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LopsNotes > Mixed Q’s 7 > Flashcards

Mixed Q’s 7 Flashcards

1
Q

Organ least vulnerable to infarction

A

Liver

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2
Q

Stroke in young patient

A

Patent foramen ovale
2o failure of the atrial septum primum and secundum to fuse

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3
Q

Administration of IV fluids in hypovolumieic pt CVS changes

A

Increased Lt vent end diastolic volume
Increased preload
Increase end diastolic sarcomere length
Increased stroke volume
Increased C.O

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4
Q

Linkage disequilibrium

A

When a pair of alleles are inherited together due to close proximity

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5
Q

HBV replication cycle

A

Partial dsDNA is transcribed —> single strand mRNA template and then converted by viral reverse transcriptase into partial dsDNa of viral progeny which are released from cells

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6
Q

Achalasia

A

Motility disorder 2o reduced inhibitory ganglion cells in oesophageal wall
Decreased strength of peristalsis
Incomplete relaxation of LES

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7
Q

Finasteride

A

5 alpha reductase inhibitor

MoA:- blocks conversion of testosterone to DHT in prostate . Decrease prostate volume

Use:BPH

SE: ED, decreased libido

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8
Q

Tamsulosin

A

Alpha adrenergic antagonist

MoA:- relax smooth muscle in bladder neck

Use: BPH

SE:- othostatic HTN, dizziness

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9
Q

Dubin Johnson syndrome

A

Defective hepatic excretion of bilirubin glucuronides

Presentation:- hyperbilirubinaemia
Jaundice
Trigger illness, ocp
Other labs normal

Histo: Liver appears black 2o impaired excretion of epinephrine metabolites / pigment in lysosomes

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10
Q

CVS/ Renal SLE manifestation

A

Libman-Sacks endocarditis :- sterile vegetations on both sides of valve
Accelerated atherosclerosis
Pericarditis

Diffuse GN :- diffuse thickening of glomerular capillary wall with wire loop structures on light microscopy

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11
Q

Retroperitoneal haematoma likely due to damage to which organ

A

Pancrease

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12
Q

Drug target stops HIV viral fusion

A

Chemokine receptor CCR5 antagonist —>maraviroc

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13
Q

Phenoxybenzamine

A

Alpha 1 and alpha 2 adrenergic antagonist

Non competitive inhibitor of norepinephrine

When given with epinephrine —> decreases maximal effect Vmax non change in affinity Km

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14
Q

Pathogenesis of type I and II DM MODY

A

I DM —> cell mediated immunity —> infiltration of islet by inflammatory cells

MODY :- impaired glucose sensing and insulin secretion from pancreatic beta cells

II DM :- islet amyloid deposition

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15
Q

Increased osteoclast activity

A

2o decreased osteoprotegerin
Increased RANK/RANKL

Increasing bone resporption

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16
Q

Fluphenazine / first gen antipsychotics

A

MoA :- low potency 9 chlopromazine) —> histamine anticholinergic
high potency ( haloperidol, fluphenazine) —-> D2 receptor antagonist

Use: schizophrenia, psychosis

SE ;- low potency :— sedation, orthostatic hypotension, constipation
High potency:- extrapyramidal symptoms

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17
Q

Statin MoA

A

Causes hepatocytes to increase their LDL receptor density

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18
Q

Apoptosis-100

A

Apoprotein in VLDL and LDL
If VLDL/LDL decrease —> decrease in AP0B-100

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19
Q

Familial Dilated cardiomyopathy

A

AD mutation in the TTN gene coding for Titin protein

Presentation: -decompensated HF
Sudden death 2o ventricular arrhythmia

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20
Q

Path of venous catheter to LA

A

Iliac vein —> IVC—> RA —> intraatrial septum at the site of the foramen ovale —> LA

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21
Q

Pulsus paradoxus

A

Drop in SBP during inspiration / drop in pulse amplitude during inspiration

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22
Q

Abdominal aortic aneurysm Pathogenesis

A

Chronic inflammation and extracellular matrix degreadation of wall of aorta

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23
Q

WPW ecg triad

A

Short PR
Slurred upstroke of QRS - delta wave
QRS widening

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24
Q

Dobutamine

A

B adrenergic agonist
Weak alpha agonist

Stimulation of B1 reception —> increased production of cAMP and increased cytosolic Ca conc

Increased myocardial contractility

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25
Q

Cardiac haemochromatosis

A

Diastolic LT ventricular dysfunction
Progresses to dilated cardiomyopathy
Sinus node dysfunction ( syncope, malignancy arrhythmias)
Sudden death 2o ventricular

Brown granular deposits on myocyte as

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26
Q

Transposition of the great arteries

A

Cyanosis congenital heart disease
2o failed spiraling of the aorticopulmopnary septum

The aorta lies anterior and to the Rt of the pulmonary artery carrying deoxygenated bld

