A
  • Acts to inactivate forms of pro-coagulant factors Va and VIIIa
  • Deficiency of protein C causes increased risk of venous
    thromboses.
  • Protein C —> vitamin K dependent serine protease
  • Thrombin activate protein C when bound to thrombomodulin.
  • Skin necrosis on administration of warfarin occurs
  • Autosomal codominant condition
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536
Q

mycosis fungoides

A
  • Indolent lymphoma of mature T-cells predominantly involving skin
  • Patient has circulating abnormal T cells called Sezary cells
  • Sezary cells + erythroderma = Sezary syndrome
  • Sezary syndrome —> severe pruritic, psoriasis like lesions.
  • Mx : Chemo
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537
Q

nephrotic syndroem

A

protein S deficiency

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538
Q

gross splenomegaly

A

= CML & Myelofibrosis.
In CML —> white cell count > 100,000.
Myelofibrosis —> WCC mildly raised
leucoerythroblastic blood picture with teardrop cells
typical of diagnosis of myelofibrosis

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539
Q

Neurofibromatosis type 2 chromosome 22q12.2

A

B/L acoustic neuroma
juvenile posterior sub capsular lenticular opacities

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540
Q

risk of relapse in AML

A

most important prognostic marker is bone marrow karyotype

Low risk of relapse - t(8;21) or chromosome 16 inversion
High risk of relapse - deletion of chromosome 5 or 7

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541
Q

breakdown times of cells

A

RBC 120 days
Neutrophils 5.4 days
Platelets 8-9 days

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542
Q

alpha thalassaemia

A
  • Pallor
  • Jaundice
  • Haemolytic anaemia
  • Hepatosplenomegaly
  • Frontal bossing of skull
  • Dysrythmas
  • Cardiac failure - myocardial siderosis
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543
Q

abs of paraneoplastic syndromes

A

1) Anti Yo antibodies - ovarian and breast Paraneoplastic cerebellar
degeneration
Paraneoplastic cerebellar degeneration occurs when tumor cells
express proteins that are normally expressed in cerebellum
triggering autoimmune reaction : dysarthria, ataxia, nystagmus.

2) Anti Hu antibodies - small cell lung cancer

3) Anti Ro antibodies - associated with SLE and neonatal heart block

4) Anti-Tr antibodies - Hodgkins lymphoma

5) Anti-Zic4 - small cell lung cancer

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544
Q

colorectal ca FOLFOX

A
  • Folinic Acid, Flurouracil & Oxiplatin
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545
Q

lytic lesions of MM

A

Low intensity on T1 weighted fission MRI
High intensity on T2 weighted diffusion MRI

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546
Q

hypernephroma

A
  • clear cell or renal adenocarcinoma
  • Hematogenous spread to bone causes lytic lesions and
    hypercalcemia
  • Classic train : hematuria + loin pain + abdominal mass
  • Other C/F : night sweats, left varicocele due to compression of
    renal vein
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547
Q

warfarin and protein C and S

A

vit K dependent, one month off warfarin before screen

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548
Q

cisplatin SEs

A

Ototoxicity, Nephrotoxicity,
Neurotoxicity, Hypomagnesemia, Hypokaleia, Hypocalcemia

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549
Q

cisplatin moa

A

promotes cross-linking to form DNA adducts —>
leads to promotion of intra-cellular signalling via pathways such as
p53, p73, and MAP kinase leading to increased cellular apoptosis

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550
Q

T315KD

A

ponatinib

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551
Q

important syndromes

A

1) Felty’s syndrome - neutropenia + chronic arthritis +
splenomegaly
2) Curran syndrome - association of kidney, hand and foot
abnormalities
3) Di George syndrome - genetic disorder - heart defects, learning
difficulties, cleft palate and thymus anomalies
4) Kostmann syndrome - severe congenital neutropenia
5) De Grouchy syndrome - 18q deletion syndrome, problems from
childbirth

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552
Q

meds for specific ca

A

Imatnib for GIST —> inhibition of c-kit
Imatinib for CML —> inhibition of tyrosine kinase
B-raf inhibitor —> malignant melanoma - Vemurafenib
PDGFR alpha inhibitor —> also tyrosine kinase inhibitor of imatinib

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553
Q

aplastic anaemia

A

Pancytopenia with hypo cellular bone marrow in the absence of
an abnormal infiltrate or marrow fibrosis

  • Congenital causes - Fanconi anaemia, Dyskeratosis congenita,
    Reticular dysgenesis
  • Acquired causes :
    1. Cytotoxic drugs and cancer treatment
    2. Drugs - anti epileptics ( Carbamazepine, Phenytoin),
    antibiotics ( Sulphonamides, Chloramphenicol), NSAID,
    Gold
    3. Virus - Parvovirus B19, HIV, Hepatitis
    4. PNH, Myelodysplastic syndrome
  • Fanconi anaemia : autosomal recessive or X-linked; mutations
    in genes that code for nuclear complex involved in DNA damage
    response
  • GATA2 deficiency : dysfunction in zinc finger transcription
    factors involved in hematopoiesis; cytopenia, myelodysplastic
    syndromes, acute leukaemia, infection, immunodeficiency,
    lymphoedema.

Clinical Features
- recurrent infections
- Fatigue
- Pallor
- Bleeding
- Easy bruising
- Tachycardia
- Dyspnoea
- Fanconi anaemia : hearing loss, pigmentation abnormalities,
urogenital abnormalities

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554
Q

MEN2a

A

Medullary thyroid cancer + pheochromocytoma +
primary hyperparathyroidism

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555
Q

MEN2b

A

Medullary thyroid cancer + Pheochromocytoma +
Marfaboid habitus + mucosal/digestive neurofibromatosis

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556
Q

RET proto-oncogene

A
  • Found on chromosome 10
  • Codes for receptor Tyrosine kinase
  • Loss of function mutations associated with Hirschsprung’s
    disease
  • Gain of function mutations associated with MEN-2 and medullary
    thyroid carcinoma
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557
Q

nephrogenic DI sickle

A

cell trait or disease

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558
Q

AIP kidneys

A

SIADH

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559
Q

ITP severe

A

Severe ITP —> platelets less than 30,000 : treat with IV
Immunoglobulins IVIG
IVIG&raquo_space; Methylprednisolone — if patient is diabetic and has
uncontrolled blood sugars
No IVIG in options —> choose Methylprednisolone

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560
Q

protein C deficiency test

A

copperhead snake venom

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561
Q

chemo for SCLC

A

cisplatin and etoposide

or carboplatin

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562
Q

absence seizures

A

3Hz spike and wave pattern
sodium valproate and ethosuximide

563
Q

extensor plantars

A

UMN

564
Q

absent ankle jerk

A

LMN

565
Q

ataxia telangectasia

A

AR
ATM gene
most common inherited combined immunodeficiency

cerebellar ataxia
telangiectasia - spider angiomas
IgA deficiency -> recurrent chest infections
10% risk of malignancy or blood ca

566
Q

causes of autonomic neuropathy

A
  • Diabetes
  • GBS
  • Multisystem atrophy (MSA)
  • Shy Drager syndrome
  • Parkinsons’s
  • Infections - HIV, Chagas disease, neurosyphilis
  • Drugs - anti hypertensives, TCA
  • Craniopharyngioma
567
Q

benign rolandic epilepsy

A
  • Form of childhood epilepsy that typically occurs between 4-12
    years

Features :
* Seizures occur mostly at nights
* Typically partial seizures [paraesthesia affecting face]
* Secondary generalisation of seizures may occur
* EEG - centretemporal spikes
* Seizures stop by adolescence

568
Q

parietal lobe lesions

A

sensory inattention
apraxia
astereognosis
inf hom quadr
Gerstmanns - alexia, acalculia, finger agnosia and R-L disorientation

569
Q

occipital lobe lesions

A

HH with mac spar
cortical blindness
visual agnosia

570
Q

temporal lobe lesions

A
  • Wernicke’s aphasia - word substitution, neologism, speech fluent
  • Superior homonymous quadrantanopia
  • Auditory agnosia
  • Prospoagnosia = difficulty recognising faces
571
Q

frontal lobe lesions

A
  • Broca’s apahsia
  • Disinhibits
  • Perseveration = repetition of articular process such as word,
    phrase regardless of absence or cessation of stimulus
  • Anosmia
  • Inability to generate list
572
Q

cerebellum lesions

A
  • Midline lesions - gait and truncal ataxia
  • Hemisphere lesion - intention tremor, past pointing,
    dysdiadokinesis, nystagmus
573
Q

where do Wernicke and Korsakoff syndrome affect

A

medial thalamus and mamillary bodies of the hypothalamus

574
Q

which area causes hemiballismus

A

sub thalamic nuclei of BG

575
Q

Huntingtons chorea affected region

A

striate (caudate nucleus) of BG

576
Q

Kluver bucy syndrome

A

amygdala
hypersexuality, hyperorality, hyperphagia, visual agnosia

577
Q

CADASIL

A

AD
NOTCH3 mutation on chr 19
migraines + strokes + dementia

578
Q

hyponatraemia with carbamazepine

A

SIADH

579
Q

raised lymphocytes in CSF

A
  • viral meningitis/encephalitis
  • TB meningitis
  • Lyme disease
  • Behcets disease
  • SLE
  • Lymphoma
  • Leukaemia
580
Q

raised protein in CSF

A
  • GBS
  • TB meningits
  • Bacterial meningits
  • Viral meningitis
  • Groin’s syndrome - increase CSF protein below a spinal canal
    blockage like tumor, disc, infection
581
Q

cervical spondylitic myelopathy

A

motor weakness
sensory loss
bladder/bowel dysfunction
neck pain
wide ataxic spastic gait
UMN weakness in LL - hyper-reflexia, hypertonia, upgoing plantars

582
Q

drug causes of peripheral neuropathy

A

Amiodarone
- Isoniazid
- Vincristine
- Nitrofurantoin
- Metronidazole

583
Q

DVLA rules

A

epilepsy/seizures
- first one, 6 months
- established multiple - free for 12 mo
- none for 5 years - license back
- no driving for 6 months after last dose of AED

syncope
- single, explained - 4 weeks
- unexplained - 6 months
- 2 or more - 12 months

stroke/TIA
- 1 month off
- multiple -> 3 months
- craniotomy - 1 year
- pituitary tumour - 6 months
chronic -> inform dvla

584
Q

dystrophinopathies

A

XLR

mutation in gene encoding dystrophin on xp21
- protein which connects muscle membrane to actin

DMD - frameshift mutation causing one or both binding sites to be lost
- 5 years onwards

Beckers - non frameshift, milder, 10 years onwards

585
Q

infantile spasms

A

vigabatrin and steroids

586
Q

lennox-gastaut syndrome

A

extension of infantile spasms
atypical absences, falls, seizures
EEG - slow spike
ketogenic diet

587
Q

JME/Janz syndrome

A

teenage, F>M
infrequent generalised seizures following sleep deprivation
valproate (levetirac)

588
Q

pregnancy and epilepsy

A

lamotrigine - ?dose increase
monotherapy

  • Sodium valproate : associated with neural tube defects
  • Phenytoin : associated with cleft palate, give vit K
589
Q

GTCS mx

A

valproate - m
leve/lamot - f

590
Q

focal seizures

A

lamotrigine
carbamazepine

591
Q

carbamazepine exacerbates

A

absence seizures

592
Q

moa of ethosuximide

A

blocks T type Ca channels in thalamic neurons

593
Q

BL facial nerve palsy causes

A

sarcoid
GBS
Lyme
BL acoustic neuromas

594
Q

UL facial palsy

A

LMN - Bell’s palsy, Ramsay hunt syndrome, Acoustic neuroma, HIV, Parotid tumor, MS, DM
LMN - affects all facial muscles

UMN u/l facial palsy - Stroke.
UMN lesion - - spares upper face

595
Q

foot drop and weakness of hip abduction radiculopathy

A

L5

596
Q

Friedrich’s ataxia

A

most common cause of early onset hereditary ataxias
AR - TNR disorder - GAA on X25 on chr9 (frataxin)

Clinical features :
* Absent ankle jerks / extensor planters
* Cerebellar ataxia
* Optic atrophy
* Spinocerebellar tract degeneration
* HOCM - most common cause of death
* High arched palate
* Diabetes mellitus
* Kyphoscolisos

597
Q

GBS cross reaction of

A

abs with gangliosides in the PNS
correlation between the anti-GM1 and clin features

598
Q

LP in GBS

A

increase in protein with normal WBC

599
Q

NCS in GBS

A

decreased velocity, prolonged distal motor latency, increased F wave latency

600
Q

Miller Fisher syndrome

A
  • variant of GBS
  • Ass. With - ophthalmoplegia, areflexia, and ataxia
  • Descending paralysis
  • anti-GQ1b antibodies are present in 90% of cases
601
Q

GBS mx

A

IVIG or PExc

602
Q

poor prognostic factors in GBS

A
  • age > 40 years
  • Poor upper extremity muscle strength
  • Previous history of diarrhoea illness
  • High anti-GM1 titre
  • Need for ventilatory support
603
Q

HSMN1 genetics

A

AD
PMP22 gene - myelin
motor dx
wasting of distal muscles, pes cavus, clawed toes
foot drop and leg weakness

604
Q

Huntingtons genetics

A

AD
TNR disorder - CAG repeat
chr4

605
Q

lateral medullary syndrome - PICA

A

cerebellar features - ataxia, nystagmus

brainstem - ipsilateral -> dysphagia, facial numbness, CN palsy

brainstem - contralateral -> limb sensory loss

606
Q

MND mx

A

Management :
- Riluzole - prevents stimulation of glutamate receptors, main use
in ALS, prolongs life by about 3 months
- Respiratory care - BiPAP - prolongs life around 7 months
- Nutrition - Percutaneous gastrostomy tube

607
Q

familial ALS

A

chr 21
superoxide dismutase

608
Q

natalizumab

A
  • recombinant monoclonal antibody;
  • antagonist to alpha -4 beta - 1 integrin found on surface of
    leucocytes
  • Inhibits migration of leucocytes across the endothelium and
    into the BBB
  • Given IV
609
Q

ocrelizumab

A

antiCD20

610
Q

fingolimod

A

Sphingosine 1 phosphate receptor modulator,
ORAL administration; MOA : prevents lymphocytes from leaving
lymph nodes

611
Q

glatiramer acetate

A

immune decoy in MS

612
Q

drugs exacerbating MG

A
  • penicillamine
  • Quinidine
  • Procaiamide
  • Beta blockers
  • Lithium
  • Phenytoin
  • Antibiotics - gentamicin, macrocodes, quinolones, tetracycline
613
Q

myotonic dystrophy

A
  • Autosomal dominant, trinucleotide repeat disorder
  • Two main types - DM1 and DM2
  • DM1 : CTG repeat at end of DMPK gene - chromosome 19; distal
    weakness more prominent
  • DM2 : repeat expansion of ZNF9 gene on chromosome 3;
    proximal weakness more prominent

General features :
- myotonic facies : long haggard appearance
- Frontal balding
- Bilateral ptosis
- Cataracts
- Dysarthria

Other features :
- myotonia - tonic spasm of muscle
- Weakness of arms and legs
- Mild mental impairment
- Diabetes mellitus
- Testicular atrophy
- Cardiac - heart block, cardiomyopathy
- Dysphagia

614
Q

where does CSF absorption take place

A

arachnoid villi

615
Q

otosclerosis inheritance

A

AD

616
Q

CNS paraneoplastic sx

A

LES - SCLS, pre-synaptic VGCC

anti-Hu - SCLC/neuroblastoma, cerebellar syndrome, sensory neuropathy, encephalomyelitis

anti-Yo - ovarian/breast, cerebellar syndrome

anti-GAD - breast/colorectal/SCLS, Stiff person’s syndrome or diffuse hypertonia

anti-Ri -
breast/SCLS, ocular opsoclonus-myoclonus

Purkinje cell ab - peripheral neuropathy, breast ca

617
Q

differentiate essential tremor from PD

A

123 Iodine-FP-CIT single photon emission CT (SPECT)
scan

618
Q

dopamine receptor agonists AE

A

hallucinations
impulse control disorders
excessive daytime somnolence

619
Q

MAO-B

A

selegiline
inhibits breakdown of dopamine

620
Q

COMT inh

A

entacapone/tolcapone

621
Q

conductive hearing loss

A

Rinne’s Bone>Air
Webers to affected ear

622
Q

sensorineural hearing loss

A

air>bone
Webers to unaffected

623
Q

valproate AEs

A

teratogenic
P450 inhibition
alopecia
ataxia
tremor
hepatotoxicity
pancreatitis
thrombocytopenia
hyponatraemia
hyperammoneic encephalopathy - Give L carnitine for tx

624
Q

Brown Seqard

A

IS spastic paresis
IS loss of proprioception and vibration
CL loss of pain and temp

625
Q

SACD

A

BL spastic paresis
loss of proprioception and vibration
limb ataxia

626
Q

Friedrichs ataxia

A

same as above but with cerebellar signs

627
Q

types of cerebellar nystagmus

A

oscillopsia - alteranti nystagmus
jerk nystagmus
direction of fast and slow components changes every 2 minutes

lesion - flocculus and nodulus

628
Q

optic chiasma nystagmus

A

see saw nystagmus

629
Q

topiramate urinary stones

A

calcium phosphate due to formation of alkaline urine due to reduction of citrate excretion

630
Q

VHL

A

AD
predisposes to neoplasia
VHL gene - chr 3

631
Q

VHL features

A
  • cerebellar hemangiomas - can cause SAH
  • Retinal hemangiomas - can cause vitreous hmmge
  • Renal cysts - premalignant cysts
  • Pheochromocytoma
  • Extra renal cysts : epididymal cyst, pancreatic cyst, hepatic cyst
  • Endolymphatic sac tumor
  • Clear cell renal cell carcinoma
632
Q

Foster Kennedy syndrome

A

ipsilateral optic atrophy and papilloedema of the contralateral optic nerve

AVMs and juvenile nasopharyngeal angiofibroma

optic atrophy - SOL

633
Q

INO

A

MLF in paramedian area of midbrain and pons

impaired adduction on same side
horizontal nystagmus on opposite side

634
Q

meningioma surgery visual defect

A

pie in the sky - R superior homonymous quadrantanopia

635
Q

neuromyelitis optica

A

optic neuritis and acute myelitis
NMO-IgG seropositive
aquaporin 4 antigen
brain MRI not MS-like

636
Q
  • Mutation in NOTCH3 gene
  • Multi infarct dementia
  • Recurrent TIAs and strokes
  • Neuro-cognitive decline : depression, low mood,
  • Presents with migraine and depression
  • Family history ++
  • MRI - multiple widespread hyper intense lesion in white matter,
    basal ganglia, thalamus and pons
A

CADASIL

637
Q

what is contraindicated in absence seizures

A

carbamazepine

638
Q

fluent speech
intact comprehension
poor repetition

A

conduction aphasia
arcuate fasciculus

639
Q

paraneoplastic opsoclonus-myoclonus-ataxia
syndrome (POMAS)

A

Antibodies to RNA-binding protein Nova-1 are not
responsible for this patient’s findings.

Presents with involuntary eye
movements (opsoclonus), jerking movements of the limbs
(myoclonus), and unsteady gait (ataxia).

POMAS is also linked to
small cell lung carcinoma but has a distinct clinical presentation
from LEMS.

640
Q

Holmes-Adie

A
  • Post viral degeneration in the ciliary ganglion
  • Pupil is initially dilated with a tonic reaction to light and sectorial
    vermiform movements
  • Pupil sphincter is impaired by accommodative spasm —> Miosis
    (constricted)
  • Holmes-Adie = Adie’s pupil + hyporeflexia
641
Q

medications precipitating myasthenic crisis

A

aminoglycosides
corticosteroids

642
Q

MG mx

A
  • Cholinesterase inhibitor - Pyridostigmine
  • MMF, Azathiprine, Cyclophosphamide can be used
  • Plasmapheresis & IVIG
  • Rituximab
643
Q

anterior spinal artery occlusion

A

supplies the anterior 2/3rds
of the spinal cord.
- segments of the core in watershed areas : T2-T4 are at high risk
of ischaemia.
- Sudden pain in back and distribution of the affected segment
associated with b/l flaccid weakness and dissociated sensory
loss
- Impaired pinprick sensation and temperature sensation below the
level of lesion.
- Intact joint position and vibration sense.

