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LopsNotes > Mixed Q’s 5 > Flashcards

Mixed Q’s 5 Flashcards

1
Q

Botulinum toxicity features?

A

Blocks presynaptic ACh
Impaired nicotinic and muscarinic neurotransmission
Symmetrical descending paralysis with cranial nerve involvement 2o eating home canned foods

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2
Q

Treatment of pts with cryptococcal meningitis?

A

Amphotericin B and flucytosine

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3
Q

Cryptococcal meningitis features?

A

Slowly worsening headache
Fever
Lethargy
LP: low glucose high protein, predominant lymphocytes

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4
Q

NMDA receptor excess activation ?

A

Is a glutamate receptor and Ca ion channel found in neurons
Excessive activation of the NMDA receptor causes neuronal death through uncontrolled Ca influx.
The receptor is blocked by Mg —> decreased influx of Ca and Na

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5
Q

Pathology behind raised intracranial pressure?

A

Idiopathic
2o cerebral venous sinus thrombosis decreased resorption of cerebrospinal fluid

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6
Q

What is the benefit of giving dexamethasone prior to Abx therapy in bacterial meningitis?

A

Decreases inflammatory response in the CSF

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7
Q

Virulence factor of Neisseria meningitidis?

A

Use Pili to attach to and colonise the nasopharyngeal epithelial surface

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8
Q

Negative equilibrium indicates the membrane is permeable to ?

A

K or CL-
Positive equilibrium indicated membrane is permeable to (Na and Ca)

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9
Q

Cryptococcus Neoformans appearance on histopathology?

A

Encapsulated yeast with thick polysaccharide capsule ( clean on H&E tissue stain)

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10
Q

Upregulation of which channels lead to pain at site of neuroma after nerve injury?

A

Na channel upregulation

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11
Q

Febrile seizures features?

A

6/12 - 5 years
Temp >38
Hyperthermia induced neuronal dysfunction triggering a short generalised seizure.

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12
Q

Age related sleep changes features?

A

Decreased total sleep time
Increased nighttime waking
Sleepiness earlier in the evening
Earlier morning waking
Increased daytime napping

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13
Q

Frontal lobe dysfunction?

A

Change in personality, languages, motor function and executive function. Abstraction ability ( asking about similarities between 2 related objects) affected

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14
Q

Buildup of very long chain and branched chain fatty acids is due to a dysfunction in which cellular structure?

A

Peroxisome

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15
Q

Multiple ring enhancing lesion in a patient with AIDS ?

A

Toxoplasmosis encephalitis

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16
Q

Cryptococcus Neoformans primary site of infection?

A

Lungs / inhalation
Soil contaminated by bird droppings

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17
Q

Shingles occurs because of ?

A

Reactivation of latent pathogen in neural ganglia

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18
Q

Influx of ca is important in voltage gated neurotransmission because ?

A

It’s essential for fusion and release of neurotransmitter vesicles

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19
Q

Drugs that bind to GABA-A receptors affect on resting membrane potential?

A

Will increase CL influx causing membrane potential to become more hyper polarised i.e. negative

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20
Q

Guillian Barre syndrome features?

A

Symmetric Ascending weakness
Immune mediated polyneuropathy
Follow campylobacter jejuni diarrhoeal illness

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21
Q

Hydrocephalus features?

A

Macrocephaly
Poor feeding
Poor growth
Developmental delays
Untreated —> muscle spasticity

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22
Q

Guillemot Barre Syndrome features?

A

Symmetric ascending weakness immune mediated polyneuropathy
Follows campylobacter jejuni
diarrhoea illness

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23
Q

Alzheimer’s disease pathogenesis ?

A

Neuro degeneration lead into cerebral atrophy
Beta amyloid plaques
Tau proteins microtuble associated protein polymerised and hyperphosphorylated

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24
Q

Rabies attaches to which receptor?

A

Nicotinic muscle acetylcholine receptors

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25
Q

Tay-Sachs disease features?

A

AR
Beta heoxsaminidase A deficiency
Accumulation of GM2 ganglioside
Progressive neurodegenreation ( developmental regression)
Exaggerated startle reflex
Cherry red macula

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26
Q

Osmotic demyelination syndrome (central pontine myelinosis features?

