Mixed Q’s 3 Flashcards
Pertussis presentation?
Adult who hasn’t has a booster
Hx of coryzal symptoms
Paroxysmal cough lasts for >2/52
Post-tussive emesis
Bordetella pertussis bacteria type and virulence factor?
G-ve coco bacillus
Virulence factor adhesion and
Pertussis toxins
Adenylcyclate toxin
Tracheal cytotoxin
Cryptococcoal Neoformans presentation?
Meningeoenchephalitis in immunocompromised
Intracellular changes see with epinephrine?
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
Pulmonary Actinomycosis findings?
Found in dental caries, gum margins in people with poor dentition.
Develops pulmonary aspiration
Actinomycosis bacteria features?
G+ve filamentous branching bacteria with sulfur granules
How will isotonic saline affect ICF,ECF, plasma volume?
No change ICF
Increase ECF
Increase plasma volume
Serum osmolarity and fluid shift relationship?
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
No change in RBF or GFR when BP increases is because ?
Auto regulation
Myogenic stretch —> afferent arteriole vasoconstriction
Increase NaCl —> sensed by macula densa —->vasoconstriction of afferent arteriole
How does urinary obstruction affect the
GFR?
Will increase hydrostatic pressure in Bowman’s space —> decreased GFR increase BUN
Effect of ARBs on the GFR and kidneys?
ARBs selectively dilate the efferent arteriole—-> decrease in capillary hydrostatic pressure —>
Decrease in GFR
Increase in creatinine
Effect of haemorrhage on RBF, GFR?
If haemorrhage causes BP to drop <100
Decrease RBF
Decrease GFR
Isotonic saline infusion on ICF, ECF, Na levels?
ECF increase
ICF no change
Na no change
Renal regulated substance are?
Na and K
Their plasma conc doesn’t change with fall in GFR
What to expect Reduced GFR bld levels?
N serum K
N serum Na
Increased BUN
Lisinopril affect on GFR, RBF?
RBF increases 2o vasodilation of efferent arteriole
GFR decreases 2o reduced hydrostatic pressure in glomerular capillaries
Ibuprofen affect on GFR , RBF?
Decreased RBF —> inhibits PG —> afferent arteriole vasoconstriction
Decreased GFR —> decreasing hydrostatic pressure in capillaries
Horseshoe kidney is a congenital anomaly due to?
Fusion of the metanephros (specifically metanephric blastema) in utero
What is the best method to detect gene transcription?
Northern blot ( detect mRNA in a sample and can be used to assess the degree of gene transcription)
What is a case control study?
Observational study
Select pts with outcome (cases) then pts who do not have outcome (controls) and retrospectively compare history of exposure to risk
What type hypersensitivity is a drug reaction?
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
Ulnar nerve injury features?
Paraesthesia/ loss of sensation 5th digit and medial 1/2 of 4th digit and hypothenar eminence.
Impaired wrist flexion and adduction
Finger weakness/ clumsiness
Hookworm infection features?
Hx of walking barefoot in sand/ soil
Pruritic maculopapular papule
Followed by reddish brown serpiginous tracks
What is a diagnostic feature of strongyloides steroralis active infection?
Rhabditiform larvae detected on stool microscopy
Commonest cause of coronary sinus dilatation?
Pulmonary HTN causing high Rt sided heart pressure
PCWP is representative of which chamber pressure?
Lt atrial pressure
Lt ventricular end diastolic pressure
Cause of Extrahepatic obstruction of bile ducts in newborn?
Biliary atresia
Conjugated hyperbilirubinaemia
In first 2/12 of life
Absent or abnormal gallbladder
Portal tract oedema and inflammation
Fibrosis
Levels of Na/K HCO3 and Cl when secretin is released in response to increasing H+ concentration?
Secretin increases HCO3
Cl level decreases with increase HCO3
Pancreatic secretions are isotonic so Na and K no change
Which enzyme is responsible fore the non oxidative branch of Pentose phosphate pathway?
Transketolase
Conversion of ribose -5-phosphate to fructose-6-phosphate
How to diagnose major depressive disorders in adolescents ?
