Mixed Q’s 4 Flashcards
Features of urolithiasis due to hyperparathyroidism?
Abdo pain
Vomiting
Haematuria
Hypercalcaemia
Hypophosphataemia
Risk factors for urothelial cancer of the bladder?
Age >60
Cigarette smoking
Occupational exposure to :- rubber plastic
Cyclophosphamide therapy
Painless Haematuria
Vesicoureteral reflux features?
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
Adverse renal affect of penicillamine?
Membranous nephropathy
Glomerulonephritis 2o small vessel vasculitis features
Bld levels acute kidney injury
Proteinuria
HTN
Red cell cast
Exogenous immune complex deposition
1o thrombotic microangiopathy syndrome features?
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
Risk factors for kidney stones?
Increase urinary calcium
Increase urinary oxalate
Increase urinary uric acid
Decrease urinary citrate
Decrease fluid intake
Prerenal acute kidney injury features?
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
Homogenous deposition of eosinophilic hyaline material in the intima and media of arteries is due to ?
Poorly controlled DM or HTN
CKD renal osteodystrophy features?
High PO4
Low 1,25 Vitmain D
Low Ca
2o hyperparathyroidism
Multiple myeloma features?
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)
Post streptococcal glomerulonephritis features?
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
Earliest sign of diabetic nephropathy?
Albuminuria
Urine sediment in kidney stone shows ?
Free red blood cells (Haematuria)
Red cell casts are seen in glomerulonephritis
Renal amyloidosis features?
Proteinuria and nephrotic syndrome
Biopsy:- apple green bifiringence with Congo red stain
Serum protein electrophoresis showing a monoclonal protein —>Ig light chain AL amyloidosis
Contrast induced nephropathy features?
acute tubular necrosis —> diffuse necrosis of the proximal tubular cells
Acute inc in Creatinine and BUN
Henoch-Schonlein purpura features?
Lower limb palpable purpura
Abdominal pain +/- GI bleeding
Renal disease ( Haematuria )
Joint pain
IgA mediated
Triad:- MAHA, thrombocytopenia, acute kidney injury
1o hyperparathyroidism bone osteoporosis involves?
Subperiosteal absorption with cortical thinning
Affecting the appendicular skeleton (limbs and pelvis)
Mobitz type I block after NSTEMI suggests blockage of which artery?
RCA —> supplies AV node
Oestrogen therapy + pregnancy affect on thyroid levels?
Increase in THG
Increase in total T4 and T3
Pt with diarrhoea weight loss and +ve tissue transglutaminase diagnosis?
Coeliac disease
Lab findings in Coeliac disease?
Low 25 hydroxyvitmain D
Low PO4
Low Ca leading to
High PTH
High ALP
Dopamine effect on renal and cardiac blood flow?
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
Adenomysosis features?
Regular, heavy painful period
Gross pathology:- uniformly enlarged globular uterus with abnormal presence of endometrial glands and stroma in myometrium
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
Large pituitary adenoma characteristics?
Commonest cause is prolactinoma
Headaches
Bitemporal hemianopia
Hemithorax volume and inspiratory lung compliance in pneumothorax?
Lung compliance decreases
Chest wall springs outward —-> hemithorax volume increases
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
TB meningitis pathology findings by?
Thick gelatinous exudate at the base of the brain
cerebral vasculitis
hydrocephalus.
TB meningitis presentation
Subacute slowly progressively nausea
Vomiting
Fever
Cranial nerve deficits
Strokes
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)
1o adrenal insufficiency features?
Occurs in pts with pre-existing autoimmune disease
Hypotension, hypovolumemia
Hypoglycaemia
Normocytic Anaemia
Eosinophilia
I
Low cortisol, low aldosterone
1o adrenal insufficiency lab results renal?
Increase K
Low Na
Increase urine Na
Decrease urine K
Adhesion of cells to extracellular matrix involves which integrin?