A

2o rapid correction if chronic hyponatremia esp alcoholic
Quadriplegia
Pseudobulbar palsy (dysarthria, dysphagia, dysphonia)
Reduced level of consciousness

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27
Q

Myasthenia gravis pathogenesis?

A

Decreased number of functional acetylcholine receptors
Reduced amplitude of motor endurance plate potential

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28
Q

Mgx of myasthenia gravis?

A

Cholinesterase inhibitor e.g pyramidine
Selective muscarinic inhibitors e.g glycopyrollate can reduce the SE

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29
Q

Reye’s syndrome features?

A

Acute liver failure and encephalopathy in child who took aspirin
Causing mitochondrial toxicity
Diffuse astrocyte swelling

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30
Q

Commonest cause of bacterial meningitis?

A

Strep pneumoniae

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31
Q

Ectopic pregnancy should be suspected in ?

A

Abnormally rising b-hcg
2o amenorrhea
Endometrium will be showing pregnancy changes

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32
Q

Raised Acetylcholinesterase and AFP in amniocentesis suggests?

A

Neural tube defect

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33
Q

DiGeorge is due to what genetic mutation?

A

Ch 22q11.2 microdeletion

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34
Q

DiGeorge features?

A

Hypo calacaemia/hypoparathyroidiam
Thymic aplasia( T cell deficiency)
Dysmorphic face ( cleft palate)
Cardiac anomalies (tetralogy of fallout)

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35
Q

Frontotemporal dementia due to abnormal accumulation of ?

A

Pathologically ubiquinated TDP-43 and neurofibrillary tangles due to abnormal TAU protein

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36
Q

Rapid corrections of chronic hyponatremia leads to ?

A

Osmotic demyelination syndrome …a cerebral demyelination abnormality

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37
Q

Migraine features?

A

Episodic neurologic disorder resulting in severe, unilateral pulsatile headaches assoc with photophobia, photophobia N+V
+/- aura

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38
Q

Cerebral palsy cause?

A

Periventricular focal necrosis /
(Periventricular leukomalacia ( white matter necrosis)

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39
Q

Narcolepsy features?

A

Chronic sleep disorder characterised by daytime sleepiness cataplexy and REM sleep related phenomenon (hallucinations, sleep paralysis)

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40
Q

Guillain barre histology ?

A

Endoneurial inflammatory infiltrate seen on light microscopy

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41
Q

Haemorrhage and necrosis of the mnamillary bodies causes?

A

Wernicke’s encephalopathy
2o thiamine deficiency
By way of deficiency of erythrocytes transketolase activity impairing glucose production and use

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42
Q

Neuro imaging findings in Huntington’s disease?

A

Atrophy of the caudate nuclei and enlargement of the front horns of the lateral ventricle

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43
Q

Optic neuritis and intranuclear opthalmoplegia in MS is usually due to which mechanism?

A

Reduced saltatory conduction
2o demyelination

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44
Q

HSV-1 encephalitis features?

A

Headache
Fever
Altered mental state
Seizure
Pathology:- haemorrhagic necrosis of temporal lobe

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45
Q

Findings in irreversible ischaemic injury in brain ?

A

12-24hrs
Shrinkage of cell body
Pykinosis of nucleus
Loss of nissl bodies
Cytoplasmic eosinophilia

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46
Q

Route of entry of primary amoebic meningoencephalitis?

A

Caused by protozoa naegleria fowleri
Penetrated olfactory mucosa and migrates retrograde through the olfactory nerve

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47
Q

Multiple sclerosis findings ?

A

Demyelinating plaques lesions
Hyperintense lesions on T2 weighted MRI of the brain and spinal cord

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48
Q

AML pathology?

A

Degeneration and atrophy of the corticospinal tract and precentral gyrus (UMN)
Degeneration of anterior horn of the spinal cord and cranial nerve motor nuclei (LMN)

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49
Q

Glutamate neurotransmitter features?

A

Main excitatory neurotransmitter of the CNS
Induces postsynaptic neuron depolarisation
Calcium entry programs the neurons to be more sensitive with repeat stimulation
Function long term learning and memory

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50
Q

Signs of vitamin A toxicity?

