Mixed Q’s 4 Flashcards

1
Q

Features of urolithiasis due to hyperparathyroidism?

A

Abdo pain
Vomiting
Haematuria
Hypercalcaemia
Hypophosphataemia

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2
Q

Risk factors for urothelial cancer of the bladder?

A

Age >60
Cigarette smoking
Occupational exposure to :- rubber plastic
Cyclophosphamide therapy

Painless Haematuria

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3
Q

Vesicoureteral reflux features?

A

Retrograde urine flow from the bladder to the ureter
Hx of repeated infection
Increased risk of chronic pyelonephritis
U/S renal scarring —> dilated calyces with overlying cortical atrophy

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4
Q

Adverse renal affect of penicillamine?

A

Membranous nephropathy

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5
Q

Glomerulonephritis 2o small vessel vasculitis features

A

Bld levels acute kidney injury
Proteinuria
HTN
Red cell cast
Exogenous immune complex deposition

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6
Q

1o thrombotic microangiopathy syndrome features?

A

Microangiopathic haemolytic Anaemia (MAHA) ( schistocytes on bld smear )
Thrombocytopenia
Organ damage
Neuro symptoms
Renal failure
Fever
N PT and PTT
Prolonged bleeding time
Histology:- plt rich thrombi in glomeruli and arterioles

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7
Q

Risk factors for kidney stones?

A

Increase urinary calcium
Increase urinary oxalate
Increase urinary uric acid
Decrease urinary citrate
Decrease fluid intake

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8
Q

Prerenal acute kidney injury features?

A

Due to renal hypoperfusioin
Characteristics findings are:-
High urea
Nitrogen/creatinine ration >20:1
Low urine Na <20mEq/L
Low fractional excretion of Na <1%
High urine osmolality + specific gravity
Unremarkable urinanalysis

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9
Q

Homogenous deposition of eosinophilic hyaline material in the intima and media of arteries is due to ?

A

Poorly controlled DM or HTN

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10
Q

CKD renal osteodystrophy features?

A

High PO4
Low 1,25 Vitmain D
Low Ca
2o hyperparathyroidism

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11
Q

Multiple myeloma features?

A

Hypercalcaemia
Normocytic Anaemia
Elevated gamma gap
Renal failure 2o light chain cast nephropathy ( large waxy eosinophilic casts composed of Bence Jones proteins in tubular lumen)

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12
Q

Post streptococcal glomerulonephritis features?

A

Commonest cause of nephritic syndrome in children
Light microscopy: - enlarged hypercellular glomeruli
Lab results:- low C3 low total complement levels
Normal C4
High antistreptoccal antibodies

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13
Q

Earliest sign of diabetic nephropathy?

A

Albuminuria

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14
Q

Urine sediment in kidney stone shows ?

A

Free red blood cells (Haematuria)
Red cell casts are seen in glomerulonephritis

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15
Q

Renal amyloidosis features?

A

Proteinuria and nephrotic syndrome
Biopsy:- apple green bifiringence with Congo red stain
Serum protein electrophoresis showing a monoclonal protein —>Ig light chain AL amyloidosis

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16
Q

Contrast induced nephropathy features?

A

acute tubular necrosis —> diffuse necrosis of the proximal tubular cells
Acute inc in Creatinine and BUN

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17
Q

Henoch-Schonlein purpura features?

A

Lower limb palpable purpura
Abdominal pain +/- GI bleeding
Renal disease ( Haematuria )
Joint pain
IgA mediated

Triad:- MAHA, thrombocytopenia, acute kidney injury

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18
Q

1o hyperparathyroidism bone osteoporosis involves?

A

Subperiosteal absorption with cortical thinning
Affecting the appendicular skeleton (limbs and pelvis)

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19
Q

Mobitz type I block after NSTEMI suggests blockage of which artery?

A

RCA —> supplies AV node

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20
Q

Oestrogen therapy + pregnancy affect on thyroid levels?

A

Increase in THG
Increase in total T4 and T3

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21
Q

Pt with diarrhoea weight loss and +ve tissue transglutaminase diagnosis?

A

Coeliac disease

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22
Q

Lab findings in Coeliac disease?