> 2/52 of >5 of 9 symptoms
Sleep disturbance
Loss of Interest
Guilt
Low Energy
Impaired Concentration
Appetite disturbance
Psychomotor agitation
Suicidal ideation
Mechanism of action of local anaesthetics?
Diffuse through Neuronal cell membrane to block influx of Na into cell
SE of thiazide diuretics?
Hyperkalaemia and metabolic alkalosis
causing muscle weakness, cramps and possible rhabodmyolysis
HyperGLUC
What are the changes seen in O2 saturation in heart chambers in VSD?
RT ventricle increase o2 saturation
All other chambers unaffected
Systemic circulation is normal
Day 1-3 post MI cellular changes seen?
Neutrophil infiltration (2o to IL6 and IL8 ) surrounded by normal myocytes
Microscopic features of pulmonary oedema?
Engorged alveolar capillaries with acellular pink material (Transudate) in the alveoli
Constrictive pericarditis physical signs?
Raised JVP
Pericardial knock
Pulsus paradoxus
Paradoxical rise in JVP with inspiration (Kussmaul sign)
Which amino acid is important in acid excretion in chronic metabolic acidosis?
Glutamine
Metabolised to glutamate generated ammonium
Effect of NSAIDS on the kidney?
Inhibit PG —-> causing vasoconstriction
Decreased RBF
Decrease GFR
Normal range of pH, HCO3 and PaCO2?
PH : 7.35-7.42 think 7.4
CO2 ; —-> 35- 45 think 40
HCO3 :—-> 22-26. Think. 24
Affect of acute ureteral constriction on GFR and FF?
Decreased GFR
Decrease FF
Administration of desmopressin effect ?
On DCT V2 receptors
Increases H2O, Na and urea reabsorption
What is nonanion gap metabolic acidosis?
Anion gap = Na - (Cl +HCO3)
Normal is 10-14
Also called hyperchloremic acidosis
Low HCO3 high Cl
What decrease renal drug excretion?
Decreased GFR
Decreased renal tubular secretion
Increased renal tubular reabsorption
Desmopressin water deprivation test results interpretation ?
Central DI ( ADH deficiency) urine osmolality increases to normal
Nephrogenic DI ( complete/partial unresponsiveness to ADH) no change never goes above 500
PTH affect on Ca and urine PO4?
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)
Concentrations of creatinine, urea, glucose, HCO3 and Na, K during length of proximal tubule?
Na and K remain no concentration change
Glucose, HCO3 decrease
Creatinine increase ( not reabsorbed by nephron )
Urea slight decrease (only 50% reabsorbed by PCT)
Causes of non anion gap acidosis?
“UP yours HARD ASS”
Uretersigmoid fistula
Pancreatic fistula
Hyperalimentation (starting TPN)
Acetozolamide
Renal tubular acidosis
Diarrhoea
Addison’s disease
Saline infusion
Spironolactone
Non anion metabolic acidosis results expected?
Low pH
Low HCO3
High Cl
Increase urine Na
Cardiorenal syndrome?
Occurs as a complication of decompensated heart failure.
Decreased RPF
Increase renal venous pressure
Decreased GFR
Activates RAAS —> increase in NA/H2O reabsorption
Refeeding syndrome features?
Occurs after the introduction of carbohydrates in pt with chronic malnourishment. Drives PO4 intracellularly into hepatic and muscle cells. ( can cause hypoPO4)
Cystinuria features?
AR disorder
Defective transportation of cysteine ornithine, lysine and arginine (COLA)
Recurrent kidney stones
MS pts with acute spine lesion, urinary frequency and urgency due to?
Spastic bladder
K+ route through the tubules?
Majority filtered in the PCT and ascending loop of henle
If excess K in serum it’s secreted by principal cells in DCT
Compensatory changes seen in hypovolaemia?
Increase vasopressin
Increase SNS —> increase norepinephrine
Activate RAAS- —> increase angiotensin II and
Endothelin 1
Hypovolaemic changes in bld/ urine?
Serum osmolality low
Serum Na low
Increase serum urea
Increase BUN:Creatinine (>20:1)
Low urine Na concentration
High urine osmolality
Metabolic acidoses seen with DKA?