A

Benign intracranial HTN
Headache
Vomiting
Papilloedema
Dry skin
Hepatomegally

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51
Q

Cholinesterase inhibitors (donepezil, galantamine) use in Alzheimer’s?

A

May temporarily improve cognitive function but do not alter the disease progression

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52
Q

Guillain Barre pathology?

A

Molecular mimicry
Ab against infectious agents cross react with myelin and Schwann cells leading to immune mediated demyelination ( Tcell response)
Microscopy:- segmental demyelination + endoneurial infiltration with lymphocytes and macrophages

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53
Q

Subarachnoid haemorrhage is usually due to?

A

Saccular ( berry) aneurysm

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54
Q

Essential tremor features?

A

Tremor worse on extension of arms and at the end of intended action
Assoc with head tremor
No other neuro findings
AD
+ve Fhx

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55
Q

Mechanism of action of B blockers in essential tremor and SE?

A

Blocks interaction of norepinephrine with at adrenergic synapse
SE :- b2 block —> bronchoconstriction

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56
Q

Von Hippel Lindau disease features?

A

Cerebellar haemangoblastoma
Congenital cysts in kidneys, liver and/or pancreas
AD

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57
Q

Treatment of trigeminal neuralgia?

A

Carbamazepine
Reduces the ability of Na channels to recover from inactivation thereby reducing high frequency firing

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58
Q

SE of volatile anaesthetics?

A

Increase cerebral bld flow ( risk of increase ICP)

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59
Q

Management of cerebral palsy?

A

GABA agonist
CP —> symptoms of spasticity due to loss of descending inhibitory control.
GABA is the inhibitory neurotransmitter

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60
Q

Weakening diaphragmatic contraction during maximal ventilation with intact phrenic nerve stimulation suggests?

A

Neuromuscular junction pathology
Abnormally rapid 1o muscle fatigue

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61
Q

UMN facial palsy features?

A

Spares the forehead
Contralateral

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62
Q

Which symptoms of Parkinson’s are helped with Carbidopa and which are not?

A

Blocks levodopa to dopamine in periphery
Improve N+V
Improve tachyarrhythmias
Hot flashes and postural hypotension
No effect or worsen anxiety and agitation

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63
Q

Histopathology specific to MS ?

A

Demylinating plaques containing foci of pervenular inflammatory infiltrates made up pf T lymphocytes and macrophages

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64
Q

Pathogenesis of migraines?

A

Genetic predisposition to increased cerebral excitability —> activation of trigeminal afferents and release of calcitonin gene related peptide (CGRP) —> vasodilation and inc transmission of pain signals

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65
Q

Meningioma in the cerebellopontine angle features?

A

Can compress CN VIII causing hearing loss, tinnitus, imbalance

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66
Q

Loss of which neurotransmitter is found in Huntington’s disease?

A

GABA

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67
Q

Pathogenesis of irreversible CNS ischaemic injury?

A

Liquefactive necrosis

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68
Q

Restriction of which food group will help in impaired ornithine transport?

A

Protein ( decrease amino acid turnover for urea cycle)

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69
Q

Ependymomas features?

A

Childhood brain tumour
Ependymal cells of ventricles
ICP - headache, papilloedema
2o blocking flow of CSF

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70
Q

What is the genetic defect in ataxia telengectasia ?

A

Defect in DNA break repair
Classic findings:- cerebellar ataxia, telangiectasia and recurrent sinopulmonary infections

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71
Q

Characteristics of REM sleep?

A

Dreaming
Voluntary muscle paralysis
Final 1/3 of night
Nightmares / vivid dreams

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72
Q

Commonest cause of death in Friedrich’s ataxia ?

A

HCM

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73
Q

What are the compensatory mechanisms in prodromal Parkinson’s disease?

A

Upregulation of tryrosin hydroxlase activity
Presynatic Dopamine reuptake is inhibited
Dopamine levels is still low because of a loss in total dopaminergic neurons
Proliferation of dopamine receptors

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74
Q

Speed of neuronal conduction down an axon depends on which 2 constants ?

