Mixed Q’s 6 Flashcards

1
Q

Impaired transport of ornithine - restriction of which nutritional substance helps?

A

Impaired transport of ornithine is due to ornithine translocase deficiency in hepatic urea cycle.
Restriction of protein helps

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2
Q

Erythrocytosis features causes

A

HCT >52% in males and >48% females
Absolute high RBC mass
1o due to myeloproliferative disorders PCV
2o due to hypoxia PaO2 <65mmHg
Or epo producing tumour

Relative low RBC mass 2o dehydration/ excessive diuresis

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3
Q

What shifts the HgB O2 dissociation curve to the left

A

Hgb wants to hang on to the O2 and not release it to tissues

Decreased H+ —> high pH
Decreased 2,3 BPG
Decreased temp —> hypothermia
Carbon monoxide poisoning

Will lead to renal hypoxia, increase EPO production in—> erythrocytosis

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4
Q

What moves HgB O2 dissociation curve to the Rt

A

I.e less affinity for O2 —> will give it up easily
Increased H+ —-> decreased pH —> anaemia, strenuous exercise
Increased 2,3 BPG —> COPD, HF , chronic high altitude
Hyperthermia

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5
Q

Erythrocytes use of glycolysis

A

Produces no ATP
Using 2,3 bisphosphoglycerate to by pass the ATP generating step.
Uses when there’s low blood O2 concentrations.
2,3 BPG lowers Hgb’s affinity for O2

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6
Q

Cold agglutinins

A

Bacteria e.g mycoplasma pneumoniae attaches to I antigen in resp epithelium also found in RBC, body forms cross reacting IgM —> these bind to RBC in cold areas of body , ears ,nose.
Causing haemolytic anaemia, high Retics count, high LDH

IgM level falls 4 weeks after initial infection 2o fading immune response

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7
Q

Hepcidin

A

Central regulator of iron homeostasis
Produced by hepatic parenchymal cells

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8
Q

Myoglobin and HgB O2 dissociation curve

A

Myoglobin has one monomeric subunit. If HgB is divided it too will act like myoglobin

Myoglobin found in skeletal tissue has v high affinity for O2.

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9
Q

Tumour lysis syndrome

A

Occurs after initiation of chemotherapy in pts with high cell turnover haemotologic malignancy (e.g. ALL)

Hyper PO4 —> CaPo4 stones
Hyperuricaemia —> Uric acid stones
Hyper K —-> cardiac arrhythmias
HypoCa

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10
Q

INH haematologic SE

A

Can lead to sideroblastic anaemia

INH inhibits pyridoxine phosphokinase enz needed to convert B6 (pyridoxine) to PLP. which is a co-factor for ALA synthase. Rate limiting enz in haem synthesis

Causing accumulation of iron in mitochondria around the nucleus

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11
Q

HgB types

A

HbA:- 2 alpha 2 beta ( starts to get produced last month of gestation onwards)
HbF:- 2 alpha 2 gamma ( gets replaced by HbA postnatally)
HbA2:- 2 alpha 2 delta
Hb gower:- ( first weeks of gestation) 2 zeta 2 epsilon

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12
Q

Aplastic crisis features and causes

A

Cause:- Parvovirus B19– nonenveloped single stranded DNA virus

Features :- severe anaemia following minor febrile illness. BM unable to repsond —> low Retics count

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13
Q

CKD anaemia

A

Normocytic anaemia 2o decrease EPO production in peritubular fibroblasts cells in renal cortex.

Therefore decrease in progenitor cell differentiation

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14
Q

Fluorescence in situ hybridisation use

A

Used to identify specific chromosomal translocations, duplication or deletions

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15
Q

Complication of high volume transfusion

A

Acute hypocalcaemia
2o citrate used as an anticoag in the blood chelating Ca

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16
Q

G6PD like clinical scenario with another causative enzyme

A

Glutathione reductase deficiency
Haemolytic anaemia and jaundice 2o oxidative stress due to inability to use NADPH

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17
Q

Underlying biochemical feature of megaloblastic anaemia in the setting of chronic alcohol misuse

A

Deficiency in B9/B12 —> defect in DNA synthesis
Lack of purine, pyramidine (thymidine) synthesis

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18
Q

HgB C

A

Caused by missence mutation
Glutamate substituted by lysine in beta globe chain

Features:- asymptomatic, mild haemolytic anaemia, splenomegaly

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19
Q

Carbon monoxide poisoning

A

Shifts O2 Hgb association curve to the LT
Increase carboxy HgB %
No change in PaO2
No change in methaemoglobin level

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20
Q

VWF features

A

VWF binds to G1B receptors on plts to mediate plt adhesion
Carrier for factor VIII

Labs:- N plt count , abnormal ristocetin cofactor assay—> Normally plts donor agglutinate in presence of ristocetin