Elevated anion gap metabolic acidosis +/- resp alkalosis
Low pH
Low HCO3
Low PaCO2
What test can be used to determine cause of metabolic acidosis ?
Urine chloride
Which drug affect the reabsorption of glucose at the PCT?
SGLT-2 inhibitors (canagliflozin, dapagliflozin)
PCT Dysfunction results in loss of ?
Loss of HCO3
Increase serum chloride
Loss of PO4
Loss of K
Serum glucose remains normal
Hereditary vitamin D resistant rickets lab results?
low Ca
Low PO4
25-hydroxyvitamin D normal
1,25 dihydroxy vitamin D is increased (2o compensatory PTH activation)
Structural Changes 2o renal artery stenosis?
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
Are creatinine clearance and GFR equal in number?
No creatinine clearance overestimates GFR by 10-20%
Titration rate of glucose?
Fully reabsorbed below Tmax (transport max)
Beyond 200mg/dl glycosuria starts
What inc/dec GFR, RPF, FF?
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
Treatment of nephrogenic DI?
Thiazide diuretic and replacement of water loss
Normal urine specific gravity?
1.005-1.030
Which part of the nephron is impermeable to water regardless of vasopressin levels?
Ascending loop of Henle
Causes of elevated anion gap metabolic acidosis?
Lactic acidosis
DKA
Renal failure (ureamia)
Methanol
Ethylene glycol
Salicylate toxicity
Causes of normal anion gap metabolic acidosis?
Severe diarrhoea
Renal tubular acidosis
Excessive saline infusion
Causes of normal anion gap metabolic acidosis?
HARDASS
Hyperalimentatin (TPN)
Addison’s disease
Renal tubular acidosis
Diarrhoea
Acetozolamide
Spironolactione
Saline infusion
Affect of hypoalbuminaemia in nephrotic syndrome?
Decrease plasma oncotic pressure
Decrease renal perfusion
RAAS activation
Causing 2o Na retention
Leading to increase intravascular volume —> oedema
Type 4 renal tubular acidosis causes?
Diabetes
1o aldosterone deficiency
2o alsdosterone deficiency to spironolactoin, Epleronone, amiloride, triamterene
Features of type 4 renal tubular acidosis?
Hyperkalemic metabolic acidosis
Low HCO3
N Na serum concentration
Hyponatremia with lung mass think?
SIADH 2o to SCLC
SIADH labs?
Hyponatraemia
Low serum osmolality
High urine osmolality
High Na urine (2o ANP/BNP activation)
CKD bone labs ?
Hyperphosphatemia
Low 1, 25oH vitamin D
Hypocalcaemia
high PTH
N 25OH vitamin D
What is the initial change seen in diabetic nephropathy?
Increase GFR
What is the initial change seen in diabetic nephropathy?
Increase GFR
ADH works on which part of the nephron?
Medullary segment of the collecting duct
Type 2 renal tubular acidosis features?
Loss of HCO3
Normal anion gap metabolic acidosis
Low serum PO4
Glycosuria with N bld glucose
Low K+
Aminoaciduria
Metabolic response to high altitude ?
Respiratory alkalosis( 2o hyperventilation due hypoxaemia)
+/- metabolic acidosis
Decrease reasborption of HCO3
Decrease renal secretion
Hypocalcaemia presentation?
Muscle cramps
Perioral paraesthesia
Hypotension
Neuromuscular hyper excitability
Chvostek sign
Commonest cause of hypocalcaemia?
Injury to parathyroid gland commonest cause
Others
Autoimmune hypoparathyroidism
Sepsis
Tumour lysis syndrome
Acute pancreatitis
Deficiency vitamin D / Mg
How does angiotensin II afffect the net filtration pressure?
Vasoconstriction
Increases hydrostatic pressure and therefore net filtration pressure
Urine chemistry in DKA?
Low pH
Low HCO3
Raised NH4+
Absence of ADH effect of urine conc on tubule?
Urine most concentrated at the junction between the descending and ascending loops of hele
Most dilute at the collecting ducts
Affect of urine obstruction of pressures?
Increase the tubular hydrostatic pressure
Where is EPO produced?