A

Low 25 hydroxyvitmain D
Low PO4
Low Ca leading to
High PTH
High ALP

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23
Q

Dopamine effect on renal and cardiac blood flow?

A

At low doses stimulates D1 reception causing vasodilation and increase renal and cardiac bld flow.

At higher dosages stimulates B1 and alpha 1 resulting in increased C.O and vasoconstriction ultimately leading to decreased C.O

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24
Q

Adenomysosis features?

A

Regular, heavy painful period
Gross pathology:- uniformly enlarged globular uterus with abnormal presence of endometrial glands and stroma in myometrium

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25
What is a case-control study?
Pts with the outcome ( case) compared to pts without the outcome ( control) according to history of exposure to >= 1 factor
26
Large pituitary adenoma characteristics?
Commonest cause is prolactinoma Headaches Bitemporal hemianopia
27
Hemithorax volume and inspiratory lung compliance in pneumothorax?
Lung compliance decreases Chest wall springs outward —-> hemithorax volume increases
28
Best test to assess for impaired attention and concentration?
Counting down from 100 by intervals of 3 or 7 Reciting the months of the year backwards Spelling world backwards
29
TB meningitis pathology findings by?
Thick gelatinous exudate at the base of the brain cerebral vasculitis hydrocephalus.
30
TB meningitis presentation
Subacute slowly progressively nausea Vomiting Fever Cranial nerve deficits Strokes
31
Sensitisation to allergens occur when?
Inhaled antigens induce Th cells to differentiate to TH2 —> promotes B cell maturation to switch to IgE (T lymphocyte induction)
32
1o adrenal insufficiency features?
Occurs in pts with pre-existing autoimmune disease Hypotension, hypovolumemia Hypoglycaemia Normocytic Anaemia Eosinophilia I Low cortisol, low aldosterone
33
1o adrenal insufficiency lab results renal?
Increase K Low Na Increase urine Na Decrease urine K
34
Adhesion of cells to extracellular matrix involves which integrin?
Fibronectin Collagen Lamin
35
Francisella Tularensis (G-ve coco bacillus) mode of transmission
Contact with Wild animal (Ulceroglandular disease, painful regional lymphadenopathy)
36
Commonest pathogens in sickle cell patients?
Strep pneumoniae Neisseria meningitidis H influenzae
37
CF genetic defect?
3 base pair deletion of phenylalanine (position 508) leading to abnormal post translational processing of transmembrane protein
38
Midgut malrotation can cause ischaemia to structures supplied by which vessel?
Superior mesenteric
39
Which protein is most involved in the transport process reactivating cold sores?
Kinesin
40
Normal Na level
Think 140 135-145
41
Normal urine osmolality?
300 Think a lot of stuff in the urine
42
Pale yellow fluid leaking from umbilical stump cause?
Persistence of allantois remnant / patent urachus
43
Cause of fetal unilateral hydronephrosis
Ureteropelvic junction obstruction
44
Sevelamer what is it and mechanism of action?
PO4 binder Used in CKD to reduce levels of phosphorus Works by binding to intestinal phosphate and reducing absorption
45
Cause of stress incontinence?
Urethral sphincter dysfunction
46
Henoch-Schonlein purpura renal involvement is caused by?
IgA Immune complex deposition in glomerular mesangium
47
Normal WBC level
4 -12 K
48
Hgb normal level?
11-15 X3 = HCT
49
Platlet normal level
150-450k
50
N eosinophil level?
3%
51
N eosinophil level?
3%
52
Normal TIBC level?
250-400
53
Pre-renal acute kidney injury labs ?
BUN/creatinine ratio >20:1 High urine osmolarity Low factional excretion of Na
54
Minimal change disease secondary changes?
Increase liver lipoprotein synthesis Increase aldosterone + ADH Increase liver albumin synthesis ( minimal compensation) Increase Na and H2O retention
55
Spironolactone effect?
Decrease excretion of Na and H2O Decrease secretion of H and K in collecting tubules
56
Obstruction of IVC by RCC sign?
Bilateral pitting oedema Tortuous vertical collateral abdominal veins
57
Paraneoplastic syndromes assoc with RCC?
Erythrocytosis Hypercalcaemia
58
Urine pH in struvite stones?
High ph
59