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27
Q

AS complications

A

Decreased Lt vent compliance —-> diastolic dysfucntion —> heart failure

Increased in LT ventricular wall stress —> due to high chamber pressures —> increased in O2 demand —> angina

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28
Q

Local Complication of norepinephrine IV

A

Venous balancing, induration and pallor 2o norepinephrine leak —> alpha 1 mediated vasoconstriction —> eventual tissue necrosis

Treatment:- phenytolamine —> alpha 1 blocker

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29
Q

Complication of fermoral arter catheterisation above inguinal ligament

A

Retroperitoneal haemorrhage

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30
Q

Down syndrome complications

A

Early onset Alzheimers
ALL
Duodenal atresia 2o failure of duodenal recanalisation
Hypothyroidism
ASD/VSD
Hirschsprung disease

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31
Q

Pronator teres syndrome

A

Forceful pronation - playing tennis
Median nerve compression between 2 heads of the pronator teres

Presentation: sensory loss lateral plam, thenar, 3 1/2 digits

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32
Q

GLUT

A

GLUT 4 is only one responsive to insulin found in skeletal and adipocytes facilitating glucose uptake

GLUT 1,2,3,5 are insulin independent found in brain, kidney, liver, RBC, intestine

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33
Q

Pt with CF confused, lethargy vomiting likely electrolyte distrutabce

A

Hyponatraemia
Hypochloraemia

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34
Q

Aging changes in lung capacity

A

Decreased chest wall compliance
Lung compliance increases
Increase in RV
TLC unchanged
Decreased FVC
Decreased FEV1

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35
Q

Polio antibody level between IM and ORal

A

Oral - Sabin has more oropharygeal and duodenal luminal IgA

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36
Q

Thyroglossal duct cyst

A

Failed atrophy of thyroglossal duct in utero

Located between base of tongue to thryroid isthmus

Ant midline mass moves with swallowing of sticking out tongue

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37
Q

Stem cell transplantation 2o congenital genomic disease. Suitable donors

A

Matched unrelated donor

Self/ identical sibling donor will have the congenital disease
Unmatched siblings wont have the same HLA alleles

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38
Q

Thiamine deficiency

A

Wet beriberi :- cardiomyopathy, HF
Dry beriberi:- symmetric preipheral neuropathy

Maternal thiamine deficiency can lead to deficiency in exclusively breast fed baby

Decreased erythrocytes transketolase ( thiamine dependent enz)

Will also affecte alpha ketogluterate and pyruvate dehydrogenase ( producing + lactate)

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39
Q

Chronic lung transplant rejection

A

Presentation:- months/ years after transplantation
slowly worsening dypnoea, dry cough
End resp squeaks or pops
FEV1 reduced ( obstructive)

Pathology:- submucosal lymphocytic inflammation small airways

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40
Q

Ehrlichia chaffeensis

A

Transmission:- tick bite white tailed deer in the south

Histo:- replicates in monocytes, forms mulberry shaped intraleukocytic inclusions ( morulae)

Presentation:- fever, myalgia, macuolpapular rash, lymphopenia

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41
Q

Conversion disorder

A

Deficits os voluntary motor +/- sensory function incompatible with any neuro condition

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42
Q

Somatic symptoms disorder

A

1 or more unexplained symptoms, excessive thoughts health anxiety and preoccupation worth the symptoms

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43
Q

When does bld flow into the vascular beds of the left ventricle

A

During diastole

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44
Q

MEN2A

A

Mutation of RET
Medullary thyroid cancer > 95%
Phaeochromocytoma >50%
Parathyroid hyperplasia

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45
Q

Malaria in Brazil

A

P vivax
Has hyponozoite phase —> can reappear after weeks or ,months

Trophozoite phase:- rings in RBCs

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46
Q

Giardiasis Mgx

A

Diarrhoea in hikers/campers malabsorption, flatulence
Metronidazole

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47
Q

Ciprofloxacin is used to treat what kind of diarrhoeal illness

A

Inflammatory traveler’s diarrhoea ( blood and mucus in stool)

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48
Q

Diphtheria primary treatment

A

G+ve rod non spore forming
Diphtheria antitoxin to inactivate circulating toxins

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49
Q

Vibrio vulnificus

A

Curved G-ve bacteria
Lives in marine environment
Transmission:- raw seafood , wound contamination

Usually mild symptoms

Increased risk of severe disease with liver disease or iron overload

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50
Q

Chancroid

A

2o Haemophilius ducreyi
Curved G-ve rods in a clumping pattern

Causes:- painful deep ulcer with ragged borders, gray exudate and inguinal lymphadenopathy

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51
Q

Nocardia

A

G+ve filamentous bacteria, aerobic, partially acid fast
(2o Mycolic acid in cell wall )