Fibronectin
Collagen
Lamin
Francisella Tularensis (G-ve coco bacillus) mode of transmission
Contact with Wild animal
(Ulceroglandular disease, painful regional lymphadenopathy)
Commonest pathogens in sickle cell patients?
Strep pneumoniae
Neisseria meningitidis
H influenzae
CF genetic defect?
3 base pair deletion of phenylalanine (position 508) leading to abnormal post translational processing of transmembrane protein
Midgut malrotation can cause ischaemia to structures supplied by which vessel?
Superior mesenteric
Which protein is most involved in the transport process reactivating cold sores?
Kinesin
Normal Na level
Think 140
135-145
Normal urine osmolality?
300
Think a lot of stuff in the urine
Pale yellow fluid leaking from umbilical stump cause?
Persistence of allantois remnant / patent urachus
Cause of fetal unilateral hydronephrosis
Ureteropelvic junction obstruction
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
Cause of stress incontinence?
Urethral sphincter dysfunction
Henoch-Schonlein purpura renal involvement is caused by?
IgA Immune complex deposition in glomerular mesangium
Normal WBC level
4 -12 K
Hgb normal level?
11-15
X3 = HCT
Platlet normal level
150-450k
N eosinophil level?
3%
N eosinophil level?
3%
Normal TIBC level?
250-400
Pre-renal acute kidney injury labs ?
BUN/creatinine ratio >20:1
High urine osmolarity
Low factional excretion of Na
Minimal change disease secondary changes?
Increase liver lipoprotein synthesis
Increase aldosterone + ADH
Increase liver albumin synthesis ( minimal compensation)
Increase Na and H2O retention
Spironolactone effect?
Decrease excretion of Na and H2O
Decrease secretion of H and K in collecting tubules
Obstruction of IVC by RCC sign?
Bilateral pitting oedema
Tortuous vertical collateral abdominal veins
Paraneoplastic syndromes assoc with RCC?
Erythrocytosis
Hypercalcaemia
Urine pH in struvite stones?
High ph
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
Vesicoureteral reflux characteristics?
Short intravesical ureter length ( can resolve spontaneously)
Retrograde urine flow
Salicylate poisoning features?
Tinnitus
Hyperventilation ( causing 1o resp alkalosis with 1o anion gap metabolic acidosis)
N+V
Hyperthermia
Increase lactic acid
Altered mental status
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
Pt with high renin and aldosterone causes?
Renal artery stenosis
Malignant HTN
Renin secreting tumour ( JG cell tumour)
Diuretic use ( thiazides)
Early cellular changes in acute tubular necrosis?
Loss of epithelial cell polarity
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
Lab findings in SIADH?
Hyponatraemia
Low serum osmolality
High urine osmolality
High urine Na
Causes of SIADH?
CNS disturbance ( stroke, haemorrhage, trauma)
Medications (carbamazepine, SSRIs, NSAIDS)
Lung disease (pneumonia)
Malignancy (SCLC)
Changes in hepatocytes after administration of insulin?
Autophophorylation
Epiglottis presentation?
Fever
Dysphagia
Drooling
Serum insulin level after administration of epinephrine?
Increase glucose
Low insulin
Group B Strep virulence factor?
Polysaccharide capsule contains Salic acid that prevents phagocytosis via molecular mimicry
Acute physiologic response to high altitude?
- Pulmonary vasoconstriction —> increased pulmonary vascular resistance
- Increase minute ventilation —> net increase PaO2 and Dec PaCO2
- Increase SNS —> net:- increase C.O
- Reduced aldosterone activity —> increase HCO3 excretion—> net:- diuresis and decreased plasma volume
Diabetes symptoms are due to which metabolic process?
Gluconeogenesis
Round mass filling previous TB cavity?
Aspergilloma
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
How does PEEP help in ARDS?
Increase FRC
Reduce intrapulmonary shunting
Decrease V/Q mismatch
Familial hypcalcuiric Hypercalcaemia receptor mutation?