Normal ADH nephron osmolarity?
PCT is isotonic with plasma Decending loop of Henle is hypertonic >300 DCT most dilute 100 (impermeable to H2O) Collecting tubules hypertonic
60
Vesicoureteral reflux characteristics?
Short intravesical ureter length ( can resolve spontaneously) Retrograde urine flow
61
Salicylate poisoning features?
Tinnitus Hyperventilation ( causing 1o resp alkalosis with 1o anion gap metabolic acidosis) N+V Hyperthermia Increase lactic acid Altered mental status
62
GFR creatinine relationship ?
Need large decrease in GFR for a small decrease in creatinine After significant GFR decrease then a small further decrease leads to a larger increase in creatinine Everytime GFR halves, creatinine doubles
63
Pt with high renin and aldosterone causes?
Renal artery stenosis Malignant HTN Renin secreting tumour ( JG cell tumour) Diuretic use ( thiazides)
64
Early cellular changes in acute tubular necrosis?
Loss of epithelial cell polarity
65
Intracellular causes of hypokalaemia?
Insulin B2 activity e.g. albuterol, dobutamine Stress induced e.g alcohol withdrawal, MI Alkalosis Increase cell reproduction e.g AML
66
Lab findings in SIADH?
Hyponatraemia Low serum osmolality High urine osmolality High urine Na
67
Causes of SIADH?
CNS disturbance ( stroke, haemorrhage, trauma) Medications (carbamazepine, SSRIs, NSAIDS) Lung disease (pneumonia) Malignancy (SCLC)
68
Changes in hepatocytes after administration of insulin?
Autophophorylation
69
Epiglottis presentation?
Fever Dysphagia Drooling
70
Serum insulin level after administration of epinephrine?
Increase glucose Low insulin
71
Group B Strep virulence factor?
Polysaccharide capsule contains Salic acid that prevents phagocytosis via molecular mimicry
72
Acute physiologic response to high altitude?
1. Pulmonary vasoconstriction —> increased pulmonary vascular resistance 2. Increase minute ventilation —> net increase PaO2 and Dec PaCO2 3. Increase SNS —> net:- increase C.O 3. Reduced aldosterone activity —> increase HCO3 excretion—> net:- diuresis and decreased plasma volume
73
Diabetes symptoms are due to which metabolic process?
Gluconeogenesis
74
Round mass filling previous TB cavity?
Aspergilloma
75
Bld results in pt with craniopharyngioma ?
(Tumour arising from pituitary gland embryonic tissue Childhood Pressure on on pituitary stalk) Low glucose Low ACTH Normal Na / K
76
How does PEEP help in ARDS?
Increase FRC Reduce intrapulmonary shunting Decrease V/Q mismatch
77
Familial hypcalcuiric Hypercalcaemia receptor mutation?
Mutation in the Calcium sensing receptors (CaSRs) membrane bound receptor coupled with a G protein that regulate PTH secretion
78
What are the DNA binding proteins ?
Transcription factors (Myc, CREB) Steroid receptors ( cortisol, aldosterone, progesterone) Thyroid hormone receptor Fat soluble vitamin receptors (vitamin D, retinoic acid) DNA transcription and replication proteins
79
KRAS is active when bound to ?
GTP
80
Which cellular function occurs in the rough Endoplasmic reticulum ?
Synthesis of cell membrane protein
81
Elevated CK Weakness Cardiomyopathy Absence of ketones in urine Hypoglycaemia Diagnosis?
1o carnitine deficiency
82
Hereditary fructose intolerance enzyme and precipitant?
Aldolase B deficiency Consumption of fructose or sucrose
83
What is the most abundant amino acid in collagen
Glycine
84
Mitochondrial DNA features?
Exists as small circular chromosomes Most common non nuclear DNA found in eukarotytic cells that resemble prokaryotic cells
85
Which ion is most likely to flow out of the cell when its ion channel opens?
K+ only
86
Protein kinase C is activated by ?
Broken down diacylglycerol (DAG ) And Ca+ released by IP3
87
Central DI is caused by deficiency in which hormone?
Vasopressin
88
Increase in oxygenation following pneumonia despite no change in CXR is due to?
Restored hypoxia pulmonary vasoconstriction
89
Definitive test for acromegaly ?
OGTT with GH measurements ( pts with acromegaly minimal suppression >75 after drinking glucose solution- N should drop)
90
Anaplastic thryroid cancer biopsy findings?
Undifferentiated cells
91
Medullary thyroid cancer bld findings?
High calcitonin Normal TFT
92