In the peritubular firbroblasts in the renal cortex
Multiple myeloma affect on Vit D Ca+ axis?
Low PTH
High Ca
High urine Ca
Decreased 1,25 dihydroxy vitamin D
Normal PTH related protein
Intrapleural administration of which drug in emphysema would aid drainage?
.tPA ( tissue plasminogen activator) by activation of fibrin bound plasminogen
( and DNase enzyme cleaving nucleic acids)
Complication of prostatectomy ?
Electile dysfunction if prostatic plexus in surrounding fascia are damaged
What red cell index is most specific for spherocytosis?
MCHC
Which test distinguish Candida albicans?
+Ve germ tube test ( incubating at 37oc results in true hyphae with no constrictions)
Candida Albicans blood cultures will reveal?
Smooth, creamy, white glistening colonies
Micro budding yeast with pseudo hyphae
Equation for false negative?
FN= 1- sensitivity x number of pts who truly have the disease
True positive equation?
TP= sensitivity x number of patient who truly have the disease
Fragile X syndrome presentation?
Long face
Prominent jaw
Macroorchidism
Intellectual disability
Cytogenetic studies results for fragile X ?
When cells are cultured in folate deficient medium —> area of increased repeats that does not stain appears broken
What and where would you find type I collagen?
Found in mature scars
Found in bones , tendons, ligaments and skin
Why is diphenhydramine sometimes co-administered with metoclopramide?
Metoclopramide is dopamine antagonist SE is excess cholinergic activity e.g acute dystonic reactions
Diphenhydramine is anticholinergic and can counteract those SE
What drug effect causes redistribution of blood away from ischaemic areas worsening MI?
Coronary arteriolar dilation leading to coronary steal.
( vessels are dilated distal to ischaemia redirecting bld away from ischaemic myocardium)
Route of inferior epigastric artery?
Branches off the external iliac proximal to the inguinal ligament. Supplies lower ant Abdo wall
Transference vs counter transference
Transference is redirection of pts emotions from person in their past to current provider
Counter transference is providers redirection of emotions
Murmur of TR?
Holosystolic murmur
increases with inspiration
best heard at Lt sternal border
AS murmur?
Mid-ejection systolic murmur crescendo decrescendo
best hear at Rt 2nd intercostal space
Increase with squatting , leg raising
MR murmur ?
Holosytolic murmur
best head at apex
increases on Lt lateral decubitus position
MS murmur?
Opening snap and rumbling diastolic murmur
Increase with squatting or hand grip
Decreased standing valaalva
Apex
PR murmur ?
Blowing early diasotolic murmur decrescendo best head over LT 3rd+4th intercostal space
What causes the green color seen in sputum 2o bacterial infections?
Myeloperoxidase released from neutrophils
Vascular dementia features ?
Executive dyfunction
Focal motor deficits
Abnormal gait
Urinary symptoms
Psychiatric symptoms
What is the cause of chemo associated neutropenic fever?
Endogenous commensal bacteria that have moved across damaged mucosal sites
What biochemical changes occur after folic acid supplementation?
Decrease homocysteine (all converted)
Increase methionine
How does hepatitis B vaccination protect against Hep B infection?
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
What are the features of axonal reaction?
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.
What is the cause of cleft lip?
Failure of fusion of the Lt or RT maxillary prominence with inter maxillary segment in early gestation
What causes a cleft palate?
Failure of fusion of the palatine shelves
When to use the delta delta equation?
When there is an anion gap metabolic acidosis to see if there is another metabolic acid base issue
What is the delta delta equation?
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
Pleural fluid findings in HF?
2o inc fluid inflow
Inc pulmonary capillary hydrostatic pressure
Inc lymphatic outflow
N vascular permeability
N vascular oncotic pressure
Changes expected in mixed venous HgB O2 content in Anaemia ?
Decreased in Anaemia
(Also decreased in exercise 2o increase O2 demand)
PACO2 to PAO2 relationship?
Inversely proportional
PACO2 is an indicator of alveolar ventilation
The lung pressure/volume curve is used to determine what feature ?
Lung compliance
What moves the lung pressure/volume curve to the RT?