Mutation in the Calcium sensing receptors (CaSRs) membrane bound receptor coupled with a G protein that regulate PTH secretion
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
KRAS is active when bound to ?
GTP
Which cellular function occurs in the rough Endoplasmic reticulum ?
Synthesis of cell membrane protein
Elevated CK
Weakness
Cardiomyopathy
Absence of ketones in urine
Hypoglycaemia
Diagnosis?
1o carnitine deficiency
Hereditary fructose intolerance enzyme and precipitant?
Aldolase B deficiency
Consumption of fructose or sucrose
What is the most abundant amino acid in collagen
Glycine
Mitochondrial DNA features?
Exists as small circular chromosomes
Most common non nuclear DNA found in eukarotytic cells that resemble prokaryotic cells
Which ion is most likely to flow out of the cell when its ion channel opens?
K+ only
Protein kinase C is activated by ?
Broken down diacylglycerol (DAG )
And Ca+ released by IP3
Central DI is caused by deficiency in which hormone?
Vasopressin
Increase in oxygenation following pneumonia despite no change in CXR is due to?
Restored hypoxia pulmonary vasoconstriction
Definitive test for acromegaly ?
OGTT with GH measurements ( pts with acromegaly minimal suppression >75 after drinking glucose solution- N should drop)
Anaplastic thryroid cancer biopsy findings?
Undifferentiated cells
Medullary thyroid cancer bld findings?
High calcitonin
Normal TFT
Bld results in androgen abuse?
Low GnRh
Low LH/FSH
High oestrogen
Reduced testosterone secretion
Impaired spermatogenesis
Which intracellular pathway is stimulated by use of growth hormone?
JaK-STAT pathway
Niemann- Pick presentation?
Deficiency of sphingomyleinase
Accumulation of sphyinogmyeloin
Neurologic regression (demyelination)
Hepatosplenomegaly
Retinal opacification ( cherry-red macula)
Lipid laden (foam) macrophages on histology
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
Niemann- Pick deficiency?
Sphingomyelinase deficiency
Accumulation of sphingomyelin
Effect of fructose 2,6 bisphosphate ?
Increase glycolysis
Decrease gluconeogenesis
Decrease conversion of alanine to glucose
Protein defect and lipoprotein levels in familial dyslipidaemia?
Protein defect:- ApoE3 and ApoE4
Elevated chylomicrons and VLDL —> elevated cholesterol and TG
Familial dysbetalipoproteinaemia presentation?
AR
Eruptive palmar xanthomas
Premature atherosclerosis
The initial step of steroidogenesis occurs in the mitochondria the remaining steps occur in ?
The smooth endoplasmic reticulum
Sorbitol accumulation accelerates presentation of ?
Cataract
Polyol pathway steps?
Glucose —-aldose reductase —-> sorbitol—-sorbitol dehydrogenase —-> fructose
Effects of unilateral orchidectomy?
Decreased sperm count
N erection
N libido
N 2o sexual characteristics
Sarcoidosis Ca/vit D complication?
Activated macrophages in sarcoidosis express 1 alpha hydroxylase—-> excess production of 1,25 dihydroxy vitamin D and Hypercalcaemia
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
What is a precursor of niacin ?
Tryptophan
Lead toxicity affect on haem synthesis?
Inhibit ferrochelatase and gamma aminolevulinic acid (ALA) dehydratase
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
Activation of phospholipase C leads to ?
Formation of IP3 —> activations of protein kinase C and increase in intracellular Ca
HGPRT deficiency leads to an increase in which enzyme?
PRPP aminotransferase
By increasing de novo purine synthesis
Which vitamin is involved as a cofactor in amino acid transamination and decarboxylation?
B6 pyridoxine
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
Impaired tetrahydrobiopterin (BH4) synthesis causes deficiency in ?
