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LopsNotes > Mixed Q’s 6 > Flashcards

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
Q

Cyanide poisoning

A

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+

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26
Q

Autosomal recessive disease chance of passing to the child

A

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

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27
Q

Hearing loss test

A

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

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28
Q

Tumour in temporal lobe -> visual field defect

A

Contralateral homonymous hemianopia superior quadrantopia ( top lt corner both eyes)

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29
Q

Argatroban MoA and use

A

Direct thrombin inhibitor
Along with hirudin and lepirudin, bivalirudin, dabigatran

Use: Heparin induced thrombocytopenia

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30
Q

Direct Xa inhibitors

A

Block active site of Xa and prevent conversion of prothrombin (II) to thrombin (IIa)
Names end in Xa-ban

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31
Q

Which organ repsonds to chronic hypoxaemia by increasing HCt

A

Kidney sense hypoxia inducing factor 1 alpha —->increase EPO production —> stimulate BM to accelerate erythrocytes precursor —> raised HCt

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32
Q

DIC

A

Can be caused by exertional heat stroke
Prolonged PT/PTT
Low PLT
Increased plasminogen
Increased fibrinolysis
Increased thrombin production

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33
Q

Etoposide MOA and use

A

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

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34
Q

Ureamic plt dysfunction

A

Disorder with plt quality
Prolonged BT
N PLt
N PT/PTT

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35
Q

Factor V Leiden mutation

A

Hypercoagulable
Young pt <50
Inherited
Factor Va resistant to inactivation by activated protein C
PTT not changed when adding protein C to plasma

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36
Q

Sickle cell disease complication

A

Autosplenectomy 2o repeated splenic infarction a

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37
Q

Anaemia of chronic disease

A

Triggered by longstanding inflammation cytokines
Hepcidin —> inhibits iron channels reducing iron availability

Normocytic non haemolysis anaemia with minimal retics response

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38
Q

VWF disease

A

Impaired vWF —> decreased ability for plt to adhere to endothelial —> normal PLT count
VWF is a carrier for VIII

Normal PT , prolonged PTT

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39
Q

Vitamin K deficiency

A

Risk with cystic fibrosis patient 2o fat malabsorption and decreased fat soluble vitamins ADEK

Causes:- mucosal bleeding, epistaxis
Prolonged PT

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40
Q

Enoxaparin MoA

A

Low molecular weight heparin
Bind and activates anti thrombin III
Binds to Xa and stops it from converting prothrombin to thrombin

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41
Q

Hairy cell leukaemia

A

B cell neoplasm
Middle aged men
Pancytopenia and massive spleenomegly
BM fibrosis —> dry Tap
TRAP +ve
Lymphocytes with cytoplasmic protections

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42
Q

T cell acute lymphoblastic leukaemia

A

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)

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43
Q

Doxazocin

A

Alpha 1 blocker
Relax smooth muscle

Use:- HTN, BPH

Similar drugs:- prazosin, terazosin

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44
Q

Thickened bladder, bilateral vesicourreteral reflux and hydronephrosis in a newborn boy?

A

Posterior urethral valve
Likely 2o persistent urogenital membrane obstruction the posterior urethra

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45
Q

Niacin by production and SE of OD

A

Niacin is the precursor of NAD and NADPH

Toxicity:- cutaneous flushing, pruritis, 2o increase prostaglandin production
Pre-treat with NSAIDS

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46
Q

Serotoli and testicular trauma

A

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

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47
Q

Why is there a drop between alveolar capillary blood and systemic arterial blood

A

2o mixture with deoxygenated bld
Bld coming from the pulmonary veins is not 100% oxygenated - contains deoxygenated blood from bronchial veins

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48
Q

Normal grief reaction in child

A

Transient behavioural disturbances e.g hallucinations of the deceased relative normal grief

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49
Q

Cells responsible for protecting against Invasive candida

A

Neutrophils most important
Pts on chemo develop neutropenia are at risk

T cells responsible for protection against superficial mucosal candida

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50
Q

SAH complication hydrocephalus cause

A

Communicating hydrocephalus is 2o Impaired absorption of CSF by arachnoid granulations

Enlargement of all 4 ventricles
Deteriorating mental status

Treatment:- external ventricular drain

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51
Q

Complication from schistosomiasis

A

Portal HTN —> 2o periportal fibrosis
Hepatosplenomegaly
Oesophageal varices
Sq cell Bladder Ca

