Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

LopsNotes > Mixed Q’s 3 > Flashcards

Mixed Q’s 3 Flashcards

1
Q

Pertussis presentation?

A

Adult who hasn’t has a booster
Hx of coryzal symptoms
Paroxysmal cough lasts for >2/52
Post-tussive emesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bordetella pertussis bacteria type and virulence factor?

A

G-ve coco bacillus
Virulence factor adhesion and toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cryptococcoal Neoformans presentation?

A

Meningeoenchephalitis in immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Intracellular changes see with epinephrine?

A

Acts on alpha 1 receptors
Increases inositol triphosphate (IP3) in vascular smooth muscle
Stimulates PNS/ inhibits SNS —> vasoconstriction
Increases BP
Decreases cAMP —-> decrease HR, contractility
Decrease Ca current in SA cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pulmonary Actinomycosis findings?

A

Found in dental caries, gum margins in people with poor dentition.
Develops pulmonary aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Actinomycosis bacteria features?

A

G+ve filamentous branching bacteria with sulfur granules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How will isotonic saline affect ICF,ECF, plasma volume?

A

No change ICF
Increase ECF
Increase plasma volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Serum osmolarity and fluid shift relationship?

A

Fluid shift (in or out of cell) only occurs if there is a change in osmolarity.
No change in osmolarity means any fluid added or lost will only involve ECF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

No change in RBF or GFR when BP increases is because ?

A

Auto regulation
Myogenic stretch —> afferent arteriole vasoconstriction
Increase NaCl —> sensed by macula densa —->vasoconstriction of afferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does urinary obstruction affect the
GFR?

A

Will increase hydrostatic pressure in Bowman’s space —> decreased GFR increase BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Effect of ARBs on the GFR and kidneys?

A

ARBs selectively dilate the efferent arteriole—-> decrease in capillary hydrostatic pressure —>
Decrease in GFR
Increase in creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Effect of haemorrhage on RBF, GFR?

A

If haemorrhage causes BP to drop <100
Decrease RBF
Decrease GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Isotonic saline infusion on ICF, ECF, Na levels?

A

ECF increase
ICF no change
Na no change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Renal regulated substance are?

A

Na and K
Their plasma conc doesn’t change with fall in GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What to expect Reduced GFR bld levels?

A

N serum K
N serum Na
Increased BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Lisinopril affect on GFR, RBF?

A

RBF increases 2o vasodilation of efferent arteriole
GFR decreases 2o reduced hydrostatic pressure in glomerular capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Ibuprofen affect on GFR , RBF?

A

Decreased RBF —> inhibits PG —> afferent arteriole vasoconstriction
Decreased GFR —> decreasing hydrostatic pressure in capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Horseshoe kidney is a congenital anomaly due to?

A

Fusion of the metanephros (specifically metanephric blastema) in utero

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the best method to detect gene transcription?

A

Northern blot ( detect mRNA in a sample and can be used to assess the degree of gene transcription)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a case control study?

A

Observational study
Select pts with outcome (cases) then pts who do not have outcome (controls) and retrospectively compare history of exposure to risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type hypersensitivity is a drug reaction?

A

Type IV hypersensitivity( cell mediated)
(Anticonvulsants, —> carbamezapine/ phenytoin)
antibiotics, trimethoprim)
antiretrovirals)
Occurs 5-21 days after starting drug
Symmetrical Erythematous maculaes/papules (resembles measles)
No pain or mucosal involvement
Low grade fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ulnar nerve injury features?

A

Paraesthesia/ loss of sensation 5th digit and medial 1/2 of 4th digit and hypothenar eminence.
Impaired wrist flexion and adduction
Finger weakness/ clumsiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Hookworm infection features?

A

Hx of walking barefoot in sand/ soil
Pruritic maculopapular papule
Followed by reddish brown serpiginous tracks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a diagnostic feature of strongyloides steroralis active infection?

A

Rhabditiform larvae detected on stool microscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Commonest cause of coronary sinus dilatation?

A

Pulmonary HTN causing high Rt sided heart pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PCWP is representative of which chamber pressure?

A

Lt atrial pressure
Lt ventricular end diastolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cause of Extrahepatic obstruction of bile ducts in newborn?