Bld results in androgen abuse?
Low GnRh Low LH/FSH High oestrogen Reduced testosterone secretion Impaired spermatogenesis
93
Which intracellular pathway is stimulated by use of growth hormone?
JaK-STAT pathway
94
Niemann- Pick presentation?
Deficiency of sphingomyleinase Accumulation of sphyinogmyeloin Neurologic regression (demyelination) Hepatosplenomegaly Retinal opacification ( cherry-red macula) Lipid laden (foam) macrophages on histology
95
How do testicular germ cell tumours cause gynaecomastia?
Secretion of hCG leading to impaired production of testosterone in Leydig cells. Increased Leydig cell aromatase converting androgen to oestrogen
96
Niemann- Pick deficiency?
Sphingomyelinase deficiency Accumulation of sphingomyelin
97
Effect of fructose 2,6 bisphosphate ?
Increase glycolysis Decrease gluconeogenesis Decrease conversion of alanine to glucose
98
Protein defect and lipoprotein levels in familial dyslipidaemia?
Protein defect:- ApoE3 and ApoE4 Elevated chylomicrons and VLDL —> elevated cholesterol and TG
99
Familial dysbetalipoproteinaemia presentation?
AR Eruptive palmar xanthomas Premature atherosclerosis
100
The initial step of steroidogenesis occurs in the mitochondria the remaining steps occur in ?
The smooth endoplasmic reticulum
101
Sorbitol accumulation accelerates presentation of ?
Cataract
102
Polyol pathway steps?
Glucose —-aldose reductase —-> sorbitol—-sorbitol dehydrogenase —-> fructose
103
Effects of unilateral orchidectomy?
Decreased sperm count N erection N libido N 2o sexual characteristics
104
Sarcoidosis Ca/vit D complication?
Activated macrophages in sarcoidosis express 1 alpha hydroxylase—-> excess production of 1,25 dihydroxy vitamin D and Hypercalcaemia
105
Stress Hyperglycaemia features?
Transiently elevated bld glucose level in context of severe illness in pts with no hx of DM Cortisol and catecholamines increase hepatic glycogenolysis and gluconeogenesis
106
What is a precursor of niacin ?
Tryptophan
107
Lead toxicity affect on haem synthesis?
Inhibit ferrochelatase and gamma aminolevulinic acid (ALA) dehydratase
108
Brown pigment stones features?
Arise 2o to E.Coli or helminthic infections B glucuronidase is released from injured hepatocytes and hydrolyses bilirubin to unconjugated bilirubin
109
Activation of phospholipase C leads to ?
Formation of IP3 —> activations of protein kinase C and increase in intracellular Ca
110
HGPRT deficiency leads to an increase in which enzyme?
PRPP aminotransferase By increasing de novo purine synthesis
111
Which vitamin is involved as a cofactor in amino acid transamination and decarboxylation?
B6 pyridoxine
112
What is Inclusion cell disease ?
AR Lysosomal storage disorder Defect in protein tagging in Golgi Deficiency in N acetyl- glucosaminyl 1 phosphotransferase Failure to thrive Resp tract infections Cognitive deficits in early life Coarse facies Corneal clouding Hepatosplenomegaly Restricted joint movements
113
Impaired tetrahydrobiopterin (BH4) synthesis causes deficiency in ?
Phenylalanine BH4 is a cofactor
114
Fatty acid beta oxidation is inhibited by ?
Malonyl-CoA inhibits CAT-1 rate limiting enzyme
115
Organophosphate poisoning features?
Organophosphates widely used as pesticides Irreversible cholinesterase (breakdown) inhibitor Symptoms:- salivation, lacrimation Diaphoresis Bradycardia Bronchospasm
116
Mature erythrocytes lose their ability to synthesize haem because they lose which organelle?
Mitochondria
117
Amatoxins in poisonous mushroom inhibit ?
RNA polymerase II —-> messenger RNA ( RNA I —> Ribosomal RNA) (RNA III—-> Transfer RNA)
118
Which collagen synthesis step is impaired in Ehlers Danlos?
SSLevage Cleavage of N terminal peptides
119
How does CO poisoning impairs HgB function ?
Competitive binding to haem with greater affinity than O2
120
Niacin is an important cofactor for what enzymes ?
Dehydrogenases and reductases
121
Glycerol /
Produced by degradation of TG in adipose tissue Used by glycerol kinase in the liver and kidney to synthesise glucose during gluconeogenesis
122
Classic galactosaemia features?
Deficiency of galactose-1-phosphate uridyl transferase Clinical features Cataracts Liver enlargement Autosomal Recessive Sepsis (E.Coli) Start of feeding Intellectual disability Colour (jaundice