Transmission:- soil spore inhalation /inoculation

Presentation:- pneumonia, brain abscess, cutaneous involvement

Mg:- TMP-SMX

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52
Q

Chagas disease

A

2o trypanosoma Cruzi a C or U shaped flagellated parasite

Transmission:- kissing
Endemic:- S. America

Presentation :- dilated oesphagus +/- 2o achalasia
Dilated cardiomyopathy
Megacolon

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53
Q

Common causes of intraabdominal infection

A

Bacterioides fragilis
E. Coli

Both part of the Normal colonic flora

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54
Q

Herpes Simplex encephalitis

A

Presentation :- altered mental state
Headache
Seizures
Focal neuro deficits

MRI:- abnormal signal in bitemporal lobes
LP:- haemorrhagic lymphocytosis, increased protein, Normal glucose

Mgx:- acyclovir : - nucleoside analog when active competes with viral DNA polymerase

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55
Q

Babesiosis

A

Babesia microti

Transmission:- deer tick
NE USA

Presentation:- fever, myalgia, flu like symptom
Anaemia, thrombocytopenia, spleenomegaly

Bld smear:- intraeythrocytic inclusion

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56
Q

How can Ethanol cause hypoglycaemia

A

Inhibiting gluconeogenesis

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57
Q

Before alanine can be converted to glucose it transfers its amino group to

A

Alpha ketoglutarate —-> glutamate which then enters the urea cycle in the liver to dispose of nitrogen in catabolism

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58
Q

Benign neonatal hyperbilirubinaemia

A

Peak in first few days of life and self resolve

Raised bilirubin
Decreased bilirubin conjugation
Raised enterohepatic bilirubin circulation

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59
Q

What enzyme takes over in fructokinase deficiency

A

Hexokinase
Fructose ——> fructose -6-phosphate

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60
Q

Transcription factors that contain zinc fingers

A

Interact with intracellular receptors bind lipid soluble hormones and bid directly to target DNS via zinc fingers to regulate gene expression

Thryoid hormone
Steroids ( oestrogen, aldosterone, cortisol)
Fat soluble vitamins

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61
Q

Causes of 2o lactose intolerance

A

Inflammation —> coeliac
Infection —> giardiasis

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62
Q

Symptoms of vitamin C deficiency are due to which impairment

A

Impairment of collagen hydroxylation which occurs in the rough endoplasmic reticulum

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63
Q

Fluid loss in diabetes insidious

A

Hyperosmotic volume contraction
Osmolarity increased
Volume decreased in ECF and ICF

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64
Q

Fructokinase deficiency

A

Benign condition AR
Copper reduction test +Ve ( detects reducing sugar)
Urine dip / testing for glucose oxidase -ve ( wont test for fructose or galactose )

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65
Q

Maneuvers that increase/decrease HCM murmur

A

Increase:- standing, nitroglycerin administration, valsalva strain phase ( all decrease preload)

Decrease:- hand grip, passive leg raising, squatting

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66
Q

Carcinoid syndrome

A

Presentation:- episodic flushing, secretory diarrhoea and wheezing

Pathognomic —> plaque like deposits of fibrous tissue in RT side of heart —> TR and Rt HF

Raised levels urinary 5 hydrooxyindoleacetic acid

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67
Q

Presence of S3

A

Sign of systolic HF
Indicate severe MR

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68
Q

Carotid sinus hypersensitivity

A

Common in older pts
Assoc with tactile stimulation of the carotid sinus e.g while shaving
Increase BP —> baroreceptor—> increase fatal stimulation —> PSNS —> decreased HR increased SNS vasodilation decreased systemic vascular resistance
Lead to vasovagal attack

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69
Q

complication of lrge PE a

A

Increase RV pressure
RV cavity enlargement —> RV dysfunction — > decreased CO —> Rt HF / corpulmonale

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70
Q

Major contributor to AF

A

Atrial remodelling
Other risk factors :- age , HF, mitral valve diseae

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71
Q

Bicuspid aortic valve complication

A

Significant aortic stenosis age 50 ( >10 years sooner than normal aging)

Normally asymptomatic in childhood

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72
Q

Peripartum. Cardiomyopathy

A

Form of dilated cardiomyopathy
Eccentric hypertrophy
Increase vent compliance
CO maintained ( temporarily)
Eventually
Low EF and Lt vent HF

S3 sound in dilated cardiomyopathy

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73
Q

Acute MR ventricular haemodynamics

A

Increase LT Vent EDV —> i.e increase preload
Decreased afterload
Increased Ejection fraction
Decrease SV

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74
Q

Failure of obliteration of ompahlomesentric duct

A

Meckels diverticulum

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75
Q

Intestinal malrotation

A

Presentation:- neonatal bilious vomiting

Pathology:- intestinal malrotation —> duodenal compression by Ladd bands

Midgut volvulus

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76
Q

Matching in case control studies is used to eliminate what type of bias

A

Confounding ( external unmeasured factors confounding the results)