Deficiency symptoms:- mucocutaneous bleeding

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21
Q

Adenomysosis

A

Abnormal presence of endometrial glands and storms in myometrium

Features:- dysmenorrhea, heavy menses and a uniformly enlarged uterus

Risk factor:- previous uterine surgery, previous pregnancy

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22
Q

Types of population pyramids

A

Expansive:- young growing population, high birth rates, high rates of mortality shorter life expectancy ( upside down v)

Stationary:- (Empire State building) decline birth rates, low mortatlity, long life expectancy, stable population

Constrictive:- low birth rates, low mortality rate, long life expectancy, shrinking population ( think china

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23
Q

Eosinophil role in parasitic infection

A

Stimulated by antibodies bound to parasite
Destroy parasite by antibody dependent cell mediated cytotoxicity with enzymes from their cytoplasmic granules

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24
Q

Chains of command of reporting a impaired colleague

A

Should be done in timely fashion
1. Colleagues supervisor
2. In non emergency - physician health progress
3. If not possible - the state licensing board

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25
Cyanide poisoning
Mitochondrial toxin bind to Fe3+ / in cytochrome c oxidase—> blocks electron transport chain —> prevent ADP production by oxidative phosphorylation —> cells switch to anaerobic glycolysis —> lactic acidosis Symptoms:- SoB, dizziness, palpitations, reddish discoloration of the skin Mgx:- hydroxycobalamin prevents cyanide binding to ferric Fe3+
26
Autosomal recessive disease chance of passing to the child
25% (1in 4) of child inheriting 2 normal alleles 50% (2 in 4) of child inheriting 1 abnormal allele ( carrier) 25% (1 in 4) of child inheriting 2 abnormal alleles (Affected) 75% chance of having 1 or more abnormal allele
27
Hearing loss test
Rinne:- Normal and sensorineural loss:- AC > BC Conductive hearing loss BC> AC in affected ear Weber:- (glabellar) Normal:- Midline Senorineural hearing loss:- unaffected ear Conductive hearing loss:- affected ear
28
Tumour in temporal lobe -> visual field defect
Contralateral homonymous hemianopia superior quadrantopia ( top lt corner both eyes)
29
Argatroban MoA and use
Direct thrombin inhibitor Along with hirudin and lepirudin, bivalirudin, dabigatran Use: Heparin induced thrombocytopenia
30
Direct Xa inhibitors
Block active site of Xa and prevent conversion of prothrombin (II) to thrombin (IIa) Names end in Xa-ban
31
Which organ repsonds to chronic hypoxaemia by increasing HCt
Kidney sense hypoxia inducing factor 1 alpha —->increase EPO production —> stimulate BM to accelerate erythrocytes precursor —> raised HCt
32
DIC
Can be caused by exertional heat stroke Prolonged PT/PTT Low PLT Increased plasminogen Increased fibrinolysis Increased thrombin production
33
Etoposide MOA and use
Derivative of plant alkaloid podophylotoxin Targets topisomerase II —> induces transient breaks on both DNA strands causing chromosomal breaks and cell death Use :- testicular cancer and small cell lung cancer
34
Ureamic plt dysfunction
Disorder with plt quality Prolonged BT N PLt N PT/PTT
35
Factor V Leiden mutation
Hypercoagulable Young pt <50 Inherited Factor Va resistant to inactivation by activated protein C PTT not changed when adding protein C to plasma
36
Sickle cell disease complication
Autosplenectomy 2o repeated splenic infarction a
37
Anaemia of chronic disease
Triggered by longstanding inflammation cytokines Hepcidin —> inhibits iron channels reducing iron availability Normocytic non haemolysis anaemia with minimal retics response
38
VWF disease
Impaired vWF —> decreased ability for plt to adhere to endothelial —> normal PLT count VWF is a carrier for VIII Normal PT , prolonged PTT
39
Vitamin K deficiency
Risk with cystic fibrosis patient 2o fat malabsorption and decreased fat soluble vitamins ADEK Causes:- mucosal bleeding, epistaxis Prolonged PT
40
Enoxaparin MoA
Low molecular weight heparin Bind and activates anti thrombin III Binds to Xa and stops it from converting prothrombin to thrombin
41
Hairy cell leukaemia
B cell neoplasm Middle aged men Pancytopenia and massive spleenomegly BM fibrosis —> dry Tap TRAP +ve Lymphocytes with cytoplasmic protections
42
T cell acute lymphoblastic leukaemia
Young adults signs of bone marrow failure Signs:- mediastinal mass, resp symptoms or superior vena caval syndrome 2o compression Flow cytometry with T lymphoblast TdT ( terminal deoxynucleotidyl transferase) CD 3 +ve (CD <10)