123
Lynch syndrome features?
Hereditary non polyposis colon cancer AD Abnormal nucleotide mismatch repair
124
porphyria cutanea tarda enzyme deficiency?
Uropophyriongen decarboxylase
125
Glycolysis rate limiting enzyme, cofactors, end product /
Glucose — Phophofructokinase 1 Inhibited by citrate and ATP Stimulated by AMP, fructose 2, 6 bisphophonate Pyruvate
126
Gluconeogenesis points?
Pyruvate Fructose 1,6 bisphosphotase Inhibited by AMp, fructose 2,6 bisphosphate Stimulated citrate Glucose Require GTP, Biotin Pathway stimulated by acetyl CoA
127
Glycolysis points?
Glycolygen Glycolygen phosphorylase + glucagon, epinephrine, cAMP Glucose -1- phosphate
128
Glycogenisis points?
Glucose -1-phosphate Glycogenolysis synthase + insulin Glycogen
129
HMP shunt points?
Glucose -6- phosphate G6P dehydrogenase Ribose 5 phosphate NADH produced
130
Fructose metabolism?
Fructose — fructokinase —> fructose -1-phosphate —-> aldolase B —-> glyaceraldehyde + DHAP Glyceraldehyde- 3- phosphate
131
Pyruvate metabolism points ?
Pyruvate Pyruvate dehydrogenase Co-factors B1, B2, B3 , B5, lipoic acid Acetyl-CoA Mitochondria
132
TCA cycle points ?
Isocitrate dehydrogenase +ADP -ve ATP, NADH, FADH NIKO F
133
Urea cycle points ?
NH3 + CO2 Carbomoyl Po4 synthetase I +Nacetylglutamate Urea
134
Fatty acid synthesis points ?
Citrate Acetyl CoA carboxylase + insulin +citrate -ve glucagon, palmitoyl CoA Palmitate
135
Fatty acid oxidation points?
Fatty acid Carnitine acyltransferase I (CAT-1) -ve malonyl-CoA Acetyl CoA
136
Ketogenesis points?
2 Acetyl CoA HMG CoA synthase Acetone + B hydroxybutarate
137
Cholesterol synthesis points?
HMG CoA reductase +insulin, thyroxine, oestrogen -ve glucagon , cholesterol
138
Acute cervicitis features?
Causes:- chalmydia, gonorrohea, foreign object, douching Risk factors:- <25 Symptoms mucopurulent discharge and friable cx Complications :- PID, infertility, ectopic pregnancy
139
Complications of PCOS?
Endometrial hyperplasia and carcinoma
140
Cycle variability with intermenustral spotting, heavy bleeding at start of menarche is due to?
Low and irregular GnRH pulses
141
Monozygotic twins vs dizygotic twins /
Dizygotic= different sexes usually dichorionic/diamniotic Monozygotic =same sex
142
Incomplete fusion of the urethral(urogenital folds) results in ?
Hypospadias
143
Failure of fusion of the genital tubercle?
Epispadias
144
Maternal rubella infection features?
Maculopapular rash with head to toe progression Joint pain Postauricular lymphadenopathy Fetus signs;- sensorineural deafness Cataracts PDA Growth restriction ( microcephaly)
145
Most common cause of UTI in men and women?
E.Coli (nitrate reductase producing bacteria) Urine +ve nitrites +ve leukocytes esterase Mildly acidic pH
146
Which hernias pass through inguinal canal to scrotum?
Indirect hernia 2o incomplete obliteration of the processus vaginalis
147
Progesterone withdrawal causes endometrium to undergo?
Apoptosis —> menstrual bleeding
148
Adverse effects with excess anabolic use?
Acne Gynaemcomastia Azospermia Decreased testicular size Increase aggression Decreased endogenous testosterone Decreased spermatogenesis
149
Risk factor for ectopic pregnancy?
PID 2o gonorrhoea or chlamydia
150
Congenital androgen insensitivity syndrome features?
Mutation of androgen receptors XY male Have testes No internal or external genitalia male Female or ambiguous external genitalia No uterus or fallopian tubes
151
Polyhydramnios fetal causes ?
Decreased fetal swallowing 2o anencephaly or GI obstruction Increased fetal urination
152
Pregnancy haematologic changes?
Decrease Hgb ( dilutional anaemia) Prothrombotic state :- increase fibrinogen Decreased Protein S and reduced fibrinolysis
153
Loss of testosterone following bilateral orchiectomy changes?
Hypogonadal state ;- low testosterone Decreased lean body wt Increased subcut fat Decreased bone density Significant decrease in prostate volume
154
Bacterial vaginosis features ?
Disruption of normal vaginal flora leading to overgrowth of gardnerella vaginalis Greyish - white fishy smelling discharge Clue cells —;- sq epithelial cells with adherent bacteria on wet mount microscopy