644
Q

CO poisoning eye finding

A

Roth spots

645
Q

hockey stick sign MRI

A

vCJD

646
Q

paroxysmal hemicrania mx

A

indomethacin

647
Q

Miller-Fisher syndrome check

A

IgA levels
opthalmoplegia + areflexia + ataxia

648
Q

sudden severe headache +bitemporal hemianopia

A

pituitary apoplexy
elevated prolactin
hyponatraemia

649
Q

how does riluzole work

A

reduces release of glutamate

650
Q

fibrosis neuro drugs

A

ergot derived dopamine receptor agonists
5-HT2B receptors

pergolide -> heart valvular disease

651
Q

gene mutation associations

A

NOD2/CARD15 mutations are associated with Crohn’s
FXN mutations are associated with Friedreich’s ataxia
GLA mutations with Fabry disease
SCN5a mutations are associated with Brugada Syndrome

652
Q

Wernicke’s

A

CAN OPEN

653
Q

GBS poor prognostic factors

A

age >40
poor upper muscle strength
hx of diarrhoeal illness
high anti-GM1 ab titre
need for ventilatory support

654
Q

dentate nucleus lesion

A

ataxia

655
Q

red nucleus lesion

A

tremor

656
Q
  • Acute flaccid weakness
  • Reduced motor function and tone of affected limb
  • Reduced tendon reflexes of affected limb
  • Atrophy of affected limb
  • GIT - nausea, vomititng, abdominal pain, constipation, diarrhoea
  • Bulbar paralytic poliomyelitis - respiratory muscle atrophy
  • Aseptic viral meningitis - fever, headache, vomiting
A

polio

Investigations :
- viral culture from CSF, stool and pharynx
- CSF - lymphocytosis & increased protein
- Antibodies to poliovirus
Management :
- prevention through vaccines : OPV and IPV - injection form
- Supportive management

657
Q

FTD/Picks

A

2 genes - MAPT, GRN
most common genetic - hexanucleotide repeat expansion in C9orf72

658
Q

CNS tumours

A
  • Glioblastoma - M/C : regional heterogeneity within a single lesion,
    highly anapaestic glial cells, vascular proliferation and
    thrombosis, necrosis.
  • Glioblastoma - macroscopic : greyish ill defined mass, areas of
    necrosis & haemorrhage
    ANaplastic Astrocytoma :
  • Microscopic : astrocytes, nuclear atypic
  • Macroscopic : white ill defined mass, extending into gyrus
    Meningioma :
  • M/C : pacification, Psammoma bodies, sheets of spindle shaped
    cells
  • Gross : rubbery, round lobulated mass, firmly attached to dura
    Clinical Features :
  • raised ICP due to mass effect
  • Seizures
659
Q
  • progressive ataxia - early sign
  • Absence of deep tendon reflexes
  • Spasticity
  • Peripheral sensory neuropathy
  • Dysarthria - early sign of disease
  • Difficulty swallowing
  • Muscle weakness
  • Progressive kyphoscolisosi
  • Pes cavus
  • Hammer toes
  • Heart - hypertrophic cardiomyopathy, myocardial fibrosis, CHF
    and cardiac arrhythmia - most common cause of death
  • Pancreas - diabetes mellitus, impaired glucose tolerance
  • Eyes - optic atrophy
  • Hearing loss - later stages of disease
A

Friedrichs ataxia

660
Q

FA mx

A

coenzyme Q10 and vit E

661
Q

medial medulla lesion

A

Dejerine syndrome

hypoglossal - deviation of tongue
weakness of limps due to disruption of descending CS fibres

662
Q

VOR

A

brainstem reflex -> bs death

663
Q

levetiracetam in liver disease

A

half if severe

phenytoin and valproate contraindicated
lamotrigine - massive reduction

664
Q

negri bodies

A

rabies

665
Q

mallory bodies

A

alcoholic liver disease

666
Q

diagnostic scan —> Lumbar
puncture - RT-QuIC peptide assay 95.8% sensitivity and 100%
specificity

A

for sporadic CJD

667
Q

spinal bulbar muscular atrophy - Kennedy

A
  • proximal weakness and cramps
  • Wasting
  • Fasciculations
  • Weakness
  • Hyporeflexia
  • Perioral fasciculations ***
  • Androgen insensitivity - gynecomastia , infertility
  • X-linked recessive : CAG trinucleotide repeat
668
Q

palatal myoclonus

A

central tegmental tract
lateral medullary syndrome

669
Q

optic neuritis

A

if one lesion -> 50% MS
if none 25%

670
Q

unilateral dilated pupil which constricts very slowly in response to light + loss of deep tendon reflexes

A

HA pupil

Ross syndrome - also hypohidrosis

671
Q

muscle weakness of quadriceps and long finger flexors
asymmetry of signs
presents with falls
serum CK normal

A

IBM

672
Q

MMN

A

Conduction block present
- MCB : failure of nerve action potential to propagate across a
segment of intact myelinated nerve fibre
- MCB —> reduction in amplitude and area of Compound muscle
action potential after stimulation
- CMAP is normal distal to the affected segment
- MCB ==> ulnar and median nerves

Causes progressive, asymmetrical and distal upper limb weakness
anti-GM1 abs

673
Q
  • blurred vision, diplopia, and ptosis secondary to CN III, IV and VI
    palsies
  • Dysarthria and dysphagia due to oculobulbar weakness - cranial
    nerves IX, X and XII
  • Symmetric descending paralysis
  • Absent deep tendon reflexes
  • Infants - hypotonia, weak cry, feeding difficulties
  • Autonomic dysfunction - urianry retention, postural hypotension,
    dry mouth
A

botulism

674
Q

ornithine aminotransferase

A

atrophy of choroid and retina

675
Q

REM sleep disorder in PD

A

melatonin

676
Q

syringomyelia can be associated with

A

T1 chiara malformation

Elongated cerebellar tonsils - displaced into upper cervical canal
through the foramen magnum

677
Q

Bell’s palsy before the geniculate ganglion

A

hyperacusis and loss of lacrimation

678
Q

natalizumab moa

A
  • Antagonist to alpha 4 - beta 1 integrin found on surface of
    leucocytes
  • Inhibits migration of leucocytes across endothelium across the
    BBB
  • IV administration
679
Q

fingolimod

A
  • sphingosine 1 phosphate receptor modulator
  • Prevents lymphocytes from leaving the lymph nodes
  • Oral formula available
680
Q

global wasting of hand muscles

A

damage to T1 nerve root

681
Q

phenytoin half life

A

22 hours
5-14 days to reach steady conc
wait 2 weeks after dose change to check serum phenytoin level

3-4mg/kg

682
Q

Binswanger’s disease : cerebral white matter disorder

A
  • occurring in those with a multitude of vascular problems
  • MRI : diffuse small occlusive vessel disease
  • C/F : multiple TIAs or lacunar strokes
  • Complications : dementia, pseudobulbar palsy and gait apraxia
683
Q

Moya Moya disease : occlusive vasculopathy

A

Occlusion of terminal segments of intra cranial internal carotid
arteries and extensive collateral vascularisation gives a typical hazy
appearance on cerebral angiograms.
C/F : recurrent headache, recurrent TIA and seizures

684
Q

Horner syndrome causes

A

1st order neuron causes / central causes - anhidrosis of face, arm
and trunk
1) syringomyelia
2) Multiple sclerosis
3) Encephalitis
4) Brain tumors
5) Lateral medullary syndrome

2nd order neuron / preganglionin - anhidrosis of face
1) cervical rib
2) Thyroid carcinoma
3) Thyroidectomy
4) Bronchogenic carcinoma
5) Trauma
6) Thoracic artery aneurysm

3rd order - no anhidrosis
1) cluster headache
2) Carotid artery dissection
3) Cavernous sinus thrombosis
4) Middle ear infection

685
Q

tx for Tourette

A

risperidone

686
Q

types of nystagmus

A

Downbeat nystagmus - lesion at foramen magnum —> Arnold
Chiari malformation- downward gaze — oscillopsia of vision

Upbeat nystagmus —> brainstem lesion - lesion between midbrain
and medulla

Brun’s nystagmus : mild horizontal nystagmus in one direction of
gaze and coarse horizontal nystagmus in opposite direction

Brainstem compression —> cerebello pontine angle tumors

Convergence retraction nystagmus : Parinaud syndrome - dorsal midbrain lesions

Pendular nystagmus —> multiple sclerosis

687
Q

Increased signal in pulvinar of thalamus

A

variant CJD

688
Q

drugs worsening MG

A

1) D-penicillamine
2) Succinylcholine
3) Aminoglycosides
4) Fluoroquinolones
5) Quinidine, Procainamide
6) Propranolol
7) Lithium
8) Macrolides, Tetracyclines, Gentamicin, Quinolones

689
Q

ADP inhibitors

A

ADP inhibitors - Clopidogrel, Prasugrel, Ticagrelor, Ticlodipine

  • MOA : Adenosine Diphosphate inhibitors - P2Y1 and P2Y12
    inhibitors
  • Aspirin 75 mg + Clopidogrel (75mg) / Prasugrel (10mg) /
    Ticagrelor (90mg) for 12 months followed by aspirin alone
  • Ticargrelor - dyspnoea : due to reduced Adenosine clearance
  • Clopidogrel x PPI - Omeprazole, Esmoprazole —> reduced anti
    platelet effect
  • Absolute CI to Prasugrel use :
    1. Patients with prior stroke or TIA
    2. High risk of bleeding
    3. Prasugrel hypersensitivity
  • Ticagrelor contraindicated in :
    (a)patients with high risk of bleeding
    (b)History of intracranial haemorrhage
    (c)Severe hepatic dysfunction
    (d)Caution in patients with Asthma/COPD - due to
    higher risk of dyspnea
690
Q

amiodarone in ALS

A

300 after 3 shocks
150 after 5 shocks

691
Q

amiodarone moa

A
  • Class III anti-arrhythmic drug
  • Treatment of atrial, nodal and ventricular tachycardias
  • MOA : Blocks K channel —> inhibits repolarisation and prolongs
    action potential.
  • Can also block sodium channels class Ia activity
692
Q

aortic dissection backwards v forwards

A
  • backward tear : Aortic regurgitation, aortic incompetence
  • Backward tear can give rise to inferior MI - right coronary artery
    involvement
  • Forward tear will give rise to unequal BP in arms, stroke, renal
    failure
693
Q
  • narrow pulse pressure
  • Slow rising pulse
  • Delayed ESM
  • Absent S2
  • S4 preset
  • Thrill
  • LVH can be LVfailure
A

aortic stenosis

693
Q

ARVC

A

AD
- INV : ECG abnormalities in V1-V3 : T wave inversions.
- Epsilon wave in 50% of patients - terminal notch in QRS complex
- ECHO - enlarged, hypo kinetic right ventricle with thin free wall

  • Mx : Sotalol, Catheter ablation to prevent V-tac; implantable
    cardioverter-defibrilaltor
694
Q

CHADSVASC

C - congestive heart failure : 1 point
H - hypertension : 1 point
A2 - age >= 75 years : 2 points
age 65-74 years. : 1 point
D - Diabetes : 1 point
S2 - prior stroke / TIA / thromboembolism : 2 points
V - vascular disease - IHD and PAD : 1 point
S - female : 1 point

A
  • score 0 = no treatment
  • Score 1 = males : consider anticoagulation; females - no
    treatment
  • Score 2 or > 2 : anticoagulation
695
Q

Holt Oram syndrome

A

Ostium secundum - associated with Holt-Oram syndrome :
tri-phalangeal thumbs
ECG - RBBB with Right axis deviation

Osmium primum - presents earlier than ostium secundum;
associated with abnormal AV valves
ECG : RBBB with LAD, prolonged PR interval

696
Q

Bicuspid aortic valve assoc with

A

Left dominant
circulation ( posterior descending arises from LCX and not RCA)
and Turner’s syndrome
Complications - AR, AS
High risk of aortic dissection and aneurysm formation of ascending
aorta

697
Q

bivalirudin

A

reversible direct thrombin inhibitor

698
Q

features suggestive of VT and not SVT

A

1) AV dissoc
2) Fusion or capture beats
3) Positive QRS concordance in chest leads
4) Marked LAD
5) History of IHD
6) QRS > 160 ms
7) No response to adenosine or vagal manoeuvres

699
Q

Brugada

A
  • autsomal dominant
  • Cause of SCD
  • SCN5A gene - encodes for myocardial sodium ion channel
  • ECG : convex ST segment election > 2mm in >1 out of V1 - V3
    chest leads followed by a negative T wave inversion
  • Partial RBBB
  • ECG changes more apparent after giving Flecainide or Ajmaline
700
Q

Brugada

A
  • autsomal dominant
  • Cause of SCD
  • SCN5A gene - encodes for myocardial sodium ion channel
  • ECG : convex ST segment election > 2mm in >1 out of V1 - V3
    chest leads followed by a negative T wave inversion
  • Partial RBBB
  • ECG changes more apparent after giving Flecainide or Ajmaline
701
Q

cardiac catheterisation

A

Atrial Septal Defect :
- RA, RV, PA - 85% oxygen
- LA, LV, Aorta - 100 % oxygen

Ventricular septal defect : oxygenated blood mixed in RV and RV
onwards increased saturation
- RA : 70% oxygen
- RV, PA - 85% oxygen
- LA, LV, Aorta - 100% oxygen

Patent Ductus arteriosus : higher pressure aorta with lower
pressure PA
- RA, RV : 70%
- PA - 85%
- LA, LV, Aorta 100%

VSD with Eisenmenger’s :
- RA, RV, PA : 70%
- LA : 100%
- LV, Aorta - 85%

PDA with Eisenmenger’s :
- RA, RV, PA - 70%
- LA, LV - 100%
- Aorta - 85%

ASD with Eisenmenger’s :
- RA, RV, PA - 70%
- LA, LV, Aorta - 85%

702
Q

HOCM mutation

A

beta myosin heavy chain

703
Q

ARVC mutation

A

desmosome

704
Q

causes of dilated cardiomyopathy

A

1) Alcohol
2) Coxsackie B virus
3) Wet beri beri
4) Doxorubicin

705
Q

causes of restrictive cardiomyopathy

A

1) amyloidosis
2) Post radiotherapy
3) Loeffler’s endocarditis

706
Q

acquired and secondary cardiomyopathy

A

Acquired Cardiomyopathy :
1) Peripartum cardiomyopathy —> late month of pregnancy to 5
months postpartum; common with multiple pregnancies
2) Takutsubo cardiomyopathy —> stress induced cardiomyopathy;
patient develops chest pain and heart failure. Apical ballooning
of myocardium.

Secondary cardiomyopathies :
1. Infective : Coxsackie B virus, Chagas disease
2. Infiltrative - amyloidosis
3. Storage : Hemochroamtosis
4. Toxicity - Doxorubicin, Alcoholic
5. Endocrine - DM, Thyrotoxicosis, Acromegaly
6. Inflammatory - Sarcoidosis
7. Neuromuscular - Friedrich’s ataxia, DMD, Myotonic dystrophy
8. Nutritional deficiencies : Wet beri beri
9. Autoimmune - SLE

707
Q

catecholaminergic polymorphic VT

A
  • autosomal dominant,
    causes SCD.
    Autosomal dominant —> Defect in Ryanodine receptor RYR2 in the
    myocardial sarcoplasmic reticulum
    Autosomal recessive forms may be present which involves
    mutation of calsequestrin 2 gene

C/F - exercise or emotion induced Polymorphic VT causing
syncope, SCD
Mx - Beta blockers, Implantable cardioverter-defibrillator

708
Q

centrally acting hypertensives

A

methyldopa
monoxidine
conidine - a2

709
Q

eosinophilia
purpura
renal failure
livedo reticularis

A

cholesterol embolism

710
Q

cardiac resync therapy in HF

A

heart failure and wide QRS; biventricular pacing, Reduces hospitalisation in NYHA Class III patients

711
Q

dipyridamole

A

inhibits Phosphodiesterase —> elevates cAMP levels —> reduced intracellular Ca levels

Also reduced cellular uptake of adenosine and inhibition of
thromboxane synthesis

712
Q

DVLA cardiology

A

HTN >180 - no HGV
angioplasty - 1 week
ACS - 4 weeks
PPM - 1 week
ICD - arrhythmia 6mo, prophy 1 mo
permanent gr2 ban
catheter ablation - 2 days
aortic aneurysm >6.5 -> disqualified
heart transplant - 6 weeks

713
Q

LAD

A
  • left anterior hemiblock
  • LBBB
  • Inferior MI
  • WPW syndrome - right sided accessory pathway
  • Hyperkalemia
  • Ostium primum ASD, Tricuspid atresia
  • Minor LAD in obese people
714
Q

RAD

A
  • right ventricular hypertrophy
  • Left posterior hemiblock
  • Lateral MI
  • CLD - cor pulmonale
  • Pulmonary embolism
  • Osmium secundum ASD
  • WPW - left accessory pathway
  • Minor RAD in tall people
715
Q

anteroseptal

A

V1-4
LAD

716
Q

anterolateral

A

2,3,avf
RCA

717
Q

lateral

A

1, avl, V5 and 6
LCx

718
Q

posterior

A

V1-3
LCx and RCA

719
Q

reciprocal changes of STEMI in posterior MI

A
  • horizontal ST depression
  • Tall broad R waves
  • Upright T waves
  • Dominant R wave in V2
    Posterior infarct confirmed by ST elevation and Q waves in
    posterior leads (V7 - V9)
720
Q

digoxin ECG

A
  • down sloping of ST segment - never tick sign or scooped out
    sign
  • Flattened / inverted T waves
  • Short QT interval
  • AV block, bradycardia
  • LBBB
721
Q

ECG hypothermia

A

bradycardia
J wave
1st degree heart block - PR prolongation
long QT
atrial and ventricular arrhythmia

722
Q

short PR interval

A

WPW

723
Q

S1

A
  • Soft S1 : prolonged PR, MR
  • Loud S1 : MS, Left to right shunt, short PR interval, atrial
    premature beats, hyper dynamic states
724
Q

S2

A

Soft S2 - aortic stenosis
* Loud S2 -
1. Hypertension
2. hyper dynamic states
3. ASD w/o pulmonary hypertension

  • Fixed split in the middle : Atrial septal defect
  • Widely split S2 :
  • Deep inspiration
  • Pulmonary stenosis
  • Severe MR
  • RBBB
  • Reversed / Paradoxical split { P2 occurs before A2 }
  • LBBB
  • Severe AS
  • Right ventricular pacing
  • WPW - type B — causes early P2
  • PDA
725
Q

S3

A
  • due to diastolic filling of ventricle
  • Heard in LVF (dilated cardiomyopathy), constrictive pericarditis
    (pericardial knock) and mitral regurgitation.
726
Q

S4

A
  • aortic stenosis, HOCM, Hypertension
  • Atrial contraction against stiff ventricle - coincides with P wave on
    ECG
  • HOCM - double apical impulse due to a palpable S4
727
Q

hydralazine contraindicated in

A

SLE
CVA
IHD

increased cGMP causing smooth muscle cell contraction

728
Q

palmar xanthoma

A

remnant hyperlipidaemia

729
Q

eruptive xanthoma

A

familial hypertriglyceridemia, Lipoprotein
lipase deficiency

730
Q

tendon xanthoma, tuberous xanthoma, xanthelasma

A

familial hypercholesterolemia, remnant hyperlipidemia

Xanthelasma - yellowish papule and plaques cased by localised
accumulation of lipid deposits on the eyelid.

Mx : surgical excision / topical trichloroacetic acid / laser therapy /
electrodesiccation

731
Q

poor prognostic factors in IE

A

S aureus
prosthetic valve
culture -ve
low complement levels

732
Q

indications for surgery in IE

A
  1. Severe valvular incompetence
  2. Aortic abscess - indicated by a lengthened PR interval
  3. Infections resistant to Abx and anti-fungals
  4. Cardiac failure refractory to standard medical treatment
  5. Recurrent emboli after antibiotic therapy
732
Q

IE mx

A

initial blind
- amox and gent
pen allergy/MRSA -> vanc and gent
prosthetic valve - vanc + rif + gent

native Staph - fluclox
pen allergy-> vanc and rif

prosthetic Staph - benpen
pen allergy -> vanc+rif+gent

endocarditis by sensitive species of strep viridans - benpen
pen allergy -> vanc+gent

less sens streptococci - benpen + gent
pen allergy -> vanc + gent

733
Q

non pulsatile JVP

A

SVCO

734
Q

Kussmaul’s sign

A

paradoxical rise of jvp
constrictive pericarditis

735
Q

large a wave on JVP

A

TS/PS/pulm htn

736
Q

cannon a wave on JVP

A

CHB, V tac, ventricular ectopics, nodal rhythm, single chamber ventricular pacing

737
Q

large v waves on jvp

A

TR

738
Q

long qt syndrome

A

inherited conditions associated with
delayed repolarization of ventricles.
- common defects are LQT1 and LQT2 gene mutations - affects
the slow delayed rectifier potassium channels
- LQT1 : Exertional syncope - swimming
- LQT2 : emotion / exercise / auditory stimuli
- LQT3 : at rest or at night

739
Q

congenital long QT

A
  1. Jervell-Lange-Nielsen syndrome : includes deafness
  2. Romano Ward syndrome - no deafness
740
Q

other causes of long QT

A

amiodarone
sotalol
class 1a anti-arrhythmic
TCA
SSRI
methadone
chloroquine
terfenadine
erythromycin
haloperidol
ondansetron

hypoCa
hypoK
hypoMg

acute MI
myocarditis
hypothermia
SAH

Mx - BB, ICD

741
Q

loop diuretics AEs

A

1) Hypotension
2) Hyponatremia
3) Hypokalaemia
4) Hyomagnesemia
5) Hypocalcemia
6) Hypochloraemic alkalosis
7) Ototoxicity
8) Renal impairment - dehydration + direct toxic effect
9) Hyperglycaemia
10)Gout

742
Q

Ebstein’s anomaly

A

adherence of septal and posterior leaflets of tricuspid valve to
underlying myocardium
- Downward (apical) dispalvemnt of functional annulus of tricuspid
valve
- Dilation of atrailised right ventricle with varying degree of
hypertrophy and thinning of wall
- Redundancy, fenestration and tethering of anterior leaflet of
tricuspid valve
- Dilation of right atrioventricular junction

743
Q

clopidogrel inhibition

A

CYP2C19 by omeprazole

744
Q

moxonidine moa

A

imidazoline receptors -> reduced sympathetic outflow

745
Q

key diagnostic tests to identify patients likely to benefit from cardiac resynchronisation therapy