Eosinophilia important clue

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52
Q

Femoral hernia landmarks

A

Bulge lateral to pubic tubercle
Inferior to inguinal ligament
Lateral to it is VAN ( femoral vein, artery, nerve)
More common in women

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53
Q

CMV oesophagitis

A

HIV assoc oesophagitis
Linear ulceraration
Intranuclear and cytoplasmic inclusion

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54
Q

Pt with CKD, Normal PLT, N coag with hx of excessive bruising

A

Platelet dysfunction
2o upregulation of nitric oxide —> decreased plt adhesion, activation and aggregation

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55
Q

Allergic contact dermatitis

A

Type IV hypersensitivity reaction
Intercellular epidermal oedema, with infiltration of lymphocytes and eosinophils

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56
Q

Teratoma features

A

Contain tissues from each of the 3 germ cell layers e.g , hair, teeth skeletal muscle, intestinal epithelium

Arise from primordial germ cell

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57
Q

Mgx of panic disorder

A

SSRI first line

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58
Q

Chronic Granulomatous disease

A

1o immunodeficiency X linked
Impaired NADPH
Recurrent infection with catalase +Ve organisms

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59
Q

HER2 breast Ca Mgx

A

HER2 is a receptor tyrosine kinase
Monoclonal antibody used ( trastuzumab) blocks HER2 and inhibits cellular proliferation

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60
Q

Rett Syndrome

A

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)

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61
Q

Small intestinal bacterial overgrowth features

A

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

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62
Q

MoA of fusion inhibitors in HIV treatment

A

Fusion inhibitors (enfuvirtide) bind HIV transmembrane glycoprotein gp41 prevent entry of viral core into the new host cell

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63
Q

Listeriosis

A

Listeria
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

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64
Q

2,3 BPG and HBF

A

Decrease binding between the 2
Leading to increased Hgb O2 affinity

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65
Q

Parvovirus B19 can cause

A

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

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66
Q

Lambert Eaton myasthenic syndrome features:

A

Progressive muscle weakness
Decreased deep tendon reflexes
Improve with exercise

Assoc with SCLC

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67
Q

Hydrocele common in newborns cause

A

Communicating hydrocele
2o patent processus vaginalis

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68
Q

Cardiopulmonary changes seen with old age

A

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

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69
Q

Inferior alveolar nerve innervation

A

Lower teeth and gives off the mental nerve which innervates the chin and lower lip

Can be injured during dental procedures

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70
Q

Neurohormonal levels in asymptomatic Lt ventricular systolic dysfunction

A

Increased angiotensin II
Increased norepinephrine
Increased ANP

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71
Q

Blood supply of the distal oesophagus - affected in oesphageal varices

A

Lt gastric artery

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72
Q

Ornithine transcarbamylase deficiency

A

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***

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73
Q

Pernicious Anaemia site of pathology in the stomach

A

Cell mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and fundus.

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74
Q

Genetic anticipation

A

Inherited disease condition that presents earlier and more severe in subsequent generations

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75
Q

The difference between minute ventilation and alveolar ventilation

A

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

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76
Q

Wernicke’s aphasia

A

Receptive aphasia - well articulated but meaningless (word salad)

Middle cerebral artery supplies both wernicke and Broca’s area (expressive aphasia)

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77
Q

Tracheoesophageal fistula with oesophageal atresia features

A

Results from failure of primitive foregut to divide into separate trachea and oesphagus

Symptoms:- shortly after birth excessive secretion choking/cyanonsis during feeds

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78
Q

Marijuana use features

A

Mild euphoria, inappropriate laughter, increased appetite, slow reaction
Tachycardia and conjunctival injection

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79
Q

Epithelial ovarian cancer features

A

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

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80
Q

Acute effects of corticosteroids on WC count

A

Increase neutrophils 2o neutrophil demargination
Decrease lymphocytes, basophils, eosinophils, monocytes

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81
Q

SE of antidepressant mono therapy in susceptible pts

A

Risk of inducing mania in pts with family hx of bipolar disorder

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82
Q

Commonest causes of most oropharyngeal carcinomas

A

HPV
In particular HPV 16-18 cause transformation to malignancy

Tongue, tonsil etc

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83
Q

Medications that can cause constipation

A

Non dihydropyridine Ca channel blockers ( diltiazem, verapamil)
5HT3 antagonist ( ondansetron, granisetron)
Anticholinergics
Opioids