A

The length (space) constant
Time constant

Demyelination in MS decreases the length constant and increases the time constant

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75
Q

Histologic appearance of Schwannoma?

A

2 types of cellular pattern Antoni A (hypercellular) Antoni B (hypocellular) and positive S-100

76
Q

What is oppositional defiant disorder?

A

Behavioural disorder of childhood
Argumentative and defiant towards authority figure
>6/12

77
Q

What is delusional disorder?

A

1 or more delusions for 1 or more months in the absence of other psychotic symptom.
Outside of the delusion can function normally.

78
Q

Transtheoretical stage of change what is preparation?

A

Pt has committed to behavioural change but has yet to institute a specific course of action

79
Q

How to diagnose ADHD?

A

Evidence of inattentive / hyperactive, impulsive symptoms over >6/12 in >2 settings

80
Q

What is body dysmorphic disorder?

A

Fixation on a perceived defect in appearance and repetitive behaviours in response to the fixation

81
Q

What is transference?

A

Unconscious recreation and experience, thoughts, behaviours associated with past relationships

82
Q

What is bulimia nervous?

A

Recurrent episodes of binge eating followed by compensatory behaviour to prevent weight gain ( fasting , exercising, vomiting, using laxatives)

83
Q

What is tardive dyskinesia

A

Abnormal involuntary movement of the mouth, tongue, face , extremities and truck assoc with prolonged exposure to antipsychotics
Hypersensitivity of D2 receptors following prolonged block

84
Q

What is antisocial behaviour?

A

Pattern of violating rights of others, engaging in unlawful behaviour and lacking remorse.
Must be >18 to diagnose

85
Q

What is specific phobia?

A

Anxiety disorder
High levels of anxiety and panic attack triggers by exposure or anticipation of exposure of feared stimulus

86
Q

How do antipsychotics work and SE ?

A

Work by blocking D2 receptors in mesolimbic dopamine pathway
Blockage in the tuberoinfundibular pathway can cause hyperprolactinaemia — > galactorrhoea and amenorrhoea

87
Q

Enzymes that require B1 and co-factor?

A

Pyruvate dehydrogenase ( pyruvate to acetyl coA)
Alpha ketoglutarate dehydrogenase ( citric acid cycle)
(Alpha ketoglutarate to succinylco-A0

88
Q

Symptoms of opioid withdrawal?

A

Mydriasis
Abdo pain
Diarrhoea
Piloerection
Lacrmiation
Yawning

89
Q

What is panic disorder?

A

Recurrent unexpected anxiety attacks assoc with
Somatic symptoms
And worry about additional attacks and avoidance behaviour

90
Q

Obstructive sleep apnoea features?

A

Sleep related apnoea and chocking loud snoring
Disrupted non restful sleep
Excessive daytime somnolence

91
Q

Schizoid personality disorder features?

A

Persistent pattern of social detachment, prefers solitary activities and Ltd emotional expression when interacting with others

92
Q

What is projection?

A

Defence mechanism
Attributing one’s unacceptable feelings of thoughts to another person who may not have them

93
Q

What is reaction formation?

A

Defence mechanism
Replacing unacceptable feelings and impulses with their extreme opposite

94
Q

Features of fetal alcohol syndrome?

A

Facial dysmorphisim (short palpebral fissure, thing upper lip, smooth filtrum.
Growth retardation
Neurological abnormalities
Behavioural difficulties

95
Q

Neural tube defects causes?

A

Folate deficiency
Valproate
Methotrexate
trimethoprim -suflamethoxazole

96
Q

What molecular change is seen in labour as a result of rising oestrogen ?

A

Gap junctions which facilitate communication and coordination between cells and help in labour contractions

97
Q

What is the function of primase?

A

It’s a DNA dependent RNA polymerase that incorporates RNA primers into replicating DNA
By product is uracil

98
Q

What is genomic imprinting?

A

Offspring’s genes are expressed in a parent specific manner. Caused by DNA methylation an epigenetic process where genes are silenced by attaching methyl groups to cytosine residues in DNA molecule

99
Q

What is an ecological study?

A

Observational study analysing population level data rather than individual

100
Q

What is epistasis?