43
Doxazocin
Alpha 1 blocker Relax smooth muscle Use:- HTN, BPH Similar drugs:- prazosin, terazosin
44
Thickened bladder, bilateral vesicourreteral reflux and hydronephrosis in a newborn boy?
Posterior urethral valve Likely 2o persistent urogenital membrane obstruction the posterior urethra
45
Niacin by production and SE of OD
Niacin is the precursor of NAD and NADPH Toxicity:- cutaneous flushing, pruritis, 2o increase prostaglandin production Pre-treat with NSAIDS
46
Serotoli and testicular trauma
Sertoli cells form tight junction to make the blood testis barrier which controls environment for developing sperm. Damage to blood testis barrier will lead to anti sperm AB and decreased fertility
47
Why is there a drop in oxygenation between alveolar capillary blood and systemic arterial blood
2o mixture with deoxygenated bld Bld coming from the pulmonary veins is not 100% oxygenated - contains deoxygenated blood from bronchial veins
48
Normal grief reaction in child
Transient behavioural disturbances e.g hallucinations of the deceased relative normal grief
49
Cells responsible for protecting against Invasive candida
Neutrophils most important Pts on chemo develop neutropenia are at risk T cells responsible for protection against superficial mucosal candida
50
SAH complication hydrocephalus cause
Communicating hydrocephalus is 2o Impaired absorption of CSF by arachnoid granulations Enlargement of all 4 ventricles Deteriorating mental status Treatment:- external ventricular drain
51
Complication from schistosomiasis
Portal HTN —> 2o periportal fibrosis Hepatosplenomegaly Oesophageal varices Sq cell Bladder Ca Eosinophilia important clue
52
Femoral hernia landmarks
Bulge lateral to pubic tubercle Inferior to inguinal ligament Medial to Lateral to it is VAN ( femoral vein, artery, nerve) More common in women
53
CMV oesophagitis
HIV assoc oesophagitis Linear ulceraration Intranuclear and cytoplasmic inclusion
54
Pt with CKD, Normal PLT, N coag with hx of excessive bruising
Platelet dysfunction 2o upregulation of nitric oxide —> decreased plt adhesion, activation and aggregation
55
Allergic contact dermatitis
Type IV hypersensitivity reaction Intercellular epidermal oedema, with infiltration of lymphocytes and eosinophils
56
Teratoma features
Contain tissues from each of the 3 germ cell layers e.g , hair, teeth skeletal muscle, intestinal epithelium Arise from primordial germ cell
57
Mgx of panic disorder
SSRI first line
58
Chronic Granulomatous disease
1o immunodeficiency X linked Impaired NADPH Recurrent infection with catalase +Ve organisms
59
HER2 breast Ca Mgx
HER2 is a receptor tyrosine kinase Monoclonal antibody used ( trastuzumab) blocks HER2 and inhibits cellular proliferation
60
Rett Syndrome
Occurs mainly in girls MECP2 gene mutation Normal development till age 6-18/12 Then loss of motor and language skills Development of stereotypic hand movement Slowing of head growth ( classic feature)
61
Small intestinal bacterial overgrowth features
Excessive intestinal gas and diarrhoea Excessive bacterial proliferation in intenstine on jeujunal fluid culture Imp cause impaired migrating motor complex (i.e. impaired gut motility) esp in otherwise normal pts
62
MoA of fusion inhibitors in HIV treatment
Fusion inhibitors (enfuvirtide) bind HIV transmembrane glycoprotein gp41 prevent entry of viral core into the new host cell
63
Listeriosis
G+ve mobile rod Common cause of food borne illness outbreaks Contaminated processed meat and dairy products Gastroenteritis, can cause prem birth, fetal death Invasive ( meningioencephalitis, sepsis) in immunocompromised
64
2,3 BPG and HBF
Decrease binding between the 2 Leading to increased Hgb O2 affinity
65
Parvovirus B19 can cause
Slapped check (erythema infectious/ fifth disease) in children Acute symmetrical Arthritis in adults (can mimic RA but is self resolving ) affects proximal interphalangeal, metacarpal, knee, ankle
66
Lambert Eaton myasthenic syndrome features:
Progressive muscle weakness Decreased deep tendon reflexes Improve with exercise Assoc with SCLC
67
Hydrocele common in newborns cause
Communicating hydrocele 2o patent processus vaginalis
68
Cardiopulmonary changes seen with old age
Decreased HR and C.O —> 2o decreased responsiveness to adrenergic stimuli Decreased artery compliance Mild LVH Increased V/Q mismatch Decreased gas exhange surface area Decreased diaphragm strength
69
Inferior alveolar nerve innervation