A

TTE
ECG

746
Q

treatment of prinzmetal angina

A

felodipine

747
Q

ESM louder on inspiration vs expiration

A

PS, ASD - ins
AS, HOCM - exp
TOF also has ESM

748
Q

PSM types

A

MR - high pitched, blowing
TR - inc on insp
VSD - harsh

749
Q

late systolic murmurs

A

MVP, coarctation

750
Q

early diastolic murmur

A

AR - high pitched, blowing
Graham steel - PR - high pitched, blowing

751
Q

mid-late diastolic murmur

A

MS - rumbling
Austin flint - severe AR

752
Q

most common cause of death after MI

A

cardiac arrest due to VF

753
Q

bradyarrhythmias after MI

A

inferior - AV block

754
Q

pericarditis in first

A

48 hours after transmural MI

755
Q

Dresslers syndrome

A

2-6 weeks after MI, autoimmune reaction to antigenic proteins
give NSAIDs

756
Q

persistent ST elevation and LVF following MI

A

LV aneurysm
inc risk of stroke

757
Q

LV free wall rupture

A

1-2 weeks afterwards, acute HF 2y to cardiac tamponade - JVP, pulsus paradoxus, diminished HS

pericardiocentesis urgently

758
Q

VSD

A

within first week
-> acute HF associated with PSM

759
Q

acute MR

A

infero-posterior infarct
early-mid systolic murmur
acute hypotension, pulmonary oedema

760
Q

MI 2y prevention

A

DAPT
ACEI
BB
statin

761
Q

for 4 weeks after MI

A

avoid sexual activity
avoid PDE5 inhibitors WITH nitrates, nicorandil

762
Q

thrombolysis med moa

A

tissue plasminogen activator

763
Q

ECG within how long of thrombolysis

A

90 minutes to assess if >50% reduction in ST elevation

if no -> rescue PCI

764
Q

cardiac resync therapy

A

BiV pacing
RA LA LV

765
Q

which BB not used in AF

A

sotalol

766
Q

fondaparinux moa

A

AT3 activator
inhibits factor Xa

767
Q

bivalirudin

A

direct thrombin inhibitor

768
Q

risk factors for asystole in brady

A
  • complete heart block with broad complex QRS
  • Recent asystole
  • Mobitz type II AV block
  • Ventricular pause > 3 seconds
769
Q

naftidofuryl oxalate

A

vasodilator in patients with poor QoL

770
Q

cilotazol

A

PDE3 inhibitor - both antiplatelet and vasodilator effects

771
Q

vasodilator testing for PAH

A

oral CCBs if +ve response

-ve response
-> prostacycline analogues
endothelin receptor antagonist
selective receptor A antagonist
phosphodiesterase inhibitor

772
Q

pulsus paradoxus

A

greater than normal (>10mm Hg) fall in BP
during inspiration
Faint or absent pulse on inspiration
Dx - severe asthma, cardiac tamponade

773
Q

pulsus alternans

A

Pulsus alterans : regular alteration of the force of arterial pulse
Seen in severe LVF

774
Q

bisferiens pulse

A

double pulse two peaks in systole
Seen in mixed aortic valve disease
Can also be seen in HOCM

775
Q

nicorandil promotes efflux of

A

K+

776
Q

. Cardiac enzyme affected early on in myonecrosis : specific to
cardiac muscle

A

-> glycogen phosphorylase isoenzyme BB,
increased 1-3 hours after myocardial event

777
Q

haemolytic anaemia with which valve type

A

mechanical more than bioprosthetic

778
Q

complete heart block after inferior MI

A

not for pacing
is if anterior

779
Q

mitral stenosis opening snap

A

leaflet mobility

780
Q

features of severe AS

A

narrow pulse pressure
slow rising pulse
delayed ESM
soft/absent S2
S4
thrill
duration of murmur
LVH/F

781
Q

antithrombotic therapy in prosthetic heart valves

A

bio - aspirin
mech - warfarin and aspirin

INR target:
aortic 3
mitral 3.5

782
Q

Keshan disease

A

selenium deficiency -> dilated CM

783
Q

most common cause of restrictive CM

A

amyloid

784
Q

neprilysin

A

ANP and BNP are inactivated by this
hence inhibitor - sacubitril

increases risk of angioedema

785
Q

hyperlipoproteinemia

A
  • type I hyperlipoproteinaemia : hyper chylomicronaemia -
    associated with eruptive xanthomas. Complications include
    occlusion of retinal vein, acute pancreatitis, steatosis,
    organomegaly and lipaemia retinals.
  • Type II hyperlipoproteinaemia : associated with xanthoma
    tendinosum - nodular swellings on tendons. Type II
    hyperliproteinaemia classified further into types IIa and IIb :
    whether increase in triglyceride occurs in addition to increase in
    lLDL-colesterol.
  • Type III hyperlipoproteinaemia : tuboeruptive xanthomas - due to
    high numbers of chylomicron and high levels of intermediatedensity lipoprotein.
  • Most common cause : apolipoprotein E2/E2 genotype.
  • Type III is due to cholesterol rich VLDL.
  • Associated with hypercholesterolaemia and hypertriglyceridemia,
    normal concentration of apolipoprotein B
  • Two types of skin signs - 1) palmar xanthomata or orange
    discolouration of skin palmar creases 2) tuboeruptive xanthomata
    on elbows and knees.
  • Associated with early onset CVD and PVD
  • type IV hyperlipoproteinaemia : associated with eruptive
    xanthomas
  • Type V hyperlipoproteinaemia : mixed hyperlipoproteinaemia
    familiar or mixed hyperlipidemia. High levels of VLDL + high
    chylomicron. Associated with glucose intolerance and
    hperuricemia.
786
Q

sick sinus syndrome

A

periods of sinus brady
sinus arrest
SA+AV vonduction defect
SVT possible

PPM

787
Q

cardiac catheterisation and thyroid

A
  • Cardiac catheterisation requires the use of an iodine-containing
    contrast.
  • This may worsen hyperthyroidism caused by toxic multinodular
    goitre, whereas it may improve the symptoms in patients with
    Grave’s disease (Wolff-Chaikoff effect).
788
Q

epsilon waves

A

RV conduction delay
ARVC

789
Q

commonest site of obstruction in coarctation

A

distal to origin of L subclav

790
Q

LQT1 syndrome

A
  • LQTI gene = KCNQ1 on chromosome 11
  • KCNQ1 codes for voltage gated potassium channel KvLQT1 and
    is highly expressed in heart
  • This is a slow delayed rectifier potassium channel

LQT2 - KCNH2

791
Q

amiodarone only given through

A

central line

792
Q

S1

A

R wave

  • Quiet S1 : MR, Long PR interval, Obesity, 1st degree heart block,
    LBBB
  • Loud S1 : MS, Hyperdynamic states, Tachycardia, low BMI, Atrial
    Myxoma
  • Widely split S1 - RBBB, Ebstein’s anomaly, Ventricular
    tachycardia
793
Q

S2

A

Loud S2 - hypertension
- Quiet S2 - aortic stenosis
- Wide split S2 - RBBB, Pulmonary stenosis, VSD, MR
- Fixed split S2 - ASD
- Paradoxical split S2 - LBBB, PDA, Aortic stenosis. HOCM

794
Q

S4

A
  • Left sided S4 : HTN, hypertrophic cardiomyopathy, aortic
    stenosis
  • Right sided S4 : pulmonary stenosis, Pulmonary HTN
795
Q

thiazide diuretics in pregnancy

A

neonatal thrombocytopenia,
bone marrow suppression, jaundice, electrolyte disturbances,
hypoglycaemia

796
Q

Eisenmenger complications

A
  • polycythemia
  • bleeding disorder
  • cerebral embolism or abscess
  • Avoid pregnancy
  • Syncopal episodes can precede death
797
Q

restrictive cm

A

secondary to Amyloidosis with immunocyte dyscrasia
- Right heart failure, raised JVP, deep Y descent
- Heart size commonly is normal
- Apex frequently non palpable due to thick pericardium
- CXR : pericardial calcifications
- ECG : diffusely diminished voltages
- ECHO - small, thick ventricles, and thick intertribal septum due to
amyloid deposit which leaves a granular sparkling appearance

798
Q

lutembacher syndrome

A

Ostium secundum (ass.
With RBBB with RAD) in combination with Rheumatic mitral stenosis

799
Q

early graft occlusions after CABG

A

5-10% within 30 days
aspirin reduces

800
Q

primary pum htn gene

A

BMPR2

ALK3, ENG, SMAD9, CAV1, KCNK3

801
Q

tricuspid regurg

A

loss of x descent and fusion of c and v to create -> giant v

802
Q

defib voltage

A

monophasic 360J
biphasic 150-200J

803
Q

PPM indications

A
  • persistent symptomatic bradycardia
  • Trifasicular block
  • Mobitz Type 2 AV block
  • Sinus pause > 3 seconds
804
Q

stabbing chest valve

A

pulmonary as anterior

805
Q

contraindications to carotid sinus massage

A
  • myocardial infarction
  • TIA in the last 3 months
  • Cerebrovascular accident in last 3 months
  • Carotid artery occlusion
  • Previous ventricular arrhythmia
806
Q

chemo assoc with CVD

A

Doxorubicin, Daunorubicin, Idarubicin, Mitoxantrone

807
Q

SVT in pregnancy

A

use metoprolol

808
Q

adenosine moa

A

purine nucleoside - rapid IV injection - slows
conduction through AV node by acting as a G protein-coupled
receptor agonist of Adenosine A1 receptor on AV node
- inhibition of adenylate cyclase —> reduction cAMP

809
Q

subclavian steal syndrome

A

occlusion or stenosis of proximal SCA leading to decreased flow in the IL vertebral artery

810
Q

drug induced TdP

A
  • Antiarrhythmic drugs (e.g. sotalol, quinidine, disopyramide,
    procainamide, flecainide)
  • Certain non-sedating antihistamines (e.g. terfenadine and
    astemizole)
  • Antibiotics - Erythromycin, clarithromycin, azithromycin,
    levofloxacin, moxifloxacin, gatifloxacin,
    trimethoprim-sulfamethoxazole, clindamycin, pentamidine,
    chloroquine
  • Antifungals - Ketoconazole, itraconazole
  • Certain psychotropic medications (e.g. risperidone,
    haloperidol, phenothiazines, thioridazine, trifluoperazine,
    sertindole, zimeldine, ziprasidone)
  • Tricyclic and tetracyclic antidepressants
  • Certain gastric motility agents (e.g. cisapride)
  • Lithium.
811
Q

sotalol has both

A

Class III agents : blocks cardiac potassium channels
Class II - beta blockers

812
Q

broad complex irregular tachy in structurally normal heart

A

procainamide

813
Q

S wave occurs between

A

S1 and S2

T wave - occurs between S2 and S3

U wave - depolarisation of Purkinje fibers

814
Q

statins monitoring

A

LFTs baseline 3 12

if 3x ULN then switch

815
Q

hydralazine moa

A

increases cGMP leading to smooth muscle relaxation in arterioles more than veins

816
Q

pt on warfarin undergoing emergency surgery

A

4 factor PCC

817
Q

area of the heart causing a flutter

A

tricuspid valve isthmus - ablate

818
Q

romana’s sign

A

trypanosomiasis - chagas

819
Q

valsalva increases murmur in

A

HOCM
MVP

820
Q

valsalva quietens murmurs in

A

AS, PS, TR

821
Q

squatting increases murmurs of

A

VSD, AS, aortic insufficiency and
mitral insufficiency
Squatting causes quiet murmurs in HOCM

822
Q

drugs causing pulmonary hypertension

A

methamphetamine
fenfluramine

823
Q

carcinoid heart disease

A

TS and R due to semi-closed valve

Liver metastasis of carcinoid syndrome —> releases serotonin and
kallikrein which travels through liver sinusoids —> central vein of
each lobule —> hepatic veins —> IVC and right heart

Increased serotonin and kvllikrein — bronchospasm, diarrhoea,
flushing

824
Q

HOCM mutations

A

MYH7
MYBPC3

825
Q

EF equation

A

EDV-ESV / EDV

826
Q

allergic myocarditis to medication

A

co-trimoxazole

827
Q

Type A vs B aortic dissection sx

A

hypotension and syncope

vs

hypertension

828
Q

AIN

A

drug causes - penicillin, rifampicin, NSAIDs, furosemide, allopurinol

interstitial oedema and infiltrates in connective tissue between renal tubules

829
Q

pre-renal vs ATN

A

ATN has more urine sodium, poor response to fluid challenge, normal urea:creatinine, brown granular casts

pre-renal -> kidneys hold on to sodium to preserve volume

830
Q

ADPKD genes

A

T1 - chr 16
2 - chr 4, later presentation

831
Q

most common form of amyloidosis

A

AL
nephrotic syndrome, cardiac and neurological involvement,
macroglossia, periorbital ecchymoses

832
Q

amyloidosis where renal involvement is most common

A

AA amyloid

833
Q

normal anion gap metabolic acidosis

A
  • GI bicarbonate loss - diarrhoea, ureterosigmoidostomy, fistula
  • RTA
  • Drugs - Acetazolamide
  • Ammonium chloride injection
  • Addison’s disease
834
Q

Goodpasture’s mx

A

PEx
steroids
cyclophosphamide

835
Q

CKD iron

A

Elevate hepcidin levels leads to decreased iron absorption from
gut and impaired release of stored iron from macrophages and
hepatocytes
This causes reduced iron levels available for erythropoiesis
In CKD - metabolic acidosis inhibits the conversion of Fe3+ to
Fe2+ in the duodenum leading to reduced iron absorption.

836
Q

CKD bone disease

A

low vit D due to low alpha-1 hydroxylation in kidneys
high phosphate
low Ca due to lack of vit D and high phosphate
2y hyperPTH - due to low calc, high phosph and low vit D

837
Q

CKD bone disease mx

A
  • Phosphate binders:
  • calcium based binders : problems include hypercalcemia and
    vascular calcification
  • Sevelamer : non calcium based binder, binds to dietary
    phosphate and prevents its absorption.
  • Sevelamer can also reduce uric acid levels and improves lipid
    profiles of patients with CKD
  • Vitamin D : alfacalcidiol, calcitriol
838
Q

renal transplant rejection

A

hyperacute - immediate

acute - mononuclear cells predominate

chronic - HLA mismatch, vascular changes with myointimal proliferation leading to organ ischaemia

839
Q

complications of renal transplant

A
  • Renal artery thrombosis : sudden loss of urine output; immediate
    surgery, delays > 30 minutes high rate of graft loss
  • Renal artery stenosis : uncontrolled hypertension, allograft
    dysfunction and oedema; Mx - angioplasty
  • Renal vein thrombosis : pain and swelling over graft site,
    hematuria and oliguria
  • Urine leaks : diminished urine output, rising creatinine, fever,
    abdominal pain; USG - perigrafj collection, necrosis of ureter tip
    and anastomosis revision is needed
  • Lymphocyte : presents as a mas; drained with percutaneous
    technique and sclerotherapy
840
Q

cystinuria

A

AR
* Recurrent formation of renal stones
* Defect in membrane transport of cysteine, ornithine, lysine and
arginine COLA
* Chromosome 2 - SLC3A1 gene
* Chromosome 19 - SLC7A9 gene
* Recurrent renal stones
* Yellow and crystalline, semi-opaque on X-ray
* Dx : Cyanide - nitroprusside test
* Mx : hydration, D-penicillamine, urinary alkalisation

841
Q

genetic nephrogenic DI

A

ADH receptor

high plasma low urine osm

842
Q

adverse effects of EPO

A
  • accelerated hypertension —> encephalopathy & seizures
  • Bone aches
  • Flu-like symptoms
  • Skin rashes, urticaria
  • Pure red cell aplasia - reduced risk with Darbepoietin
  • Raised PCV increases risk of thrombosis
    -Iron deficiency secondary to increased erythropoiesis
843
Q

Fanconi syndrome

A
  • generalised reabsoprtive disorders of renal tubular transport in
    PCT
  • Type 2 RTA
  • Polyuria
  • Aminoaciduria
  • Glucosuira
  • Phophaturia
  • Osteomalacia
844
Q

most common cause of fanconi in children

A

cystinosis

845
Q

mixed nephrotic/nephritic presentation

A
  • diffuse proliferative glomerulonephritis - post streptoccolal GN in
    children, most common form of renal disease in SLE
  • MPGN = mesangiocapillary - type 1 —> cryoglobulinemia,
    hepatitis C; type 2 : Partial lipodystrophy
846
Q

nephrotic syndrome

A
  • MInimal change disease : child with nephrotic syndrome, causes
  • Hodgkin’s, NSAIDs; good response to steroids
  • Membranous glomerulonephritis - proteinuria, nephrotic
    syndrome, chronic kidney disease; causes : infection, rheumatoid
    drugs, malignancy; 1/3 develop CKD, 1/3 resolve, 1/3 respond to
    cytotoxic
  • Focal segmental glomerulosclerosis : secondary to HIV, heroin;
    presentation - proteinuria, nephrotic syndrome , chronic kidney
    disease
847
Q

HUS

A

triad of AKI, MAHA, thrombocytopenia

primary/atypical - complement dysreg
-> eculizumab *C5 inhibitor mab

848
Q

HSP

A

IgA mediated small vessel vasculitis

mx - analgesia

849
Q

IgA nephropathy

A

Associated with -
- alcoholic cirrhosis
- Coeliac disease
- Dermatitis herpetiformis
- Henoch Schonlein purpura
- due to mesangial deposition of IgA immune complexes
- Mesangial hypercelluairty, +ve IF for IgA & C3

  • young male, recurrent macroscopic hematuria
  • Associated with recent URTI
  • 25% patients develop ESRF
  • Good prognosis - frank hematuria
  • Poor prognosis : male gender, proteinuria, HTN, smoking,
    hyperlipidemia, ACE genotype D
850
Q

Membranoproliferative GN / Mesangiocapillary GN

A
  • nephrotic syndrome / hematuria / proteinuria
  • Type 1 - cryoglobulinemia, hepatitis C
  • Renal Bx : tram track appearance due to subendothelial and
    mesangial immune deposits
  • Type 2 - dense deposit disease
  • Caused by partial lipodystrophy, factor H deficiency
  • Persistent activation of complement pathway - low circulating
    levels of C3
  • C3b nephritic factor can also be found in 70% of cases
  • C3b nephritic factor stabilises C3 converts
  • Renal Bx : EM - intramembranous immune complex deposits with
    dense deposits
  • type 3 : hepatitis B, hepatitis C
851
Q

membranous glomerulonephritis

A
  • Sub epithelial deposits - spike and dome appearance
  • Idiopathic - anti-phospholipase A2 antibodies
  • Infections : hepatitis B, malaria, syphilis
  • Malignancy
  • Drugs - gold, penicillamine, NSAIDs
  • SLE, thyroiditis
    Good prognosis : female sex, young age, asymptomatic proteinuria
    at time of presentation
852
Q

peritoneal dialysis infection rx

A

vanc/teic + ceftaz

853
Q

complications of plasma exchange

A
  • Hypocalcemia
  • Metabolic alkalosis
  • Coagulation factor depletion
  • Immunoglobulin depletion
854
Q

bicalutamide moa

A

non steroidal anti-androgen, blocks androgen
receptor

Cyproterone acetate - steroidal anti androgen, prevents DHT
binding from intra -cytoplasmic protein complexes
Abiratone - androgen synthesis inhibitor

855
Q

pollakiuria

A

risperidone

856
Q

renal cell ca paraneoplastic effects

A
  • erythropoietin = polycythemia
  • PTH related peptide = hypercalcemia
  • Renin
  • Paraneoplastic hepatic dysfunction syndrome = cholestasis, hepatosplenomegaly
  • Varicocele - left sided, due to tumor compressing veins
  • Stauffer syndrome - cholestasis/hepatosplenomegaly, secondary to increased levels of IL-6
  • Receptor tyrosine kinase inhibitors - Sorafenib, Sunitinib - better efficacy than IFN-alpha
857
Q

when to use percutaneous nephrolithotomy

A

> 20mm renal stone

858
Q

renal stones prevention

A

Renal stones prevention -
- calcium stones : high fluid intake, thiazide diuretics
- Oxalate stones : CHolestyramine, pyridoxine
- Uric acid stone - allopurinol, urinary arlkalinization

Urate stones R/F : gout, ileostomy

Drug causes of renal stones : loop diuretics, steroids ,
Acetazolamide, Theophylline

859
Q

what causes hyperacute rejection

A

antibodies against ABO or HLA
antigens ; type II hypersensitivity reaction

860
Q

method of acute graft rejection

A

mismatched HLA - cell mediated - cytotoxic
T cells ; CMV can also cause acute graft rejection

861
Q

membranous nephropathy

A

commonest type in adults

associated with SLE, malignancies of the bowel and Bronchus,
penicilliamine therapy, and hepatitis B infection.
Can also be associated with plasmodium malaria infection in the
tropics.
Strong association with HLA-DR3
Commonly seen in males

862
Q

what type of lupus nephritis

A

diffusive proliferative type

863
Q

testicular tumour markers

A
  • seminomas : hCG
  • Non seminomas : AFP and/or hCG
  • Germ cell tumors - LDH
864
Q

COLT Pee

A

C : Carbonic anhydrase - PCT
O : Osmotic diuretics - loop of Henle
L : Loop diuretics : ascending limb of loop of Henle
T : Thiazide diuretics - early DCT
P : Potassium sparing diuretics - distal section of DCT

865
Q

Type 2 MCGN

A

idiopathic or after measles
persistent complement pathway activation
low circulating C3
mesangial cell proliferation
partial lipodystrophy and factor H deficiency

866
Q

Type 1 MCGN

A

tramline appearance
C/F : hematuria, proteinuria, nephrotic syndrome or frank kidney
disease Low C3, C4. Infections with Hepatitis B, hepatitis C,
cryoglobulinemia

867
Q

IgA nephropathy

A

Hematuria , Hypretension
Recurrent episodes of micro- or macro-hematuria.
IgA nephropathy - familial.
Elevated IgA levels
Circulating IgA immune complexes and abnormal IgA
glycosylation

IgA deposition may occur in cirrhosis and gluten enteropathy

868
Q

ATN dx

A

1) urine osmolality < 350 mOsm / kg
2) Urinary sodium > 40 mmol/L
3) FeNa > 1%

869
Q

abdominal aortic aneurysm

A
  • thought to be an auto allergic response from the leak f ceroid
    material out of atherosclerotic plaques
  • Ureters become embedded in dense retroperitoneal fibrous tissue
    —> unilateral or bilateral ureteric obstruction.
  • May extend from L2 to pelvic brim
  • Excretion Urography - ureteric obstruction at level of pelvic brim
  • Mx : corticosteroids and surgical stenting of ureteric obstruction
870
Q

TB urinary tract

A

CT urography
-> cavitating lesions in renal papillary areas commonly with calcification

hydronephrosis

871
Q

cystinuria profile

A
  • defective renal tubular reabsorption and jejunal absorption of
    cysteine and other dibasic amino acids - Ornithine, Lysine,
    Arginine
  • SLC3A1 - chromosome 2
  • SLC7A9 - chromosome 19
  • Mx : hydration, Penicillamine, urinary arlkalinization
872
Q

Bartter vs Gitelman

A

inc vs reduced excretion of Ca

873
Q

aristolochic acid nephropathy

A

Chinese herb nephropathy
and Balkan endemic nephropathy
Anaemia, rapid renal atrophy and fibrosis, proteinuria and high
incidence of genitourinary cancer.

