MedGEMS Flashcards
what does probenecid do?
increase FEUA
reduce urate in non-acute gout
what is Fanconi syndrome?
failure of PCR in kidneys to resorb molecules
causes of Fanconi syndrome
congenital Wilson's tetracyclines MM lead poisnoning
what is the anti-PCSK9 Ab?
Evolocumab
what causes familial hypercholesterolaemia?
LDLR mutations = increase LDL
what is the MoA of lomitapine?
- inhibits microsomal triglyceride transfer protein (MTP)
= blocks release of VLDL from liver = lower LDL levels
used in treatment of familial hypercholesterolaemia
what is the job of human apolipoprotein E (ApoE)?
crucial role in cholesterol and lipid metabolism
3 major isoforms: ApoE2, ApoE3, ApoE4
thinks to remember about ApoE3, ApoE3, ApoE2
ApoE3 = most common ApoE4 = Alzheimer's link ApoE2 = Type 3 hyperlipoproteinemia (inc total cholesterol + TGs)
MoA of ezetimibe
NPC1L1 inhibitor
= sterol absorption inhibitor
cause of Tangier disease
ABC A1 gene mutation = dec HDL levels
prevents release of cholesterol/lipids from cells = accumulates in organs (hepatomegaly, splenomegaly, orange tonsils in children)
what enzyme is involved in the formation of bile acids from cholesterol in classical pathway?
cholesterol 7 alpha hydroxylase
causes of normal anion gap metabolic acidosis (ABCD)
- Addison’s disease
- Bicarbonate loss (diarrhoea, laxative abuse, RTA)
- Chloride gain (NaCl 0.9% infusion)
- Drugs (Acetazolamide)
inheritance of MEN
AD
cytoplasm in SCC
eosinophillic cytoplasm
gold standard diagnostic for Leishmaniasis
splenic aspirate
how is leishmaniasis spread? where do they mutiply?
spread by sandflies
multiply inside macrophaghes
what are the fungal antigen tests?
- cryptococcus: CXM
- aspergillus: Galactomannan
- candida/asper/pcp: Beta-D-Glucan
treatment of visceral leishmaniasis
amphotericin B
HSV that causes encephalitis
1
what is the most common cause of diarrhoea in returning traveller?
E. coli
cause of Q fever
Coxiella Burnetti
medium for mycobacterium tuberculosis
Lowenstein-Jenson medium
side effect of pyraxinamde
hyperuricaemia
features of cutaenous leishmaniasis
ulcerative lesion
long time to heal
microscopy for the fungi
- cryptococcus (India Ink)
- candida (periodic acid-schiff stain, methenamine silver stain)
- aspergillus (methenamine silver stain, PAS stain)
beef tapeworm
Taenia saginata
what is a decent diagnostic test for tinea/trycophyton?
potassium hydroxide
how does pityriasis versicolor appear under wood lamp?
orange
reaction in response to syphillis treatment
Jarisch Herxheimer reaction
treatment of sinusitis
phenoxymethylpenicillin
anti-IL17
secukinumab
used in psoriatic arthritis, AS
one sign of LAD
delayed sloughing of umbilical cord
RSV prophylaxis
palivizumab
Ab in ITP
anti-glyoprotein 2b/3a
what happens if there is anti-Ro in pregnancy?
baby at risk of congenital heart block
features of X-linked SCID
absent T cells
elevated B cells
eczema like rash
xenograft
between different species
problem in X-linked SCID
defective common gamma chain
Muromonab
monoclonal Ab targets CD3 (all T cells)
isograft
genetically identical
what does CH50 actually assess?
patient ability to lyse sheep erythrocytes coated with rabbit and anti-sheep Ab
problem in CGD
NAPDH oxidade fef
what does Natalizumab target?
alpha 4 integrin
MS
role of IL2
promotes T cell activation
Ustekinumab
Ab targets IL-23, IL-12
in psoriasis and psoriatic arthritis
what is protein losing enteropathy?
loss of protein from blood
state of immunodeficiency
diagnosed with faecal alpha 1 antitrypsin
patch testing for which type of reactions
type 4
gold standard test for food allergy
double blind oral food challenge
antibody in RA
anti-CCP
what is radioallergosorbent test?
detection of allergen specific IgE in blood
order of tests in TB
- mantoux test
2. IGRA
what is neutralisation?
target molecule is covered in ABs so that it can bind to its receptors
what molecules are involved in the initial binding of CD4 in HIV?
gp120 and CCR5
what does binding of gp120 do?
expose gp41
what is CD14 found on?
monocytes
what is the main Ab in breast milk?
IgA
what is latex food allergy syndrome?
IgE mediated
cross reactivity to latex antigens in fruits/seed
what kind of organisms are people with CGD at risk of?
catalase +ve E. coli Staph. Aureus Listeria Klebsiella Candida
what do Basiliximab/Daclizumab target?
CD25
what does Tofacitinib do?
inhibits tyrosine kinase (JAK)
reduces expression of pro-inflammatory cytokines
indication?
RA
UC
psoriatic arthritis
treatment of Kostmann syndrome
GCSF injection
Tisagenlecleucel
chimeric antigen receptor T cell
Alemtuzimab
anti-CD52
affect of haemophillia on bleeding time
no effect
levels of vWF in vWF deficiency
leves of vWF may be normal or low
depends if issue is with function of vWF or lack of production
what is the starry sky appearnace?
large number of lymphocytes
significant macrophages
what is the most common cause of Fe deficiency in developing world?
Hookworm
reversal of rivaroxaban
adexanet alfa
what feature does haemophilia increase?
increased APTT (defect of intrinsic pathway)
treatment of acute promyelocytic leukaemia
all-transretinoic acid
features of Scwachmann-Diamond
neutropenia
pancreatic dysfunction
short stature
what is small molecule inhibitor for CLL?
ibrutinib
what is ventoclax?
BCL2 inhibitor for CLL
what is the issue is heparin induced thrombocytopaenia?
Abs directed against heparin and PLATELET FACTOR 4
- prothrombotic
- thrombocytopaenia
- immune complex formation
most common lymphoma in >40 year olds
diffuse large B cell lympoma
absolute levels of G6PD in acute haemolytic crisis
may be normal
what is the most common INR target?
2.5
high risk e.g. metallic valve INR target
3.5
factor with shortest half life
7
anticoag treatment in cancer
DOAC
bronchiectasis appearance on CT
bronchial wall thickening
+ve signet ring sign
score system for HIT
4 Ts
cancer with highest mortality
lung cancer
inheritance of SCD
AD
what does Fanconi anaemia increase chance of?
MDS
AML
most sensitive marker for IDA
low ferritin
anticoagulant in renal failure
warfarin
what is a dacrocyte
poikilocyte erythrocyte
Idarucizumab
reversal agent of dabigatran
what proteins require Vit K?
protein C and protein S seasoning
appearance of basophil
deep blue granules
bilobed nucleus
x3 larger than erythrocyte
appearance of eosinophil
reddish purple granules
bilobed nucleus
x3 larger than erythrocyte
follicular lymphoma translocation
14;18
what is high/low in TLS?
increase K, P, urate
decrease Ca
Diamond Black fan
- anaemia
- elevated fetal Hb
- craniofacial malformation (e.g. cleft palate/cardiac defect)
appearance of a lymphocyte
small
giant nucleus
no granules
thin blue cytoplasm
what is a poor prognostic marker in ALL?
philidelphia chromosome (9;22)
enzyme that warfarin inhibits
Vit K epoxide reductase
treatment of HIT
- stop heparin
- rapid anticoagulation with direct thrombin inhibitor
gene mutation in Burkitts
c-myc (oncogene)
appearance of monocyte
large
kidney bean shaped nucleus
relatively common
bicalutamide
androgen antagonist
prostate cancer
pancreatic chemo
FOLFIRINOX
benign familial haematuria
microscopic haematuria
otherwise well
AD
what damage causes mitral regurg?
papillary muscle damage
what valve affected in drug users endocarditis?
Tricuspid
HSV encephalitis affects the?
temporal lobe
H&E stain
Haematoxylin and Eosin stain
inheritance of MODY
AD
Men 1
3Ps
Pituitary
Parathyroid
Pancreatic
Men 2a
2P’s 1M
Parathyroid
Phaeo
Medullary thyroid
Men 2b
1P 2M’s
Marfanoid
Medullary
Phaeo
what is the misfolded protein in MND?
superoxide dismutase
what are the features of Alport syndrome?
- nephritic syndrome
- cataracts
- sensorineural deafness
prostate cancer chemo
docetaxel
what protein is defective in PCKD
polycystin 1
Courvoisier’s sign
casts in CKD
waxy
what type of cancer does schistosomasis case?
SCC of bladder
what are the weak points that allow diverticular to form?
taenia coli
nodules on renal biopsy in Diabetes
Kimmelstiel wilson nodules
most common type of lung cancer
Adenocarcinoma
hepatobilliary disease associated with p-ANCA
PSC
bronchiectasis key sign
tram track opacity
A1AT inheritance pattern
autosomal co-dominant
A1AT clinical spirometry and CXR
obstructive
CXR = hyperinflation
what is acantholysis?
lost intracellular connections between neighbouring cells
V1 and V2 area
septal region
tumour associated with zollinger ellison
gastrinoma