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77
Q

Involvement of lactiferous ducts would lead to what symptom

A

Nipple discharge

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78
Q

Skin puckering in breast is due to involvement of which structure

A

Suspensory ligament

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79
Q

MoA of monoclonal antibodies in cancer immunotherapy

A

The Fc portion of antibody identified by NK cells which released perforins and granzymes to induce apoptosis

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80
Q

Why is HbS prone to sickling

A

Substitution of valine to glutamic acid at the 6th amino acid promotes hydrophobic interaction between HBV molecules leading to sickling

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81
Q

Persistent depressive disorder

A

Depressive disorder >= 2 years of

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82
Q

Adjustment disorder

A

Symptoms of sadness, distress, or functional impairment occur 3/12 or less from psychosocial stressor

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83
Q

Major Depressive disorder

A

> =5 5 symptoms lasting more than 2/52
Depressed mood
Anhedonia
Loss of appetite
Insomnia/hypersomnia
Low energy
Poor concentration
Feelings of worthlessness
Thoughts of death/ suicide

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84
Q

Hypovoluemic shock

A

Reduced baroreceptor firing
Reduced stretch
Reduced ANP/ reduced PCWP
Increased Contractility
Increased SNS
Increase vasoconstriction
Increase HR

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85
Q

Stop codons

A

UAA
UAG
UGA
Signal termination of protein synthesis

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86
Q

Releasing factors MoA

A

Recognise stop codons and terminate protein synthesis

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87
Q

Lactose intolerance findings

A

Decreased stool pH
Increased breath hydrogen content
Increased stool osmolality

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88
Q

Korotkoff sounds in pulsus paradoxus

A

The difference in SBP at which korotokoff is first heard in expiration and pressure when is heard through all phases of respiration

If >10mmg = pulsus paradoxus

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89
Q

salbutamol/albuterol MoA

A

B adrenergic receptor agonists
Relaxation of bronchial smooth muscle
Via Gs protein receptor —> increase cAMP

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90
Q

3rd degree HB

A

Complete dissociation between P and QRS
SA node transmission being blocked at level of AVN and HIS
accessory electrical impulses are sent from either the AV node/ HIS bundle ( both can generate their own electrical impulses)

91
Q

Prostacyclin

A

Synthesised from prostaglandin H2
Released by vascular endothelial cells
Inhibits plt aggregation
Opposes thombaxane A2 ( plt aggregator)

92
Q

Differential cyanosis

A

Cyanosis affecting only the lower body
Seen in PDA with RT to LT shunt
Usually 2o persistent pulmonary HTN of the newborn

93
Q

Murmur of bicuspid aortic valve

A

Soft systolic ejection murmur at the RT 2nd intercostal

94
Q

Cocaine MoA

A

Blocks presynaptic reuptake of catecholamines inc dopamine and NE

Toxicity can cause stroke / MI

95
Q

In folate deficiency addiction of which substance can reduce apoptosis

A

Thymidine supplementation
Will bypass thymidylate synthase and reduce apoptosis

96
Q

Common pathogens in acute otitis media

A

S Pneumoniae
H influenzae
Moraxella catarrhalis

97
Q

Presbyopia

A

Far sighted related to age
Improves mild myopia
2o loss of lens elasticity due to decreased collagen synthesis 2o age like wrinkles

98
Q

Turner syndrome features

A

45XO
1o amenorrhoea
Short stature
High arched palate
Widely spaced nipple
Atrophic ovaries
Coarctation of the aorta
Horseshoe kidney
Bicuspid aortic valve

99
Q

Transient global amnesia

A

Transient dysfunction in hippocampus

Presentation:- sudden onset prominent anterograde amnesia and repetitive question
Oriented to person
Disoriented to place

100
Q

What happens in LN during an infection

A

In germinal centres B cells undergo isotope/ Ig switching to be able to produce antibodies

101
Q

Bacterial cell wall

A

Main component peptidoglycan
Glycosyltransferase is a important enzyme in peptidoglycan synthesis

mycoplasma genus have on peptidoglycan cell wall

102
Q

Primary amoebic meningoencephalitis

A

Caused by Naegleria Fowleri
Transmission:- warm water inhaled during water activities

Presentation:- meningoencephalitis, confusion
CSF:- motile trophozites

103
Q

Chikingunya

A

Toga virus, +ve SS RNA
Transmission: - Aedes mosquito
Hx of travel to S America

Presentation:- fever, lymphadenopathy, rash, severe Polyarthritis

( dengue fever would have additional haemorrhagic symptoms)

104
Q

Candida chorioretinitis

A

Transmission:- Haematogenous spreads in fungaemia
In hospitalised pts with indwelling central catheters, GI surgery

Presentation:- Unilateral floaters, progressive vision loss

105
Q

Osteomyelitis Pathogens

A

In healthy children
1. S Aureus
2. Strep pyogens

106
Q

Viral meningitis CSF features

A

Enterovirus commonest pathogen (coxsackievirus, echovirus, poliovirus)