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84
Q

Major pathogen for resp colonisation in adult pts with CF

A

Pseudomonas aeruginosa

In children ( Staph aureus)

85
Q

Follicular lymphoma

A

Middle aged pts
Painless LN englargement
Waxing and waning course
T14:18 translocation
Overexpression of BCL2 oncogene

86
Q

Rt sided heart failure 2o hypoxic lung disease

A

Increased Rt ventricular after load
Low P2
Raised JVP
Lower limb oedema
Reduced pulmonary arterial compliance
Decreased LT SV, preload and PCWP ( LA)

87
Q

Leptin

A

Produced in adipocytes
Acts on hypothalamus to inhibit production of neuropeptide Y —> decreased appetite
Ineffective leptin signaling > appetite > BMI

88
Q

Which enzyme pathways are in the cytosol

A

Enzymes responsible for glycolysis, fatty acid synthesis and Pentose phosphate pathway

89
Q

Which enzyme pathways are in the mitochondria

A

Beta oxidation of fatty acids, the TCA cycle, and carboxyoation of pyruvate ( gluconeogenesis)

90
Q

Aspergillus

A

Thin septation fungus with acute 45o bifurcation/ branching

91
Q

Infectious mononucleosis symptoms with no agglutination horse erythrocytes causative organism

A

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
Q

Pancreas is derived from the

A

Mesoderm

93
Q

Mutation of gene coding for protein on the base lateral surface of hepatocytes and enterocytes and interacts with transferrin refers to which disease?

A

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
Q

Neurofibromatosis 1 features

A

Single gene AD disorder
Chromosome 17

Presentation:- cafe au lait spots, skinfold freckling, lisch nodules

95
Q

Old age Changes salivary gland

A

Acinar atrophy fatty infiltration
Reduced saliva
Dental carries

96
Q

Sign of being on A2RB and ACE I

A

Renin will be raised

97
Q

Diagnosis of bipolar I

A

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
Q

In lactate dehydrogenase deficiency anaerobic conditions depletion of which intracellular substance will inhibit glycolysis

A

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
Q

Earliest cause of change following a burn

A

Superficial burn:- blanching erythema :- neutrophils from mast cells

Partial thickness burns :- blisters—-> fluid extravasation in gaps between endothelial cells in venues

100
Q

Serotonin syndrome features

A

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
Q

Femoral block location and uses

A

Block near the inguinal ligament

Anasethetises ant thigh, femur and knee

102
Q

HCV reasons why anibody doesn’t confer immunity

A

HCV envelope proteins have variations in their antigenic structure

RNA dependent RNA polymerase has no proof reading and has manny errors during replication

103
Q

E. coli 0157:H7 toxin virulence

A

Inactivates 60S ribosomal unit

104
Q

21 hydroxylase deficiency which reaction will be affected

A

Progesterone —-> 11 deoxycorticosterone

105
Q

Methimazole MoA

A

Decreases formation of thyroid hormone via thyroid peroxidase inhibiting coupling of iodotyroisines

106
Q

CN VI

A

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
Q

ST elevation in I and aVL, where is the occlusion?

A

Lt circumflex

108
Q

Galactokinase deficiency features

A

Galactose cannot be broken down to galactose-1-phpsphate

—-> Accumulation of galactitol
Causing cataracts

109
Q

Southwestern blot

A

Uses double strand DNA probes to identify DNA binding protein including transcription factors

110
Q

C diff contact precautions

A

Handwashing
Gloves and gown

111
Q

Pt with new HIV pol mutations suggests that

A

Pt may not be compliant with therapy

Pol gene encodes for HIV enzyme protease, reverse transcriptase and integrase

112
Q

Methylmalonic acidema

A

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
Q

MoA of glucocorticoids in allergy

A

Inhibits transcription of inflammatory mediators leading to apoptosis of eosinophils, T cells and monocytes

114
Q

Hydatiform mole

A

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
Q

Lyme’s disease features

A

B burgdorferi
Tick bite
Spreading Bulls eye annular eruthematous rash mild pruritis
Fever , myalgia, headache

116
Q

Eosinophilic meningitis

A

Common cause helminthic infection ( angiostrongylus)
Eating contaminated shell fish SE Asia

Eosinophils in CSF

117
Q

Glycine features

A

Inhibitory neurotransmitter GABA a
> in spine than bran
Allow Cl influx and cause hyperpolarisation