A

Biliary atresia
Conjugated hyperbilirubinaemia
In first 2/12 of life
Absent or abnormal gallbladder
Portal tract oedema and inflammation
Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Levels of Na/K HCO3 and Cl when secretin is released in response to increasing H+ concentration?

A

Secretin increases HCO3
Cl level decreases with increase HCO3
Pancreatic secretions are isotonic so Na and K no change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which enzyme is responsible fore the non oxidative branch of Pentose phosphate pathway?

A

Transketolase
Conversion of ribose -5-phosphate to fructose-6-phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How to diagnose major depressive disorders in adolescents ?

A

> 2/52 of >5 of 9 symptoms
Sleep disturbance
Loss of Interest
Guilt
Low Energy
Impaired Concentration
Appetite disturbance
Psychomotor agitation
Suicidal ideation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mechanism of action of local anaesthetics?

A

Diffuse through Neuronal cell membrane to block influx of Na into cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SE of thiazide diuretics?

A

Hyperkalaemia and metabolic alkalosis
causing muscle weakness, cramps and possible rhabodmyolysis
HyperGLUC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the changes seen in O2 saturation in heart chambers in VSD?

A

RT ventricle increase o2 saturation
All other chambers unaffected
Systemic circulation is normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Day 1-3 post MI cellular changes seen?

A

Neutrophil infiltration (2o to IL6 and IL8 ) surrounded by normal myocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Microscopic features of pulmonary oedema?

A

Engorged alveolar capillaries with acellular pink material (Transudate) in the alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Constrictive pericarditis physical signs?

A

Raised JVP
Pericardial knock
Pulsus paradoxus
Paradoxical rise in JVP with inspiration (Kussmaul sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which amino acid is important in acid excretion in chronic metabolic acidosis?

A

Glutamine
Metabolised to glutamate generated ammonium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Effect of NSAIDS on the kidney?

A

Inhibit PG —-> causing vasoconstriction
Decreased RBF
Decrease GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Normal range of pH, HCO3 and PaCO2?

A

PH : 7.35-7.42 think 7.4
CO2 ; —-> 35- 45 think 40
HCO3 :—-> 22-26. Think. 24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Affect of acute ureteral constriction on GFR and FF?

A

Decreased GFR
Decrease FF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Administration of desmopressin effect ?

A

On DCT V2 receptors
Increases H2O, Na and urea reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is nonanion gap metabolic acidosis?

A

Anion gap = Na - (Cl +HCO3)
Normal is 10-14
Also called hyperchloremic acidosis
Low HCO3 high Cl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What decrease renal drug excretion?

A

Decreased GFR
Decreased renal tubular secretion
Increased renal tubular reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Desmopressin water deprivation test results interpretation ?

A

Central DI ( ADH deficiency) urine osmolality increases to normal
Nephrogenic DI ( complete/partial unresponsiveness to ADH) no change never goes above 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

PTH affect on Ca and urine PO4?

A

Increases serum Ca ( increase reabsorption in kidney and affect on bone)
Increases renal PO4 excretion ( decrease renal absorption in kidney on bone increases PO4 release)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Concentrations of creatinine, urea, glucose, HCO3 and Na, K during length of proximal tubule?

A

Na and K remain no concentration change
Glucose, HCO3 decrease
Creatinine increase ( not reabsorbed by nephron )
Urea slight decrease (only 50% reabsorbed by PCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Causes of non anion gap acidosis?

A

“UP yours HARD ASS”
Uretersigmoid fistula
Pancreatic fistula
Hyperalimentation (starting TPN)
Acetozolamide
Renal tubular acidosis
Diarrhoea
Addison’s disease
Saline infusion
Spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Non anion metabolic acidosis results expected?

A

Low pH
Low HCO3
High Cl
Increase urine Na

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Cardiorenal syndrome?

A

Occurs as a complication of decompensated heart failure.
Decreased RPF
Increase renal venous pressure
Decreased GFR
Activates RAAS —> increase in NA/H2O reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Refeeding syndrome features?

A

Occurs after the introduction of carbohydrates in pt with chronic malnourishment. Drives PO4 intracellularly into hepatic and muscle cells. ( can cause hypoPO4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Cystinuria features?