Decreased compliance
Pulmonary fibrosis
What moves the lung pressure/volume curve to the LT?
Increased compliance
Emphysema
What is given to accelerate fetal lung maturation and inc surfactant?
Dexamethasone/betamethasone
What is the virulence factor in Staph aureus?
Panton-Valentine Leukocidin
Protease kills the leukocytes and causes necrosis
Seen in MRSA infections
Necrotising pneumonia
Legionella bacteria features?
Not well visualised on gram stain
Diagnosis via PCR / urine Ag test
High fever, fatigue, headache, confusion
GI symptoms
Pulmonary symptoms
Airway resistance pattern in the upper airways?
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
Common pathogens in purulent pericarditis?
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)
Cellular features of acute cardiac transplant rejection?
Interstitial lymphocytes infiltrate with myocyte damage
Occurs within 6/12 following transplant
What maneuver increases pressure of Rt to LT shunting?
Release phase of valsavla maneuver ( inc bld surge and pressure in Rt atrium )
For PFO
In trisomy 21, 18 and 13 what is the defect during conception?
Meitotic nondisjunction
(Chromosomes fail to separate daughter cell pass on an extra copy of a chromosome)
Ascites due to Rt HF is assoc with which portal capillary finding?
Increased hydrostatic pressure
Normal oncotic pressure (early in disease)
Normal capillary permeability
Granulomatous is with polyangiitis presentation?
ANCA associated systemic vascular is
.cANCA +Ve
Upper Resp tract —> purulent nasal discharge
Lower RT —> cavitary lung lesion, resp symptoms
Renal insufficiency 2o glomerulonephritis
Biopsy finding of Granulomatousis with polyangiitis ?
Necrotising arteritis with Granulomatous inflammation e.g epithelioid histocytes, multinucleated giant cells
Lack on Ig/complement deposition
Drug that can increase cardiac contractility and decrease SVR?
Isoproterenol (B1 +B2 adrenergic receptor agonist)
Hand grip increases which murmurs?
(Increases aortic and LV pressure)
VSD
AR
MR
Commonest cause of acute pericarditis ?
Viral
Causes a fibrinous pericarditis
Tetralogy of Fallot features ?
Blue episodes improve with squatting
VSD
Right ventricular outflow tract obstruction
Overriding of the aorta
Rt verntricular hypertrophy
Embryological defect in tetralogy of fallot?
Deviation of the infundibular septum
adenosine
MoA:- bind to adenosine receptors causing vasodilation
Use:- SVT
SE:- Flushing
Chest burning (bronchospasm)
Hypotension
PDA murmur?
Continuous machinery murmur at the Lt infraclavicular
(Aorta to pulmonary artery)
Where is the AV node located ?
Endocardial surface of the RT atrium - interatrial septum near the opening of the coronary sinus
When is the earliest you can see fatty streaks?
As early as the second decade of life
Predominant cells in atherosclerotic fatty streaks?
Lipid laden macrophages (foam cells) in the intima
Carotid sinus massage affect?
Increase Parasympathetic node
Causing temporary inhibition of SA node activity
Slow conduction to AV node
Prolonged AV node refractory period
Commonest site of thrombus formation in
AF?
Lt atrial appendage
Midsystolic click followed by systolic mumur at the apex that disappears with squatting?
Mitral valve prolapse
Mitral valve prolapse is associated with?
Defect in Connective tissue protein
Which drug class will induce naturiesis while inhibiting aldosterone, and angiotensin II?
Direct Renin inhibitor
Pressure changes during blue episodes of tetralogy of Fallot?
Increase Rt ventricular pressure
Decreased pulmonary arterial pressure
Decreased LT atrial pressure
How do statins work?
Inhibit rate limiting step in cholesterol synthesis
Via competitive inhibition of HMG-CoA reductase
Also increases hepatic LDL receptor recycling
Aging changes in the kidneys?
Decrease in renal mass
Decrease in functional glomeruli
Reduced RBF
Reduced hormonal responsiveness
Decrease GFR and Cr clearance
N EPO production
N solute excretion
Effect of B blockers on RAAS?