CSF:- WBC <500, lymphocytic
Glucose level N or slightly reduced
Protein <150

107
Q

HIV 2

A

Endemic to W Africa
Assoc with lower viral loads, less risk of transmission, slower progression to AIDS
+ve screening with negative plasma HIV-1RNA

108
Q

HIV 2

A

Endemic to W Africa
Assoc with lower viral loads, less risk of transmission, slower progression to AIDS
+ve screening with negative plasma HIV-1RNA

109
Q

Rotavirus

A

Segmented naked DsRNA

Presentation:- watery diarrhoea

Blinding of the villi in the duodenum and proximal jejunum

110
Q

PCR

A

Used to amplify small fragments of DNA

111
Q

Oculocutaneous albinism

A

AR
Tyrosin are mutation
Tyrosin—-X—-> DOPA
Impaired melanin synthesis
Abnormal optic nerve
White skin, hair

112
Q

Lactic acidosis in septic shock is due to

A

Hypoxia which impairs oxidative phosphorylation

113
Q

Lung lobes affected in aspiration pneumonia

A

Post segment of upper lobes.
Post segment of lower lobes lobes

114
Q

Hartnup disease

A

Impaired transport of neutral amino acid in small intestine and PCT

Symptoms:- pellagra like skin eruptions
Cerebellar ataxia
2o niacin deficiency

115
Q

Riboflavin deficiency

A

Symptoms:- chelitis, glossitis, angular stomatitis

Is a precursor of coenzymes FMN and FAD uses in TCA and Electron transport chain —>succinate dehydrogenase impaired in deficiency

116
Q

Cancer cells use of glucose

A

Increase rate of glycolysis with excess lactate production

Due to Warburg effect Ca cells use anaerobic glycolysis

117
Q

Spironolactone and Epleronone

A

Mineralocorticoid receptor antagonist

K sparing diuretics
Improve survival in pts with CCF and low EF

SE:- gynaecomastia

Contraindicated in hyper kalaemia or renal failure

118
Q

Digoxin toxicity

A

Colour vision changes
Anorexia
Vomiting
Confusion
Weakness
Arrhythmias

119
Q

Class I antiarrhythmics

A

Na channel blockers
1C > 1A> 1B

1C :- Flecinide, propafenone (tachyarrhythmias)
1A:- Quinidine, procainamide, disopyramide
1B:- lidocaine, mexiletine ( ischaemic myodcardium)

120
Q

Pts taking nitrates can develop

A

Tolerance therefore need go have nitrates free period

121
Q

Hydralazine SE

A

Na and H2O retention via RAAS

Baroreceptors sense decrease in BP
SNS stimulated
Activate RAAS

122
Q

Hypertensive emergency

A

Severe HTN with end organ damage

123
Q

Fenoldopam

A

Dopa 1 receptor agonist

MoA:- increase cAMP —> vasodilation of arterial bed and increased renal perfusion

Use:- hypertensive emergency esp with renal insufficiency

124
Q

Verapamil

A

Non dihydropyridine Ca channel blocker

MoA:- decrease HR, decrease LV contractility, increase bld volume, decrease LV outflow obstruction
Increase diastolic filling time —> increase preload

Use:- HCM

125
Q

B12 deficiency

A

Presentation:- paraesthesia, ataxic gait, weakness —> vibration and position sense ( subacute combined degeneration of the cord)
With megaloblastic anaemia

Vegan diet risk factor

126
Q

Control selection In case control studies

A

Controls should be selected on disease status not on exposure status

127
Q

Malformation

A

Defect in organogenesis e.g genetic or teratogenic

128
Q

Deformation

A

Mechanical forces alter shape/position of a structure that was previously developing normally

129
Q

Vascular calcifications in CKD

A

2o high PO4
Hig Ca
Chronic inflammation 2o uraemia, hyperlipidaemia
Atherosclerosis

130
Q

Heteroplasmy

A

Range of phenotypes

131
Q

Physician burnout vs fatigue

A

Burnout:- jaded, emotionally exhausted make mistakes and don’t care

Fatigue:- due to sleep deprivation

132
Q

Tetanus

A

Clostridium tetani
Presentation:-
puncture injury —-> motor neuron —> spinal cord

Increase painful muscle tone, spasm, lock jaw triggered by sensory stimuli

133
Q

Cauda equina syndrome

A

Involvement of pelvic splanchinic nerves

Constipation
Difficultly urinating
Saddle anesthesia
Lower back pain

134
Q

Multiple Myeloma presentation

A

Osteolytic lesions
Hypercalcaemia
Anaemia
Acute renal injury
Free light chains nephropathy