A

AR disorder
Defective transportation of cysteine ornithine, lysine and arginine (COLA)
Recurrent kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

MS pts with acute spine lesion, urinary frequency and urgency due to?

A

Spastic bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

K+ route through the tubules?

A

Majority filtered in the PCT and ascending loop of henle
If excess K in serum it’s secreted by principal cells in DCT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Compensatory changes seen in hypovolaemia?

A

Increase vasopressin
Increase SNS —> increase norepinephrine
Activate RAAS- —> increase angiotensin II and
Endothelin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Hypovolaemic changes in bld/ urine?

A

Serum osmolality low
Serum Na low
Increase serum urea
Increase BUN:Creatinine (>20:1)
Low urine Na concentration
High urine osmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Metabolic acidoses seen with DKA?

A

Elevated anion gap metabolic acidosis +/- resp alkalosis
Low pH
Low HCO3
Low PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What test can be used to determine cause of metabolic acidosis ?

A

Urine chloride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Which drug affect the reabsorption of glucose at the PCT?

A

SGLT-2 inhibitors (canagliflozin, dapagliflozin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

PCT Dysfunction results in loss of ?

A

Loss of HCO3
Increase serum chloride
Loss of PO4
Loss of K
Serum glucose remains normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Hereditary vitamin D resistant rickets lab results?

A

low Ca
Low PO4
25-hydroxyvitamin D normal
1,25 dihydroxy vitamin D is increased (2o compensatory PTH activation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Structural Changes 2o renal artery stenosis?

A

Significant renal hypoperfusion
Decreased GFR
Activate RAAS —> increase renin ( by modified smooth muscle JG cells in the wall of afferent glomerular arterioles)
Chrionically —>hyperplasia of JG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Are creatinine clearance and GFR equal in number?

A

No creatinine clearance overestimates GFR by 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Titration rate of glucose?

A

Fully reabsorbed below Tmax (transport max)
Beyond 200mg/dl glycosuria starts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What inc/dec GFR, RPF, FF?

A

Increase in capillary hydrostatic pressure or increase in Bowman’s oncotic pressure —-> increase in GFR

Increase in capillary oncotic pressure or increase in BOwman’s hydrostatic pressure —> decrease GFR

Increase in GFR or decrease in RPF —-> increase in FF
FF= GFR/RPF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Treatment of nephrogenic DI?

A

Thiazide diuretic and replacement of water loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Normal urine specific gravity?

A

1.005-1.030

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which part of the nephron is impermeable to water regardless of vasopressin levels?

A

Ascending loop of Henle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Causes of elevated anion gap metabolic acidosis?

A

Lactic acidosis
DKA
Renal failure (ureamia)
Methanol
Ethylene glycol
Salicylate toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Causes of normal anion gap metabolic acidosis?

A

Severe diarrhoea
Renal tubular acidosis
Excessive saline infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Causes of normal anion gap metabolic acidosis?

A

Severe diarrhoea
Renal tubular acidosis
Excessive saline infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Affect of hypoalbuminaemia in nephrotic syndrome?

A

Decrease plasma oncotic pressure
Decrease renal perfusion
RAAS activation
Causing 2o Na retention
Leading to increase intravascular volume —> oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Type 4 renal tubular acidosis causes?

A

Diabetes
1o aldosterone deficiency
2o alsdosterone deficiency to spironolactoin, Epleronone, amiloride, triamterene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Features of type 4 renal tubular acidosis?

A

Hyperkalemic metabolic acidosis
Low HCO3
N Na serum concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Hyponatremia with lung mass think?

A

SIADH 2o to SCLC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

SIADH labs?

A

Hyponatraemia
Low serum osmolality
High urine osmolality
High Na urine (2o ANP/BNP activation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

CKD bone labs ?

A

Hyperphosphatemia
Low 1, 25oH vitamin D
Hypocalcaemia
high PTH
N 25OH vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the initial change seen in diabetic nephropathy?

A

Increase GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is the initial change seen in diabetic nephropathy?

A

Increase GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

ADH works on which part of the nephron?

A

Medullary segment of the collecting duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Type 2 renal tubular acidosis features?