874
Q

Fabrys

A
  • X linked lysosomal storage disorder
  • Myelin deposits in tubular epithelium and vascular epithelium
    causing ischaemic nephropathy
  • Defect in enzyme alpha glucosidase
  • Dx : slit lamp examination of cornea
  • M/C of urie sedan - Maltese cross lipid globules
  • Skin angiokeratomas
  • Decreased sweating
  • Leg lymphoedema
  • Peripheral neuropathy
  • Cardiac - complete heart block, left ventricular hypertrophy,
    restrictive cardiomyopathy
875
Q

LIDDLE

A

Low Hydrogen ions - metabolic acidosis
I - high BP
D - autosomal dominant
D - drugs - amiloride
L - low potassium
E - ENaC activation

  • Increased Na levels, increased water retention, hypertension
  • Low Potassium and low hydrogen ions
  • Hypokalaemia, metabolic alkalosis, with HTN and volume
    overload
876
Q

RTAs

A

T1 - distal tubule
hypoK
nephrocalcinosis and renal stones
RA, SLE, Sjogrens, ampho B, analgesics

T2 - proximal
hypoK
osteomalacia
Fanconi, Wilsons, cystinosis, tetracyc, CA inhib

T3 - mixed
CA 2 deficiency
hypoK

T4 -proximal ammonium, reduced aldosterone
hyperK
hypoaldosteronism, diabetes

877
Q

tremors renal med

A

tacrolimus

878
Q

HIVAN

A

rapidly advancing nephropathy
large echogeneic kidneys on USS
light microscopy - FSGS - podocyte proliferation with
marked focal collapse of the glomerular basement membrane

879
Q

abiraterone acetate

A

cytochrome P450 17 alpha hydroxylase

treating metastatic castration resistant
(hormone-relapsed) prostate cancer in adult men who are
asymptomatic or mildly symptomatic after failure of androgen
deprivation therapy in whom chemotherapy is not yet clinically
indicated or progression despite docetaxel regimen

880
Q

dialysis related amyloidosis

A
  • Due to accumulation of beta-2 micro globulin
  • Component of class 1 HLA and is normally filtered at the
    glomerulus, reabsorbed and metabolised in the PCT.
  • Accumulation of beta-2 micro globulin in CKD patients occur in
    HD patients after at least 5 years.
  • C/F : Carpal tunnel syndrome, chronic arthropathy of shoulders b/l, followed by knees, wrists and small joints of hands; periarticular soft-tissue swelling may be seen.
881
Q

renal transplant immunosuppression

A
  • Cardiovascular disease : Tacrolimus and Ciclosporin can cause
    hypertension and hyperglycaemia.
  • Tacrolimus - hyperlipidemia
  • Monitor patients for accelerated cardiovascular disease
  • Renal failure : nephrotoxic effects of Tacrolimus and Ciclosporin;
    graft rejection; recurrence of original disease in transplanted
    kidney
  • Tacrolimus - hyperkalemia common side effect
  • MMF - hyperkalemia is seen, lesser incidence than with
    Tacrolimus
  • Valganciclovir - reduces renal function, not as common as
    hyperkalemia with Tacrolimus

Immunosuppression :
1. INITIAL : Ciclosporin / Tacrolimus + monoclonal antibody
2. MAINTENANCE : Ciclosporin / Tacrolimus + MMF
3. Add steroids if more than one steroid responsive acute rejection
episode

Monoclonal antibody = selective IL-2 inhibitors —> Daclizumab,
Basilximab

882
Q

haemodialysis most common malnutrition

A

protein calorie

883
Q

where is EPO released

A

interstitial fibroblasts in renal cortex

extra-renal -> perisinusoidal cells in liver

884
Q

Goodpasture’s lung biopsy

A

haemosiderin laden macrophages

885
Q

hepatorenal syndrome

A

splanchnic vasodilation, renal
vasoconstriction.
Splanchnic vasodilation releases Nitric oxide which dilates the
splanchnic and systemic due to portal hypertension.
This causes arteriolar underselling, increasing bacterial
translocation.
Ultimately, systemic vascular resistance falls and renal
vasoconstriction occurs.
Medical management : Midodrine, Somatostatin, Dopamine

886
Q

diabetes renal changes

A

renal glomerulosclerosis
Also prone to papillary necrosis.
Thickening of GBM and glomerulosclerosis - Kimmelsteil Wilson lesions

887
Q

indications for emergency dialysis

A

hyperkalemia
- Refractory pulmonary edema
- Refractory metabolic acidosis pH < 7.2
- Uraemic complications - pericarditis, encephalopathy

888
Q

patients with lithium related DI

A

may benefit from taking amiloride 5-10mg/day

889
Q

Patient with chronic alcohol and raised anion gap —> check
Na and K

A

If normal —> points towards lactic acidosis
If abnormal —> alcohol ketoacidosis - excessive vomiting
would cause loss of Na, K and Cl

890
Q

causes of large kidneys

A

amyloidosis
diabetic neph stg1
hydronephrosis
acromegaly
renal vein thrombosis
ADPKD

891
Q

loin pain-haematuria syndrome

A
  • poorly defined disorder characterised by loin / flank pain - severe
    nature + hematuria
  • Co-existent thin basement membrane disease
  • Bleeding into loin and obstruction causes the pain
  • Dependency on narcotics is common
892
Q

cystinuria crystals

A

hexagon shaped

893
Q

what stimulates renin secretion

A

low Na
low blood volume

894
Q

haemodialysis processes

A

solutes - diffusion
water and fluids - ultrafiltration

895
Q

CKD diminishes activity of

A

one alpha hydroxylase, which
leads to failure of converting CholeCalciferol to its active metabolite
1,25 - dihydroxycholecalciferol

896
Q

where does Na get reabsorbed in the nephron

A

PCT

897
Q

xanthogranulomatous pyelo

A

macrophage increase
related to malakoplakia
palpable unilateral flank mass - anorexia feveres pain
CT - replacement of renal parenchyma with rounded, low density areas surrounded by ring of enhancement
later - AA amyloid
pigment laden macrophages

898
Q

negative acute phase proteins

A

albumin
transthyretin
transferrin
retinol binding protein
cortisol binding protein

899
Q

positive acute phase reactants

A

CRP
procalcitonin
ferritin
fibrinogen
alpha1antitryp
caeruloplasmin
amyloid
haptoglobulin
complement

900
Q

androgen insensitivity syndrome

A
  • X-linked recessive
  • End organ resistance to testosterone in genotypical male children
    46XY to have female phenotype
  • Complete androgen insensitivity syndrome = testicular
    feminisation syndrome
  • C/F : primary amenorrhoea, little or no pubic and axillary hair,
    undescended tests, breast development due to increased
    conversion of testosterone to estradiol

chromosome analysis - 46XY

901
Q

autoimmune polyendocrinopathy syndrome

A

APS 1 - AIRE1 on chr 21 - chronic mucocutaneous candidiasis, Addison’s disease, primary hypoparathyroidism

APS 2 - HLA DR3/4 - Addisons, T1DM, thyroid

902
Q

carbimazole moa

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues

903
Q

salt wasting crisis

A

dehydration
hypotension
electrolyte imbalance

can occur in CAH

904
Q

gold standard for non-salt losing CAH

A

corticotrophin stimulation test

905
Q

management of Cushings

A
  • Metyrapone : normalises cortisol levels where surgery is not
    possible
  • Mitotane - adjunct to chemotherapy
  • Primary treatment - surgical resection of tumor
  • B/L Adrenalectomy —> Nelson’s syndrome : high ACTH from
    removal of negative feedback of Hpothalamic - pituitary - adrenal
    axis ; causes skin pigmentation
    Insulin stress test - to differentiate between true Cushing’s
    syndrome and Pseudo-Cushing’s
906
Q

antidiabetic drugs

A

1) Insulin - direct replacement of endogenous insulin - Sub-Q
* Main side effects : hypoglycaemia, weight gain, lipodystrophy

2) Metformin
* increases insulin sensitivity, decreases hepatic gluconeogenesis
* GI upset, lactic acidosis type B
* First line
* CI in renal failure with eGFR < 30 mL/min

3) Sulfonylureas
* Stimulate pancreatic beta cells to secrete more insulin
* Glimeperide, Gliclazide
* Adverse effects : weight gain, fluid retention
* CI - heart failure

4) Thiazolidinediones
* Activates PPAR-gamma receptor in adipocytes to promote
adipogenesis and fatty acid uptake
* Adv - weight gain, fluid retention
* Pioglitazone
* CI - heart failure

5) DPP-4 inhibitors - Vidagliptin, Sitagliptin
* Gliptins
* Increases incretin levels which inhibits glucagon secretions
* Increases incretin levels by decreasing their breakdown
* Well tolerated
* Risk of acute pancreatitis

6) SGLT-2 inhibitors - Canagliflozin, Dapagliflozin,
Empagliflozin
* Inhabits reabsoprtion og glucose in kidney
* Reversible inhibiton of SGLT-2 in renal PCT to decrease glucose
reabsorption and increases glucose urinary secretion
* UTI, Fournier gangrene
* Normoglycaemic ketoacidosis
* Increased risk of lower limb amputation
* Typically results in weight loss

7) GLP-1 agonists
* -tides
* Incretin mimetic which inhibits glucagon secretion
* Subcutaneous
* Adv - nausea, vomiting, pancreatitis
* Weight loss
GLP-1 agonists / mimetics = Exenatide , Liraglutide
- increases insulin secretion
- Decreases glucagon secretion
- Weight loss
- Sub-Q injection within 60 minutes before morning and evening
meals
Consider adding Exenatide to Metformin + Sulfonylurea if :
- BMI > 35
- BMI < 35 and insulin is not advised or weight loss is beneficial

907
Q

MODY Types

A

Glucokinase MODY 2 - mild, rarely any
complications

HNF 1AE MODY 3 - progressive beta cell
failure but sensitive to
sulfonyureas

HNF 4AE MODY 1 - neonatal hyperinsulinusim

HNF 1B MODY 5 - associated with renal
anomalies or cysts

IPF-1 MODY 4, MODY 6-11, MODY X

SUR1, Kir6.2 Hyperinsulinism in infancy and beta
cell failure in adulthood

908
Q

ezetimibe used in

A

primary heterozygous familial and non familial
hypercholesterolaemia
- Used in patients where statins are contra-indicaed.
- In combination with statin, Ezetimibe is given if serum total or
LDL cholesterol is not well controlled

  • inhibits cholesterol receptor on enterocytes —>
    decreases absorption of cholesterol on small intestine
909
Q

familial hypercholesterolaemia

A
  • Autosomal dominant condition
  • High LDL cholesterol —> early cardiovascular disease and death
  • Mutation in gene which encodes LDL receptor protein.
    Clinical Diagnosis :
  • Total cholesterol > 7.5 mmol / L
  • LDL > 4.9 mmol / L
  • Children TC > 6.7 mmol / L and LDL > 4 mmol / L
  • Definite FH : tendon xanthomas in patients or 1st or 2nd degree
    relatives or DNA based evidence of FH
  • Possible FH : family history of. MI < 50 years in 2nd degree
    relatives, below 60 years in 1st degree relative or family history of
    raised cholesterol

high dose statins
screen relatives

910
Q

when are fibrates used

A

particularly raised triglycerides
Activating PPAR alpha receptors causing increase in LPL activity
reducing triglyceride levels
Adv - GI side effects, increased risk of thromboembolism

911
Q

galactosaemia

A
  • Autosomal recessive
  • Absence of Galactose-1-phosphate Uridyl transferase enzyme
  • Causes increased accumulation of galactose-1-phosphate
    C/F :
  • jaundice
  • FTT
  • Hepatomegaly
  • Cataracts
  • Hypoglycaemia after exposure to Galactose
  • Fanconi’s syndrome

urine reducing substances
galactose free diet

912
Q

Hypokalaemia with alkalosis

A
  1. Vomiting
  2. Thiazide and loop diuretics
  3. Cushing’s syndrome ( increased cortisol -> activation of
    mineralocorticoid receptors in distal tubules —> increased
    reabsorption of sodium and excretion of hydrogen & K ions —>
    alkalosis)
  4. Conn’s syndrome - Primary hyperaldosteronism
913
Q

Hypokalaemia with acidosis

A

Diarrhoea - non anion gap metabolic acidosis
- Renal tubular acidosis
- Acetazolamide ( inhibits CA enzyme —> inhibits reabsorption of
HCO3 in proximal tubule —> increased bicarbonate excretion in
urine —> acidosis and hypokalaemia)
- Partial treatment DKA

914
Q

primary hypoPTH

A

decreased secretion
low Ca, high phosphate
alfacalcidol

CF - hypoCa symptoms

915
Q

pseudohypoPTH

A
  • target cells insensitive to PTH
  • Due to abnormality in G protein
  • Associated with : low IQ, short stature, short 4th and 5th
    metacarpals
  • Dx INV : urinary cAMP and phosphate levels following infusion of
    PTH
  • Type 1 - no increase in cAMP / Phosphate
  • Type 2 - increase only in cAMP
  • Hypoparathyroidism true - increase in both cAMP and Phosphate
916
Q

glucagonoma

A

necrolytic migratory erythema - erythematous
rash in the groin, extending to lower limbs, buttocks and perineum
Other features of glucagonoma - NC NC Anaemia, weight loss,
angular stomatitis

917
Q

MEN1

A

parathyroid (high)
pituitary
pancreas
adrenal and thyroid

918
Q

MEN2

A

2a
medullary thyroid ca
parathyroid
phaeochromocytoma
RET oncogene

2b similar
mucosal neuromas
marfanoid

919
Q

Pendred’s syndrome

A
  • Autosomal recessive
  • Pendred syndrome gene - chromosome 7
  • B/L sensorineural deafness, mild hypothyroidism and goitre.
  • Progressive hearing loss and delay in academic progression.
  • Defect in organification of iodine —> leading to
    dyshormonogenesis
  • MRI brain : 1.5 turns of cochlea ( normal - 2.5 turns )
  • Mx : thyroid hormone replacement and cochlear implants
920
Q

primary hyperaldosteronism

A
  • Adrenal adenoma = Conn’s syndrome
  • Most common cause - b/l idiopathic adrenal hyperplasia
  • C/F : hypertension, hypokalaemia, muscle weakness
  • 1st line investigation - plasma aldosterone/renin ratio - high
    aldosterone levels and low renin levels
  • CT abdomen and adrenal vein sampling is used to differentiate
    between unilateral and bilateral causes
  • Mx : adrenal adenoma => surgery
  • B/L adrenocortical hyperplasia => aldosterone antagonist
    Spironolactone
921
Q

primary hyperPTH

A
  • Express secretion of PTH causing hypercalcemia
  • 85% solitary adenoma
    C/F :
  • polydipsia, polyuria
  • depression
  • Anorexia, nausea, constipation
  • Peptic ulceration
  • Pancreatitis
  • Bone pain/fracture
  • Renal stones
  • HTN
    A/W : HTN, MEN I and II.
    X-ray : pepper pot skull, osteitis fibrosis cystica
    Mx : total parathyroidectomy
922
Q

drug causes of raised prolactin

A

metoclopramide
domperidone
haloperidol
phenothiazines
SSRI
opioids

923
Q

Remnant hyperlipidemia / Fredrickson type III hyperlipidemia /
broad-beta disease / dysbetalipoproteinemia

A

Associated with apo-E2 homozygosity
High incidence of IHD and PAD
C/F : yellow palmar creases, palmar xanthomas, tuberous
xanthomas
Mx : fibre

924
Q

High urine osmolality > 100 mOsm / kg
Urine sodium > 40 mol / L due to action of ADH on renal tubules
Mx : Fluid restriction, Demeclocycline, Vasopressin R antagonists

A

SIADH

925
Q

medullary thyroid carcinoma

A

C cells derived from neural crest
raised calcitonin

926
Q

papillary thyroid ca

A
  • mixture of papillary and colloid filled follicles
  • Tumors have papillary projections and pale empty nuclei
  • Lymph node metastases present
927
Q

neutrophil left shift

A

Prednisolone can cause neutrophilic through
* Demargination of neutrophils via the endovascular lining.
* Delayed migration of neutrophils into tissue.
* Release of immature neutrophils from bone marrow.
During bacterial infection, there is an increased ‘left shift’ seen on
microscopy. In ‘left shift’ neutrophils are produced and released
from the bone marrow at an equal rate to their consumption in the
circulation.
With steroid use, ‘left shift’ generally does not occur due to
increased production and release of neutrophils from the bone
marrow but no neutrophil consumption.

928
Q

initial treatment of myxoedema coma

A

hydrocortisone and levothyroxine

929
Q

insulinoma

A
  • Unusual symptoms such as visual disturbances, irritability,
    abnormal behaviour, confusion, amnesia, paraesthesiae,
    drowsiness
  • Symptoms arise after an overnight fast or before meals as a result
    of hypoglycaemia
  • Hypoglycaemic symptoms predominate - weakness, confusion,
    sweating, tachycardia
  • INV : gold standard - 72 hour supervised fasting
  • Blood glucose, insulin levels, C-peptide test.
  • Mx : surgical excision due to malignant potential of tumors
    Glucagon stimulation test : to assess pituitary function - GH
    production
    Sulphonyllurea assay test : helpful in conjunction with 72 hour fast
    in Insulinoma
    Calcium stimulation test : used when USG, CT and MRI often fails
    to localise the tumor in Insulinoma
    Exercise provocation test : rarely used
930
Q

alcohol and ADH

A

ADH suppression in posterior pituitary
gland; picture is similar to cranial diabetes insipidus -
hypernatremia, raised serum osmolality, decreased urine osmolality

931
Q

PCT

A
  • Acquired deficiency in Uroporphyrinogen decardoxylase UROD
  • Leads to accumulation of highly carboxylate porphyrinogens in
    liver which are oxidised to porphyrins and enters the plasma and
    excreted in urine
  • Photosensitive porphyrins are transported to skin and causes
    photo damage on exposure to light
  • This causes derma-epidermal separation and blister formation
  • Excess porphyrins in urine causes urine to become reddish or
    dark
    C/F :
  • Blistering skin lesions on sun exposed areas of body
  • blisters contain serous or serosanguinous fluid
  • Increased susceptibility to infections
  • Rupturing leads to scarring with hypo- or hyperpigmentation
  • Hypertrichosis - cheeks and forearms
  • Scarring alopecia
  • Red urine due to porphyrins
  • Fragile skin
    Labs :
    A.Elevated plasma and total porphyrins levels
    B.LFT - mildly elevated AST and ALT, iron overload

Mx :
* Avoid exacerbating factors - sunlight, excess alcohol, smoking,
oestrogen use
* Repeated phlebotomy
* Low dose Hydroxy chloroquine if ferritin > 600 ng/mL
* Reflectant sunscreens containing titanium dioxide or zinc oxide
* Low dose HCQ
* HIV anti retro viral
* Antiviral therapy for Hepatitis C

932
Q

acromegaly increased risk of ca

A

colon

933
Q

HAART lipodystrophy

A

These include a lipodystrophy-type syndrome that is characterised
by the loss of peripheral and facial subcutaneous fat, but with
increased abdominal and visceral fat deposition. There is also an
increase in the size of the dorsocervical fat pad (buffalo hump).
This fat redistribution is associated with a group of abnormalities
that is usually associated with insulin resistance, such as
impaired glucose tolerance, low high-density lipoprotein (HDL)
cholesterol levels and high triglycerides.
Glitazones can be used to treat the condition, although some
small trials have proved equivocal.