135
Q

IVC formed by which vessels

A

Formed by the RT and LT iliac veins at L4-L5

136
Q

Cephalosporin

A

MoA:- transpeptidase peptidoglycan cell wall inhibitor

Resistance:- change in structure of protein preventing cephalosporin binding

137
Q

Lab findings in bulimia

A

Hypokalaemia
Metabolic alkalosis

138
Q

Probability of a female sibling of a male affected with X linked recessive disease giving birth to affected child is

A

1/8

139
Q

Correlation coefficient

A

Positive :- proportional —> strong closer to 1 weak closer to 0

Negative :- inversely proportional —-> strong relationship/ correlation closer to -1, weak closer to 0

140
Q

Cytokines seen in sepsis

A

TNF alpha
IL-1
I’ll-6

141
Q

Incretins

A

GLP1 glucagon like peptide 1
GIP glucose independent insulinotropic peptide

Stimulate pancreas to release insulin

Effect PO>IV

142
Q

Methemoglobin

A

Caused by exposure to nitrite poisoning

Presentation:- dusky discoloration to skin

PO2 ( how much dissolved o2 in the plasma not related to HgB function )
decreaed O2 delivery to peripheral tissue

143
Q

Cutaneous Warts are caused by

A

HPB

144
Q

H influenzae and staph aureus on same agar

A

H influenzae is blood loving organism
Staph aureus is b haemolytic secrete V factor (NAD+)
H influenzae grows near the staph aureus colonies as it needs X (haemain) and V (NAD+) factors

145
Q

Why is Hep C is genetically unstable

A

Because it lacks proof reading 3’—->5’

146
Q

Bronchiolitis

A

RSV

Presentation:- Children <2
nasal congestion, discharge, cough
Wheezing/ crackles and resp distress

147
Q

hook worms

A

Necator americanus and ancylostoma duodenale

Transmission:- dermal penetration

Complication: - pruruitis, serpiginous rash at time of dermal penetration
microcytic iron deficiency Anaemia

148
Q

Epidermal multinucleated giant cells seen with

A

HSV
VZV

149
Q

Nectortining kertinocytes in the epidermis seen in

A

Stevens Johnson syndrome

1-3/52 after infection (CMV, mycoplasma)
Drug exposure

150
Q

Artemisinin

A

Use:- plasmodium falciparum to avoid cholorquine resistance

Also atovaquone-proguanil

151
Q

Nifurtimox

A

Use:- trypanosomiasis ( tsetse )

152
Q

Treatment for social anxiety disorder

A

SSRI/SNRI
CBT
B Blocker or benzos ( for specific performance only )

153
Q

Pain and blurring vision in previously normal eye when other eye has undergone trauma

A

Eyes and testes have immune privilege
After trauma T cells recognise self antigens in the N side as foreign and launch an attack

154
Q

True negative equation

A

Specificity X total number of pts without the disease

155
Q

False positive equation

A

1-Specificity X total number of pts without the disease

156
Q

Homocystinuria defect and supplementation

A

Deficiency :- cystathionine synthase

Supplement with B6 —> cofactors in metabolism

Restrict:- methionine

157
Q

Influenza virus depends on what to interact with host cells

A

Antigenic surface glycoprotein called haemaglutnin

158
Q

COPD lung function parameters

A

increase RV
Increase TLC
RV/TLC ration increased
Decreased FVC
Decreased FEV1/FVC

159
Q

Crohns disease complication

A

Gallstones 2o increased bile acid wasting leading to supersaturation of cholesterol in gallbladder

160
Q

Chi square test

A

Association between qualitative variables

161
Q

Anencephaly is due to defect in

A

Rostral ( anterior) neupore closure

162
Q

Clearance of a substance equation

A

Cs= urine concentration of substance X urine flow rate / plasma concentration of substance

163
Q

Filtration fraction equation

A

FF= GFR /RPF

GFR estimated from creatinine clearance or inulin clearance
RPF estimated from para-aminohippuric acid clearance

164
Q

Vitamin C deficiency features

A

Perifollicular haemorrhage
Petechia
Periodontal diseae
Subperiosteal haemorhage/ haematoma —> pain on walking esp in children

165
Q

S Epidermidis virulence

A

G+ve cocci catalase +ve coagulase -ve, novobicin sensitive

Virulence factor:= synthesis of extracellular polysaccharide matrix allowing it to produce adherent biofilm

166
Q

Afferent pupillary defect

A

Can occur 2o optic neuritis/ retinal detachment
Sluggish or absent pupil reaction both eyes in ipsilateral side and intact pupil reflex in normal side

167
Q

Schizotypal personality disorder

A

Eccentric, magical thinking odd beliefs, perceptual distortions and social anxiety despite familiarity

168
Q

TAP mutation affects which process

A

Cytotoxic T cell activation by MHC class I molecules

169
Q

Telomerase

A

Ribonucleoprotein reverse transcriptase that adds TTAGGG to the 3’ end of chromosomes

Found in cells that constantly divide like skin

170
Q

Finasteride

A

5 alpha reductase inhibitor
MoA:- block conversion of testosterone to DHT

Use:- BPH
SE:- gynaecomastia (2o increased conversion of testosterone to estradiol)