118
Q

Glutamate in neruonal injury

A

Release from injured neurons
Hyper activation of NMDA receptors
Depolarisation and Ca overload —-=> death to neighbouring cells

119
Q

CRACK AMIGOS

A

CYP450 inhibitors ( increased drug SE)
Cimetidine
Ritonavir
Amiodarone
Ciprofloxacin
Ketoconazole
Acute alcohol
Macrolides
Isoniazid
Grapefruit
Omeprazole
Sulfonamide

120
Q

Antibodies causing anaemia and haemolysis pathophysiology

A

Immune mediated
Bind to erythrocytes acting as happens for IgG attachment. Cleared by splenic macrophages —> haemolytic anaemia

121
Q

Microthrombi haemolytic anaemia

A

Commonest cause is DIC
Assoc severe infection nor OB complications
Prolonged coag times and thrombocytopenia

122
Q

Vascular dementia features

A

Presentation:= prominent executive dysfunction

MRI:- multiple infarcts, micro bleeds , areas of hyper intensity in white matter and gray matter

123
Q

Adenovirus features

A

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
Q

Gastric banding circles the stomach and which other structure

A

Lesser omentum
Attaches between stomach and liver

Divided into 2 ligaments hepatogastric ligament/ hepatoduodenal ligament

125
Q

Methotrexate teratoginicity

A

Folic acid antagonist
Neural tube defect

126
Q

Brief psychotic disorder

A

1 or more psychotic symptom lasting >1/7 <1/12

127
Q

Which cell lines are increased in COPD

A

Neutrophils
Macrophages
CD8+ cells

128
Q

Age related cardiovascular changes

A

Aortic stiffening :- elastin replaced with collagen

Mild concentric LVH

Conduction cell degeneration

Reduced baroreceptor sensitivity

Reduced adrenergic responsiveness

129
Q

Endurance muscle fibres

A

Type I red muscle fibres
Use oxidative phosphorylation for energy metabolism
Contain high quantities of mitochondria, lipids and myoglobin

130
Q

Which cytokines is an important mediation in GCA

A

IL-6
Correlates with severity of symptoms

131
Q

Thoracic outlet syndrome

A

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
Q

Ewing sarcoma

A

Malignant bone Ca
<15 white

Histo:- sheets of small round blue tumours, clear cytoplasm

X-ray:- lytic lessons moth eaten appearance

Mets:- lung

133
Q

Ankylosing spondylitis

A

Assoc HLA B27

Presentation:- reduced spinal mobility, back pain
Worse in am better with exercise

X-ray pelvis:- erosions with subchondral sclerosis ( sacroilitis)

134
Q

Pagers disease of the bone phases

A
  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
Q

Dermatomyositis

A

Proximal muscle weakness and skin manifestation

Labs:- raised CK and anti Jo-1

Mgx: - initial glucocorticoids

136
Q

Enthesitis

A

Inflammation and pain at point of tender insertion

Assoc with ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis

137
Q

Supraspinatus

A

Part of the rotator cuff —> most commonly injured
Abductor of the arm
Innervation:- suprascapular nerve

138
Q

Lunate dislocation complication

A

Spilled tea cup sign on X-ray

Compresses carpal tunnel ==> median nerve injury

presentation:- weak thumb abduction, flexion and opposition

139
Q

Cellular Pathogenesis of RA

A

Anti CCP antibodies specific
Activation of CD4+cells

TH1, Th17

TNF (collagenase) and IL1 (metaloprotease) —> involved in progressive articular destruction by activating osteoclasts

140
Q

Olecranon bursitis

A

Localised swelling in olecranon proces
Pain and erythema minimal
2o overuse

141
Q

Deep brachial artery

A

Runs along with radial nerves
Midshaft fractures put them at risk

142
Q

Polymyositis

A

Symmetric proximal muscle weakness
Assoc with ANA and anti Jo1 ( anti tRNA synthetase)

Labs:- raised CK

Biopsy:- endomysial mononuclear infiltrate, patchy necrosis

143
Q

Myositis ossificans

A

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
Q

Paget’s disease

A

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
Q

Vitamin D deficiency in children

A

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
Q

Osteosarcoma

A

<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
Q

Scaphoid bone fracture

A

Anatomical snuff box
On outstretched hand
Risk of a vascular necrosis of scaphoid

148
Q

McCune Albright syndrome

A

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
Q

Cells involved in scleroderma

A

Vascular endothelial cells ( inc endothelin 1)
T lymphocytes (cytokines recruit fibroblast)
Dermal fibroblasts ( production of collagen)