934
Q

ix for retrosternal thyroid extension

A

CT scan

935
Q

hypothyroid pericarditis

A

silent pericarditis : pericardial effusion
has high cholesterol content, unusual secondary pericarditis with
cholesterol deposits of gold paint appearance. Pericardial effusion
very rarely needs to be treated in its own right and subsides with
thyroid replacement therapy

936
Q

Carney complex

A

1) spotty skin pigmentation
2) Myxoma
3) Endocrine tumors - primary pigmanet nodular adrenocortical
disease (commonest), Sertoli cell tumors, GH / PRL producing
tumors, pituitary adenomas, thyroid adenomas and ovarian cysts
4) Psammomatus melanotic Schwannoma

937
Q

VIPoma

A

watery diarrhoea and normal anion gap metabolic acidosis

938
Q

indications for total thyroidectomy

A
  • medullary cancer > 5mm
  • All other cancers > 4 cm
  • Metastasis +
  • Extra - thyroid spread +
  • Lymph node involvement
  • B/L spread
  • Familial disease
939
Q

sex hormone binding globulin

A

reduced in insulin resistance and PCOS

940
Q

GLUT4

A

GLUT-4 : glycoprotein coded on short arm of chromosome 19.
Insulin binding to GLUT-4 => tyrosine kinase activation and
initiation of cascade of secondary intracellular process.
GLUT-4 => channel through which glucose is taken up into muscle
and adipose tissue.
GLUT - 1 : non insulin stimulated glucose into cells
GLUT - 2 : transports glucose into beta cells
GLUT - 3 : non-insulin mediated glucose uptake into brain neurone
GLUT - 5 : fructose transporter expressed on apical border of
enterocytes into small intestine

941
Q

Sturge weber syndrome

A

phaeo and port wine stain

942
Q

hypokalaemic periodic paralysis

A

related to muscle voltage
gated calcium channel mutation CACLN1A3
CACNA1 - calcium channel
SCN4A - alpha sub unit of sodium channel

943
Q

hypercalcaemia
VITAMINS TRAP

A

V - Vitamins A & D
I - Immobilisation
T - thyrotoxicosis
A - Addison’s disease
M - Milk alkali syndrome
I - Inflammatory disorders
N - Neoplasia
S - Sarcoidosis
T - Thiazides
R - Rhabdomyolysis
A - AIDS
P - Paget’s disease, Parenteral nutrition, Parathyroidism

944
Q

saline suppression test

A

2y confirmation of hyperaldosteronism

945
Q

Primary hypertriglyceridemia (w/o hypercholesterolaemia)

A
  • elevated VLDL : which is associated with even higher risk than
    elevated LDL

elevated triglyceride levels, NORMAL cholesterol levels. Due to
excess hepatic production of VLDL
Heterozygous for lipoprotein lipase gene inactivating mutations
Autosomal dominant disorder.
Accompanied by insulin resistance, obesity, hyperglycaemia,
hypertension and hyperuricaemia

  • Lipoprotein lipase and Apoprotein CII deficiency - elevated
    triglycerides
  • Apoprotein CII deficiency : hyperlipoproteinemia type IB / familial
    apolipoprotein CII deficiency
  • C/F : eruptive xanthomas, lipaemia retinalis, retinal vein
    thrombosis, pancreatitis and hepatosplenomegaly.
  • Chylomicrons can be detected in fasting blood sample/
946
Q

Primary mixed hyperlipidemia

A
  • elevated cholesterol and Triglycerides.
  • Premature atherosclerosis
  • Remnant hyperlipidemia (= type 3 hyperlipidemia) - rare cause f
    mixed hyperlipidemia
  • Associated with Apoprotein E2
947
Q

bipolar in preg

A

stop lithium
use lamotrigine/carbamazepine

948
Q

commonest cause of ESRD in UK

A

diabetes

949
Q

somatostatin receptor

A

7-transmembrane GPCR

950
Q

what drives development of 2y sexual characteristics

A

DHT
also prostate/seminal

951
Q

rapidly growing thyroid mass with regional lymphadenopathy and tracheal compression

A

anaplastic thyroid carcinoma

952
Q

sarcoidosis vitamin D

A

increased hydroxylation as can occur outside the kidney

mainly in macrophages in granulomas

953
Q

insulin inhibits

A

pyruvate decarboxylase

upregulates G6PD, glucokinase, pyruvate dehydrogenase, glycogen synthetase

954
Q

teprotumumab

A

IGF1 inhibitor
thyroid eye disease

955
Q

ovulation pattern

A

rise in LH and progesterone

956
Q

1y vs 2y ovarian failure

A

elevated FSH LH vs low

957
Q

HLA DR27

A

minimal change disease

A28 - schizo

958
Q

glucagon moa in BB overdose

A

bypassing the blocked Beta blocker in beta
blocker overdose and activates adenyl cycles and promotes
formation of cAMP from ATP. cAMP in turn exerts a direct Beta
stimulant action on heart.

959
Q

melatonin

A

synthesised and secreted by pineal gland from Serotonin

  • N-acetyl transferase + acetyl CoA converts serotonin to N-acetyl
    serotonin.
  • N-acetyl serotonin is converted to melatonin by hydroxyindoleO-methyltransferase
  • Exposure to darkness causes activation of hypothalamus by
    retinohypothalamic nerves
  • Results in increased Noradrenaline secretion by post-ganglionic
    sympathetic nerves (Nervi conarii) that innervate the pineal gland
  • Noradrenaline acts by alpha receptors in the pineal gland to
    increase intracellular cAMP levels which then causes an increase
    in serotonin N-acetyltransferase activity
960
Q

Riedel’s thyroiditis

A

dense fibrosis replacing parenchyma
extends beyond thyroid capsule
hoarseness, stridor, dysphagia
mx steroids and tamoxifen

961
Q

screening for MEN2

A

pentagastrin
calcitonin
calcium
phaeo - 24 hr catechol

962
Q

exenatide cannot be used in

A

patients with CrCl <30

liraglutide - not in IBD
semaglutide - safe

963
Q

familial hypocalciuric hyperca

A

AD
CaSR gene - in parathyroid and kidney tissue

964
Q

Gordon’s syndrome

A
  • aka pseudo-hypoaldosteronism - that mimics
    hypoaldosteronism
  • Due to failure of response to aldosterone and levels of
    aldosterone are elevated due to a lack of feedback inhibition.
  • C/F : short stature, severe hypertension, low FeNa, normal renal
    function, hyperchloraemic metabolic acidosis, low renin and
    elevated aldosterone levels.
  • Hyperkalemia **
965
Q

surgery indications for 1y hyperPTH

A

hyperCa
impaired renal function
renal stones
nephrocalcinosis
reduced BMD
elevated urinary Ca excretion

966
Q

deficiency of cystathione synthase

A

type 1 homocystinuria

967
Q

branched chain ketoacid dehydrogenase deficiency

A

MSUD

968
Q

if CT/MRI inconclusive in phaeo

A

MIBG scan

969
Q

hormone responsible for fusion of epiphyseal plates and cessation of growth and skeletal maturation

A

oestrogen

970
Q

increased prolactin inhibits

A

GnRH -> decreased FSH and LH

971
Q

metoclopramide binds to

A

D2 receptor on pituitary lactotrophes

972
Q

glucagon activates

A

adenyl cyclase

973
Q

sulphonylureas moa

A

mimicking role of ATP on potassium-ATP channels from the outside

block -> open VGCC -> insulin release

974
Q

sipuleucel-T

A

autologous cellular immunotherapy - prostate ca

975
Q

fibrate drugs increase risk of

A

DVT

976
Q

evolocumab

A

prevents PCSK9-mediated LDL receptor degradation

977
Q

canagliflozin inc risk of

A

foot amputations

978
Q

hypothyroidism lipid

A

hyperchol rather than triglycerides

979
Q

Mullerian duct agensesis

A

Mayer-RokitanskyKuster-Hauser (MRKH) syndrome - congenital absence or underdevelopment of the uterus and upper two-thirds of the vagina in females with normal 46,XX karyotype and ovarian function.

Although primary amenorrhoea would be expected in these
individuals, they would typically have normal secondary sexual
characteristics including pubic hair growth, which is inconsistent with the clinical presentation described in the question.

980
Q

carbenoxolone

A

glycyrrhizinic acid
peptic ulcer mx
hypokalaemia

981
Q

tomatoes CKD

A

hyperK

982
Q

false negative renin:aldosterone ratio results

A

ACEI
ARB
direct renin inhibitors - aliskiren
aldosterone antagonists

983
Q

alcoholic liver disease depleted

A

glycogen storres

984
Q

achondroplasia

A

AD
short stature
FGFR3 - fibroblast growth factor receptor
abnormal cartilage
A.Short limbs (rhizomelia) and shortened fingers (brachydactyly)
B.Large head with frontal bossing and narrow foramen magnum
C.Midface hypoplasia with flattened nasal bridge
D.Trident hands
E. Lumbar lordosis

985
Q

alkaptonuria

A
  • Autosomal recessive
  • Disorder of Phenylalanine and tyrosine metabolism due to lack of
    enzyme homogentisic dioxygenase
  • Accumulation of toxic homogentisic acid

C/F :
- pigmented sclera
- Urine turns black when exposed to air
- Intervertebral disc calcification —> back pain
- Renal stones

Mx : high dose vitamin C, dietary restriction of phenylalanine and
tyrosine

986
Q

ADH

A

aquaporin 2 in CD
supraoptic nuclei of hypothalamus -> posterior pituitary

987
Q

arachidonic acid metabolism

A
  • PGI2 : vasodilation, decreased platelet aggregation, decreases
    uterine tone
  • PGE2 : increased pain, increases temperature, increase uterine
    tone, increases gastric mucus
  • PGE2 : decreased gastric acid
  • Thromboxane TXA2 : vasoconstriction, increases platelet
    aggregative
  • LTB4 : neutrophil chemotaxis
  • LTA4, LTC4, LTD4, LTE4 : increases bronchoconstriction
988
Q

ANP

A

secreted by myocytes of RA and RV (also LA but less) in response to inc blood volume

28 AA peptide - acts by cGMP

Na excretion
lowers BP
aldosterone and AT2 antag

989
Q

otosclerosis complication inheritance

A

non-penetrance

990
Q

spontaneous mutation

A

achondroplasia

991
Q

AD vs AR quick

A

structural vs metabolic

except hyperlipidaemia T2, hypokalaemic periodic paralysis (AD)

Hunters, G6PD (XLR)

ataxia tel and FRAX (AR)

992
Q

glioblastoma multiforme

A

A.Most common primary brain tumor in adults
B.Poor prognosis
C.Imaging : solid tumors with central necrosis and a rim enhances
with contrast
D.Causes disruption of BBB and associated with vasogenic
oedema
E. M/C : pleomorphic tumor cells border necrotic area
F. Mx : Surgical, post op Chemo/Radio; Edema = Dexamethasone

993
Q

meningioma

A
  • Second most common primary tumor in adults
  • Benign, extrinsic tumors of CNS
  • Arises from : Arachnoid cap cells of meninges and typically
    located next to dura
  • Causes symptoms by compression
  • M/C : spindle cells in concentric whorls, calcification of
    Psammoma bodies
994
Q

BL acoustic neuroma

A

NF2

Antoni A or B patterns, Verocay bodies - acellular areas surrounded by nuclear palisades

995
Q

paediatric brain tumours

A

Pilocytic astrocytoma
* M/C - Rosenthal fibers - corkscrew eosinophilic bundle
* Most common primary brain tumor in children

Medulloblastoma
* Aggressive paediatric brain tumor
* Spreads through CSF system
* M/C : Small, blue cells, Rosenthal pattern of cells with many
mitotic figures

Ependymoma
- seen in 4th ventricle
- Can cause hydrocephalus
- M/C : Perivascular pseudo-rosettes

Oligodendroma
- benign slow growing tumor found in frontal lobes
- M/C : Calcifications with fried egg appearance

995
Q

haemangioblastoma

A

vascular
VHL
foam cells

996
Q

drugs CI in breast feeding

A

I. Antibiotics - Ciprofloxacin, Tetracyclines, Chloramphenicol,
Sulphonamides
II. Psychiatric : Lithium, Benzodiazepines
III.Aspirin
IV.Carbimazole
V. Methotrexate
VI.Sulfonylureas
VII.Cytotoxic drugs
VIII.Amiodarone
IX.Antipsychotics - Clozapine

997
Q

cardiac action potential

A

Phase 0
- rapid depol
- Na influx

Phase 1
- early repol
- efflux of K and Cl

Phase 2
- plateau
- slow Ca influx

Phase 3
- final repol
- K efflux

Phase 4
- restoration
- slow entry of Na
NaK ATPase

998
Q

LVEF

A

(SV/ED LV vol) * 100%

999
Q

CO =

A

SV * HR

1000
Q

pulse pressure

A

SBP-DBP

1001
Q

SVR =

A

MAP/CO

1002
Q

cell cycle

A

G1
- inc in size
determines length of cycle
p53
Cyclin D/DK4/DK6/R/DK2

S
- synth of DNA/RNA/histone
centrosome duplication
cyclin A/DK2

G2
- inc in size
cyclin B/DK11

M
mitosis - cell division
shortest phase of cell cycle

1003
Q

phases of mitosis

A

prometaphase
- nuclear membrane breaks down allowing microtubules to attach to chromosome

metaphase
- chromosomes aligned in middle of cell

anaphase
- paired chromosome separate at kinetochores and more to opposite sides of cell

telophase
- chromatids arrive at opposite poles of cell

cytokinesis
- actin-myosin complex in centre of cell contracts resulting in it being picked into two daughter cells

1004
Q

rough endoplasmic reticulum

A

translation and folding of new proteins
manufacture of lysosomal enzymes
N-linked acetylation

1005
Q

smooth ER

A

steroid and lipid synthesis

1006
Q

Golgi apparatus

A

modifies, sorts and packages molecules destined for cell secretion
addition of mannose-6-phosphate to protein designates transport to lysosome

1007
Q

mitochondria

A

aerobic respiratory
circular DNA

1008
Q

nucleus

A

DNA maintenance
RNA transcription
RNA splicing

1009
Q

lysosome

A

breakdown of large molecules such as proteins and polysaccharides

1010
Q

nucleolus

A

ribosome production

1011
Q

peroxisome

A

catabolism of v long chain fatty acids and amino acids
formation of hydrogen peroxide

1012
Q

proteasome

A

degradation of protein moleculres tagged with ubiquitin

1013
Q

Patau vs Edwards syndrome

A

trisomy 13 - polydactyly, cleft lip and palate, microcephaly

Trisomy 18 - micrognathia, low set ears, rocker bottom foot, overlapping fingers

1014
Q

Prader Willi

A

hypogonadism
hypotonia
obesity

1015
Q

cri du chat

A

5p deletion
larynx and neuro problems
microcephaly
hypertelorism

1016
Q

collagen defects

A

T1 - OI
3 - vEDS
4 - Alports, Goodpastures
5 - EDS

1017
Q

complement deficiencies

A
  • C1 - INH deficiency : CI inhibitor deficiency - hereditary
    angioedema
  • C1q, C1rs, C2, C4 deficiency : classical pathway components,
    predisposes to immune complex disease - SLE, Henoch
    Schonlein purpura
  • C3 deficiency : recurrent bacterial infection
  • C5 deficiency : Leiner disease - recurrent diarrhoea, wasting and
    seborrhoeic dermatitis
  • C5 - C9 deficiency : enodes the membrane attack complex (MAC)
    ; prone to Neiserria meningitides infection
1018
Q

congenital infections

A

rubella - sensorineural deafness, cataracts, PDA, HSmeg, purpuric lesions, salt and pepper chorioretinitis, micrcophthalmia, CP

toxo - calcification, chorioretinitis, hydrocephalus, hsmeg, CP, anaemia

CMV - lbw, purpuric lesions, all issues + pneumonitis and jaundice

1019
Q

cytokines

A

IL-1 Macrophages Acute inflammation,
induces fever

IL-2 Th1 cells Stimulates growth
and differentiation of
T cell response

IL-3 Activated Th1 cells Stimulates
differentiation and
proliferation of
myeloid progenitor
cells

IL-4 Th2 cells Stimulates
proliferation and
differentiation of B
cells

IL-5 Th2 cells Stimulates
production of
eosinophils

IL-6 Macrophages, Th2
cells
Stimulates
differentiation of B
cells, induces fever

IL-8 Macrohages Neutrophil
chemotaxis

IL-10 Th2 cells Inhibits APCs and
Th1 cytokine
production
AKA human cytokine
synthesis inhibitory
factor
Anti inflammatory
cytokine

IL-12 Dendritic cells,
macrophages, B
cells
Activated NK cells
and stimulates
differentiation of
naive T cells into Th1
cells

TNF-alpha Macrophages Induces fever,
neutrophil
chemotaxis

Interferon-gamma Th1 cells Activates
macrophages

1020
Q

DiGeorge syndrome

A

T-cell
microdel 22q11.2
AD

CATCH 22
C - Cardiac abnormalities (endocardial cushion defect most common ie - AV septal defect)
A - Abnormal facies
T - thyme aplasia
C - Cleft palate
H - hypocalcemia, hypoparathyroidism
22 - Chromosome 22 deletion

single palmar crease, pronounced sandal gap, hypotonia, heart defects, duodenal atresia

1021
Q

endothelin

A
  • potent, long acting vasoconstrictor and broncho-constrictor
  • Prohormone converted to endothelin-1 by enzyme Endothelin
    converting enzyme
  • Acts via G-protein liked to phospholipase C leading to calcium
    release

promotes - AT2, ADH, hypoxia, shearing

inhibits - NO, prostacyc

1022
Q

erythropoeisis

A
  • Red bone marrow found in flat bones - vertebrate, sternum, ribs,
    proximal ends of long bones
  • Fonts - erythrocytes produced in liver
  • RBC lifespan - 120 days
  • Levels of erythrocytes = hematocit
1023
Q

Fabry disease

A

XLR
alpha galactosidase A
burning pain/parasthesia in childhood
angiokeratomas
lens opacities
proteinuria
CVD early

1024
Q

Fragile X is a

A

TNR disorder

analysis of number of
CGG repeats using restriction endonuclease digestion and Souther
blot analysis

1025
Q

HIV immune cell reactions

A
  • Reduction in CD4 count
  • Increase in beta - 2 micro globulin
  • Decreased IL-2 production
  • Polyclonal B cell activation
  • Decrease in NK cell function
  • Reduced delayed hypersensitivity responses
1026
Q

type 1 hypersensitivity

A

Antigen reacts with IgE bound
to mast cells

Anaphylaxis
Atopy - asthma, eczema, hay
fever

1027
Q

type 2 hypersensitivity

A

cell bound

IgG or IgM binds to antigen on
cell surface

Autoimmune haemolytic
anaemia
Goodpasture’s syndrome
ITP
Pernicious anaemia
Acute haemolytic transfusion
reaction
Rheumatic fever
Pemphigus vulgairs
Bullus pemphigoid

1028
Q

Type 3 hypersensitivity

A

Free antigen and antibody
(IgG, IgA) combine

Serum sickness
SLE
Post - strept GN
Extrinsic allergic alveolitis

1029
Q

Type 4 hypersensitivity

A

T - cell mediated

Tuberculosis/ Tuberculin skin
reaction
Graft v/s host disease
Scabies
Allergic contact dermatitis
Multiple sclerosis
EAA - chronic phase
GBS

1030
Q

Type 5 hypersensitivity

A

Antibodies that recognise and
bind to cell surface receptors -
either stimulates them or
blocks ligand binding

Myasthenia gravis
Graves’ disease

1031
Q

IL1 actions

A
  • Acts as a co-stimulator of T cell and B cell proliferation.
  • Increases expression of adhesion molecules on the endothelium.
  • Stimulates the release of endothelium of vasoactive factors such
    as PAF, NO and prostacyclin.
  • Causes vasodilation and increases vascular permeability.
  • One of the mediators of shock in sepsis
  • IL-1, IL-6, TNF -> acts on hypothalamus and causes pyrexia.
  • Anakinra - IL-1 receptor antagonist; management of rheumatoid
    arthritis
  • Canakinumab : monoclonal antibody targeted at IL-1 beta; used
    in systemic JIA and adult onset Still’s disease
1032
Q

innate immunity

A

neutrophils
- primary phagocytic cell in acute inflammation
- granules contain myeloperoxidase and lysozyme
- multi lobed nucleus

eosinophil
- protozoan and helminth
- bi lobed nucleus

monocytes
- differentiate into macrophages
- kidney shaped nucleus

mast cells
- present in tissue
- release histamine, contain heparin
- expressed IgE receptors on cell surface

macrophages
- phagocytosis of debris and pathodens
- APC

1033
Q

NK cells

A

induces apoptosis in infected and tumour cells

1034
Q

adaptive immunity

A

helper T cells
* Involved in cell mediated immune response
* Recognises antigen presented by class II MHC molecule
* Expressed CD4, CD3, TCR, CD28
* Major source of IL-2
* Mediates acute and chronic graft rejection

cytotoxic T cells
* Recognises antigens presented by MHC Class I molecules
* Expressed CD8, TCR, CD3
* Mediates acute and chronic organ rejection

B cells
Major cell of humeral immune response
* Acts as APC
* Mediates hyper acute rejection
* Differentiated from plasma cells
* Produces large amout of antibody specific to particular antigen

1035
Q

most abundant antibody

A

IgG

1036
Q

most commonly produced Ab

A

IgA

1037
Q

least abundant Ab

A

IgE

1038
Q

breast milk ab

A

IgA
protection on mucosal membranes, transported via transcytosis

1039
Q

ab activating B cells

A

IgD

1040
Q

ab synthesised by plasma cells

A

IgE

1041
Q

glycogen storage disorders

A

Von Gierke’s disease -
Type 1
Glucose 6 phosphatase Hepatic glycogen accumulation
C/F : hypoglycaemia, lactic
acidosis, hepatomegaly

Pompe’s disease -
type 2
Lysosomal alpha 1,4
glucosidase
Cardiac, hepatic and muscle
glycogen accumulation,
cardiomegaly

Cori disease - type 3 Alpha - 1,6 - glucosidase
debranching enzyme
Hepatic, cardiac glycogen
accumulation. Muscle
hypotonia

McArdle’s disease Glycogen phosphorylase
(myophosphorylase)
Skeletal muscle glycogen
accumulation. C/F : myalgia,
myoglobinuria with exercise

1042
Q

lysosomal storage disorders

A

Gaucher’s disease Beta
glucocerebrosidase
Most common; accumulation
of glucocerebrocidase in
brain, liver, spleen;
C/F : hepatosplenomegaly,
aseptic necrosis of femur
Increased levels of Acid
phosphatase
Miglustat - recombinant glucosidase and glucosylceramide inhibitors