A

The allele of one gene affect the phenotypic expression of alleles in another gene e.g. albinism masks the expression of skin hair, colour etc

101
Q

What is pleitropy?

A

A single gene influences multiple phenotypes e.g PKU many effects - skiing pigmentation, learning difficulties

102
Q

Naloxone works on which receptor?

A

Pure opioid receptor
Greatest affinity for Mu receptor

103
Q

Which medication can be used as a mood stabiliser and antiepileptic?

A

Valproate

104
Q

What medication can be uses as 1st line for psychomotor agitation associated with alcohol withdrawal?

A

Benzodiazepines

105
Q

What is the dysregulation in neuroleptic malignant syndrome?

A

Dopamine dysregulation

106
Q

1st line therapy for alcohol use disorder and mechanism?

A

Naltrexone :- Mu opioid receptor blocker
Inhibits reward and reinforcing effect of alcohol
2nd line disulfiram (aldehyde dehydrogenase inhibitor ) unpleasant SE if they drink

107
Q

Mechanism of action of 2nd gen antipsychotics ?

A

Dopamine D2 antagonist
5HT2A antagonist

108
Q

Mechanism of action of benzos?

A

Bind and allosterically modulate the GABA A receptor —> increase in CL ion channel opening and Cl influx

109
Q

How can risperidone and similar drugs cause hyperprolactinaemia?

A

Prolactin controlled by inhibitory effect of hypothalamic dopamine.
Blocked by these drugs ( D2 receptor blockers) — > high prolactin

110
Q

Pathology in hypertensive crisis?

A

Increase in tackle of tyramine in pts taking MAO I —> failure of monoamine breakdown —> tyramine induced hypertensive crisis

111
Q

Which drug interactions can cause lithium toxicity?

A

NSAIDS
ACE I
Thiazide diuretics
Tetracycline
Metronidazole

112
Q

Management of bulimia?

A

Nutritional rehabilitation
CBT
SSRI (Fluoxetine)

113
Q

Neuroleptic malignant syndrome features?

A

Adverse reaction to antipsychotic medication/ dopamine antagonist
Severe lead pipe rigidity
Hyperthermia, HTN
Inc SNS activity
Mental status changes

114
Q

Buspirone mechanism of action and uses?

A

Nonbenzodiazepine anxiolytic (partial agonist 5HT1A receptor )
No muscle relaxant or anticonvulsant properties
No risk dependence
Use in general anxiety disorders

115
Q

Potential SE of TCA?

A

Strong anticholinergic properties
Confusion
Constipation urinary retention
Also
Tremor
Arrhythmias
Hypotension
Sedation

116
Q

Mechanism of action of benzos?

A

Bind and modulate GABA A receptors
Increased frequency of opening of Cl channel

117
Q

Possible major SE of clozapine?

A

Agranulocytosis
Need to check absolute neutrophil count

118
Q

Management of OCD?

A

1st line SSRIs
CBT

119
Q

Which medications will increase concentration of methadone if taken concurrently?

A

CyP3A4 inhibitors
Fluconazole, ketoconazole
Ciprofloxacin
Clarithromycin
Cimetidine
Fluvoxamine

120
Q

Alcohol withdrawal is caused by increase in which CNS receptor?

A

NMDA glutamate receptor
(Chronic Alcohol down regulates inhibitory GABA receptors and upregulates excitatory NMDA receptors)

121
Q

Non bacterial thrombotic endocarditis features?

A

Valvular deposition of sterile plt rich thrombi. Seen in advanced malignancy and SLE

122
Q

Causes of concentric left ventricular hypertrophy?

A

Aortic stenosis
Prolonged HTN

123
Q

Changes seen 0-4 hr after MI ?

A

Normal myocardium
Changes seen after 4 hrs

124
Q

Membranous nephropathy features?

A

Immune complex deposition in sub epithelial glomerular capillary wall causing diffuse thickening of the glomerular basement membrane no increase in cellularity.
Spike and dome appearance on silver stain

125
Q

Membranous nephropathy associations?

A

Malignancy
Viral hepatitis
SLE

126
Q

Uterine sarcoma features?