Lower teeth and gives off the mental nerve which innervates the chin and lower lip Can be injured during dental procedures
70
Neurohormonal levels in asymptomatic Lt ventricular systolic dysfunction
Increased angiotensin II Increased norepinephrine Increased ANP
71
Blood supply of the distal oesophagus - affected in oesphageal varices
Lt gastric artery
72
Ornithine transcarbamylase deficiency
X linked Urea cycle —> decreased ability to break down ammonia Increase orthonine —> increase urinary Orotic acid Hyperammonemia Symptom:- vomiting, confusion, coma ** difference between this and ortoic acid urea from pyrimidine synthesis defect is presence of hyperammonemia here***
73
Pernicious Anaemia site of pathology in the stomach
Cell mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and fundus.
74
Genetic anticipation
Inherited disease condition that presents earlier and more severe in subsequent generations
75
The difference between minute ventilation and alveolar ventilation
Minute ventilation = VT ( tidal volume) x RR Alveolar ventilation= (VT- Vd dead space) X RR Therefore what accounts for the difference is the dead stance
76
Wernicke’s aphasia
Receptive aphasia - well articulated but meaningless (word salad) Middle cerebral artery supplies both wernicke and Broca’s area (expressive aphasia)
77
Tracheoesophageal fistula with oesophageal atresia features
Results from failure of primitive foregut to divide into separate trachea and oesphagus Symptoms:- shortly after birth excessive secretion choking/cyanonsis during feeds
78
Marijuana use features
Mild euphoria, inappropriate laughter, increased appetite, slow reaction Tachycardia and conjunctival injection
79
Epithelial ovarian cancer features
Most common Anaplasia of epithelial cells, invasion into the storms and multiple papillary formations with cellular atypia, psammoma bodies Marker:- high CA-125 Symptoms:- pelvic mass, ascites, decreased appetite, bowel or bladder changes
80
Acute effects of corticosteroids on WC count
Increase neutrophils 2o neutrophil demargination Decrease lymphocytes, basophils, eosinophils, monocytes
81
SE of antidepressant mono therapy in susceptible pts
Risk of inducing mania in pts with family hx of bipolar disorder
82
Commonest causes of most oropharyngeal carcinomas
HPV In particular HPV 16-18 cause transformation to malignancy Tongue, tonsil etc
83
Medications that can cause constipation
Non dihydropyridine Ca channel blockers ( diltiazem, verapamil) 5HT3 antagonist ( ondansetron, granisetron) Anticholinergics Opioids
84
Major pathogen for resp colonisation in adult pts with CF
Pseudomonas aeruginosa In children ( Staph aureus)
85
Follicular lymphoma
Middle aged pts Painless LN englargement Waxing and waning course T14:18 translocation Overexpression of BCL2 oncogene
86
Rt sided heart failure 2o hypoxic lung disease
Increased Rt ventricular after load Low P2 Raised JVP Lower limb oedema Reduced pulmonary arterial compliance Decreased LT SV, preload and PCWP ( LA)
87
Leptin
Produced in adipocytes Acts on hypothalamus to inhibit production of neuropeptide Y —> decreased appetite Ineffective leptin signaling > appetite > BMI
88
Which enzyme pathways are in the cytosol
Enzymes responsible for glycolysis, fatty acid synthesis and Pentose phosphate pathway
89
Which enzyme pathways are in the mitochondria
Beta oxidation of fatty acids, the TCA cycle, and carboxyoation of pyruvate ( gluconeogenesis)
90
Aspergillus
Thin septation fungus with acute 45o bifurcation/ branching
91
Infectious mononucleosis symptoms with no agglutination horse erythrocytes causative organism
CMV, human herpes 6, HIV and toxoplasmosis can cause -ve monospot infectious mononucleosis Infectious mononucleosis symptoms:- spleenomegaly, fever, fatigue atypical lymphocytosis Mono spot test:- agglutination to horse erythrocytes
92
Pancreas is derived from the
Mesoderm
93
Mutation of gene coding for protein on the base lateral surface of hepatocytes and enterocytes and interacts with transferrin refers to which disease?
1o haemochromatosis Mutation in HFE gene Interacts with transferrin to sense iron stores Increased risk of HCC Presentation:- low hepcidin, micronodular cirrhosis, bronze diabetes
94
Neurofibromatosis 1 features
Single gene AD disorder Chromosome 17 Presentation:- cafe au lait spots, skinfold freckling, lisch nodules
95
Old age Changes salivary gland
Acinar atrophy fatty infiltration Reduced saliva Dental carries
96
Sign of being on A2RB and ACE I
Renin will be raised
97
Diagnosis of bipolar I