171
Q

Intensive endurance training affect on heart

A

Enlarged RT and LT ventricle
Increase SV
Increase CO
Pulmonic flow murmur
Unchanged LVEF

172
Q

LAbetalol

A

Non selective vasodilators B blocker
Blockers alpha 1 > beta 2 and beta 1

Causes:- peripheral vasodilation in veins and arterioles
Decreased BP
Decrease SVR

No change in SV
Decreased HR ( B2 effect)

173
Q

Metoprolol

A

Cardioselective beta blocker

Blocks B1» B2

Mild reduction BP
No change in SVR

Decreased HR
Decrease contractiliy

174
Q

Milrinone

A

Phosphodiesterase -3 inhibitor

MoA:- increase cAMP increase Ca influx
Increase Contractility
Causes: vasodilation
Reduce preload
Reduces Afterload

Use: - systolic HF

175
Q

Complete AV canal defect

A

ASD
VSD
Common AV valse

Seen in trisomy 21

176
Q

Paradoxical embolism is seen in

A

Patent foramen ovale
ASD ( wide fixed splitting of S2)
VSD
Large pulmonary AV malformation

177
Q

Treatment of S epidermidis

A

Vancomycin
If methicillin sensitive
Nafcillin / oxacillin

178
Q

Acute myocarditis

A

Viral cause
Myocyte necrosis with inflammatory mononuclear cell infiltrate

Presentation:- asymptomatic
Decompensated HF
Dilated cardiomyopathy
Sudden cardiac death

179
Q

Diffusion limited gas exchange

A

Huge drop between alveolar PO2 and capillary pO2
High A-a gradient (normally 4-150

180
Q

Cystic fibrosis mutation

A

AR
Mutation F508 in the CF transmembrane regulator CFTR gene
ATP gated chloride channel

181
Q

Acute PE blood gas findings

A

hypoxia
PH alkalosis
Low PaCO2
Initially no HCO3 changes eventually HCO3 will be lost to balance resp alkalosis

182
Q

Hypoxaemia causes

A

Alveolar hypoventilation
V/Q mismatch —> dead space ventilation/ intrapulmonary shunt
Diffusion impairment
RT - Lt Shunt

183
Q

Anaemia arterial bld sample results

A

PaO2 normal
SaO2 normal
Total arterial O2 content low

184
Q

Interstitial lung disease LFT

A

Decrease TLC, VC, inspiratory capacity, FRC, RSV
Decreased FEV1 and FVC
FEV1/FVC increased

Exp flow rates higher than normal 2o radial traction on the airway walls by the interstitial fibrosis

185
Q

Which chemoreceptors respond to O2 and CO2

A

Peripheral chemoreceptors respond to PaO2 sense hypoxia

Central chemoreceptors in medulla —> response to CO2 / hypercapnia

186
Q

High content of chlorid in RBC in venous bld

A

Chloride shift
Most of CO2 transported to lungs as HCO3 in plasma
In RBC carbonic anhydrase forms HCO3 from CO2 and H2O
The excess HCO3 is transferred our of RBC to plasma with Cl exchange

187
Q

PE V/Q mismatch

A

Large perfusion defect without ventilation defect

188
Q

Auscultation findings in consolidation

A

Increased breath sounds
Increased tactile fremitus
Dull to percussion

189
Q

Ferruginous bodies

A

Seen in asbestosis
Translucent fibres coated with iron containing material

Histopathology:- diffuse interstitial fibrosis and ferruginous asbestos bodies
Pleural plaques and effusions

190
Q

Neonatal resp distress

A

Caused by immaturity of type 2 pneumocytes
Deficiency in surfactant
Decreased compliance
Increase surface tension of alveoli
Alveolar collapse

—> leading to atelactasis

CXR bilateral ground glass appearance

191
Q

Acute resp distress syndrome major contributor to lung damage

A

Release of reactive oxygen species and proteases by neutrophils

192
Q

Propionic acidaemia

A

Deficiency of propionyl -CoA carboxylase
Propionyl CoA—X—–> methylmalonyl-CoA

Presentation:- lethargy, poor feeding, hypotonia, vomiting
1-2/52 after birth

Propionyl CoA metabolised from valine, methionine, threonine and odd chain fatty acids

193
Q

Colchicine

A

MoA:- microtubular polymeritsation —> leading to decreased chemotaxis, phagocytosis inhibit leukocyte migration

Use:- acute gout

SE :- nausea, diarrhoea

194
Q

Cutaneous neurofibromas are derived from which emnbryologic structure

A

Schwann cells —> from neural crest

195
Q

RNA splicing and alternative RNA splicing

A

Occurs after transcription
Process by which exons are either included or excluded to create multiple mature mRNA transcripts of different lengths
Seen on northern booth as bands of different migration distances