A

Loss of HCO3
Normal anion gap metabolic acidosis
Low serum PO4
Glycosuria with N bld glucose
Low K+
Aminoaciduria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Metabolic response to high altitude ?

A

Respiratory alkalosis( 2o hyperventilation due hypoxaemia)
+/- metabolic acidosis
Decrease reasborption of HCO3
Decrease renal secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Hypocalcaemia presentation?

A

Muscle cramps
Perioral paraesthesia
Hypotension
Neuromuscular hyper excitability
Chvostek sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Commonest cause of hypocalcaemia?

A

Injury to parathyroid gland commonest cause
Others
Autoimmune hypoparathyroidism
Sepsis
Tumour lysis syndrome
Acute pancreatitis
Deficiency vitamin D / Mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How does angiotensin II afffect the net filtration pressure?

A

Vasoconstriction
Increases hydrostatic pressure and therefore net filtration pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Urine chemistry in DKA?

A

Low pH
Low HCO3
Raised NH4+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Absence of ADH effect of urine conc on tubule?

A

Urine most concentrated at the junction between the descending and ascending loops of hele
Most dilute at the collecting ducts

87
Q

Affect of urine obstruction of pressures?

A

Increase the tubular hydrostatic pressure

88
Q

Where is EPO produced?

A

In the peritubular firbroblasts in the renal cortex

89
Q

Multiple myeloma affect on Vit D Ca+ axis?

A

Low PTH
High Ca
High urine Ca
Decreased 1,25 dihydroxy vitamin D
Normal PTH related protein

90
Q

Intrapleural administration of which drug in emphysema would aid drainage?

A

.tPA ( tissue plasminogen activator) by activation of fibrin bound plasminogen
( and DNase enzyme cleaving nucleic acids)

91
Q

Complication of prostatectomy ?

A

Electile dysfunction if prostatic plexus in surrounding fascia are damaged

92
Q

What red cell index is most specific for spherocytosis?

A

MCHC

93
Q

Which test distinguish Candida albicans?

A

+Ve germ tube test ( incubating at 37oc results in true hyphae with no constrictions)

94
Q

Candida Albicans blood cultures will reveal?

A

Smooth, creamy, white glistening colonies
Micro budding yeast with pseudo hyphae

95
Q

Equation for false negative?

A

FN= 1- sensitivity x number of pts who truly have the disease

96
Q

True positive equation?

A

TP= sensitivity x number of patient who truly have the disease

97
Q

Fragile X syndrome presentation?

A

Long face
Prominent jaw
Macroorchidism
Intellectual disability

98
Q

Cytogenetic studies results for fragile X ?

A

When cells are cultured in folate deficient medium —> area of increased repeats that does not stain appears broken

99
Q

What and where would you find type I collagen?

A

Found in mature scars
Found in bones , tendons, ligaments and skin

100
Q

Why is diphenhydramine sometimes co-administered with metoclopramide?

A

Metoclopramide is dopamine antagonist SE is excess cholinergic activity e.g acute dystonic reactions
Diphenhydramine is anticholinergic and can counteract those SE

101
Q

What drug effect causes redistribution of blood away from ischaemic areas worsening MI?

A

Coronary arteriolar dilation leading to coronary steal.
( vessels are dilated distal to ischaemia redirecting bld away from ischaemic myocardium)

102
Q

Route of inferior epigastric artery?

A

Branches off the external iliac proximal to the inguinal ligament. Supplies lower ant Abdo wall

103
Q

Transference vs counter transference

A

Transference is redirection of pts emotions from person in their past to current provider

Counter transference is providers redirection of emotions

104
Q

Murmur of TR?

A

Holosystolic murmur increases with inspiration and best heard at Lt sternal border

105
Q

AS murmur?

A

Mid-ejection systolic murmur crescendo decrescendo best hear at Rt 2nd intercostal space

106
Q

MR murmur ?

A

Holosytolic murmur best head at apex increases on Lt lateral decubitus position

107
Q

MS murmur?

A

Opening snap and rumbling diastolic murmur

108
Q

PR murmur ?

A

Blowing early diasotolic murmur decrescendo best head over LT 3rd+4th intercostal space

109
Q

What causes the green color seen in sputum 2o bacterial infections?

A

Myeloperoxidase released from neutrophils

110
Q

Vascular dementia features ?