In pts with 1 or more episodes of mania > 1/52 duration of mania >3 symptoms DIGFAST Distractibility Impulsivity Grandiosity Flight of ideas Increased activity Decreased sleep Talkativeness
98
In lactate dehydrogenase deficiency anaerobic conditions depletion of which intracellular substance will inhibit glycolysis
NAD+ In anaerobic conditions pyruvate is converted to lactate via lactate dehydrogenase Generating NAD from NADH In lactate dehydrogenase deficiency failure to generate NAD and glycolysis inhibited
99
Earliest cause of change following a burn
Superficial burn:- blanching erythema :- neutrophils from mast cells Partial thickness burns :- blisters—-> fluid extravasation in gaps between endothelial cells in venues
100
Serotonin syndrome features
Altered mental status Autonomic hyperactivity Neuromuscular excitation Presentation:- anxiety, de;ilium, diaphoresis, HTN, tachycardia, vomiting, diarrhoea, hyper reflex is, tremor Antidote for OD :;- cyprohetadine
101
Femoral block location and uses
Block near the inguinal ligament Anasethetises ant thigh, femur and knee
102
HCV reasons why anibody doesn’t confer immunity
HCV envelope proteins have variations in their antigenic structure RNA dependent RNA polymerase has no proof reading and has manny errors during replication
103
E. coli 0157:H7 toxin virulence
Inactivates 60S ribosomal unit
104
21 hydroxylase deficiency which reaction will be affected
Progesterone —-> 11 deoxycorticosterone
105
Methimazole MoA
Decreases formation of thyroid hormone via thyroid peroxidase inhibiting coupling of iodotyroisines
106
CN VI
Abducens innervates lateral recutus muscle which inserts on temporal surf fence of globe Dysfunctional can lead to double vision Function to abduct the eye
107
ST elevation in I and aVL, where is the occlusion?
Lt circumflex
108
Galactokinase deficiency features
Galactose cannot be broken down to galactose-1-phpsphate —-> Accumulation of galactitol Causing cataracts
109
Southwestern blot
Uses double strand DNA probes to identify DNA binding protein including transcription factors
110
C diff contact precautions
Handwashing Gloves and gown
111
Pt with new HIV pol mutations suggests that
Pt may not be compliant with therapy Pol gene encodes for HIV enzyme protease, reverse transcriptase and integrase
112
Methylmalonic acidema
Deficiency in methylmalonyl- CoA mutase Methylmalonyl CoA—X—> succinylCoA Presentation:- first 2 weeks of life. Sleepiness, poor feeding Vomiting, dehydration Tachypnoea ( 2o metabolic acidosis) Hypoglycaemia Hyperammonaemia Urine ketones High proprionic and methylmalonic acid
113
MoA of glucocorticoids in allergy
Inhibits transcription of inflammatory mediators leading to apoptosis of eosinophils, T cells and monocytes
114
Hydatiform mole
Commonly 46 XX Presentation:- v high B HcG Pelvic pain, vaginal bleeding U/s :- multiple cystic areas in a central mass Large oedema toys distorted chorionic villi Risk factors:- phx, maternal age, prior miscarriage or infertility
115
Lyme’s disease features
B burgdorferi Tick bite Spreading Bulls eye annular eruthematous rash mild pruritis Fever , myalgia, headache
116
Eosinophilic meningitis
Common cause helminthic infection ( angiostrongylus) Eating contaminated shell fish SE Asia Eosinophils in CSF
117
Glycine features
Inhibitory neurotransmitter GABA a > in spine than bran Allow Cl influx and cause hyperpolarisation
118
Glutamate in neruonal injury
Release from injured neurons Hyper activation of NMDA receptors Depolarisation and Ca overload —-=> death to neighbouring cells
119
CRACK AMIGOS
CYP450 inhibitors ( increased drug SE) Cimetidine Ritonavir Amiodarone Ciprofloxacin Ketoconazole Acute alcohol Macrolides Isoniazid Grapefruit Omeprazole Sulfonamide
120
Antibodies causing anaemia and haemolysis pathophysiology
Immune mediated Bind to erythrocytes acting as happens for IgG attachment. Cleared by splenic macrophages —> haemolytic anaemia
121
Microthrombi haemolytic anaemia
Commonest cause is DIC Assoc severe infection nor OB complications Prolonged coag times and thrombocytopenia
122
Vascular dementia features
Presentation:= prominent executive dysfunction MRI:- multiple infarcts, micro bleeds , areas of hyper intensity in white matter and gray matter
123
Adenovirus features
Double stranded DNA Transmission: direct contact, faeco-oral, resp droplets Presentation:- outbreaks in crowded shared spaces Pharyngitis Conjunctivitis Fever Cough Congestion Small # get pneumonia
124
Gastric banding circles the stomach and which other structure
Lesser omentum Attaches between stomach and liver Divided into 2 ligaments hepatogastric ligament/ hepatoduodenal ligament