Tay-Sachs disease Hexosaminidase A Accumulation of GM2
ganglioside within lysosomes.
C/F : developmental delay,
cherry red spot on macular,
normal size liver and spleen

Niemann - Pick disease Spnhingomyelinase Hepatosplenomegaly
Cherry red spot on macula

Fabry disease Alpha-galactosidase A Accumulation of ceramide
trihexoside
C/F : angiokeratomas,
peripheral neuropathy, renal
failure

Krabbe’s disease Galactocerebrosidase Peripheral neuropathy, optic
neuropathy, globoid cells

Metachromatic
leukodystrophy
Arylsulfatase A Demyelination of CNS & PNS

1043
Q

mucopolysaccharide syndromes

A

Hurler syndrome
- type 1
Alpha - 1 - Iduronidase Accumulation of GAG (heparin and
derma tan sulphate)
C/F : Gargoylism (large head and
grotesque facial appearance),
Hepatosplenomeglay, YES corneal
clouding

Hurler Syndrome
- type 2
Iduronate sulfatase Accumulation of GAGs;
C/F : coarse facial features,
behavioural problems, learning
difficulties, short stature, NO corneal
clouding

1044
Q

femoral nerve damage

A

loss of knee extension and sensory
loss to anterior and medial aspect of thigh following stab injury

1045
Q

obturator nerve injury

A

damaged nerve anterior hip dislocation - unable
to adduct thighs

1046
Q

Lateral cutaneous nerve of thigh : compression at ASIS —>
meralgia paraesthetica

A

pain, tingling, numbness in distribution
of lateral cutaneous nerve —> lateral and posterior surfaces of
thigh

1047
Q

tibial nerve issues

A

foot plantar flexion and inversion - loss of sensation
over sole of foot. Injured in popliteal laceration, posterior knee
dislocation

1048
Q

common peroneal nerve

A

loss of foot dorsiflexion and eversion,
cannot use extensor hallucis longus; injury at neck of fibula,
tightly applied plaster cast - foot drop

1049
Q

superior gluteal nerve

A

positive Trendelenburg sign : misplaced
IM injection, Pelvic #, posterior hip dislocation - cannot abduct
hips

1050
Q

inferior gluteal nerve

A

hip extension and lateral rotation - injury
causes difficulty in getting up from sitting position, cant jump /
climb stairs

1051
Q

Mc-cune albright

A

random somatic mutation in
GNAS gene
Precocious puberty, cafe au lait spots, polyostotic fibrotic
dysplasia, short stature
Polyostotic fibrous dysplasia = bone replaced by fibrous tissue -
weak bones, deformity, uneven growth

1052
Q

ligand gates ion channels

A
  • Mediates fast response
  • Nicotinic acetylcholine
  • GABA-A, GABA-C
  • Glutamate
1053
Q

tyrosine kinase receptors

A
  • Insulin
  • Insulin-like growth factor -1 IGF-1
  • Epidermal growth factor EGF

non-receptor:
* Prolactin
* Immunomodulators - IL-2, IL-6, IFN
* Growth Hormone
* G-CSF
* Erythropoietin
* Thrombopoietin

1054
Q

granulate cyclase receptors

A
  • Contains intrinsic enzyme activity
  • ANP, BNP
1055
Q

GPCR

A
  • Slow transmission, affects metabolic processes
  • Activated by wide variety of signals
  • 3 main sub-units - alpha, beta, gamma
  • G proteins are named according to the alpha subunit

Gs :
* Stimulates adenylcyclase —> increases cAMP —> activates
protein kinase A
* Beta 1 receptors - NA, Adrenaline, Dobutamine
* Beta 2 receptors : Epinephrine, Salbuterol
* H2 receptors - histamine
* D1 receptos - Dopamine
* V2 receptors - Vasopressin
* Receptors for ACTH, LH, FSH, PTH, Glucagon, Calcitonin,
Prostaglandins

Gi :
* Inhibits adenyl cyclase —> decreased cAMP —> inhibits protein
kinase A
* M2 receptors - Acetylcholine
* Alpha 2 receptors - epinephrine, norepinephrine
* D2 receptors - Dopamine
* GABA-B receptors

Gq:
* Activates phospholipase C —> splits PIP2 to IP3 + DAG —>
activates protein kinase C
* Alpha 1 receptors : Epinephrine, norepinephrine
* H1 receptor - histamine
* V1 receptors - vasopressin
* M1, M3 receptors - acetylcholine

1056
Q

microtubule function

A
  • Helps guide movement during intracellular transport and also
    binds internal organelles.
  • Found in all cells except blood cells.
  • Cylindrical structure - composed of alternating alpha and beta
    subunits which polymerises to form protofilaments
  • Microtubules are polymerised - have a negative or positive charge
  • Attachment protein = dyenin and kinesin : helps moves the
    microtubules facilitating the movement of various cell organelles.
  • Dyenin - retrograde fashion - down the microtubule - towards the
    centre +ve —> -ve
  • Kinesin : anterograde fashion - up the microtubule way from the
    centre : -ve —> +ve
1057
Q

molecular biology

A

SNOWDROP
Southern blot - detects DNA
Northern blot - detects RNA
Western blot - detect proteins; uses gel electrophoresis to separate
native proteins by 3D structure; EG - Confirmatory HIV test

ELISA - antigens and antibodies, initial HIV test

1058
Q

lack of NO

A

hypertrophic pyloric stenosis
atherosclerosis

sepsis - increased NO causes shock

1059
Q

Noonans coagulation issues

A

factor XI deficiency

1060
Q

Noonans heart

A

pulmonary stenosis

1061
Q

oncogenes

A

ABL - CML
n-MYC - neuroblastoma
BCL-2 - follicular lymphoma
c-MYC - burkitt’s lymphoma
RET - MEN 2a and 2b
RAS - pancreatic
ERB-B2/HER-NEU - breast/ovarian

1062
Q

oncoviruses

A

EBV -> Burkitts, HL, post transplant lymphoma, NPC

Hep b and c - HCC

HTLV-1 -> adult T cell leukaemia, tropical spastic paraparesis

1063
Q

p53 is a

A

TSG
breast colon lung ca
prevents entry into S phase until DNA checked and repaired

Li Fraumeni due to mutation in this

1064
Q

primary hyperPTH

A
  • PTH - elevated
  • Calcium - elevated
  • Phosphate - Low
  • Urine calcium : creatinine clearance ration > 0.01
  • Recurrent abdominal pain - pancreatitis, renal colic
  • Changes to emotional or cognitive state

Causes : 80% due to solitary adenoma

1065
Q

Secondary hyperPTH

A
  • PTH - elevated
  • Calcium - low or normal
  • Phosphate - elevated
  • Vitamin D levels - low
  • May have few symptoms
  • Complications : bone disease, osteitis fibrosa cystica, soft tissue
    calcifications
  • Parathyroid gland hyperplasia due to low calcium levels
  • Chronic renal failure

Secondary hyperparathyroidism
Usually managed with medical therapy.
Indications for surgery in secondary (renal) hyperparathyroidism:
* Bone pain
* Persistent pruritus
* Soft tissue calcifications

1066
Q

Tertiary hyperPTH

A
  • Calcium - normal or high
  • PTH - elevated
  • Phosphate - decreased
  • Vitamin D - normal or decreased
  • ALP - elevated
  • Due to - metastatic calcification
  • Nephrolithiasis
  • Pancreatitis
  • Hyperplasia of all 4 glands causes this
    Tertiary hyperparathyroidism

Allow 12 months to elapse following transplant as many cases will
resolve
The presence of an autonomously functioning parathyroid gland
may require surgery. If the culprit gland can be identified then it
should be excised. Otherwise total parathyroidectomy and reimplantation of part of the gland may be required.

1067
Q

PKUria

A

AR
phenylalanine hydroxylase defect - converts to tyrosine
learning difficulties and seizures
chr 12

C/F :
* Developmental delay
* Fair hair and blue eyes
* Learning difficulties
* Seizures - infantile spasms
* Eczema
* Musty odour due to urine and sweat (sweat = secondary to
phenyl acetate, which is a phenylketone)

Labs :
- hyper-phenylalaninaemia
- Phenylpyruvic acid in urine

1068
Q

reverse transcriptase is

A

DNA polymerase enzyme : involved in
transcribing ss RNA into lengths of ds DNA

1069
Q

xanthine oxidase

A

catalyses the oxidation of hypoxanthine to
xanthine and also further catalyse the oxidation of xanthine to uric
acid.

Xanthine oxidase inhibitors - treatment option in gout.

Cause of gouty tophi - firm nodules over the extensor surfaces of
fingers, hands, forearms, ears.

1070
Q

Klumpke’s paralysis

A
  • C8, T1 nerve roots - weakness of
    intrinsic muscles of hand, long extensors of fingers
    Supplies motor supply to all intrinsic hand muscles (except LOAF)

LOAF - Lateral 2 lumbricals, Opponens pollis, Abductor pollis
brevis, Flexor pollis brevis
LOAF muscles supplied by median nerve C6, C8, T1

1071
Q

gastric adenocarcinoma

A

signet ring cels&raquo_space; mutinous&raquo_space;
papillary&raquo_space; tubular in descending order of prognosis

1072
Q

where are G proteins located

A

in the cytoplasm

coupled with GPCR on cell membrane

ligand binding site expressed outside the surface through the plasma membrane

TSH, ACTH, GABA-B

1073
Q

Lys18 deletion mutation form

A

HOCM trop I - high risk of SCD

if trop T - milder

1074
Q

nerve damage during parotidectomy

A

tendency of food
and fluids to collect in buccal sulcus after meals due to paralysis of
buccinator muscle
Action of buccinator muscle : empty the buccal sulcus during
mastication.

Peripheral injuries of facial nerve - no loss of taste sensation as the
chord tympanii fibers pass from the lingual nerve to facial nerve
just below the skull and remains intact during peripheral injuries of
facial nerve

1075
Q

intraglomerular thrombi of immunoglobulins

A

malignant lymphoma

deposition of amorphous material in glomerular capillary lumens

1076
Q

lung surface markers

A
  • Anterior border of left lung - moves laterally to level of fourth
    costal cartilage to form the cardiac notch , before moving
    down to 6th costal cartilage.
  • Inferiorly - lung reaches upto the 8th rib at mid clavicular levels -
    10th rib at mid axillary level and 12th rib posteriorly at level of
    scapula line
  • Oblique fissure - level of T12 vertebra on posterior side to 6th
    costal cartilage on the front
1077
Q

pores of kohn

A

intra-alveolar communication

1078
Q

bronchial veins

A

drain into azygous on R and hemi on L

1079
Q

lymphatic drainage of lung

A

BP LNs at hilum

1080
Q

phase 0 of cardiac potential channels

A

L type Ca channels

1081
Q

Class 1 anti-arrhythmic

A

Na channel blockers - effect on phase 0 of potential

1082
Q

class 3 antiarrhythmics

A

amiodarone
sotalol

phase 3 - K channel blockers

1083
Q

class 4

A

verapamil
phase 2 of potential

1084
Q

CN3 nuclei location

A

midbrain at level of superior colliculus

1085
Q

surfactant composition

A

phospholipids such as DPPC, cholesterol and apolipoproteins
water least present

1086
Q

where is ventilation controlled

A

resp centre in medulla
peripheral and central chemoreceptors

DKA inc resp drive 2y to metabolic acidosis

control of normal vent - central carotid chemoreceptors
controls 2/3rd of response

1087
Q

3 elements of nucleotide which combine to form repeating unit making up DNA

A

phosphate group
sugar group
nitrogenous base

1088
Q

RNA splicing

A

by enzymes spliceosomes - composed of 5 small
nuclear RNAs and associated proteins - leads to removal of
introns and joining together of exons

1089
Q

ribosomes

A

translate mRNA into proteins using tRNA

1090
Q

Golgi apparatus

A

protein transport

1091
Q

hypoxia effect on VQ

A

vasoconstriction in pulmonary vessels - improves ratio
acute response due to NO

1092
Q

biceps femoris nerve supply

A

common fibular branch of sciatic nerve

1093
Q

peroneus muscle

A

superficial peroneal nerve

1094
Q

Absent knee reflex, loss of sensation over anterior and medial thigh

A

femoral nerve damage

1095
Q

first biochemical change in hypothyroidism

A

increase in serum TSH

1096
Q

ANP

A

28 aa peptide
released in response to atrial stretch
dilates the AFFERENT, constricts the EFFERENT, increases the eGFR

1097
Q

acute attacks of AIP

A

IV haematin/haem alginate

suppresses the hepatic synthesis
4 day course

1098
Q

bleomycin

A

degrades preformed DNA
single DNA strand scission

1099
Q

leptin increase

A

release of MSH, CRH, GnRH
stimulation production of cortical bone, decreases cancellous bone formation

1100
Q

amylin

A

slows gastric emptying

1101
Q

onset of puberty other hormons

A

leptin
kisseptin

1102
Q

stellate cells of liver

A

role in fibrosis
have fat droplets

1103
Q

activation of Ito cells

A

important mechanism for control of sinusoidal perfusion

1104
Q

bile duct epithelial cells

A

pathology of PBC and PSC

1105
Q

Kupffer cells

A

produces mediators which stimulate stellate cells to drive fibrosis

1106
Q

normal lung volumes

A

Peak expiratory flow - 520-700 L / min
Total lung capacity - 5-6.5 L
Functional residual capacity - 2-3 L
Tidal Volume - 500-700 mL
Inspiraotry Reserve Volume - 3.3 L

1107
Q

genetics

A
  • Human genome project- 20,000 genes
  • Exons = coding sequences of DNA which code for peptides
    produced from mRNA
  • Introns = exons have spaces of DNA between them called
    introns; these code for switches that control gene expression in
    splicing
  • Human genome have a higher number of segmental duplications
    vs other mammals
1108
Q

PPOX porphyria gene

A

AD

chr 1

1109
Q

CFTR gene

A

chromosome 7

1110
Q

chromosome 11

A

BWS
Ewings

1111
Q

Shock classification

A

1 - 15% 750mL
2 - 15-50% 750-1000mL tachycardia
3 - 30-40% 1500-2000mL hypotension tachycardia fall in UO
4 - >40% >2000mL anuria and severe shock

1112
Q

thumb abduction

A

APB
median nerve

1113
Q

wrist drop

A

radial extensors
radial nerve

1114
Q

inability to abduct and adduct fingers
flex little finger

A

ulnar nerve

1115
Q

hoarse voice, paralysis of posterior cricoarytenoid

A

recurrent laryngeal

1116
Q

interarytenoid muscle

A

L and R recurrent laryngeal

1117
Q

renin secretion by

A

juxtaglomerular cells

reduced by - BB, NSAIDs

1118
Q

aldosterone released in response to

A

raised AT2, hyperK, raised ACTH

retention of Na in exchange for K/H in distal tubule

1119
Q

neurons in resting state

A

+ve external
-ve internal

At rest - neuron cell membranes are less permeable to Na+ than to K+.

Inside of neuron is rich in chloride ions and contains lesser amount of potassium ions.

Outside of neurone = rich in sodium ions and positive on outside.

1120
Q

Parkinson’s increased protein aggregation

A

due to proteasome dysfunction

bortezomib - proteasome inhibitor

1121
Q

most accurate methods for testing GFR

A

inulin clearance
chromium labelled EDTA
lohexol

1122
Q

nephron

A

PCT - 50% of filtered sodium reabsorbed within the prox tubule Na/K ATPase pump

Na/H antiporter - 90% of bicarb and NaCl reabsorption

All filtered glucose and amino acids reabsorbed in PCT, damage -> albuminuria and proteinuria, hypokalaemia

LOH - thick ascending limb impermeable to water
40% of sodium vua Na/K/2Cl pump

Distal - 5% sodium Na/Cl transporter
H+ ions secreted
thiazide diuretics

CD - Na channels
spironolactone
H+ secreted acidifying urine

1123
Q

BRCA1

A

repair of double stranded breaks in DNA
if mutated, breaks accumulate

1124
Q

DNA polymerase mutation

A

DNA replication
colorectal cancers

1125
Q

RB gene

A

freezing of cell cycle
associated with impaired checkpoint regulation between G1 and S phase

1126
Q

bradykinin

A

potent vasoactive peptide

1127
Q

Hermansky-Pudlak syndrome

A

mutation of AP3 gene, responsible for trafficking specific glycoproteins from the Golgi body
AR

1128
Q

normal breathing

A

diaphragm drops down by 1 cm, creating an intro thoracic pressure drop of 1-3 mmHg, and air intake of 500 mL

Accessory muscles of respiration relax during passive expiration.

Diaphragm drops by 10 cm - during exercise

Rib cage recoils during passive expiration.

1129
Q

cervical rib

A

selective weakness of APB
C8/T1 nerve roots

1130
Q

liver supply

A

75% portal vein
25% hepatic artery

1131
Q

intrinsic factor

A

parietal cells in fundus

cardia -> mucus

1132
Q

Paget’s disease can have low ALP if

A

low Mg in highly active disease

1133
Q

Organ of Corti

A

cochlear duct
contains potassium rich endolymph
produces nerve impulses in response to sound vibrations

1134
Q

high vs low frequency sound

A

scala vestibuli - base - high

scala tympani - apex - low

contain perilymph

normal 20-2000Hz

1135
Q

diffusion

A

fat soluble molecules - e.g. Glycerol - diffused
through semi permeable cell membrane.

  • they dissolve in the phospholipid bilayer and pass through in direct of concentration gradient.
  • Endocytosis : active process where particles are captured within the cell membrane and this can be receptor or non receptor mediated.
  • Exocytosis : export of particles out of the cell via secretory
    vesicles.
  • Osmosis : diffusion of water across a membrane in which water diffuses into a solution having a greater solute concentration
  • Phagocytosis : active process by which bacteria or other
    antigenic material is engulfed by macrophages.
1136
Q

regional variations in lung

A

greater vol of blood to base
alveoli at base compressed - smaller but greater compliance

apex - less blood flow and ventilation

V/Q ratio at apex is greatest, increased PaO2 and decreased PCO2

1137
Q

congenital long QT

A

AD
K+ channels

BB
2nd line - ICD, stellate gangliotomy

ICD first line if cardiac arrest

1138
Q

atrial myxoma and freckles

A

Carney complex = atrial myxoma + freckles
- high cortisol levels independent of ACTH
- Testicular, thyroid, pancreatic carcinomas are common
- Mutation in PRKAR1A gene on chromosome 17q23-q24

1139
Q

ethylene glycol electrolyte imbalance

A

hypoCa
end product of ethylene glycol is oxalic acid
combines with Ca to form Ca oxalate -> acidosis and kidney disease

1140
Q

dextrose 50% - 1700kcal

A

40% - 1360
60% - 2040

1141
Q

dextrose 50% and lipid emulsion 20%

A

2000kcal

1142
Q

ulnar nerve injury at the elbow

A

Ulnar nerve injury at the elbow - inability to grip a sheet of
paper between his fingers when the hand is placed flat on the table
- test for paralysis of the Palmar interossei muscles - inability to
adduct the fingers.
Loss of sweating over the ulnar border of left hand due to damage
to sympathetic interruption

4th and 5th digits are held in clawed position if ulnar nerve lesion is
at the wrist.

Elbow lesions of ulnar nerve leads to paralysis of long flexors only -
NO CLAWING IN ULNAR ELBOW LESION.