150
Q

Polymyositis muscle biopsy

A

Endomysial infiltration with patchy necrosis
Overexpression MHCI and CD8 + T cells

151
Q

In Paget’s disease what factor is required for osteoclasts differentiation

A

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
Q

What is osteoprotergin

A

Decoy receptor that reduces binding of RANK=L to RANK —-> decreased differential and survival of osteoclasts. —-> increased bone resorption and increased bone density

153
Q

Giant cell arteritis visual complication

A

Ischaemic optic neuropathy 2o ophthalmic artery occlusion
Others:-
Central or branch retinal artery occlusion
Cerebral infarction leading to visual field defect

154
Q

Joint destruction in RA characteristics

A

Synovial hyperplasia
Inflammatory infiltrate
Synovial angiogenesis
Joint space replaced by synovial pannus

155
Q

Hereditary haemochromatosis presentation

A

Bronze diabetes
Arthritis esp 2nd and 3rd MCP
Chondrocalcinosis (Ca pyrophophosphate dihydrate)
2o hypogonadisim
Hypothyroidism
Restrictive/ dilated cardiomyopathy
Arrhythmias

156
Q

What type of hypersensitivity are MG and good pastures syndrome

A

Type II antibody mediated

157
Q

Cancers assoc with dermatomyositis

A

Adenocarcinoma
Ovarian
Lung
Pancreas

158
Q

1o biliary cholangitis assoc conditions

A

Autoimmune disease
CREST
Sjogren syndrome

159
Q

Reactive arthritis features

A

Can’t see, can’t pee, can’t bend the knee
Urethritis
Conjunctivitis
Mono/oligo arthritis

Assoc HLA B27
Sacroilitis

160
Q

CKD bone disease labs

A

Impaired conversion to 1,25 OH vitamin D3
Low Ca
High Po4
2o hyperparathyroidism

161
Q

Eosinophilic Granulomatousis with polyangitis (churg- Strauss) features

A

Small to med vasculitis
Late onset asthma
Rhinosinusitis
Eosinophilia
Asymmetrical multifocal neuropathy (wrist drop/radial)

Lab:- antibodies against neutrophil myeloperoxidase
P-ANCA

162
Q

RA joints involved

A

Hands
Wrist
Elbows
Knees
Cx spine

163
Q

Complications of sjogren syndrome

A

Non Hodgkin lymphoma
Corneal damage
Dental caries

164
Q

Avasular necrosis femoral head

A

Cause:- sickle cell disease
Embolic disorders
High dose steroids
+++Alcohol abuse
SLE
Femoral neck fracture

165
Q

Hypertrophic osteoarthropathy features

A

Abnormal growth of new bones

Presentation:- clubbing, painful arthropathy, periostosis of long bones, joint effusion

Assoc:- pulmonary malignancy, CF, bronchiectasis, cyanosis heart disease

166
Q

Lesion in somatosensory location and presentation

A

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
Q

MoA of ACE I

A

Reduce angiotensin II
Efferent arteriole dilation

168
Q

Etanercept

A

TNF alpha inhibitor
Soluble protein decoy receptor

Use:- adjunct with methotrexate for RA

169
Q

Factors that lead to sickling in sickle cell disease

A

Low O2 levels
Acidosis
Dehydration
O2 unloading ( extracting more O2 from bld)
Decreased 2,3 BPG

170
Q

Haemolytic uraemic syndrome labs

A

Decreased HgB, haptoglobin
Decreased Plt
Increase BT
Increased LDH
High indirect bilirubin
Negative Coombs ( haemolysis is mechanical)

171
Q

When does b hCG increase

A

Begins with blastocyst implantation and syncitotrophoblast invasion

172
Q

Focal onset seizure

A

2o to focal structural abnormality
Being localised seizures can progress to bilateral tonic clonic seizures

173
Q

Achalasia treatment

A

Botulinum toxin injected into lower oesphageal sphincter —> block cholinergic —> relaxation

174
Q

Shigella pathogenic cellular spread

A

Primary method:- Mucosal invasion and lateral spread

175
Q

Stroke affecting thalamus characteristics

A

Sensory loss affecting all modalities in the contralateral face, arm and leg
Proprioception affected
In tact motor strength

176
Q

Lacunar infarcts

A

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
Q

Actinic keratosis

A

Sun exposed skin
Scaly erythematous whitish scale Papules — sand paper texture

> felt than seen

178
Q

Seborrhoeic keratosis

A

Elderly
Stuck on - deeply pigmented/ flesh coloured verroucus well circumscribed Papule

179
Q

Congenital hypothyroidism features

A

Asymtomatic at birth
Maternal T4 goes away
C/o constipation, lethargy, hypotonia, macroglossia umbilical hernia and large ant fontanelle

180
Q

Vegan diet can lead to deficiency in

A

B12, calcium, vitamin D, iron , zinc

181
Q

Which condition increases risk of Giardia lamblia infection

A

IgA deficiency

IgA Impairs Gardia adhesion

182
Q

Synchronization of glycogen breakdown in muscle is due to

A

Increased intracellular Ca

In live cAMP, glucagon and epinephrine

183
Q

S saprophyticus

A

G+ve cocci
Catalase +ve
Coagulase -ve
Novobicin resistant

Causes UTI in sexually active women

184
Q

Hurler syndrome

A

Deficiency alpha L iduronidase

Accumulation of dermatan and heparan sulfate

Presentation:- coarse facies, intellectual disability, corneal clouding, hepatosplenomegaly

Death 2o MI <10

185
Q

Travelers diarrhoea

A

Caused by eneterotoxigenic E.Coli
Toxin resembles cholera - heat stable/heat labile enterotoxin
++ watery diarrhoea lead. To dehydration

186
Q

HBV replication sequence

A

Double stranded DNA—> +RNA template —-> partial double stranded DNA progeny

187
Q

Aldolase B deficiency

A

Hereditary fructose intolerance

Starts with introduction of fructose to diet

Presentation:- hypoglycaemia, vomiting
Failure to thrive, jaundice, hepatomegaly

188
Q

Influenza pandemics is usually due to

A

Reassortment of RNA segments (major antigenic shift)

189
Q

Hereditary orotic aciduria

A

Deficiency:- uridine % monophosphate synthase ( pyrimidine pathway)

Presentation:- developmental delay, megaloblastic anaemia, high urinary orotic acid
No ammonia

Mgx:- uridine supplementation

190
Q

Horseshoe kidney

A

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
Q

Hepatic encephalopathy

A

Increased absorption of nitrogen by the gut
Increased GABA
Impaired glutamate

192
Q

Predictive values

A

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
Q

Pharmacokinetic differences in neonates

A

Higher total body water
Blood brain barrier immaturity
Decreased CYP450 enzyme activity
Decreased renal bld flow and GFR

194
Q

Cyclin independent kinase inhibitors SE

A

MoA:- Prevent phosphorylation/activation of RB and stop G1-S cell cycle progression

SE:- bone marrow suppression

195
Q

Silencing RNA

A

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
Q

Congenital syphilis

A

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
Q

Where would you cauterize in epistaxis

A

Ant nasal septum
Kiesselbach plexus —> site to anastomosis of ant ethmoidal, sphenopalatine and sup labial arteries

198
Q

Alkaptonuria

A

Deficiency:- homogentisic acid oxidase
Defect:- tyrosin—-X—> fumerate

Presentation:- connective tissue hyperpigmentation
Arthropathy in adults
Urine darkens after several hours

199
Q

Hyperphenylalaninemia

A

Deficiency:- phenylalanine hydroxylase
Defect: phenylalanine ——X—> tyrosin
Co-factor:- BH4 tetrahydrobiopterin

Presentation:- microcephaly
Developmental delay
Seizures
Hypopigmentation

200
Q

Somatomedin C

A

Insulin like growth factor
Release in response to GH to stimulate target cells growth

201
Q

ACTH and B endorphin relationship

A

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
Q

Germinal centers

A

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
Q

Virus causing nasopharyngeal carcinoma

A

EBV

204
Q

Complication of pressure in Lt renal vein 20 compression by superior mesenteric artery and aorta

A

Nutcracker effect

Lead to varicocele

Periumbilical venous disetention —> portal HTN

205
Q

Serum sickness

A

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
Q

Adrenal cortical hyperplasia vs adrenal medullary hyperplasia

A

Cortical hyperplasia assoc increased ACTH —> stimulates it to release aldosterone, cortisol, DHEA

Medullary hyperplasia increased catecholamine / phaeochromocytoma

207
Q

Non exertional heat stroke

A

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
Q

Amitryptilline

A

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

LopsNotes (15 decks)

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