Different band thickness is transcription

196
Q

Maintenance of RV contractile function after MI is because

A

RV has higher ischaemic conditioning
RV has more collateral circulation
RV has lower resting O2 extraction
RV is perfusion both systole and diastole

197
Q

Schizophrenia chemical imbalance

A

Increase dopamine in mesolimbic pathway

198
Q

Detrusor muscle

A

Involuntary smooth muscle of the bladder

Responsible for urine expulsion
Overactive in urge incontinence

199
Q

Bulbosongiosus muscle

A

Contracts the vaginalis orifice

200
Q

Levator ani Muscle complex

A

Targeted in kegel exercises

201
Q

Murmur of AR best hear with which maneuvers

A

Decrescendo diastolic murmur
Sitting up and leaning forward

202
Q

Direct compression of gonadotrope cells

A

Low LH
N prolactin
Low testosterone
symptoms of hypogonadism
Symptoms suggesting pituitary mass
Feminization 2o persistent aromatisation of adrenal oestrogen precursors

203
Q

Familial chylonmicronaemia

A

LPL deficiency
High chylomicrons

Complication:- a true pancreatitis, lipaemia retinalis, erutptive xanthomas

204
Q

Disseminated gonococcal infection

A

N gonorrhoea

Polyarthralgia
Tenosynovitis
Dermatitis ( painless pustules on extremities)

Isolated on chocolate agar infused with ABx ( Thayer martin agar)

205
Q

Complication of long term use of glucocorticoids

A

Suppression of hypothalamic pituitary adrenal axis
Leading to bilateral adrenocoritcal atrophy
Adrenal crisis

206
Q

Massive life threatnening haemoptysis in hx of bronchiectasis/CF

A

2o bleeding from hypertrophied bronchial arteries

207
Q

Complication of hand foot and mouth disease

A

Myocarditis
Aseptic meningitis

Caused by coxsackie virus - enterovirus

208
Q

Burkhlderia cepacia

A

G-ve rod lactose negative oxidase +ve

Causes CF exacerbation
CI for lung transplant

209
Q

Common pathogens for CF exacerbations

A

Staph Aureus
H Influenza
Pseudomonas aeruginosa
Burkholderia cepacia

210
Q

Rocky Mountain spot tent fever

A

Rickettsia rickettsii —> weak G-ve intracellular bacterium

Transmission:- tick bite
Found in South central, US , Mississippi River/ Appalachia hx of camping

Presentation:- fever, headache, rash that moves centrally

Mgx: doxycycline - inhibit protein synthesis

211
Q

Lac operon

A

Consists of Regulatory gene, a promoter gene and operator gene.
The operator gene codes for galactosidase responsible for hydrolysis of lactose to glucose

212
Q

Homocystinuria

A

Cystathionine synthase deficiency

Methionine…—->Homocysteine —-X—-> cysteine

Elevated methionine
Prothrombosis
Ectopic lentis
Intellectual disability

213
Q

Which enzymes maintain blood glucose but produce ketones in starvation

A

Initially glycogen phosphrylase for the first few hours

Hormone sensitive lipase in adipose tissue breaks down TG into free fatty acids and glycerol used for hepatic gluconeogenesis and metabolised into ketones bodies

214
Q

Pulmonary arterial hypertension Mgx

A

Bosentan —> competitive antagonist of endothelin receptor

215
Q

Prolonged neuromuscular paralysis with succinylcholine is due to

A

Pseudocholinesterase deficiency

216
Q

Ketamine

A

NMDA antagonist
Sympathomimetic

Used for anaesthesia induction

SE:- increase cathecholamine release —> bronchodilation, increase HR increase contractility
Increase risk CV event

217
Q

Idiopathic pulmonary fibrosis Mgx

A

Slowing progression of fibrosis
Inhibiting
transforming growth factor Beta
PDGF
VEGF

218
Q

Succinylcholine

A

MoA depolarizing neuromuscular blocking agent
Use:- rapid sequence induction

Initial train of four sequence global reduction then gradual fade

219
Q

Pulmonary disease risk in pts with alcohol abuse disorder

A

Lung abscess
2o anaerobic and aerobic organisms
Due to aspiration of oral flora during periods of unconsciousness

220
Q

Drug used to test for asthma when Spirometry is normal

A

Methacholine

221
Q

Ipratropium

A

MoA anticholinergic agent
Blockers acetylcholine at muscarinic receptor /PSNS

Prevents bronchoconstriction
Reduced mucus secretion

222
Q

Corticosteroids in asthma

A

Anti inflammatory
Up regulate beta 2 receptors on bronchial smooth muscles
Increase beta 2 receptor responsiveness
Increase surfactant

223
Q

Rifampin

A

MoA inhibits bacterial RNA synthesis —-> RNA polymerase 2
Use:- TB
SE:- turns bodily fluids red
Stimulates P450

LopsNotes (15 decks)

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