Inhibits prorenin—->renin release
Reduced renin
Reduced Angiotensin I and II
Reduced aldosterone
No change in bradykinin
Fever, maculopapular rash and ARF occurring 1-3/52 after starting new meds suggestive of?
Acute interstitial nephritis
Also eosinophilia, WBC cast, sterile pyuria
Ureteric obstruction features?
Flank pain radiating to groin with a ballotable flank mass (hydronephrosis) within a week of pelvic surgery
Renal artery stenosis likely bld result?
Decreased RBF leads to activation of RAAS
Increased renin
Increased angiotensin I and II
Increased aldosterone
Increase in Na reabsorption
Decrease in K
What is responsible for maintains serum phosphorus within N limit in declining renal function?
FGF23 fights ‘F’osphate
Lowers plasma phophate by reducing intestinal and renal reabsorption
SE of EPO?
HTN
Increase risk of thromboembolic event
Renal Cell Carcinoma features?
‘Clear cell carcinoma’
Round polygonal cells with abundant clear/yellow cytoplasm
Common Mets site :- lung and bones
Where does the majority of H2O get reabsorbed in the nephron ?
PCT
(DCT is variable to ADH)
(Ascending loop of henle and early DCT impermeable)
First line of treatment for hyperaldosteronism?
Spironolactone, eplernone ( mineralocoricoid receptor antagonist )
How to avoid UTI in hospitalised pts?
Avoid unnecessary catheterisation
Using sterile technique
Removing the catheter asap
Renal artery stenosis presentation?
Unilateral kidney atrophy
Occurs in elderly 2o atherosclerotic narrowing of renal artery
HTN
Flank bruit
Dialysis related amyloidosis features?
B2 microglobulin accumulation in osteoarticular surfaces
Shoulder pain
Carpal tunnel syndrome
Increase risk with increase duration on dialysis
Acute urinary retention features?
Presents with Anuria, suprapubic fullness, bladder distention, hydronephrosis
Increase Cr
Increase BUN
Characteristics of recovery stage of Acute Tubular necrosis?
Transient polyuria
Hypokalaemia
Lupus nephritis features?
DPGN
DNA and anti-DNA immune complex deposition
Type III hypersensitivity reaction
Mixed nephrotic/nephritic presentation
Post-strep GN presentation?
Oedema
HTN
Haematuria
After a strep infection
Poor prognosis predictor in post -strep GN?
Adult onset
Higher risk of developing chronic HTN and renal insufficiency
Poor prognosis predictor in post -strep GN?
Adult onset
Minimal change Nephrotic syndrome features?
Proteinuria
Hypoalbuminaemia
Oedema
Periorbital oedema
Commonest cause of nephrotic syndrome in children
Principal lesion in minimal change disease?
E Microscopy diffuse foot process effacement
L Microscopy Normal
Immunofluorescence negative for complement and IgG
Effect of giving ACE I on RAAS and bradykinin?
Increase renin
Increase Angiotensin I
Decrease Angiotensin II
Decrease Aldosterone
Increase Bradykinin ( angiotensin 1 is responsible for breaking down bradykinin this action is now inhibited leading to increase )
Isolated presystolic sound heard best at the apex in the Lt decubitus position on full expiration ?
S4
Mechanical complication of transmural MI that can occur 5 -14/7?
Free wall rupture
What is causes intermittent claudication?
Lipid filled arterial intimal plaques ( atherosclerosis) of the large arteries
Congenital diaphragmatic hernia presentation?
Neonates present with resp distress shortly after birth
CXR thoracic bowel loops
Underdevelopment of lungs 2o compression
Histoplasma capsulatum presentation?
Endemic to Ohio and Mississippi River valleys
Can be asymptomatic
Subacute pneumonia with mediastinal hilar lymphadenopathy
Immunocompromised have disseminated disease
Histologic feature of focal dystonia?
Muscle hypertrophy
Obesity hypoventilation syndrome features?
Chronic fatigue
Dypnoea
Difficulty to concentrate
Pt BMI >30
Resp acidosis
PaCO2 high
PaO2 low
Normal A-a gradient
X linked agammaglobulinaemia is characterised by?
Low or absent mature B cells
Low IgG, IgA, IGM
CD19, CD20,
What are the initial features of exposure to mycobacterium TB?
Unchecked replication of bacteria within macrophages
After a week CD4+ stimulates production of IFN gamma which activates macrophages leading to epithelioid changes
What is phase II of clinical trials?
Small number of affected individuals to assess Efficacy, toxicity, adverse affects and optimal dosing
Haldane effect in COPD?
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)
Difference between lung apex and base in ventilation/ bld flow/ V/Q ratio?
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
Cryptococcus Neoformans micro?
Budding yeast with thick polysaccharide capsule demonstrated using mucicarmine or India ink
Methanphric diverticulum gives rise to which structures ?
Collecting tubules, ducts
Major and minor calcyes
Renal pelvis
Ureters
Affect of aging on breathing mechanics?
Increase lung compliance
Marked decrease in chest wall compliance
—> Total respiratory system compliance decrease
Increase in work of breathing/ minute ventilation
Increase dead space
Dead space equation?
PaCo2 - PeCO2/ PaCO2
Metanephric blastema gives rise to which structures?
PCT
Distal convoluted tubules
Loops of henle
Bowman space
Mutation of KRAS gene is associated with which diseases?
Pancreatic ductal adenocarcinoma
Non small cell lung Ca
Colorectal Ca
Paradoxical S2 splitting
LBBB
Systolic HF
AS
HCM
(Delayed closure of AV in expiration no split in inspiration)
Fixed splitting of S2
ASD
S3 associations?
Early diastole sound
2o Increase LAP, increase LVEDP
Sounds like Kentucky
S4 associations?
Late diastole
2o stiff ventricle due to LT atrial HTN, HCM , diastolic HF
Sounds like Tennessee
Most murmurs increase with preload (squatting )except?
HCM
MVP
Before starting amiodarone check?
LFT
TFT
PFT
Properties of elastin in alveolar wall?
High content of non polar (hydrophobic) amino acids
Extensive cross linking facilitated by lysyl oxidase
Blood gas findings in PE?
Decrease PaO2
Normal or decreased PaCO2
Bacterial causes of acute exacerbation of COPD?
Non-typeable Haemophilus influenzae
Strep pneumoniae
Moraxella catarrhalis
Viral causes of acute exacerbation of COPD?
Influenza
RSV
Human rhinovirus
Virulence factor of H. Influenzae type B?
Polyribositol phosphate found on it’s polysaccharide capsule
Physiologic response in exercise ?
Increase minute ventilation
Increase TV
Increase alveolar ventilation
Decrease physiologic dead space
Increase V/Q ratio
Decrease mixed venous O2 content
Types of pneumococcal vaccination?
- Pneumococcal polysaccharide vaccine —> unconjugated ( T cell independent humoral response)
- Pneumococcal conjugated vaccine ( T cell mediated humoral response)
Blastomyces dermatitidis presentation?
Pulmonary disease in immunocompetent host
Endemic in states adjacent to Mississippi and Ohio rivers
Cryptococcus Neoformans micro:-
Only pathogenic fungi with polysaccharide capsule
Red on mucicarmine stain
Clear unstained zone with India ink
Osteogenesis imperfects presentation?
Hx of fractures
Bluish sclera
Small malformed teeth
What is the defect in osteogenesis imperfecta due to?
Impaired collagen I synthesis by osteoblasts
AD
Conditions that result in cold agglutinin?
Infectious mononucleosis
Mycoplasma pneumoniae
Developmental destruction of the 3rd pharyngeal pouch would cause?
T cell dysfunction
Hypocalcaemia
Low PTH
(3rd pouch gives rise to thyroid, thymus,parathyroid)
Development disrupted —> DiGeorge
Relationship between RR, TV and dead space
Increased RR —-> decreased TV and increased dead space
Venous and arterial O2 and CO2 during exercise?
Arterial O2 and CO2 remains constant
Venous O2 either unchanged / decreased
Venous CO2 increase ( increased CO2 production by muscles)
Characteristics of CMV?
Enveloped double stranded DNA
(Hx of transplant pt with pneumonia and intranuclear + cytoplasmic inclusion bodies histologically)