1143
Q

precursor to cortisol

A

11-deoxycortisol

1144
Q

precursor to corticosterone

A

deoxycorticosterone

1145
Q

precursor to aldosterone

A

corticosterone

1146
Q

Dubin Johnson test

A

coproporphyrin excretion pattern

1147
Q

inhalation of fluids -> disordered gas exchange

A

respiratory acidosis
metabolic acidosis - due to volume depletion, hypotension and tissue hypoxia

therefore mixed acidosis

1148
Q

DNA Proofreading

A

DNA polymerase travels along a
double stranded piece of DNA - when a mismatched pair is
recognised, incorrect base is excised

  • Recombination - DNA recombination brings together DNA from multiple source
  • Replication : DNA replications is the process of producing two
    identical copies of DNA from one template molecule
  • Retro-transposition : transposition via a RNA intermediate
  • Transposition : movement of genetic element from one site to
    another in a DNA molecule
  • Splicing : removal of introns from the primary transcript of a
    discontinuous gene
1149
Q

ciliary dyenin

A

converts chemical energy from ATP into movement -> ciliary beating

100mL mucus

bronchioles no cartilage in walls
diameter 1mm

mucociliary escalator moves at 2cm/min

1150
Q

EEG waves

A
  • alpha waves : 8-13 Hz
  • Delta waves : < 4 Hz
  • Theta waves : 4-7 Hz
  • Beta waves : >14 Hz
1151
Q

hyperphagia nucleus

A

ventromedial

1152
Q

control of BP and HR nucleus

A

dorsomedial

1153
Q

BP reg, shivering, vasopressin nucleus

A

posterior

1154
Q

factors maintaining pressures within the arterial system

A

1) peripheral arterial elasticity
2) Ventricular systole
3) Recoil of elastic aorta

1155
Q

monoclonal antibodies target

A

plasma cells

1156
Q

targets for monoclonal therapy in asthma

A

1) IgE - in allergic phenotype
2) To target eosinophil maturation via IL-4/IL-5/IL-13 - in the

eosinophilic phenotype
- NICE recommends adding monoclonal IgE antibody therapy after 4 or more trials of oral corticosteroids have been completed in the previous year with optimised standard therapy
- Example - Omalizumab

  • severe eosinophilic asthma - Il-5 antibody therapy -
    Mepolizumab / Reslizumab / Benralizumab
  • Il-4/13 antibody therapy - Dupilumab
1157
Q

cytokines involved in fever/sepsis

A

IL1 -> vasodilation and hypotension
IL6
TNFa

1158
Q

FiSH

A

fluorescent DNA or RNA
probe to bind to specific gene interest for direct visualisation of
chromosomal abnormalities

1159
Q

Eastern blotting

A

post translational modifications of proteins
such as addition of lipids and phosphates

1160
Q

renal biopsy findings

A

diabetic nephropathy - Kimmelsteil Wilson nodules - nodular
glomerulosclerosis, basement membrane thickening, capillary
obliteration, mesangial widening

apple green birefringence - amyloid

enlarged and hypercellular glomeruli - PSGN

crescent moon shaped glomeruli - RPGN

wire looping of capillaries - DPGN (SLE)

1161
Q

vitamin C - scurvy

A

impaired collagen synthesis and disordered connective tissue

  • Follicular hyperkeratosis
  • Perifollicular haemorrhage
  • Ecchymosis
  • Easy bruising
  • Poor would healing
  • Gingivitis with bleeding and receding gums
  • Arthralgia
  • Edema
  • Weakness, malaise, anorexia, depression
1162
Q

Lesch-Nyhan syndrome

A

XLR
juvenile gout!
defect in purine salvage pathway due to absence of HGPRT enzyme
conversion of hypoxanthine to IMP
conversion of guanine to GMP
hyperuricaemia

aggression, self-mutilation, intellectual impairment

1163
Q

XLD disorders

A

Fragile X
hypophosphataemic rickets

1164
Q

early response in asthma

A

mast cell degranulation in response to IgE already produced by B cells - 10-20 min peak

1165
Q

late response in asthma

A

eosinophils recruited by IL13 produced by lymphocytes

3-5 hours

attraction of phagocytes

1166
Q

pemphigus vulgaris

A

antibodies against desmoglein 3 - cadherin type epithelial adhesion molecule

1167
Q

claudin disorder

A

tight junctions
neonatal sclerosing cholangitis

1168
Q

connexins

A

protein channels between two adjacent cells to allow passage of solutes up to 1000 kDa

oculodendrodigital dysplasia

1169
Q

salicylate and theophyllines cause

A

respiratory alkalosis

TCA -> resp depression, coma, fits

1170
Q

hypophosphataemia worsens

A

cardiac failure by decreasing LV contractility

1171
Q

neuralgic amyotrophy

A

= Brachial neuritis = Brachial
plezitis
* Autoimmune inflammatory aetiology
* Often occurs after infection, vaccination, traumatic injury, surgery,
childbirth
* Intense pain around shoulder and rapid patchy weakness of the
affected limb
* ** winging of scapula (long thoracic nerve C5-C7
* Loss of elbow flexion - Musculocutaneous nerve C5-C7
* CSF : mild raised protein, mild lymphocytosis.

1172
Q

methods to predict 3D structure of protein

A

1) X-ray crystallography - cannot give information about how the
conformation of protein may change over time.
2) Nuclear magnetic resonance spectroscopy
3) Cryogenic electron microscopy

Information about conformational changes of protein : 1) Dual
position inferometry; 2) nuclear magnetic resonance

1173
Q

encapsulation in stem cell derived islet cell transplants

A

prevent autoimmune attachment by introducing barrier (alginate) to prevent access by cells of immune system mainly T lymphocytes

1174
Q

increased levels of plasminogen activator inhibitor-1

A

insulin resistance

1175
Q

riboflavin is involved in

A
  • Involved in redox process involving the hydrogen transfer
    chain in mitochondria
  • Production of ATP
1176
Q

constipation in enteral feeding due to

A

inadequate fluid replacement

diarrhoea more common -
- hyperosmolar feeds
- Bacterial contamination
- Low feed temperature
- Reduced intestinal absorptive capacity
- Too rapid or irregular administration
- Lactose intolerance

1177
Q

disorders of anterior mediastinum

A

thymus
teratoma
terrible lymphoma
thyroid

1178
Q

supply of skin over first web space and EPB/EPL

A

radial nerve
via posterior interosseous branch and superficial branch

1179
Q

endothelin actions

A

constricts afferent arteriole vasoconstriction

stimulates RAAS
release of ANP

ET-A - vasoconstriction
ET-B - vasodilation due to NO production

1180
Q

ulnar nerve roots

A

C8/T1

all intrinsic except LOAF (median)

wrist flexion
FCU/FDP ulnar head

hypothenar eminence

damaged in medial epicondyle fracture and claw hand

Jeanne sign - positive test in ulnar nerve damage due to hyperextension of 1st MCP
Front’s thumb sign - APB weak

card test
egawa test - palm faced flat

1181
Q

median nerve roots

A

C6. C8, T1

damage at wrist - CTS
elbow - loss of power in forearm flexors + weak wrist flexion -> hand of benediction, ape hand

1182
Q

T2DM triglycerides pattern

A

normal LDL
low HDL
elevated triglycerides

1183
Q

insulin receptor type

A

tyrosine kinase on cell membrane

involved in intracellular signalling by phosphorylation of intra cellular proteins

IRS-1 upregulates GLUT4

Donohue syndrome - leprechaunism = AR, non functioning insulin receptor

1184
Q

thiazide diuretics imbalance

A

hypokalaemic alkalosis

1185
Q

Gaucher disease enzymes elevated

A

acid phosphatase
ACE

1186
Q

restrictive lung disease lung function tests

A
  • diffusion capacity is reduced
  • FEV 1 / FVC - normal or increased
  • TLC - reduced
1187
Q

obstructive airway test results

A
  • FEV 1 / FVC : reduced
  • TLC - normal or increased
1188
Q

what electrolyte lost a lot through ileostomy

A

Mg -> impairs PTH secretion -> hypocalcaemia resistant to giving Ca

1189
Q

azygous lobe of lung

A

reverse comma sign

1190
Q

mainstay of locating mutated oncogenes

A

PCR

1191
Q

bile salt production is catalysed by

A

cholesterol-7-alpha-hydroxylase

Total bile salt pool - 2.5-5 grams
Total fecal loss of bile salts = 20%
Bile acids concentration in gall bladder = 100-300 mmol / L
Bile salt reabsorption - 80% over 6-8 cycles

1192
Q

adrenaline is secreted by

A

adrenal medulla

1193
Q

noradrenaline is secreted by

A

adrenal medulla
nerve terminals of the sympathetic NS

1194
Q

ubiquitination

A

degraded by the proteasome

1195
Q

rough vs smooth ER

A
  • Rough ER : translation and folding of new proteins
  • Manufacture of lysosomal enzymes
  • Site of N-linked glycosylation
  • E.G of cells with extensive rough ER = pancreatic cells, goblet cells, plasma cells.

Smooth ER :
* Steroids and lipid synthesis
* E.g. : extensive smooth ER = adrenal cortex, hepatocytes, testes,
ovaries.

1196
Q

classic hereditary haemochromatosis is characterised by

A

incomplete penetrance and variable expressivity

women less affected due to menstruation

1197
Q

ampho B is a recognised cause of

A

Fanconi syndrome

  • This is due to a defect in the cells of the proximal convoluted
    tubule.
  • The proximal tubular cells fail to reabsorb bicarbonate, leading to
    type 2 (proximal) renal tubular acidosis. T
  • he proximal tubular cells also fail to reabsorb glucose and amino
    acids, explaining the findings of protein ++ and glucose +++ on
    the patient’s urinalysis, in spite of normoglycaemia.
  • The patient’s blood tests, showing depletion of potassium,
    calcium and phosphate due to failed proximal tubular
    reabsorption of electrolytes, further support the diagnosis of
    Fanconi syndrome
1198
Q

HIV immunological changes

A

A.Reduction in CD4 count
B.Decreased IL-2 production
C.Decreased NK cell function
D.Reduced delayed hypersensitivity response
E. Increased Beta-2-microglobulin
F. Polyclonal B-cell activation

1199
Q

glucose dependent insulinotropic polypeptide
GIP

A

incretin hormone that increases the gut transit time and has central effect on reducing obesity

1200
Q

peptide YY

A

PYY incretin appetite suppressant
delays gastric emptying

1201
Q

liver cirrhosis

A

metabolic alkalosis

1202
Q

teriparatide

A

PTH analogue
increases osteoblast activity
procollagen T1 propeptides - CICP PINO OC

bone turnover - CTX C terminal cross linked polypeptide

1203
Q

p51

A

colon cancer recurrence

1204
Q

p52

A

prostate cancer
nf kappa b2

1205
Q

hilum of kidney

A

level of L1 - R and L renal arteries

aorta through diaphragm at T12

1206
Q

senescence - arrest of mitosis

A

due to DNA damage

  • Apoptosis : intrinsic pathway - mitochondrial dysfunction;
    extrinsic pathway - cell receptor mediated cell death. DNA
    fragmentation occurs.
  • Cellular necrosis : occurs due to autolysis and Is a marker for
    premature cell death
  • Shortening of Telomeres : progressive shortening of telomeres
    is one of the mechanism of senescence.
1207
Q

UV radiation leads to

A

formation of pyrimidine dimers due to energy absorbed by DNA

1208
Q

triple repeat primed PCR

A

Friedrichs ataxia

1209
Q

alkaptonuria HLA

A

DR7

1210
Q

PCR process

A
  • denaturing dsDNA - 95 degree C
  • Annealing of primer 50-70 degree celsius
  • Extension of dsDNA molecules - 70 degree C
  • RT-PCR Is able to identify transcripts of a given gene by detecting
    the mRNA coding for the gene
  • Cycling of reaction - mixture temperature enable sequential
    denaturation of the new DNA strand
  • Taq polymerase is bacterial origin - Thermus aquaticus
1211
Q

pyramidal tract lesion

A

extensors in arms and flexors of lower limbs are affected

weakness of arm extensors and hip flexors

leg held in extension with foot drop
arms across body with elbow and wrist flexed

1212
Q

genetic cloning

A

enucleated oocyte fused with the nucleus to
form a donor cell.
Process is known as somatic nuclear transfer

1213
Q

long distance running leads to

A

fatty acid oxidation

1214
Q

internal capsule blood supply

A

lenticulostriate vessels
fibres of optic radiation - in posterior limb
lentiform nuclei - outer putamen and inner globus pallidus

1215
Q

sarcoid granuloma

A
  • asteroid bodies, Longhand Giant cells,
    Schaumann bodies

Lymph nodes sarcoidosis - Hamazaki - Wesenberg bodies -
inclusion bodies of lysosomes with protein, glycoprotein and iron.

1216
Q

CSF production by

A

modified ependymal cells in choroid plexus

1217
Q

astrocyte function

A

maintains biochemical stasis and provides brain micro-architecture

1218
Q

microglia function

A

tissue macrophages

1219
Q

oligodendrocytes function

A

forms the myelin sheath that coats axons within the CNS

1220
Q

Schwann cells

A

forms the myelin sheet that covers axons in PNS

1221
Q

TPN requirements

A
  • Reduced food - Nitrogen 0.15-0.2 g N/kg/day; Calories - 25-30
    kcal /kg / day
  • Moderate injury / sepsis : Nitrogen 0.2-0.3; Calories - 30-35 kcal/
    kg/day
  • Severe injury : 0.3-0.35 g N/kg/day; Calories 35-40 kcal/kg/day
1222
Q

salt intake

A

6g per day

1223
Q

saturated fat intake

A

20-30g per day

1224
Q

anaemia occurs in lead poisoning due to

A

inhibition of ferrochelatase enzyme

1225
Q

where does cartilage receive its nutrition from

A

diffusion from synovial fluid

chrondrocytes secrete collagen and proteoglycans

1226
Q

foam cells

A

CD68
derived from monocytes

1227
Q

botulinum toxin prevents release of

A

acetylcholine

immunogenic

type A neurotoxin

1228
Q

Froment’s sign

A

paper pulled
ulnar nerve

1229
Q

MMP

A

gelatinase - MMP9 - neutrophil action, angiogenesis, wound repair

stromelysin - MMP3/10/11 - degrading a number of tissue constituents including serum collagen subtypes, proteoglycans, fibronectin, laminin, elastin

enamelysin - MMP 2 - cleave enamel matrix proteins

epilysin - MMP 28 - degrade casein and plays role in tissue homeostasis and wound repair

interstitial collagenase - MMP 1 - RA

1230
Q

what correlates well with outcomes from high risk surgery

A

cardiac index
oxygen delivery - pulmonary artery cactheter

1231
Q

macula is rich in

A

cones

1232
Q

optic papilla

A

opening of optic nerve

1233
Q

femoral hernia

A

lateral and inferior to pubic tubercle

1234
Q

gas exchange happens in

A

last 7 divisions of bronchi

  • Equilibriation of gases takes about 0.25 seconds in the resting
    lung, decreasing in high cardiac output states as red cell transit
    time decreases.
  • Initial 16 branches of bronchial tree = conduction zone.
1235
Q

intense activity with reduced lactic acid

A

decreased muscle glycogenolysis
McArdle’s disease

1236
Q

decreased aortic compliance ->

A

increased pulse pressure

1237
Q

blood buffers

A
  • cell and plasma protein
  • Hemoglobin - protein and has imidazole side chains and can
    buffer H+ ions. Deoxy-Hb better buffer than Oxy-Hb
  • Phosphates
  • Bicarbonate ions
  • Carbonic acid
1238
Q

alpha vs B/G actins

A

cytoskeleton

globular protein found in microfilaments
of cytoskeleton and in thin contractile filaments of muscle cells

1239
Q

cell cycle checkpoint

A

G1/S
G2/M

1240
Q

obese patient CVC subclavian landmark

A

2 cm below mid
point of clavicle, and 1 cm laterally

1241
Q

PCT

A

AD
uroporphyrinogen decarboxylase

  • Blistering skin lesions on sun exposed parts of Boyd
  • Hypertrichosis on cheeks and forearms
  • Scarring alopecia
  • Red urine due to large quantities of porphyrins
  • Labs : mild elevates AST, ALT; Elevated plasma and urine total
    porphyrins, faporphyrins
  • Mx : avoid exacerbating factors,
  • Repeated Phlebotomy - preferred over low dose
    hydroxychloroquine if ferritin > 600 ng/mL or homozygosity or
    compound heterozygosity for HFE mutations
  • Low dose hydroxychloroquine
1242
Q

irinotecan

A

topoisomerase inhibitor
blocks the breaking
and rejoining of phosphodiester backbone of DNA strands

1243
Q

vinca alkaloids

A

inhibits microtubule assembly

1244
Q

BCR-ABL tyrosine kinase inhibitor

A

imatinib

1245
Q

fludarabine

A

competition inhibition of nucleoside synthesis

interferes with DNA synthesis and blocks replication

1246
Q

tetanus toxin

A

cleaves the specific sites of synaptobrevin (VAMP)

  • Synaptic fusion complex = Synaptobrevin + Syntax +
    Synaptosome-associated protein SNAP-25
  • This fusion complex serves to join the membranes of ACh vesicle
    and nerve cell.

Botox cleaves Types A and E - SNAP 25

1247
Q

VLDL

A
  • VLDL - transports endogenous products - TGs, Phospholipids,
    Cholesterol and cholesterol esters.
  • Chylomicrons : transport of exogenous products
  • VLDL particles are continuously excreted in the liver and contains
    most of the TGs in the body.
  • Main source of energy during prolonged fasting.
  • Apolipoprotein C-II on its surface
  • Binds to capillary endothelium
  • Allows for TGs to be progressively removed by LPL
  • LPL leaves a particle without TGs and Apolipoprotein C-II —> this
    particle is known as IDL.
    Chylomicrons are synthesised post prandially in small intestinal
    enterocytes.
    HDL - takes up cholesterol from cells.
1248
Q

riboflavin AE

A

Co-factor of Flavin adenine dinucleotide (FAD) and Flavin
mono nucleotide (FMN)
* Adverse effect : Angular cheilitis
* Formed from Ribitol - alcohol derived from pentose sugar
ribose
* Dietary sources : liver, milk, cheese, eggs, beer
* Involved in redox process involving hydrogen-transfer chain in
mitochondria and production of ATP

1249
Q

glucose transporters

A

GLUT 1 - fetal cells, in adults in erythrocytes and endothelial barrier cells. Bidirectional transporter.

GLUT 2 - transport of monosaccharides, expressed in hepatocytes, renal tubular cells, pancreatic beta cells and small intestinal epithelial cells. Bidirectional

GLUT 3 - neurons and placenta

GLUT 4 - insulin mediated glucose uptake in muscles and adipose tissue, glitazones increase cell surface expression

GLUT 14 - testes, poor prognosis in gastric adenoca

1250
Q

HH liver biopsy

A

iron overload in Kupffer cells

1251
Q

liver transplant metabolic imbalance

A

metabolic alkalosis

1252
Q

GIST and CML tx

A

imatinib

1253
Q

caspases

A
  • in extrinsic pathway of apoptosis - death domains attract
    intracellular adapter proteins - CD95/FADD = MORT-1, which in
    turn attracts Procaspase 8
  • Procaspase 8 is then modified to form a complex of two small
    and two large heterodimers - constituting active caspase 8.
  • Caspase 8 activates downstream caspases like caspase 3
    (executioner caspase) and causes host cell undergoing apoptotic
    changes - chromatin condensation and cell fragmentation
  • Caspase 3 = executioner caspase
  • Death domain - attracts intracellular adapter protein CD95/FADD
  • MORT1
1254
Q

human mitochondria contain

A

circular dsDNA

nucleus - linear dsDNA

nucleolus - RNA

1255
Q

phagocytosis

A

involves chemotaxis, ingestion within a
phagosome, intracellular enzymatic degradation and exocytosis.
- Endocytosis of antigenic material - step in antigen presentation

1256
Q

Wilson’s disease confirmation

A

liver biopsy

ATP7B gene

1257
Q

prostaglandin

A

synthesised from straight chain C20 fatty acids, arachidonic acid precursor

binds to GPCR

1258
Q

inferior alveolar nerve

A

branch of mandibular division of
trigeminal nerve
- all the teeth are anaesthesised in inferior alveolar block
- Mental branch of inferior alveolar nerve also supplies the chin and
lower lip which becomes numb in nerve block.
- Inferior alveolar nerve supplies all the teeth of semi-mandible on
the affected side including lower incisor teeth.

1259
Q

heparin inhibits

A

aldosterone secretion -> hyperK

1260
Q

isolate hypertriglyceridaemia

A

alcohol

1261
Q

where are melanocytes

A

basal layer of epidermis

no desmosome - small dark nuclei and clear cytoplasm

1262
Q

cholera endotoxin

A

binds to GM1
receptor located on small intestinal mucosal cells. Enter of A1
subunit into secretory cells leads to conitnouscAMP activation and
increase in cAMP levels leads to massive secretion of water and
electrolytes in small intestine.

1263
Q

Tay Sachs disease

A

harmful quantities of ganglioside GM2 accumulate in tissues and nerve cells

beta hexosaminidase A

deaf blind cannot swallow
muscles atrophy and paralysis
dementia seizures
increased startle
cherry red spots in macula

AR

1264
Q

metabolic response to trauma

A

catecholamines
cortisol
glucagon
GH

adrenaline and glucagon most rapid - stimulates glycogenolysis

1265
Q

interferons

A

alpha and beta interferons
same cell receptor

induce upregulation of molecules that inhibits viral production of RNA and DNA

induces MHC Class 1 expression leading to enhanced lysis of cells

IFN - alpha : activates macrophage and neutrophil killing cells.
* IFN - gamma : induces expression of MHC Class II
* IFN - alpha and beta : induces expression of MHC Class I
* IFN - alpha : also upregualtes the host response and improves
the chances of clearance of atypical mycobacterial diseases

1266
Q

tacrolimus

A

calcineurin inhibitor

1267
Q

basiliximab

A

IL2 inhibitor promotes T cell differentiation and proliferation

1268
Q

daclizumab

A

IL2 inhibitor

1269
Q

MMF inhibits

A

monophosphate dehydrogenase - blocks the
de novo pathway of purine synthesis ; adverse ; GI upset and
marrow suppression

1270
Q

sirolimus inhibits

A

receptor - dependent signal transduction
of IL-2 and other cytokines via its action on mTOR
(mammalian target of Rapamycin) - Adverse effect - causes
hyperlipidemia

1271
Q

spinal cord terminates at

A

L1-L2 (18in, 45cm)

dural sac -> S2
spinal extradural space - fat for diffusion of local anaesthetic and vertebral venous plexus

LP is at L3-4 or L4-5

1272
Q

acute pancreatitis

A

NG feed

persistent vomiting - NJ
later parenteral

1273
Q

clearance of drug =

A

urine concentration x urine volume production / plasma concentration

1274
Q

C peptide levels

A

decreased in insulin OD

increased in SU abuse

1275
Q

common femoral artery lies on

A

lateral side of femoral vein
and divides 3 cm distal to inguinal ligament.