A

Abnormal / post menopausal bleeding
Bulk symptoms ( pelvic pressure, bloating)
Uterine mass
Histopathology:- nuclear atypia, abundant mitosis and areas of tumour necrosis

127
Q

Temporal lobe epilepsy pathology?

A

Due to hippocampal sclerosis
Atrophy of the hippocampal neurons with reactive gliosis ( astrocyte proliferation) in response

128
Q

What are highly proliferative cells?

A

Skin
Stem cells
Haemotogenous progenitors
Intestinal crypt cells

129
Q

Pathologonomic cell finding in Hodgkin’s lymphoma?

A

Reed - sternberg cells ( owl eyes)

130
Q

Causes of wide splitting of S2?

A

Pulmonic stenosis
Pulmonary HTN
RBBB

131
Q

Ankylosing spondylitis features?

A

Inflammatory spondyloarthropathy charticterised but erosion and new bone formation mostly in vertebral body.
Back pain
Stooped posture
Tender at tendon insertions
Raised ESR
Age <40

132
Q

Tuberous sclerosis presentation?

A

AD
Benign multiple hamartomas in the brain ( cortical glioneuronal hamartomas and subependymal nodules) and skin
Hypopigmented macules (ash leaf spots )
Present with seizures

133
Q

NAFLD features?

A

Asymptomatic
Metabolic syndrome
AST/ALT <1
Can progress to cirrhosis

134
Q

CEA use in colon cancer?

A

Carcinoembryonic antigen (CEA) if still high after surgery indicates residual disease

low sensitivity and specificity for screening and diagnosis

135
Q

Hypersensitivity penumonitis features?

A

Exaggerated immune response to inhaled antigen (mold, animal protein)
Cough, dyspnoea
CXR diffuse interstitial opacities (interstitial fibrosis
Brocheoalveolar lavage :- high lymphocyte count >20%

136
Q

What do Granulosa cell tumours secrete and features?

A

Oestrogen
They are ovarian sex cord stromal tumours
Symptoms:- PMB, endometrial hyperplasia , large unilateral adnexal mass
Histology :- cuboidal cells nuclear grooves

137
Q

Cause of distal muscle hypertrophy in Duchennes muscular dystrophy?

A

Pseudohypertrophy - fibrofatty muscle replacement

138
Q

Back pain features suggestive of malignant cause?

A

Persistent pain at night
No relief with rest
Onset at age >50
Systemic symptoms

139
Q

UMN signs?

A

Spastic paralysis
Hyperreflexia
Upgoing planter reflex

140
Q

What are chiari malformations?

A

Congenital disorder result from under development of the posterior fossa causing parts of cerebellum and medulla to herniate through the foramen magnum
Chiari I benign in adults
Chiari II severe in neonates

141
Q

Administration of which would help in haemophilia?

A

Haemophilia A decrease factor VIII
Haemophilia B decrease level IX
Addition of thrombin helps bld to clot

142
Q

What is a case control study looking at ?

A

Group of pts with disease and group of pts without the disease assess frequency of past exposure to estimate associated and risk factors and outcomes

143
Q

Management of atypical ‘walking’ pneumonia?

A

Usually due to mycoplasma pneumoniae ( of chlamydia pneumoniae)
Both organisms don’t have a cell wall
Mgx requires a bacterial protein inhibitor e.g macrolide / tetracycline

144
Q

Features of vertebral osteomyelitis and investigation?

A

Hx of new or worsening back pain with recent endocarditis or bacteraemia
Initial investigation :- blood culture and spine MRI

145
Q

Nontyphoidal salmonella features?

A

G-ve non lactose fermenting oxidase -ve rod
Gastroenteritis fever, vomiting and diarrhoea
After eating poultry, eggs
Invasive disease causes osteomyelitis esp in sickle cell and impaired immunity, extremes of age

146
Q

Haemolytic uraemia syndrome features?

A

Complication of EHES infection Renal insufficiency, thrombocytopenia and microangiopathic haemolytic anaemia

Cause: shiga toxin producing bacterial E.coli O157:H7 (EHES) or shigella
Bloody diarrhoea
EHES from undercooked beef

147
Q

Cryptosporidium presentation and features?