Phenylalanine
BH4 is a cofactor
Fatty acid beta oxidation is inhibited by ?
Malonyl-CoA inhibits CAT-1 rate limiting enzyme
Organophosphate poisoning features?
Organophosphates widely used as pesticides
Irreversible cholinesterase (breakdown) inhibitor
Symptoms:- salivation, lacrimation
Diaphoresis
Bradycardia
Bronchospasm
Mature erythrocytes lose their ability to synthesize haem because they lose which organelle?
Mitochondria
Amatoxins in poisonous mushroom inhibit ?
RNA polymerase II —-> messenger RNA
( RNA I —> Ribosomal RNA)
(RNA III—-> Transfer RNA)
Which collagen synthesis step is impaired in Ehlers Danlos?
SSLevage
Cleavage of N terminal peptides
How does CO poisoning impairs HgB function ?
Competitive binding to haem with greater affinity than O2
Niacin is an important cofactor for what enzymes ?
Dehydrogenases and reductases
Glycerol /
Produced by degradation of TG in adipose tissue
Used by glycerol kinase in the liver and kidney to synthesise glucose during gluconeogenesis
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
Lynch syndrome features?
Hereditary non polyposis colon cancer
AD
Abnormal nucleotide mismatch repair
porphyria cutanea tarda enzyme deficiency?
Uropophyriongen decarboxylase
Glycolysis rate limiting enzyme, cofactors, end product /
Glucose —
Phophofructokinase 1
Inhibited by citrate and ATP
Stimulated by AMP, fructose 2, 6 bisphophonate
Pyruvate
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
Glycolysis points?
Glycolygen
Glycolygen phosphorylase
+ glucagon, epinephrine, cAMP
Glucose -1- phosphate
Glycogenisis points?
Glucose -1-phosphate
Glycogenolysis synthase
+ insulin
Glycogen
HMP shunt points?
Glucose -6- phosphate
G6P dehydrogenase
Ribose 5 phosphate
NADH produced
Fructose metabolism?
Fructose — fructokinase —> fructose -1-phosphate
—-> aldolase B —-> glyaceraldehyde + DHAP
Glyceraldehyde- 3- phosphate
Pyruvate metabolism points ?
Pyruvate
Pyruvate dehydrogenase
Co-factors B1, B2, B3 , B5, lipoic acid
Acetyl-CoA
Mitochondria
TCA cycle points ?
Isocitrate dehydrogenase
+ADP
-ve ATP, NADH, FADH
NIKO
F
Urea cycle points ?
NH3 + CO2
Carbomoyl Po4 synthetase I
+Nacetylglutamate
Urea
Fatty acid synthesis points ?
Citrate
Acetyl CoA carboxylase
+ insulin
+citrate
-ve glucagon, palmitoyl CoA
Palmitate
Fatty acid oxidation points?
Fatty acid
Carnitine acyltransferase I (CAT-1)
-ve malonyl-CoA
Acetyl CoA
Ketogenesis points?
2 Acetyl CoA
HMG CoA synthase
Acetone + B hydroxybutarate
Cholesterol synthesis points?
HMG CoA reductase
+insulin, thyroxine, oestrogen
-ve glucagon , cholesterol
Acute cervicitis features?
Causes:- chalmydia, gonorrohea, foreign object, douching
Risk factors:- <25
Symptoms mucopurulent discharge and friable cx
Complications :- PID, infertility, ectopic pregnancy
Complications of PCOS?
Endometrial hyperplasia and carcinoma
Cycle variability with intermenustral spotting, heavy bleeding at start of menarche is due to?
Low and irregular GnRH pulses
Monozygotic twins vs dizygotic twins /
Dizygotic= different sexes usually dichorionic/diamniotic
Monozygotic =same sex
Incomplete fusion of the urethral(urogenital folds) results in ?
Hypospadias
Failure of fusion of the genital tubercle?
Epispadias
Maternal rubella infection features?