A

Executive dyfunction
Focal motor deficits
Abnormal gait
Urinary symptoms
Psychiatric symptoms

111
Q

What is the cause of chemo associated neutropenic fever?

A

Endogenous commensal bacteria that have moved across damaged mucosal sites

112
Q

What biochemical changes occur after folic acid supplementation?

A

Decrease homocysteine (all converted)
Increase methionine

113
Q

How does hepatitis B vaccination protect against Hep B infection?

A

Vaccine uses recombinant HBsAg to generate anti-HBs antibodies. These antibodies prevent infection by binding to circulating viral particles and prevent attachment to and penetration of hepatocytes

114
Q

What are the features of axonal reaction?

A

Axonal reaction are the changes in the body of a neuron after the axon is severed.
Cells become enlarged, rounded, nucleus displaced to periphery and dispersed finely granular Nissl substances seen.

115
Q

What is the cause of cleft lip?

A

Failure of fusion of the Lt or RT maxillary prominence with inter maxillary segment in early gestation

116
Q

What causes a cleft palate?

A

Failure of fusion of the palatine shelves

117
Q

When to use the delta delta equation?

A

When there is an anion gap metabolic acidosis to see if there is another metabolic acidosis base issue

118
Q

What is the delta delta equation?

A

Delta anion gap= pts anion gap - 12(N)
Delta HCO3 = 24 (N) - pts HCO3
Delta delta = delta AG/ delta HCO3
If more than 2 concurrent metabolic alkalosis

119
Q

Pleural fluid findings in HF?

A

2o inc fluid inflow
Inc pulmonary capillary hydrostatic pressure
Inc lymphatic outflow
N vascular permeability
N vascular oncotic pressure

120
Q

Changes expected in mixed venous HgB O@ content in Anaemia ?

A

Decreased in Anaemia
(Also decreased in exercise 2o increase O2 demand)

121
Q

PACO2 to PAO2 relationship?

A

Inversely proportional
PACO2 is an indicator of alveolar ventilation

122
Q

The lung pressure/volume curve is used to determine what feature ?

A

Lung compliance

123
Q

What moves the lung pressure/volume curve to the RT?

A

Decreased compliance
Pulmonary fibrosis

124
Q

What moves the lung pressure/volume curve to the LT?

A

Increased compliance
Emphysema

125
Q

What is given to accelerate fetal lung maturation and inc surfactant?

A

Dexamethasone/betamethasone

126
Q

What is the virulence factor in Staph aureus?

A

Panton-Valentine Leukocidin
Protease kills the leukocytes and causes necrosis
Seen in MRSA infections
Necrotising pneumonia

127
Q

Legionella bacteria features?

A

Not well visualised on gram stain
Diagnosis via PCR / urine Ag test
High fever, fatigue, headache, confusion
GI symptoms
Pulmonary symptoms

128
Q

Airway resistance pattern in the upper airways?

A

Airway resistance is high in the trachea then increase until it reaches the medium bronchioles.
Progressively decreases through the smaller bronchioles, terminal bronchioles and alveoli

129
Q

Common pathogens in purulent pericarditis?

A

Staph aureus ( if there’s a portal from skin to bld stream)
Strep pneumoniae ( if there is adjacent pneumonia)
Candida albicans ( if on TPN or severe immunosuppresion)
Coxsackieviurs ( if pericardial fluid is lymphocyte predominant)

130
Q

Cellular features of acute cardiac transplant rejection?

A

Interstitial lymphocytes infiltrate with myocyte damage
Occurs within 6/12 following transplant

131
Q

What maneuver increases pressure of Rt to LT shunting?

A

Release phase of valsavla maneuver ( inc bld surge and pressure in Rt atrium )
For PFO

132
Q

In trisomy 21, 18 and 13 what is the defect during conception?

A

Meitotic nondisjunction
(Chromosomes fail to separate daughter cell pass on an extra copy of a chromosome)

133
Q

Ascites due to Rt HF is assoc with which portal capillary finding?

A

Increased hydrostatic pressure
Normal oncotic pressure (early in disease)
Normal capillary permeability

134
Q

Granulomatous is with polyangiitis presentation?