A

Severe watery diarrhoea and wt loss in pts with AIDS
Self ltd watery diarrhoea <2/52 in healthy pts
Diagnosis:- acid fast staining oocysts in stool
Basophilic organism on mucosal intestinal brush border

148
Q

Thayer martin medium

A

Chocolate sheep blood Agar used to identify neisseria organisms
Infused with vancomycin to inhibit G+ve bacteria
Colistin and trimethoprim to inhibit G-ve bacteria
Nystatin to inhibit yeast

149
Q

Tenofovir mechanism of action and complication

A

Nucleotide reverse transcriptase inhibitor
Prevents transcriptase from converting HIV RNA into complementary double stranded DNA inhibiting viral replication

Complication:- proximal tubule dysfunction ( loss of brush border)—> glycosuria, phosphaturia, proteinuria

150
Q

What antiretroviral therapy do you use during pregnancy to reduce risk of transmission?

A

Triple therapy made up of 2 nucleoside/nucleotide reverse transcriptase inhibitors
third drug :- protease inhibitor, non nucleoside reverse transcriptase inhibitor or integrase inhibitor

151
Q

MALT lymphoma features ?

A

Due to chronic stimulation for gastric MALT lymphoma its H pylori
MALT lymphoma are extranodal marginal zone lymphoma involving mucosa associated with lymphoid tissue —> aberrant B cell production
Form of non Hodgkin’s lymphoma

152
Q

CMV colitis features?

A

Common cause of colitis in AIDs pts
Reactivation disease
Abdo pain, fever, diarrhoea, wt loss
Colonoscopy:- erythema, erosions, ulceration
Biopsy:- large cells with prominent basophilic intranuclear inclusions

153
Q

Protease inhibitors mechanism of action in HIV

A

Block viral protease from cleaving gag-pol polyproteins ( inhibits production of functional viral encoded enz.)
resulting in immature virions that are non infectious

154
Q

Mefloquine chemoprophylaxis fro malaria mechanism of action

A

Must continue for 4/52 after return
Destroys replicating parasites within RBC but ineffective against schizonts in liver
P. falciprum matures in liver for 8-30/7
Ovale and vivax can remain dormant in liver for months

155
Q

G6PD deficiency

A

Assoc with fatty acid synthesis
Rate limiting enz of the pentose phosphate pathway
Major source of NADPH
starting substrate :- glucose -6-phosphate
End product:- rib u lose -5-phosphate

Triggered by eating broad beans, haemolysis

156
Q

Blotchy red muscle fibers on comprise trichome stain

A

Characteristics of mitochondrial myopathies
Red ragged muscle fibers
Show maternal inheritance

157
Q

5 alpha reducatase deficiency

A

Impaired conversion of testosterone to DHT
N testosterone and oestrogen levels
Symptoms:- external female genitalia, internal male genitalia, 1o amenorrhoea , vagina ends in blind pouch, develop body hair but no breast development

158
Q

Paget’s disease of the breast

A

Malignant breast condition / intraepithelial adenocarcinoma
Unilateral painful/pruritic eczema toys rash on nipple and alveolar
Biopsy :- infiltration of the nipple/ areolar epidermis by pagets cells

159
Q

Herpes zoster opthalmicus

A

Reactivation of VZV in ophthalmic division of CN V1
Painful dermatomal rash and ocular involvement

160
Q

What kind of medium is Thayer martin antibiotic media

A

Selective —> inhibits growth of contaminants isolates neisseria

161
Q

What cellular process contributes to the formation of granuloma

A

Cytokines secretion by CD4 T lymphocytes
Activate macrophages —> join together to form langhans giant cells

162
Q

Severe combined immunodeficiency (SCID)

A

Genetic defect in T cell development which also leads to defect in B cell
Causes:- recurrent infection with viral, fungal, opportunistic and bacterial infection + failure to thrive and diarrhoea

163
Q

Candida skin test

A

Used to asssess the activity of cell mediated immunity if shows response incact CD4 cell response.
No response in pts with SCID

164
Q

Terminal complement deficiency

A

Deficiency of complements C5-C9 that form MAC
Results recurrent infection with encapsulated bacteria
S pneumoniae, N meningitidis

165
Q

Chronic granulomatous disease

A

X linked affecting NADPH oxidase
Child with recurrent infection by catalase positive organism
N Ig
No leukopenia
Due to defective intracellular killing due to impaired respiratory burst

166
Q

PECAM-1 is assoc with which part of neutrophil function

A

Transmigration

167
Q

How does tetanus vaccine protect against developing neuro symptoms from future infection ?

A

Tetanus vaccine —> inactivated toxoid triggers production of antitoxin antibodies that neutralize the bacterial product i.e toxin

168
Q

Toxic shock syndrome

A

Assoc with S. Aureus replicating and release > pyrogenic toxic superantigen (TSST-1) into the blood.

Super Ag binds to MHC-II without processing lead to ++ release inflammatory cytokines

Causes:- hypoBP, high fever, organ failure, diffuse erythematous rash

169
Q

Congenital TORCH

A

Presentation:- growth restriction, microcephaly, hepatospleenomegally, diffuse blue rash

Mother will show evidence of previous infection with encapsulated > IgG
IgG crosses placental so new born will have IgG
And evidence of active infection > IgM

170
Q

Phenotypic mixing of viruses

A

Coinfection of a host cell by 2 viral strains resulting in a daughter virus that contains nucleocapsid(or envelope) of one parent and unchanged parental genome from the other strain.
Because no genetic exchange — > the next gen vision reverts to original unmixed phenotype

171
Q

Acute onset bloody diarrhoea in day care setting

A

Shigella
Other causes:- E.Coli O157:H7, shigella, campylobacter

172
Q

Aminoglycoside resistance

A

Methylation of the aminoglycoside binding portion of the ribosome —-> inhibits ability of aminglycoside to interfere with protein translation

173
Q

Tuberculin skin test cellular reaction

A

Type IV hypersensitivity reaction
In pts with previous infection already have CD4 T lymphocytes that recognise the protein —> activated with interaction between CD28 on the T cell and CD80/86 on APC

174
Q

Type I hypersensitivity reaction

A

Initial exposure allergen promotes class switching to IgE
Following exposure cross linking of IgE resulting in mast cell degranulation and release of histamine

175
Q

Graft versus host disease

A

Donor T cells reject the host cells —> MHC
Variable onset
Usually following bone marrow and liver transplant
Presentation:0 maculopapular rash, diarrhoea, jaundice, hepatomegaly

176
Q

Acute transplant rejection

A

Occurs within weeks < 6/12
Predominantly cell mediated
Sensitization of host T cell against donor MHC antigens
Dense lymphocytic infiltrate

177
Q

Defect in interferon gamma signaling

A

Disseminated mycobacterial infection in early childhood

178
Q

How do inactivated/ killed vaccine prevent future infection

A

Produces humoral response —> forming neutralizing antibodies that prevent virus from entering the cell

179
Q

How do live attenuated vaccine prevent future infections

A

Generate a strong cell mediated response that can result in destruction of infected cells

180
Q

Serum sickness

A

Immune complex mediated
Type III hypersensitivity reaction 7-10/7 after exposure
Immune complexes deposit on skin and joints activating classical complement pathway
Raised levels of C3a and C5a

181
Q

Pathogenesis of asthma

A

Excess of Th2 resulting in excess IgE production
Th2 cells released IL 4 stimulates B cells to produce IgE

182
Q

Endotoxin and major virulence factor of G-ve bacteria

A

Endotoxin:- lipopolysaccaride
Major virulence factor:- Lipid A
Can lead to septic shock

183
Q

Causes of hepatic abscess

A

In underdeveloped countries - foodborne exposure —: entamoeba histolytica

Developed countries :- S. Aureus via haematogenous seeding from the liver
Klebsiella, E.col via ascending cholangitis
Direct invasion G-ve bacteria

184
Q

How to diagnose C diff infection

A

PCR for bacterial toxin gene —NAAT (nuclear acid amplification test)
Highly sensitive and specific

185
Q

Legionnaire disease

A

Caused by legionellae (G-ve bacillus)

Exposure:- contaminated water source

Symptoms:- high fever, GI symptoms, cough, confusion, hyponatraemia
Sputum gram stain shows ++ neutrophils but no other organisms

LopsNotes (12 decks)

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