  • Superficial femoral artery then becomes popliteal artery by
    passing through hiatus in adductor Magnus
  • Posterior tibial artery is felt behind medial malleolus
  • Femoral artery thrombosis - PC intervention with angioplasty,
    locally delivered thrombolytics.
1276
Q

familial lipoprotein lipase deficiency

A

rare and causes marked
develatio of TG, eruptive xanthomas and recurrent pancreatitis

1277
Q

Inferior / Recurrent laryngeal nerve —> supplies sensation

A

to larynx inferior to vocal cords

  • All laryngeal muscles are supplied by recurrent laryngeal nerve except cricothyroid muscle which is supplied by superior
    laryngeal nerve - branch of vagus nerve.
  • Paralysed vocal cord - paralytic position - adducted or lateral
    from midline and does not move on phonation
  • Inferior portion of larynx is anaesthetised.
1278
Q

maturation and remodeling of wound - can last up to

A

a year

acute inflammation 3 days

initiation factor from platelets activated by exposed mature collagen

platelets aggregate and release active agents

fibrin clot develops

scabs

  • After the initial acute inflammation, macrophages become active
    as the main agents of demolition removing unwanted fibrin, dead
    cells, bacteria, and creating fluid fill spaces for granulation tissue.
  • Macrophages also release factors that stimulate the formation of
    new capillary buds during this phase and later, they initiate and
    control fibroblast activity during repair
  • Within the connective tissue randomly oriented, collagen begins
    to form after a few days, reaching a peak of activity after 5 to 7
    days
  • Acute Inflammation is the first phase of wound healing.
  • Macrophage proliferation is the hallmark of demolition phase
  • Eternal cells at the edge of the wound, start to proliferate after 24
    hours and this can last for up to 3 weeks.
1279
Q

posterior gastric ulcer

A

splenic or GD

1280
Q

lesser curve of stomach artery

A

L gastric

greater = L GE

1281
Q

rapid correction of hyponatraemia

A

CPM or osmotic demyelination

1282
Q

fleshy lumps over elbows and fat deposits in palmar creases and elevation of cholesterol and TG concentration to almost the same value

A

familial dysbetalipoproteinaemia

  • Labs will show : elevated Total cholesterol, elevated TGs,
    elevated VLDL and elevated IDL.
  • Significant risk of developing coronary heart disease
  • Presence of palmar xanthoma —> pathognomic
1283
Q

defect in DNA helicase

A

xeroderma pigmentosum
Cockayne syndrome
trichothiodystrophy

1284
Q

enzymes cell

A
  • Nuclease : enzymes that degrade nucleic acid molecules by
    cleaving the phosphodiesterase bonds between nucleic acid
    subunits
  • Phosphodiesterase : inactivation of intracellular 2nd messengers
    such as cGMP and cAMP.
  • Restriction endonuclease : cuts DNA molecules at a limited
    number of specific nucleotide sequences
  • Telomerase : enzymes that maintain the ends of eukaryotic
    chromosomes by synthesising telomeric repeat sequences
1285
Q

MCA termination of

A

ICA

MMA is a branch of maxillary

MCA passes through the lateral sulcus of cerebrum between the temporal and frontal lobes

1286
Q

involuntary vs voluntary incontinence

A
  • Involuntary faecal incontinence is controlled by internal anal
    sphincter
  • Voluntary faecal incontinence is controlled by external anal
    sphincter
1287
Q

PDA supplies

A

posterior portion of IV septum and posterior L ventricular free wall

1288
Q

facial veins

A

Cavernous sinus - lies on either side of body of sphenoid and
receive blood through facial veins
* Facial veins = superior and inferior ophthalmic veins
* sphenoid viens, middle cerebral veins also drain into cavernous
veins.
* Anterior facial veins - drains the face and upper lip which is a high
risk of spread of infection
* Occipital vein drain directly into jugular venous system
* Venous drainage of chin directly into jugular venous system
* Pinna of ear- maxillary vein - and drains into jugular venous
system
* Skin over parotid gland - maxillary vein —> jugular venous
system

1289
Q

active form of aciclovir

A

acyclovir triphosphate which is
formed by host cell kinases

allows it to incorporate into viral DNA polymerase resulting in chain termination

viral DNA polymerase unable to function and replication of virus halted

peak conc 1-2 hours

HSV - thymidine kinase

1290
Q

BRCA1 inheritance

A

AD

1291
Q

most common EDS

A

hypermobile

1292
Q

latex allergy food

A

kiwi
avocado
banana
chestnut
papaya
potato
tomato

1293
Q

female carriers of DMD develops

A

symptomatic cardiomyopathy

1294
Q

VWD chr

A

12

1295
Q

Hurler syndrome type 1

A

autosomal recessive due to
defective chromosome 4p.
C/F : intellectual disability, corneal clubbing, cafe au lait spots,
cardiac disease - death common in the first decade

1296
Q

scromboid

A

biogenic amines like histamine

1297
Q

cryoglobulinaemia

A
  • Type I : Monoclonal - IgG or IgM - Waldestrom’s
    Macroglobulinaemia (IgM), Multiple Myeloma (IgM)
  • Type II : Mixed monoclonal and polyclonal - Hepatitis C, HIV,
    Rheumatoid arthritis, Sjogren’s syndrome, Lymphoma
  • Type III - only polyclonal - Sjogren’s, Rheumatoid arthritis
  • Type II & III —> Rheumatoid factor +ve
  • Hepatitis B - not associated with Cryoglobulinaeia
  • Raynaud’s phenomenon - ONLY Type I Cryoglobulinaemia
  • Other C/F : vascular purpura, distal ulceration, arthralgia, renal -
    diffuse GN
  • Labs - Low C4, Raised ESR
  • Mx : Immunosuppression, Plasmapheresis
1298
Q

Turner syndrome

A

45XO

karyotyping

1299
Q

SCID

A

X linked
IL2 receptors

  • ADA enzyme : eliminates deoxyadenosine which is toxic to
    lymphocytes and is generated when DNA is broken down
  • ADA also converts Deoxyadenosine to Inosine
  • Mutations in ADA gene —> reduces or eliminates activity of ADA
    and allows for build up of deoxyadenosine
  • Immature lymphocytes are vulnerable to deoxyadenosine
  • C/F : current bacterial, Viral and fungal infections
  • Reduced T cell receptor excision circles
  • Stem cell transplantation may be successful
1300
Q

P1 receptor

A

GPCR
preferentially bound by adenosine

mast cell function and eosinophil apoptosis

brake in activated immune system

1301
Q

partial lipodystrophy

A

type 2 MPGN
intramembranous immune complexes with dense deposits on renal biopsy
low C3
high C3b nephritic factor
induces lysis of adipocytes

  • Associated with Type 2 MPGN, SLE, POEMS =
    polyneuropathy, organomegaly, endocrinopathy,monoclonal
    immunoglobulin, skin changes syndrome
  • Also associated with Diabetes
1302
Q

opsonisation

A

coating a target with complement to promote elimination

T cells
humoral only identifies

endotoxin - triggers immune system through linkage with CD14 on monocytes and macrophages

1303
Q

protein losing enteropathy

A

low total cholesterol

leakage of individual serum
proteins is independent of molecular weight

For this reason - low cholesterol levels are seen in protein losing
enteropathy as cholesterol molecules are having hig

1304
Q

Hyper-IgM syndrome

A

CD40 ligand deficiency
B cell defect with recurrent sinpulmonary infections
PCP ++ risk
chronic cryptosporidial infections
inc risk of malignancy

1305
Q

vecuronium

A

anaesthetic allergies
ammonium group
patch test

1306
Q

pemphigus gestationalis

A

2/3rd trimester
urticarial lesions and blisters on anterior abdominal wall
surrounding the umbilicus

linear C3 deposition at derma-epidermal junction

1307
Q

MGUS

A

presence of serum monoclonal
protein (M-protein) at a concentration < 3 g/dL, bone marrow
with < 10% of monoclonal plasma cells and absence of end
organ damage { lytic bone lesions, anaemia, hypercalcemia,
renal insufficiency, hyper viscosity}

1308
Q

AIP

A

bulbar paresis

urinary uroporphobilinogen
serum delta ALA and porphobilinogen
hyponatraemia

IV haemin
dextrose
haem alginate

1309
Q

variegate porphyria

A

AD
protoporphyrinogen oxidase
South Africans

1310
Q

treatment of C1inh deficiency

A

C1 inhibitor or icatibant (bradykinin inhibitor)

1311
Q

XLR

A

only males affected -> unaffected sons and carrier daughter

  • Heterozygous carrier female —>
    A.50% chance of male child being affected
    B.50% chance of female being carrier.
    C.25% chance of all children being affected
    D.25% chance of carrier children
1312
Q

selective IgA deficiency

A

IgG2 deficiency
recurrent bacterial infections
risk of pernicious anaemia and gastric ca

1313
Q

birch apple syndrome

A

apple celery

oranges - asthma

1314
Q

periodic fever syndromes

A

FMF
TRAPS
Hyper IgD

lack high titre abs or Ag specific T cells

1315
Q

low TNF levels

A

cachexia

1316
Q

HPA axis activation

A

TNF and IL1

1317
Q

isotope suppression levels more a feature of

A

myeloma than WM

IgA and IgG ++

in Wald only IgM

1318
Q

HHT

A

AD
endoglin deficiency - TGFb receptor

1319
Q

increased ghrelin in

A

prader willi
from arcuate nucleus and hypothalamus

1320
Q

IgG2 deficiency

A

infections with polysaccharide coated bacteria including Hib -> otitis media and resp tract infections

1321
Q

linkage analysis

A

quite common for a gene mutation not to
be found in a family member even if gene for condition is known.
* Linkage analysis can be performed using micro satellite markers.
* Testing both affected and unaffected members —> allele carrying
the mutation can be tracked through the family.

1322
Q

microarray analysis

A

gene expression

1323
Q

Kearns-Sayre syndrome

A

mitochrondrial
SNHL, RP, weak, ataxis, cardiomyopathy, dtrokes

1324
Q

Usher syndrome

A

hearing loss and RP

1325
Q

Behcets affects

A

post capillary venalities

ANCA assoc - small-med
PAN - med
Takayasu - large

1326
Q

majority of ANA

A

IgG type

1327
Q

elevation of ESR without CRP

A

typical of SLE

lymphopaenia is also typical

1328
Q

B cells can undergo

A

somatic hypermutation
isotope switching
have surface bound IgG

1329
Q

hyperacute rejection of renal transplant HLA

A

HLA-C IgG antibodies
CW5 subtype

1330
Q

vitamin D resistant rickets

A

XLD

1331
Q

isolated IgD def

A

no tx
Basque

1332
Q

CF

A

AR

  • Population carrier fluency —> 1/25 chance of father being carrier.
  • Chance of father passing the gene - 1/25 x 1/2 = 1/50
  • Mother of child had a sister with CF who died.
  • Parents of the mother are carriers Xx
  • CF gene = X
  • Normal gene = x
  • If mother is healthy —> she has 2 out 3 chances of being a
    carrier. 1/3 times she is normal.
  • Chances of passing gene is 2/3 multiplied with 1/2 = 1/3.
  • Chances of couple having cild with CF = 1/3 x 1/5- = 1/150.
1333
Q

X-linked adrenoleukodystrophy

A

ABCD1 gene
codes for ALD peroxisomal membrane transporter protein

misdiagnosed as MS

assay of long chain fatty acid elevated
mx - Lorenzo’s oil

AR leukodyst - neonates fatal by 20 -> dev delay, deafness, visual impairment

1334
Q

HbS

A

valine substitution for glutamic acid at position 6 of beta globin chain

1335
Q

LGI 1 encephalitis

A

encephalitis

1336
Q

KRAS codes for

A

GTPase
icthyosis and cancers

-p16 : 30% of patients with chronic pancreatitis
- NRAS mutation : malignant melanoma
- p53 : associated with pancreatic cancer in only 50% of
pancreatic adenocarcinoma
- Rb gene : Retinoblastoma, bladder cancer

1337
Q

Canavan’s disease

A

progressive neuro degen due to defect in aspartoacylase

1338
Q

Tendon xanthomata, total cholesterol elevated > 7.5, LDL >
4.9

A

= heterozygous familial hypercholesterolaemia

  • Familial HDL deficiency : premature cardiovascular disease with normal LDL cholesterol levels.
  • Familial mixed hyperlipidemia : rise in LDL and triglycerides
  • Heterozygous familial hypertriglycerihdemia : rise in TGs
  • Homozygous familial phypercholesterolaemia : total cholesterol in the range of 12-15 or more and very early CVD
1339
Q

homozygous C1q deficiency

A

SLE

Anti-C1q antibodies : associated with hypocomplementemic
urticarial vasculitis - rare autoimmune disease - recurrent urticaria
- nettlerash; Dx confirmed by at least 2 of the following features :
venulitis on skin biopsy, arthritis, ocular inflammation, abdominal
pain, positive Cq1 antibodies to immune complexes

1340
Q

WFS1 gene

A

Wolfram DIDMOAD AR

1341
Q

Huntington repeat

A

CAG

1342
Q

mycophenolate is

A

anti purine
selectively depletes B and T cells - neutropaenia rare

1343
Q

2 most common mutations of HHch

A

C282Y and H63D

1344
Q

eye of the tiger sign on MRI

A

deposition of iron in the BG

AR
* Pyramidal and extra pyramidal signs
* Dementia
* Optic atrophy

1345
Q

calcineurin inhibitors stop production of

A

IL2

—> inhibits
calcineurin —> decreased IL-2 production —> less T lymphocyte
mediated transplant rejection —> also reduced t-regulatory cell
activity

1346
Q

Dubin johnson syndrome

A

AR
iranian jews

cMOAT
conjugated hyperbilirubinaemia

1347
Q

follicular ca associated with

A

Gardners and Cowdens

Screening for medullary thyroid cancer - Pentagastrin and
calcium infusion test and measurement of calcitonin
* Family history of MEN2 —> total thyroidectomy in childhood to
prevent development of carcinoma is recommended
* Follicular carcinomas - associate with Gardner’s syndrome and
Cowden’s syndrome
* Papillary carcinoma - familial papillary carcinoma of thyroid -
mutations on chromosomes 1 and chromosomes 8.
* Papillary cancer of thyroid - also associated with Gardner’s
syndrome, and Cowden’s syndrome.

1348
Q

EBV quiescence

A

In B-lymphocytes —> virus is quiescent ; allows it to hide from Tlymphocyte surveiilance.

1349
Q

HS deficiency

A

spectrin and ankyrin

1350
Q

XP defect

A

in nucleotide excision repair

AR

  • Characterised by photosensitivity with severe sunburn in infancy
  • Development of numerous spots resembling freckles, larger
    atrophic lesions, associated with telangiectasia and multiple solar
    keratosis.

DNA damaged by UV radiation not repaired

1351
Q

allergic reaction

A

early phase - Due to release of histamine and mast cell degranulation,
production of leukotrienes, Pgs, cytokines due to allergenspecific IgE molecules binding to mast cel receptors

late phase - act on endothelial cells and causes endothelial
cells to express molecules such as vascular cell adhesion
molecule and selectins.
* This results in recruitment and actuation of leukocytes from the
blood into the site of allergic reaction.
* Th-2 cells and the cytokines they produce leads to further
recruitment of mast cells and eosinophils and class switching
happens in plasma cells to IgE isotype.

1352
Q

homocystinuria mutation

A

G307S

1353
Q

complement cascade

A

C1q binds to IgM/G complexed with antigen -> formation of
membrane attach complex which is responsible for disrupting the
cell membrane of bacteria

  • C2 complement is responsible for joining with C4 to form C3
    convertase.
  • C3b component of C3 is responsible for joining with C4b2a to
    form C5 convertase
  • C4 is responsible for koining with C2 to form C3 convertase
  • C5 is cleaved to form C5a - potent anaphylatoxin and C5b -
    which recruits the components of MAC.
1354
Q

alternative complement pathway

A

C5-9
meningitis

1355
Q

Remnant hyperlipidaemia / familial dyslbetalipoproteinaemia /
remnant hyperlipidaemia —>

A

fibrate and statin

1356
Q

vWD having major surgery

A

DDAVP and TXA

1357
Q

missense mutation

A

lateration in nucleotide sequence that
converts a codon for one amino acid into a codon for a different
amino acid —> protein that functions abnormally

1358
Q

repeat mutation

A

short DNA sequences are repeated a number of
times, results in abnormal protein function

1359
Q

nonsense mutation

A

alteration in nucleotide sequence that
changes a triplet coding for amino acid into a termination codon

1360
Q

point mutation

A

single nucleotide change in DNA molecule

1361
Q

placental syncytiotrophoblasts

A

Fc IgG receptors facilitates transport into circulation’

IgA in breast milk

1362
Q

EDS genes

A

COL3A1 = vascular Ehler Danlos
COL5A1 = classical Euler Danlos
PLOD1 gene = kyphoscolisosis Ehler Danos

1363
Q

Brodie’s abscess

A
  • X-ray features : lytic lesion with sclerotic margins in upper tibial
    metaphysis
  • Localised abscess present deep within the bone near the site of
    metaphysis
  • Deep boring pain
1364
Q

Takayasu

A

Chronic autoimmune inflamamtor condition - large and medium
sized aretireis
* Transmural fibrosis and stenosis with occlusion
* Pulseless disease
* CD4+ and CD8+ cells aid in the inflammatory process forming
granulomas and prompting chronic gradual process of
inflammation
C/F :
* Renal artery stenosis - hypertension
* Carotid artery involvement - stroke, dizziness, headaches
* Jaw claudaition, mesenteric ischaemia, heart failure
Labs :
* ESR > 20
* Clinical basis diagnosis

1365
Q

anti U1 RNP ab

A

MCTD

1366
Q

D penicillamine can cause

A

pancytopaenia

1367
Q

chest pain,
dyspnoea, low BP and small voltage cardiac complexes on ECG in RA

A

cardiac tamponade

1368
Q

HLA DRW4

A

Felty

1369
Q

HLA B8DR3

A

Sjogrens

1370
Q

HLA B8

A

PBC

1371
Q

rosary sign on angiography

A

PAN

1372
Q

what is RF

A
  • Antibody against epitomes of Constant region Fc portion of
    IgG1
  • Active rheumatoid arthritis —> RF complexes are present in
    synovial fluids and IgG producing B cells
1373
Q

psoriasis on mtx and ssz

A

add adalimumab

1374
Q

safe drugs in pregnancy for RA

A

HCQ
NSAID
TNF a inhibitors

1375
Q

Non productive cough and dyspnoea.
CXR - may show military or diffuse nodular pattern.

A

bronchiolitis obilterans in RA

1376
Q

Caplan syndrome

A

pneumoconiosis and rheumatoid nodules

1377
Q

synovial fluid in RA

A

marked vascular
proliferation on synovial membrane —> thickening of synovial
membrane and proliferation into folds and fronds may also be
seen.

Synovial fluid in RA is turbid with neutrophil - NOT a diagnostic
feature.

Viscosity of synovial fluid decreased in RA - increased in OA.

1378
Q

Premier’s disease

A

BL idiopathic avascular necrosis

1379
Q

raised ALP and low Ca

A

osteomalacia
Looser lines on XR and pseudofrac

1380
Q

single most important influencing factor
for attaining peak bone mass density

A

genetic factors

1381
Q

lupus nephritis mx

A

steroids + cyclo/MMF

1382
Q

RA pleural effusion

A

low glucose, exudative, low ph, high LDH

1383
Q

elevated levels of TNF-alpha, IL-1, IL-6, FGFR,
PDGF.
Il-6 can be targeted by Tocalizumab

A

RA

1384
Q

anky spond not responding to nsaid

A

adalimumab

1385
Q

WEGENERS

A

cough haemoptysis
nasal, epistaxis, saddle nose
mononeuritis multiplex, proptosis

1386
Q

PAN criteria

A

1) weight loss of 4 kg or more
2) Lived reticularis
3) Testicular pain / weakness
4) Mononeuropathy / polyneuropathy
5) DBP > 90mmHg
6) Elevated urea and creatinine
7) Hepatitis B infection
8) Abnormality on arteriography
9) Bx - polymorphonuclear neutrophils

1387
Q

chair raise test

A

tennis elbow

1388
Q

Scheuermann’s disease

A

kyphosis

** Congenital absence of neural arch —> kyphoscoliosis.
** Anterior displacement of one thoracic vertebra upon another
occurs in spondylolisthesis
*** Osteophyte formation on posterior facet joints is seen in
osteoarthritis

1389
Q

earliest xray feature of AS

A

blurring of
upper and/or lower vertebral rims at the sacroiliac junction -
best seen on a lateral x-ray.
This is caused by an enthesitis at the insertion of intervertebral ligaments.
Persistent enthesitis —> can cause bony spurs -
syndesmophytes

1390
Q

Paget’s spine

A

lumbar

1391
Q

TNFa

A
  • raised levels leads to increased insulin resistance due to
    phosphorylation of Insulin receptor Substrate - 1 IRS-1
  • Neutrophil chemoattracts, stimulates macrophage phagocytosis
    and helps drive the acute phase response
  • TNF alpha acts on wide variety of cells - hypothalamus, liver,
    neutrophils, macrophages
  • Its gene is present on chromosome 6
  • Lipopolysaccharide increases TNF-alpha production
1392
Q

gull-wing of inverted T
pattern of erosions

A

erosive inflammatory OA

1393
Q

pyrazinamide

A

ATT - storng urate retention agent - causes
>80% reduction in renal clearance of uric acid
Metabolite of Pyrazinamide —> Pyrazinoic acid - oxidised by
xanthine oxidase and is likely responsible for hyperuricaemic effect

1394
Q

eosinophilic fascitis

A
  • Swelling and tenderness of forearms with induration of skin
  • Carpal tunnel syndrome
  • Flexion contractures of fingers
  • Peripheral blood eosinophilia
  • Hyper-gammaglobulinaemia
1395
Q

how does anti Ro cause HB

A

recognises the cardiac 5-HT 4
serotonin receptor - and inhibits serotonin - activated calcium
L channels

1396
Q

Capgras and Fregoli

A

replaced by imposter

same person in disguise

1397
Q

C9orf72 - hexanucleotide repeat
expansion of GGGGCC in C9orf72 gene

A

frontotemporal dementia

1398
Q

TNR

A

CGG repeat - FMR1 gene - fragile X
CTG - DMPK gene - myotonic dystrophy
GCG - PABPN1 gene - oculopharyngeal muscular dystrophy
GAA - FXN gene - Friedrich’s ataxia

1399
Q

anorexia raised

A

GH
glucose
salivary glands

cortisol
cholesterol
carotinaemia

1400
Q
A

MRCP Part 1 (5 decks)

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