A

ANCA associated systemic vascular is
.cANCA +Ve
Upper Resp tract —> purulent nasal discharge
Lower RT —> cavitary lung lesion, resp symptoms
Renal insufficiency 2o glomerulonephritis

135
Q

Biopsy finding of Granulomatousis with polyangiitis ?

A

Necrotising arteritis with Granulomatous inflammation e.g epithelioid histocytes, multinucleated giant cells
Lack on Ig/complement deposition

136
Q

Drug that can increase cardiac contractility and decrease SVR?

A

Isoproterenol (B1 +B2 adrenergic receptor agonist)

137
Q

Hand grip increases which murmurs?

A

(Increases aortic and LV pressure)
VSD
AR
MR

138
Q

Commonest cause of acute pericarditis ?

A

Viral
Causes a fibrinous pericarditis

139
Q

Tetralogy of Fallot features ?

A

Blue episodes improve with squatting
VSD
Right ventricular outflow tract obstruction
Overriding of the aorta
Rt verntricular hypertrophy

140
Q

Embryological defect in tetralogy of fallot?

A

Deviation of the infundibular septum

141
Q

SE of adenosine ?

A

Flushing
Chest burning (bronchospasm)
Hypotension
Used in SVT

142
Q

PDA murmur?

A

Continuous machinery murmur at the Lt infraclavicular
(Aorta to pulmonary artery)

143
Q

Where is the AV node located ?

A

Endocardial surface of the RT atrium - interatrial septum near the opening of the coronary sinus

144
Q

When is the earliest you can see fatty streaks?

A

As early as the second decade of life

145
Q

Predominant cells in atherosclerotic fatty streaks?

A

Lipid laden macrophages (foam cells) in the intima

146
Q

Carotid sinus massage affect?

A

Increase Parasympathetic node
Causing temporary inhibition of SA node activity
Slow conduction to AV node
Prolonged AV node refractory period

147
Q

Commonest site of thrombus formation in
AF?

A

Lt atrial appendage

148
Q

Midsystolic click followed by systemic mumur at the apex that disappears with squatting?

A

Mitral valve prolapse

149
Q

Mitral valve prolapse is associated with?

A

Defect in Connective tissue protein

150
Q

Which drug class will induce naturiesis while inhibiting aldosterone, and angiotensin II?

A

Direct Renin inhibitor

151
Q

Pressure changes during blue episodes of tetralogy of Fallot?

A

Increase Rt ventricular pressure
Decreased pulmonary arterial pressure
Decreased LT atrial pressure

152
Q

How do statins work?

A

Inhibit rate limiting step in cholesterol synthesis
Via competitive inhibition of HMG-CoA reductase
Also increases hepatic LDL receptor recycling

153
Q

Aging changes in the kidneys?

A

Decrease in renal mass
Decrease in functional glomeruli
Reduced RBF
Reduced hormonal responsiveness
Decrease GFR and Cr clearance

N EPO production
N solute excretion

154
Q

Effect of B blockers on RAAS?

A

Inhibits renin release
Reduced renin
Reduced Angiotensin I and II
Reduced aldosterone
No change in bradykinin

155
Q

Fever, maculopapular rash and ARF occurring 1-3/52 after starting new meds suggestive of?

A

Acute interstitial nephritis

Also eosinophilia, WBC cast, sterile pyuria

156
Q

Ureteric obstruction features?

A

Flank pain radiating to groin with a ball table flank mass (hydronephrosis) within a weak of pelvic surgery

157
Q

Renal artery stenosis likely bld result?

A

Decreased RBF leads to activation of RAAS
Increased renin
Increased angiotensin I and II
Increased aldosterone
Increase in Na reabsorption
Decrease in K

158
Q

What is responsible for maintains serum phosphorus within N limit in declining renal function?

A

FGF23 fights ‘F’osphate
Lowers plasma phophate by reducing intestinal and renal reabsorption

159
Q

SE of EPO?

A

HTN
Increase risk of thromboembolic event

160
Q

Renal Cell Carcinoma features?

A

‘Clear cell carcinoma’
Round polygonal cells with abundant clear/yellow cytoplasm
Common Mets site :- lung and bones

161
Q

Where does the majority of H2O get reabsorbed in the nephron ?