Maculopapular rash with head to toe progression
Joint pain
Postauricular lymphadenopathy
Fetus signs;- sensorineural deafness
Cataracts
PDA
Growth restriction ( microcephaly)
Most common cause of UTI in men and women?
E.Coli (nitrate reductase producing bacteria)
Urine +ve nitrites
+ve leukocytes esterase
Mildly acidic pH
Which hernias pass through inguinal canal to scrotum?
Indirect hernia 2o incomplete obliteration of the processus vaginalis
Progesterone withdrawal causes endometrium to undergo?
Apoptosis —> menstrual bleeding
Adverse effects with excess anabolic use?
Acne
Gynaemcomastia
Azospermia
Decreased testicular size
Increase aggression
Decreased endogenous testosterone
Decreased spermatogenesis
Risk factor for ectopic pregnancy?
PID 2o gonorrhoea or chlamydia
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
Polyhydramnios fetal causes ?
Decreased fetal swallowing 2o anencephaly or GI obstruction
Increased fetal urination
Pregnancy haematologic changes?
Decrease Hgb ( dilutional anaemia)
Prothrombotic state :- increase fibrinogen
Decreased Protein S and reduced fibrinolysis
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
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
Commonest cause of acute bacterial prostatitis ?
E.Coli
Others include
Proteus
Klebsiella
Pseudomonas
Advise to give after vasectomy?
Viable sperm in the ejaculate for up to 3/12 and at least 20 ejaculations
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
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
Physiologic renal changes during pregnancy?
Increase GFR
Increase basement membrane permeability
Decreased tubular resorption of filtered protein
Trace proteinuria <300mg/24hrs
Transexamic acid mechanisim of action?
Antifibrinolytic medication stabilises clots
Inhibits plasminogen cleavage into plasmin formation preventing fibrin degradation and clot dissolution
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.
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
Prostate Ca bony mets findings?
Ostoblastic lesion resulting in new bone growth.
Disordered trabeculae and irregular glands with enlarged nuclei and prominent nucleoli
Osteolytic bone mets 1o ca?
(M2N2R)
Melanoma
Multiple myeloma
Non Hodgkins lymphoma
Non small cell lung cancer
Renal cell cancer
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
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
Ectopic pregnancy presentation?
Unilateral lower abdominal pain, Adnexal tenderness and vaginal bleeding.
Ruptured ectopic think acute abdomen
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
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
What prophylaxis is needed for pts with advanced HIV and CD4 count <200?
Pneumocystis jiroveci pneumonia prophylaxis with trimethoprim sulfamethoxazole
Features of I cell disease?
Similar to hurlers
Coarse facial features
Developmental delay
Clouding corneas
Recurrent resp infections
Defective step in I cell disease?
Post translational modification of proteins
Defect in phosphotransferase enzyme prevents phosphorylation of mannose
Chance of an unaffected pt to be a carrier of a AR gene if they have unaffected parents and an affected sibling?
2/3
Cardiac changes seen in endurance athletes heart?
Increase C.O
Increase S.V
Increase Lt ventricular cavity size
Increase end diastolic volume
LVEF unchanged
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
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
Stellate (Ito) cells features?
Primary cells in hepatic fibrosis
Produce large quantities of collagen
Stan blue with Masson trichrome stain
Infant with severe life threatening enteroviral infection think?
X-linked agammaglobulinaemia —> low circulated B lymphocytes and immunoglobulins
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
Haem changes on pregnancy ?
Increase blood plasma volume
Increased red cell mass
Slight decrease in Hgb( dilutional anaemia)
Teratogenic SE of valproate ?
Decreases maternal folate —> increase risk of neural tube defects ( meaningocele, myelomeningocele)
CIN grades ?
Low grade < 1/3 of epithelium involved, koilocytes
High grade >1/3 of epithelium involved, BM intact
Cervical carcinoma ( invades the BM)
Features of testicular germ cell tumours ?
Non seminomatous :- partially differentiated germ cell
High hCG, AFP, LDH
Seminomas :- don’t secrete AFP
Letrozole mechanism of action?
Aromatase inhibitor. Inhibits androgen to oestrogen conversion —> decrease oestrogen —> stimulate pituitary to increase LH/FSH —> stimulate ovulation
PCOS presentation?
Irregular Menses
Hyperandrogenism (acne, hisutisim)
Obesity
High LH/FSH ratio
Bilateral enlarged cystic ovaries
Increase androgen
Increased peripheral oestrogen production
Priapism 2o sickle cell disease?
Ischaemic priapism
Low O2
High CO2
Low pH
2o impaired penile venous outflow prevent relief
Management of Klinefelter syndrome?
Male hypogonadisim —-> testosterone.
Will improve libido, erectile dysfunction,
Increase BMD and muscle development
Ovarian torsion presentation?
Young pt
Ovary rotates around infundibulopelvic and uterovarian ligaments.
Sudden unilateral pelvic pain with tender acne all mass
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
Which finding is specific to pyelonephritis and helps differentiate it from cystitis?
White cell casts
What is a koilocyte?
Seen in HPV infection
Atypical sq cell with perinuclear cytoplasmic clearing (halo) and dark, large irregular nucleus ( raisinoid)
Features suggestive of ectopic pregnancy?
Hx of lower Abdo pain and vaginal bleeding
+ve pregnancy test
Adnexal mass
Effect of maternal use of ACE I and ARBs on foetus?
Foetal renal hypoplasia/dysplasia —> decreased foetal urine production —>oligohydramnios —> Potter sequence
Urinary incontinence seen in multiparous pregnant women?
Stress incontinence 2o increased intra-abdominal pressure, lax external urethral sphincter tone and lax pelvic floor
Incidental mass in woman age 10-30 with Abdo discomfort likely?
Mature Teratoma ( most common)
Causes of priapism?
Sickle cell disease
Trazodone
What type of vaccine is given to prevent congenital rubella syndrome?
Maternal administration of a live attenuated vaccine before conception
Cause of gallstones in pregnant women and those taking ocp?
Oestrogen induced cholesterol hypersecretion and progesterone induced gallbladder hypomotility.
Management of vulvovaginal candidiasis?
Fluconazole
Wet mount microscopy:- psuedophyphae with budding yeast
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
Empyema features?
Accumulation of pus in pleural space
Commonest cause extension from alveoli i.e parapneumonic effusion
What part of the brain regulates the circadian rhythm?
Suprachiasmatic nucleus of hypothalamic nuclei
Pt with Crohn’s disease and hx of epistaxis, bruising prolonged PT and PTT?
Vitamin K deficiency
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
What is physiologic stress test?
Administration of dobutamine mimics excercise and increase myocardial O2 demand
Stable angina and stress test ?
Is a fixed coronary artery stenosis with exercise will cause a mismatch of O2 supply and demand
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
What is factitious disorder?
Intentional falsification of symptoms or induction of disease. Goal is to assume the pt role
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
Paraneoplastic cerebellar degeneration is what kind of process ?
Autoimmune response to tumour cells cross reacting with purkinje neuron antigens
Achondroplasia inheritance ?
AD mutation of the FGFR3 gene
Therefore offspring have 50% chance of inheriting
No carrier status
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.
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
On CT scan where is the prostate located?
Between the bladder and the anal canal
Anterior to the anal canal
Cause of retinal artery occlusion?
Thromboembolic complication of atherosclerosis travelling from internal carotid artery —> ophthalmic artery —> retinal artery
Albuterol mechanism of action?
A beta 2 receptor agonist increases cAMP in bronchial smooth muscle
Induce bronchial smooth muscle relaxation to relieve airway spasm
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)
95% confidence interval ?
CI of mean = mean +/- 1.96 x SD / square root of n
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
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