125
Methotrexate teratoginicity
Folic acid antagonist Neural tube defect
126
Brief psychotic disorder
1 or more psychotic symptom lasting >1/7 <1/12
127
Which cell lines are increased in COPD
Neutrophils Macrophages CD8+ cells
128
Age related cardiovascular changes
Aortic stiffening :- elastin replaced with collagen Mild concentric LVH Conduction cell degeneration Reduced baroreceptor sensitivity Reduced adrenergic responsiveness
129
Endurance muscle fibres
Type I red muscle fibres Use oxidative phosphorylation for energy metabolism Contain high quantities of mitochondria, lipids and myoglobin
130
Which cytokines is an important mediation in GCA
IL-6 Correlates with severity of symptoms
131
Thoracic outlet syndrome
Compression of brachial plexus as it passes through the scalene triangle Increased risk with extra CXR rib Presentation:- UL numbness, tingling and weakness with repetitive overhead movements
132
Ewing sarcoma
Malignant bone Ca <15 white Histo:- sheets of small round blue tumours, clear cytoplasm X-ray:- lytic lessons moth eaten appearance Mets:- lung
133
Ankylosing spondylitis
Assoc HLA B27 Presentation:- reduced spinal mobility, back pain Worse in am better with exercise X-ray pelvis:- erosions with subchondral sclerosis ( sacroilitis)
134
Pagers disease of the bone phases
1. Osteoclasts/ osteolytic phase: 2. Mixed phase 3. Osteoblasts/ osteosclerotic phase Presentation:- raised ALP, bone pain in elderly pt Biopsy:- mosaic pattern of lamellar bone
135
Dermatomyositis
Proximal muscle weakness and skin manifestation Labs:- raised CK and anti Jo-1 Mgx: - initial glucocorticoids
136
Enthesitis
Inflammation and pain at point of tender insertion Assoc with ankylosing spondylitis Psoriatic arthritis Reactive arthritis
137
Supraspinatus
Part of the rotator cuff —> most commonly injured Abductor of the arm Innervation:- suprascapular nerve
138
Lunate dislocation complication
Spilled tea cup sign on X-ray Compresses carpal tunnel ==> median nerve injury presentation:- weak thumb abduction, flexion and opposition
139
Cellular Pathogenesis of RA
Anti CCP antibodies specific Activation of CD4+cells TH1, Th17 TNF (collagenase) and IL1 (metaloprotease) —> involved in progressive articular destruction by activating osteoclasts
140
Olecranon bursitis
Localised swelling in olecranon proces Pain and erythema minimal 2o overuse
141
Deep brachial artery
Runs along with radial nerves Midshaft fractures put them at risk
142
Polymyositis
Symmetric proximal muscle weakness Assoc with ANA and anti Jo1 ( anti tRNA synthetase) Labs:- raised CK Biopsy:- endomysial mononuclear infiltrate, patchy necrosis
143
Myositis ossificans
Formation of lamellar bone in extra skeletal tissue 2o to trauma Presentation:- painful, film mobile mass in muscle Histo:- benign metaplastic bone and proliferation fibroblasts without mitotic atypia
144
Paget’s disease
Ca, Po4 Normal ALP raised Presentation:- Frontal bossing —> headache may impinge on CN VIII Pathologic fractures High output HF 2o increased bld flow in pagetic lesions Excessive and disordered bone formation in elderly Malignancy would have no skull Mets and would have raised Ca
145
Vitamin D deficiency in children
Presentation:- exclusive breast feeding, frontal bossing Hypertrophy of costochondral joints, decreased muscle tone, tibial bowing Labs:- low 1,25 OH vitamin D. LowPO4, Low/N Ca , high ALP, high PTH, low urine Ca Histopathology: excess unmineralised osteoid
146
Osteosarcoma
<20 male Presentation:- pain and soft tissue swelling X-ray:- lytic and sclerotic bone lesion Histopathology:- malignant cells producing neoplasticism osteoid and thin trabeculae of mineralized bone
147
Scaphoid bone fracture
Anatomical snuff box On outstretched hand Risk of a vascular necrosis of scaphoid
148
McCune Albright syndrome
Mutation in GNAS gene Constant Gs protein activation Hormone overproduction Presentation:- precocious puberty Irregular cafe au lait macula ++ osteotic lesions Complications:- thyrotoxicosis, Cushing syndrome, acromegaly
149
Cells involved in scleroderma
Vascular endothelial cells ( inc endothelin 1) T lymphocytes (cytokines recruit fibroblast) Dermal fibroblasts ( production of collagen)
150
Polymyositis muscle biopsy
Endomysial infiltration with patchy necrosis Overexpression MHCI and CD8 + T cells
151
In Paget’s disease what factor is required for osteoclasts differentiation
Osteoclasts in Paget’s disease ( mutlinucleated cell > 100 nuclei) This differentiation is 2o osteoblasts producing M-CSF ( macrophages colony stimulating factor) RANK-L (receptor for activated nuclear factor kappa-B ligand)