155
Commonest cause of acute bacterial prostatitis ?
E.Coli Others include Proteus Klebsiella Pseudomonas
156
Advise to give after vasectomy?
Viable sperm in the ejaculate for up to 3/12 and at least 20 ejaculations
157
What is supine hypotension syndrome ?
Pregnant pts >20/4o due to compression of IVC by the uterus which in supine or Rt lateral decubitus position Causing reduction in venous return and C.O —> severe hypotension
158
Cause of gestational DM?
Human placental lactose —> increase insulin resistance leading to rise in serum glucose to provide nutrition for the fetus When the compensatory rise in Maternal insulin is inadequate —> excess glucose
159
Physiologic renal changes during pregnancy?
Increase GFR Increase basement membrane permeability Decreased tubular resorption of filtered protein Trace proteinuria <300mg/24hrs
160
Transexamic acid mechanisim of action?
Antifibrinolytic medication stabilises clots Inhibits plasminogen cleavage into plasmin formation preventing fibrin degradation and clot dissolution
161
Affect of gestational DM on baby’s glucose/insulin levels?
In utero to cope with high maternal glucose - fetus will develop beta cell hyperplasia producing excess insulin. When child is born this will cause fatal hypoglycaemia because they/re no longer exposed to increase maternal glucose.
162
Despite high prolactin levels during pregnancy why do women not lactate?
High progesterone produced by placenta bind to prolactin receptors in the alveolar cells in breast
163
Prostate Ca bony mets findings?
Ostoblastic lesion resulting in new bone growth. Disordered trabeculae and irregular glands with enlarged nuclei and prominent nucleoli
164
Osteolytic bone mets 1o ca?
(M2N2R) Melanoma Multiple myeloma Non Hodgkins lymphoma Non small cell lung cancer Renal cell cancer
165
Choriocarcinoma features?
Malignant gestational trophoblastic disease Composed of proliferation of anaplastic cytotrophoblasts and syncytiotrophoblasts without villi Hx:- follows pregnancy, dyspnoea, haemoptysis, abnormal vaginal bleeding and v high b-hCG levels
166
Placental abruption features/
Premature Detachment of placenta from uterus- 3rd trimester Maternal vessels rupture at uteroplacental interface Painful vaginal bleeding Tender, firm uterus Fetal HR low/N Risk factors maternal HTN, tobacco, cocaine use
167
Ectopic pregnancy presentation?
Unilateral lower abdominal pain, Adnexal tenderness and vaginal bleeding. Ruptured ectopic think acute abdomen
168
What is a krukenberg tumour?
Gastric tumour that has metastasised to the ovary. Presents with wt loss, epigastic pain and adnexal mass. Histo:- cells producing large amount of mucin displacing nuclei to periphery — signet cells
169
Acute epididymitis features?
Acute unilateral testicular pain, tenderness epididymal oedema and pyuria. -ve urine culture Retrograde passage of bacteria from the urethra Young men:- chlamydia, gonorrhoea Older men >35 g-ve colonic flora
170
What prophylaxis is needed for pts with advanced HIV and CD4 count <200?
Pneumocystis jiroveci pneumonia prophylaxis with trimethoprim sulfamethoxazole
171
Features of I cell disease?
Similar to hurlers Coarse facial features Developmental delay Clouding corneas Recurrent resp infections
172
Defective step in I cell disease?
Post translational modification of proteins Defect in phosphotransferase enzyme prevents phosphorylation of mannose
173
Chance of an unaffected pt to be a carrier of a AR gene if they have unaffected parents and an affected sibling?
2/3
174
Cardiac changes seen in endurance athletes heart?
Increase C.O Increase S.V Increase Lt ventricular cavity size Increase end diastolic volume LVEF unchanged
175
What is the multiplication law ?
The probability that 2 or more independent events occurring together can be calculated by multiplying the individual probabilities of each event
176
Injury of the auxiliary nerve?
Occurs 2o to shoulder trauma Sensory loss over the lateral shoulder and weakness of shoulder abduction 2o denervation of the deltoid
177
Stellate (Ito) cells features?
Primary cells in hepatic fibrosis Produce large quantities of collagen Stan blue with Masson trichrome stain
178
Infant with severe life threatening enteroviral infection think?
X-linked agammaglobulinaemia —> low circulated B lymphocytes and immunoglobulins
179
Blind jejunum and distal ileum that spirals around the ileocolic vessel is sure to ?
Vascular occlusion of superior mesenteric artery in utero cause intestinal atresia distal to the duodenum
180
Haem changes on pregnancy ?
Increase blood plasma volume Increased red cell mass Slight decrease in Hgb( dilutional anaemia)
181
Teratogenic SE of valproate ?
Decreases maternal folate —> increase risk of neural tube defects ( meaningocele, myelomeningocele)
182
CIN grades ?
Low grade < 1/3 of epithelium involved, koilocytes High grade >1/3 of epithelium involved, BM intact Cervical carcinoma ( invades the BM)
183
Features of testicular germ cell tumours ?
Non seminomatous :- partially differentiated germ cell High hCG, AFP, LDH Seminomas :- don’t secrete AFP
184
Letrozole mechanism of action?
Aromatase inhibitor. Inhibits androgen to oestrogen conversion —> decrease oestrogen —> stimulate pituitary to increase LH/FSH —> stimulate ovulation
185
PCOS presentation?
Irregular Menses Hyperandrogenism (acne, hisutisim) Obesity High LH/FSH ratio Bilateral enlarged cystic ovaries Increase androgen Increased peripheral oestrogen production
186
Priapism 2o sickle cell disease?
Ischaemic priapism Low O2 High CO2 Low pH 2o impaired penile venous outflow prevent relief
187
Management of Klinefelter syndrome?
Male hypogonadisim —-> testosterone. Will improve libido, erectile dysfunction, Increase BMD and muscle development
188
Ovarian torsion presentation?
Young pt Ovary rotates around infundibulopelvic and uterovarian ligaments. Sudden unilateral pelvic pain with tender acne all mass
189
Partial androgen resistance features?
Loss of function/mutation of androgen receptor High LH High testosterone N FSH Under virilisastion of the external genitalia (microphallus) Decreased hair Oligospermia Gynaecomastia
190
Which finding is specific to pyelonephritis and helps differentiate it from cystitis?
White cell casts
191
What is a koilocyte?
Seen in HPV infection Atypical sq cell with perinuclear cytoplasmic clearing (halo) and dark, large irregular nucleus ( raisinoid)
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Features suggestive of ectopic pregnancy?
Hx of lower Abdo pain and vaginal bleeding +ve pregnancy test Adnexal mass
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Effect of maternal use of ACE I and ARBs on foetus?
Foetal renal hypoplasia/dysplasia —> decreased foetal urine production —>oligohydramnios —> Potter sequence
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Urinary incontinence seen in multiparous pregnant women?
Stress incontinence 2o increased intra-abdominal pressure, lax external urethral sphincter tone and lax pelvic floor
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Incidental mass in woman age 10-30 with Abdo discomfort likely?
Mature Teratoma ( most common)
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Causes of priapism?
Sickle cell disease Trazodone
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What type of vaccine is given to prevent congenital rubella syndrome?
Maternal administration of a live attenuated vaccine before conception
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Cause of gallstones in pregnant women and those taking ocp?
Oestrogen induced cholesterol hypersecretion and progesterone induced gallbladder hypomotility.
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Management of vulvovaginal candidiasis?
Fluconazole Wet mount microscopy:- psuedophyphae with budding yeast
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Restless leg syndrome characteristics?
Uncomfortable sensation in legs with urge to move them. Worse at night Worsened by metacolopromaide, diphenhydramine Mgx:- alpha 2 delta ca channel ligands e.g gabapentin, pregabalin Dopamine agonist —> pramipexole
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Empyema features?
Accumulation of pus in pleural space Commonest cause extension from alveoli i.e parapneumonic effusion
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What part of the brain regulates the circadian rhythm?
Suprachiasmatic nucleus of hypothalamic nuclei
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Pt with Crohn’s disease and hx of epistaxis, bruising prolonged PT and PTT?
Vitamin K deficiency
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How does vitamin K activate coagulation factors?
Vitamin k is a cofactor for gamma glutamic carboxylase with activates coat factors 2,7,9,10 via postranslational gamma carboxylation
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What is physiologic stress test?
Administration of dobutamine mimics excercise and increase myocardial O2 demand
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Stable angina and stress test ?
Is a fixed coronary artery stenosis with exercise will cause a mismatch of O2 supply and demand
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DNA mismatch repair characteristics?
Large quantities of Neoantigens Downregulate expression of ‘MHC1 to avoid detection by CD8+cells Treatment with immune checkpoint inhibitors restore cytotoxic T cell activity
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What is factitious disorder?
Intentional falsification of symptoms or induction of disease. Goal is to assume the pt role
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Coeliac disease features?
Assoc with HLA-DQ2, HLA-DQ8 serotypes Symptoms:- diarrhoea, abdominal pain, malabsorption, iron deficiency anaemia Duodenal biopsy:- intraepithelial lymphocytosis, crypt hyperplasia, villous blunting -ve faecal occult bld
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Paraneoplastic cerebellar degeneration is what kind of process ?
Autoimmune response to tumour cells cross reacting with purkinje neuron antigens
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Achondroplasia inheritance ?
AD mutation of the FGFR3 gene Therefore offspring have 50% chance of inheriting No carrier status
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Spleen embryonic origin?
Spleen is of mesodermal origin (dorsal mesentry) but its blood supply ( splenic artery) is derived from the major foregut vessel, the coeliac trunk.
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Chromaffin cells in the adrenal medulla features?
Stimulated by acetylcholine and secrete catecholamines into bld stream Chromaffin cells are modified neuroendocrine cells from the neural crest
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On CT scan where is the prostate located?
Between the bladder and the anal canal Anterior to the anal canal
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Cause of retinal artery occlusion?
Thromboembolic complication of atherosclerosis travelling from internal carotid artery —> ophthalmic artery —> retinal artery
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Albuterol mechanism of action?
A beta 2 receptor agonist increases cAMP in bronchial smooth muscle Induce bronchial smooth muscle relaxation to relieve airway spasm
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68/95/99 rule
68% of all observations lie within 1SD 95% of all observations lie within 2 SD (1.96 SD in normal distribution) 99% of all observations lie within 3 SD (2.58SD in normal distribution)
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95% confidence interval ?
CI of mean = mean +/- 1.96 x SD / square root of n
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Mechanism of action of Osteoprotegerin?
Blocks binding of activator of nuclear factor kappa B (RANK) to RANK- L (ligand) reducing formation of mature osteoclasts —> decreased bone resorption
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Imiquimod mechanism and use?
Topical immunomodulatory agent Stimulates cellular and cytokines immune response to aberrant cells, also induces apoptosis and inhibits angiogenesis, activates toll like receptor up regulates NFkB Used for HPV anogenial warts, actinic keratosis and superficial basal cell carcinoma
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