A

PCT

(DCT is variable to ADH)
(Ascending loop of henle and early DCT impermeable)

162
Q

First line of treatment for hyperaldosteronism?

A

Spironolactone, eplernone ( mineralocoricoid receptor antagonist )

163
Q

How to avoid UTI in hospitalised pts?

A

Avoid unnecessary catheterisation
Using sterile technique
Removing the catheter asap

164
Q

Renal artery stenosis?

A

Unilateral kidney atrophy
Occurs in elderly 2o atherosclerotic narrowing of renal artery
HTN
Flank bruit

165
Q

Dialysis related anyloidosis features?

A

B2 microglobulin accumulation in osteoarticular surfaces
Shoulder pain
Carpal tunnel syndrome
Increase risk with increase duration on dialysis

166
Q

Acute urinary retention features?

A

Presents with Anuria, suprapubic fullness, bladder distention, hydronephrosis
Increase Cr
Increase BUN

167
Q

Characteristics of recovery stage of Acute Tubular necrosis?

A

Transient polyuria
Hypokalaemia

168
Q

Lupus nephritis features?

A

DPGN
DNA and anti-DNA immune complex deposition
Type III hypersensitivity reaction
Mixed nephrotic/nephritic presentation

169
Q

Post-strep GN presentation?

A

Oedema
HTN
Haematuria
After a strep infection

170
Q

Poor prognosis predictor in post -strep GN?

A

Adult onset
Higher risk of developing chronic HTN and renal insufficiency

171
Q

Poor prognosis predictor in post -strep GN?

A

Adult onset

172
Q

Minimal change Nephrotic syndrome features?

A

Proteinuria
Hypoalbuminaemia
Oedema
Periorbital oedema

Commonest cause of nephrotic syndrome in children

173
Q

Principal lesion in minimal change disease?

A

E Microscopy diffuse foot process effacement
L Microscopy Normal
Immunofluorescence negative for complement and IgG

174
Q

Effect of giving ACE I on RAAS and bradykinin?

A

Increase renin
Increase Angiotensin I
Decrease Angiotensin II
Decrease Aldosterone
Increase Bradykinin ( ACE is responsible for breaking down bradykinin this action is now inhibited leading to increase )

175
Q

Isolated presystolic sound heard best at the apex in the Lt decubitus position on full expiration ?

A

S4

176
Q

Mechanical complication of transmural MI that can occur 5 -14/7?

A

Free wall rupture

177
Q

What is causes intermittent claudication?

A

Lipid filled arterial intimal plaques ( atherosclerosis) of the large arteries

178
Q

Congenital diaphragmatic hernia presentation?

A

Neonates present with resp distress shortly after birth
CXR thoracic bowel loops
Underdevelopment of lungs 2o compression

179
Q

Histoplasma capsulatum presentation?

A

Endemic to Ohio and Mississippi River valleys
Can be asymptomatic
Subacute pneumonia with mediastinal hilar lymphadenopathy
Immunocompromised have disseminated disease

180
Q

Histologic feature of focal dystonia?

A

Muscle hypertrophy

181
Q

Obesity hypoventilation syndrome features?

A

Chronic fatigue
Dypnoea
Difficulty to concentrate
Pt BMI >30
Resp acidosis
PaCO2 high
PaO2 low
Normal A-a gradient

182
Q

X linked agammaglobulinaemia is characterised by?

A

Low or absent mature B cells
CD19, CD20, CD21

183
Q

What are the initial features of exposure to mycobacterium TB?

A

Unchecked replication of bacteria within macrophages
After a week CD4+ stimulates production of IFN gamma which activates macrophages leading to epithelioid changes

184
Q

What is phase II of clinical trials?

A

Small number of affected individuals to assess Efficacy, toxicity, adverse affects and optimal dosing

185
Q

Haldane effect in COPD?

A

O2 induced hypercapnia in pts with COPD given O2
( pts are CO2 sensitive and dependent on the stimulus for ventilation. Giving O2 removes the stimulus —> CO2 retention)

186
Q

Difference between lung apex and base in ventilation/ bld flow/ V/Q ratio?

A

Apex Base
Low bld flow. High bld flow
Low ventilation. High ventilation
Higher PaO2. Lower PaO2
Lower PaCO2. Higher PaCo2
High V/Q ratio. Low V/Q ratio

187
Q

Cryptococcus Neoformans micro?