152
What is osteoprotergin
Decoy receptor that reduces binding of RANK=L to RANK —-> decreased differential and survival of osteoclasts. —-> increased bone resorption and increased bone density
153
Giant cell arteritis visual complication
Ischaemic optic neuropathy 2o ophthalmic artery occlusion Others:- Central or branch retinal artery occlusion Cerebral infarction leading to visual field defect
154
Joint destruction in RA characteristics
Synovial hyperplasia Inflammatory infiltrate Synovial angiogenesis Joint space replaced by synovial pannus
155
Hereditary haemochromatosis presentation
Bronze diabetes Arthritis esp 2nd and 3rd MCP Chondrocalcinosis (Ca pyrophophosphate dihydrate) 2o hypogonadisim Hypothyroidism Restrictive/ dilated cardiomyopathy Arrhythmias
156
What type of hypersensitivity are MG and good pastures syndrome
Type II antibody mediated
157
Cancers assoc with dermatomyositis
Adenocarcinoma Ovarian Lung Pancreas
158
1o biliary cholangitis assoc conditions
Autoimmune disease CREST Sjogren syndrome
159
Reactive arthritis features
Can’t see, can’t pee, can’t bend the knee Urethritis Conjunctivitis Mono/oligo arthritis Assoc HLA B27 Sacroilitis
160
CKD bone disease labs
Impaired conversion to 1,25 OH vitamin D3 Low Ca High Po4 2o hyperparathyroidism
161
Eosinophilic Granulomatousis with polyangitis (churg- Strauss) features
Small to med vasculitis Late onset asthma Rhinosinusitis Eosinophilia Asymmetrical multifocal neuropathy (wrist drop/radial) Lab:- antibodies against neutrophil myeloperoxidase P-ANCA
162
RA joints involved
Hands Wrist Elbows Knees Cx spine
163
Complications of sjogren syndrome
Non Hodgkin lymphoma Corneal damage Dental caries
164
Avasular necrosis femoral head
Cause:- sickle cell disease Embolic disorders High dose steroids +++Alcohol abuse SLE Femoral neck fracture
165
Hypertrophic osteoarthropathy features
Abnormal growth of new bones Presentation:- clubbing, painful arthropathy, periostosis of long bones, joint effusion Assoc:- pulmonary malignancy, CF, bronchiectasis, cyanosis heart disease
166
Lesion in somatosensory location and presentation
Location:- posterior to central sulcus Presentation:- contralateral sensory deficit Cortical sensory signs ( loss of 2 point discrimination, ability to recognise numbers, ability to perceive multiple stimuli)
167
MoA of ACE I
Reduce angiotensin II Efferent arteriole dilation
168
Etanercept
TNF alpha inhibitor Soluble protein decoy receptor Use:- adjunct with methotrexate for RA
169
Factors that lead to sickling in sickle cell disease
Low O2 levels Acidosis Dehydration O2 unloading ( extracting more O2 from bld) Decreased 2,3 BPG
170
Haemolytic uraemic syndrome labs
Decreased HgB, haptoglobin Decreased Plt Increase BT Increased LDH High indirect bilirubin Negative Coombs ( haemolysis is mechanical)
171
When does b hCG increase
Begins with blastocyst implantation and syncitotrophoblast invasion
172
Focal onset seizure
2o to focal structural abnormality Being localised seizures can progress to bilateral tonic clonic seizures
173
Achalasia treatment
Botulinum toxin injected into lower oesphageal sphincter —> block cholinergic —> relaxation
174
Shigella pathogenic cellular spread
Primary method:- Mucosal invasion and lateral spread
175
Stroke affecting thalamus characteristics
Sensory loss affecting all modalities in the contralateral face, arm and leg Proprioception affected In tact motor strength
176
Lacunar infarcts
Small vessel occlusion in deep brain structures due to lipohylinosis and microartheroma formation 2o uncontrolled HTN, DM Appear as cavities <15mm in size in Deep structures of brain filled with clear fluid
177
Actinic keratosis
Sun exposed skin Scaly erythematous whitish scale Papules — sand paper texture > felt than seen
178
Seborrhoeic keratosis
Elderly Stuck on - deeply pigmented/ flesh coloured verroucus well circumscribed Papule
179
Congenital hypothyroidism features
Asymtomatic at birth Maternal T4 goes away C/o constipation, lethargy, hypotonia, macroglossia umbilical hernia and large ant fontanelle
180
Vegan diet can lead to deficiency in
B12, calcium, vitamin D, iron , zinc
181
Which condition increases risk of Giardia lamblia infection
IgA deficiency IgA Impairs Gardia adhesion
182
Synchronization of glycogen breakdown in muscle is due to
Increased intracellular Ca In live cAMP, glucagon and epinephrine
183
S saprophyticus
G+ve cocci Catalase +ve Coagulase -ve Novobicin resistant Causes UTI in sexually active women
184
Hurler syndrome
Deficiency alpha L iduronidase Accumulation of dermatan and heparan sulfate Presentation:- coarse facies, intellectual disability, corneal clouding, hepatosplenomegaly Death 2o MI <10
185
Travelers diarrhoea
Caused by eneterotoxigenic E.Coli Toxin resembles cholera - heat stable/heat labile enterotoxin ++ watery diarrhoea lead. To dehydration
186
HBV replication sequence
Double stranded DNA—> +RNA template —-> partial double stranded DNA progeny
187
Aldolase B deficiency
Hereditary fructose intolerance Starts with introduction of fructose to diet Presentation:- hypoglycaemia, vomiting Failure to thrive, jaundice, hepatomegaly
188
Influenza pandemics is usually due to
Reassortment of RNA segments (major antigenic shift)
189
Hereditary orotic aciduria
Deficiency:- uridine % monophosphate synthase ( pyrimidine pathway) Presentation:- developmental delay, megaloblastic anaemia, high urinary orotic acid No ammonia Mgx:- uridine supplementation
190
Horseshoe kidney
Abnormal migration of Rt and Lt metanephric blastema leading to fusion of inferior poles Presentation:- asymptomatic may increase risk of Kidney stones and UTIs
191
Hepatic encephalopathy
Increased absorption of nitrogen by the gut Increased GABA Impaired glutamate
192
Predictive values
Change with prevalence In low disease prevalence NPV increases ( more TN, less FN) and PPV decrease ( less TP, more FP) In high disease PPV increase and NPV decreases
193
Pharmacokinetic differences in neonates
Higher total body water Blood brain barrier immaturity Decreased CYP450 enzyme activity Decreased renal bld flow and GFR
194
Cyclin independent kinase inhibitors SE
MoA:- Prevent phosphorylation/activation of RB and stop G1-S cell cycle progression SE:- bone marrow suppression
195
Silencing RNA
Leads to less cell line production This is due to interference from small interfering RNA and microRNA This causes a disruption of the RNA translation
196
Congenital syphilis
Transplacental transmission of the spirochete treponema pallidum Presentation:- rhinorrhea Desquamating rash in soles and feet Hepatomegaly Lymphadenopathy Periosteal thickening and metaphyseal erosion of long bones
197
Where would you cauterize in epistaxis
Ant nasal septum Kiesselbach plexus —> site to anastomosis of ant ethmoidal, sphenopalatine and sup labial arteries
198
Alkaptonuria
Deficiency:- homogentisic acid oxidase Defect:- tyrosin—-X—> fumerate Presentation:- connective tissue hyperpigmentation Arthropathy in adults Urine darkens after several hours
199
Hyperphenylalaninemia
Deficiency:- phenylalanine hydroxylase Defect: phenylalanine ——X—> tyrosin Co-factor:- BH4 tetrahydrobiopterin Presentation:- microcephaly Developmental delay Seizures Hypopigmentation
200
Somatomedin C
Insulin like growth factor Release in response to GH to stimulate target cells growth
201
ACTH and B endorphin relationship
Beta endorphin is an endogenous opioid bind to receptors Mu, delta, kappa and N/OFQ. Derived from proopiomelanocortin that is also a precursor for ACTH and MSH ( melanocyte stimulating hormone)
202
Germinal centers
Are sites in LN where activated B cells proliferate and mature Gives rise to lymphadenopathy symptoms —> pain and swelling 2o to release of inflammatory cytokines
203
Virus causing nasopharyngeal carcinoma
EBV
204
Complication of pressure in Lt renal vein 20 compression by superior mesenteric artery and aorta
Nutcracker effect Lead to varicocele Periumbilical venous disetention —> portal HTN
205
Serum sickness
Immune complex type III hypersensitivity Forms 5-14/7 after exposure to foreign protein e.g. antitoxin, anti venom, MAB or vaccine Presentation:- fever, urticarial rash and arthralgia Resolution 2o immune complexes cleared by mononucelar phagocyte system
206
Adrenal cortical hyperplasia vs adrenal medullary hyperplasia
Cortical hyperplasia assoc increased ACTH —> stimulates it to release aldosterone, cortisol, DHEA Medullary hyperplasia increased catecholamine / phaeochromocytoma
207
Non exertional heat stroke
Hyperthermia CNS dysfunction:- encephalopathy, syncope Increased risk with anticholinergic meds that impair sweating e.g amitriptylline scopolamine Impaired vasodilation —> sympathomimetic e.g amphetamine, cocaine Limiting cardiac response to heat :—> furosemide, metoprolol Disruption of hypothalamic thermoregulation —> chlorpromazine, haloperidol
208
Amitryptilline
Tricyclic antidepressant MoA”- inhibit 5Ht and NE reuptake Use: MDD, peripheral neuropathy , neuropathic pain SE: anticholinergic SE ( dry mouth, eyes, no sweating) convulsions, coma, caridotoxicity