A

Budding yeast with thick polysaccharide capsule demonstrated using mucicarmine or India ink

188
Q

Methanphric diverticulum gives rise to which structures ?

A

Collecting tubules, ducts
Major and minor calcyes
Renal pelvis
Ureters

189
Q

Affect of aging on breathing mechanics?

A

Increase lung compliance
Marked decrease in chest wall compliance
—> Total respiratory system compliance decrease
Increase in work of breathing/ minute ventilation
Increase dead space

190
Q

Dead space equation?

A

PaCo2 - PeCO2/ PaCO2

191
Q

Metanephric blastema gives rise to which structures?

A

PCT
Distal convoluted tubules
Loops of henle
Bowman space

192
Q

Mutation of KRAS gene is associated with which diseases?

A

Pancreatic ductal adenocarcinoma
Non small cell lung Ca
Colorectal Ca

193
Q

Paradoxical S2 splitting

A

LBBB
Systolic HF
AS
HCM
(Delayed closure of AV in expiration no split in inspiration)

194
Q

Fixed splitting of S2

A

ASD

195
Q

S3 associations?

A

Early diastole sound
2o Increase LAP, increase LVEDP
Sounds like Kentucky

196
Q

S4 associations?

A

Late diastole
2o stiff ventricle due to LT atrial HTN, HCM , diastolic HF
Sounds like Tennessee

197
Q

Most murmurs increase with preload (squatting )except?

A

HCM
MVP

198
Q

Before starting amiodarone check?

A

LFT
TFT
PFT

199
Q

Properties of elastin in alveolar wall?

A

High content of non polar (hydrophobic) amino acids
Extensive cross linking facilitated by lysyl oxidase

200
Q

Blood gas findings in PE?

A

Decrease PaO2
Normal or decreased PaCO2

201
Q

Bacterial causes of acute exacerbation of COPD?

A

Non-typeable Haemophilus influenzae
Strep pneumoniae
Moraxella catarrhalis

202
Q

Viral causes of acute exacerbation of COPD?

A

Influenza
RSV
Human rhinovirus

203
Q

Virulence factor of H. Influenzae type B?

A

Polyribositol phosphate found on it’s polysaccharide capsule

204
Q

Physiologic response in exercise ?

A

Increase minute ventilation
Increase TV
Increase alveolar ventilation
Decrease physiologic dead space
Increase V/Q ratio
Decrease mixed venous O2 content

205
Q

Types of pneumococcal vaccination?

A
  1. Pneumococcal polysaccharide vaccine —> unconjugated ( T cell independent humoral response)
  2. Pneumococcal conjugated vaccine ( T cell mediated humoral response)
206
Q

Blastomyces dermatitidis presentation?

A

Pulmonary disease in immunocompetent host
Endemic in states adjacent to Mississippi and Ohio rivers

207
Q

Cryptococcus Neoformans micro:-

A

Only pathogenic fungi with polysaccharide capsule
Red on mucicarmine stain
Clear unstained zone with India ink

208
Q

Osteogenesis imperfects presentation?

A

Hx of fractures
Bluish sclera
Small malformed teeth

209
Q

What is the defect in osteogenesis imperfecta due to?

A

Impaired collagen I synthesis by osteoblasts
AD

210
Q

Conditions that result in cold agglutinin?

A

Infectious mononucleosis
Mycoplasma pneumoniae

211
Q

Developmental destruction of the 3rd pharyngeal pouch would cause?

A

T cell dysfunction
Hypocalcaemia
Low PTH
(3rd pouch gives rise to thyroid, thymus,parathyroid)
Development disrupted —> DiGeorge

212
Q

Relationship between RR, TV and dead space

A

Increased RR —-> decreased TV and increased dead space

213
Q

Venous and arterial O2 and CO2 during exercise?

A

Arterial O2 and CO2 remains constant
Venous O2 either unchanged / decreased
Venous CO2 increase ( increased CO2 production by muscles)

214
Q

Characteristics of CMV?

A

Enveloped double stranded DNA
(Hx of transplant pt with pneumonia and intranuclear + cytoplasmic inclusion bodies histologically)

LopsNotes (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions