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 1 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

Apoprotein B-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
Cardiac haemochromatosis
Diastolic LT ventricular dysfunction Progresses to dilated cardiomyopathy Sinus node dysfunction ( syncope, malignancy arrhythmias) Sudden death 2o ventricular Brown granular deposits on myocyte as
26
Transposition of the great arteries
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
27
AS complications
Decreased Lt vent compliance —-> diastolic dysfucntion —> heart failure Increased in LT ventricular wall stress —> due to high chamber pressures —> increased in O2 demand —> angina
28
Local Complication of norepinephrine IV
Venous balancing, induration and pallor 2o norepinephrine leak —> alpha 1 mediated vasoconstriction —> eventual tissue necrosis Treatment:- phenytolamine —> alpha 1 blocker
29
Complication of fermoral arter catheterisation above inguinal ligament
Retroperitoneal haemorrhage
30
Down syndrome complications
Early onset Alzheimers ALL Duodenal atresia 2o failure of duodenal recanalisation Hypothyroidism ASD/VSD Hirschsprung disease
31
Pronator teres syndrome
Forceful pronation - playing tennis Median nerve compression between 2 heads of the pronator teres Presentation: sensory loss lateral plam, thenar, 3 1/2 digits
32
GLUT
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
33
Pt with CF confused, lethargy vomiting likely electrolyte distrutabce
Hyponatraemia Hypochloraemia
34
Aging changes in lung capacity
Decreased chest wall compliance Lung compliance increases Increase in RV TLC unchanged Decreased FVC Decreased FEV1
35
Polio antibody level between IM and ORal
Oral - Sabin has more oropharygeal and duodenal luminal IgA
36
Thyroglossal duct cyst
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
37
Stem cell transplantation 2o congenital genomic disease. Suitable donors
Matched unrelated donor Self/ identical sibling donor will have the congenital disease Unmatched siblings wont have the same HLA alleles
38
Thiamine deficiency
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)
39
Chronic lung transplant rejection
Presentation:- months/ years after transplantation slowly worsening dypnoea, dry cough End resp squeaks or pops FEV1 reduced ( obstructive) Pathology:- submucosal lymphocytic inflammation small airways
40
Ehrlichia chaffeensis
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
41
Conversion disorder
Deficits os voluntary motor +/- sensory function incompatible with any neuro condition
42
Somatic symptoms disorder
1 or more unexplained symptoms, excessive thoughts health anxiety and preoccupation worth the symptoms
43
When does bld flow into the vascular beds of the left ventricle
During diastole
44
MEN2A
Mutation of RET Medullary thyroid cancer > 95% Phaeochromocytoma >50% Parathyroid hyperplasia
45
Malaria in Brazil
P vivax Has hyponozoite phase —> can reappear after weeks or ,months Trophozoite phase:- rings in RBCs
46
Giardiasis Mgx
Diarrhoea in hikers/campers malabsorption, flatulence Metronidazole
47
Ciprofloxacin is used to treat what kind of diarrhoeal illness
Inflammatory traveler’s diarrhoea ( blood and mucus in stool)
48
Diphtheria primary treatment
G+ve rod non spore forming Diphtheria antitoxin to inactivate circulating toxins
49
Vibrio vulnificus
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
50
Chancroid
2o Haemophilius ducreyi Curved G-ve rods in a clumping pattern Causes:- painful deep ulcer with ragged borders, gray exudate and inguinal lymphadenopathy
51
Nocardia
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
52
Chagas disease
2o trypanosoma Cruzi a C or U shaped flagellated parasite Transmission:- kissing Endemic:- S. America Presentation :- dilated oesphagus +/- 2o achalasia Dilated cardiomyopathy Megacolon
53
Common causes of intraabdominal infection
Bacterioides fragilis E. Coli Both part of the Normal colonic flora
54
Herpes Simplex encephalitis
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
55
Babesiosis
Babesia microti Transmission:- deer tick NE USA Presentation:- fever, myalgia, flu like symptom Anaemia, thrombocytopenia, spleenomegaly Bld smear:- intraeythrocytic inclusion
56
How can Ethanol cause hypoglycaemia
Inhibiting gluconeogenesis
57
Before alanine can be converted to glucose it transfers its amino group to
Alpha ketoglutarate —-> glutamate which then enters the urea cycle in the liver to dispose of nitrogen in catabolism
58
Benign neonatal hyperbilirubinaemia
Peak in first few days of life and self resolve Raised bilirubin Decreased bilirubin conjugation Raised enterohepatic bilirubin circulation
59
What enzyme takes over in fructokinase deficiency
Hexokinase Fructose ——> fructose -6-phosphate
60
Transcription factors that contain zinc fingers
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
61
Causes of 2o lactose intolerance
Inflammation —> coeliac Infection —> giardiasis
62
Symptoms of vitamin C deficiency are due to which impairment
Impairment of collagen hydroxylation which occurs in the rough endoplasmic reticulum
63
Fluid loss in diabetes insidious
Hyperosmotic volume contraction Osmolarity increased Volume decreased in ECF and ICF
64
Fructokinase deficiency
Benign condition AR Copper reduction test +Ve ( detects reducing sugar) Urine dip / testing for glucose oxidase -ve ( wont test for fructose or galactose )
65
Maneuvers that increase/decrease HCM murmur
Increase:- standing, nitroglycerin administration, valsalva strain phase ( all decrease preload) Decrease:- hand grip, passive leg raising, squatting
66
Carcinoid syndrome
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
67
Presence of S3
Sign of systolic HF Indicate severe MR
68
Carotid sinus hypersensitivity
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
69
complication of lrge PE a
Increase RV pressure RV cavity enlargement —> RV dysfunction — > decreased CO —> Rt HF / corpulmonale
70
Major contributor to AF
Atrial remodelling Other risk factors :- age , HF, mitral valve diseae
71
Bicuspid aortic valve complication
Significant aortic stenosis age 50 ( >10 years sooner than normal aging) Normally asymptomatic in childhood
72
Peripartum. Cardiomyopathy
Form of dilated cardiomyopathy Eccentric hypertrophy Increase vent compliance CO maintained ( temporarily) Eventually Low EF and Lt vent HF S3 sound in dilated cardiomyopathy
73
Acute MR ventricular haemodynamics
Increase LT Vent EDV —> i.e increase preload Decreased afterload Increased Ejection fraction Decrease SV
74
Failure of obliteration of ompahlomesentric duct
Meckels diverticulum
75
Intestinal malrotation
Presentation:- neonatal bilious vomiting Pathology:- intestinal malrotation —> duodenal compression by Ladd bands Midgut volvulus
76
Matching in case control studies is used to eliminate what type of bias
Confounding ( external unmeasured factors confounding the results)
77
Involvement of lactiferous ducts would lead to what symptom
Nipple discharge
78
Skin puckering in breast is due to involvement of which structure
Suspensory ligament
79
MoA of monoclonal antibodies in cancer immunotherapy
The Fc portion of antibody identified by NK cells which released perforins and granzymes to induce apoptosis
80
Why is HbS prone to sickling
Substitution of valine to glutamic acid at the 6th amino acid promotes hydrophobic interaction between HBV molecules leading to sickling
81
Persistent depressive disorder
Depressive disorder >= 2 years of
82
Adjustment disorder
Symptoms of sadness, distress, or functional impairment occur 3/12 or less from psychosocial stressor
83
Major Depressive disorder
>=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
84
Hypovoluemic shock
Reduced baroreceptor firing Reduced stretch Reduced ANP/ reduced PCWP Increased Contractility Increased SNS Increase vasoconstriction Increase HR
85
Stop codons
UAA UAG UGA Signal termination of protein synthesis
86
Releasing factors MoA
Recognise stop codons and terminate protein synthesis
87
Lactose intolerance findings
Decreased stool pH Increased breath hydrogen content Increased stool osmolality
88
Korotkoff sounds in pulsus paradoxus
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
89
salbutamol/albuterol MoA
B adrenergic receptor agonists Relaxation of bronchial smooth muscle Via Gs protein receptor —> increase cAMP
90
3rd degree HB
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
Prostacyclin
Synthesised from prostaglandin H2 Released by vascular endothelial cells Inhibits plt aggregation Opposes thombaxane A2 ( plt aggregator)
92
Differential cyanosis
Cyanosis affecting only the lower body Seen in PDA with RT to LT shunt Usually 2o persistent pulmonary HTN of the newborn
93
Murmur of bicuspid aortic valve
Soft systolic ejection murmur at the RT 2nd intercostal
94
Cocaine MoA
Blocks presynaptic reuptake of catecholamines inc dopamine and NE Toxicity can cause stroke / MI
95
In folate deficiency addiction of which substance can reduce apoptosis
Thymidine supplementation Will bypass thymidylate synthase and reduce apoptosis
96
Common pathogens in acute otitis media
S Pneumoniae H influenzae Moraxella catarrhalis
97
Presbyopia
Far sighted related to age Improves mild myopia 2o loss of lens elasticity due to decreased collagen synthesis 2o age like wrinkles
98
Turner syndrome features
45XO 1o amenorrhoea Short stature High arched palate Widely spaced nipple Atrophic ovaries Coarctation of the aorta Horseshoe kidney Bicuspid aortic valve
99
Transient global amnesia
Transient dysfunction in hippocampus Presentation:- sudden onset prominent anterograde amnesia and repetitive question Oriented to person Disoriented to place
100
What happens in LN during an infection
In germinal centres B cells undergo isotope/ Ig switching to be able to produce antibodies
101
Bacterial cell wall
Main component peptidoglycan Glycosyltransferase is a important enzyme in peptidoglycan synthesis mycoplasma genus have on peptidoglycan cell wall
102
Primary amoebic meningoencephalitis
Caused by Naegleria Fowleri Transmission:- warm water inhaled during water activities Presentation:- meningoencephalitis, confusion CSF:- motile trophozites
103
Chikingunya
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
Candida chorioretinitis
Transmission:- Haematogenous spreads in fungaemia In hospitalised pts with indwelling central catheters, GI surgery Presentation:- Unilateral floaters, progressive vision loss
105
Osteomyelitis Pathogens
In healthy children 1. S Aureus 2. Strep pyogens
106
Viral meningitis CSF features
Enterovirus commonest pathogen (coxsackievirus, echovirus, poliovirus) CSF:- WBC <500, lymphocytic Glucose level N or slightly reduced Protein <150
107
HIV 2
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
HIV 2
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
Rotavirus
Segmented naked DsRNA Presentation:- watery diarrhoea Blinding of the villi in the duodenum and proximal jejunum
110
PCR
Used to amplify small fragments of DNA
111
Oculocutaneous albinism
AR Tyrosin are mutation Tyrosin—-X—-> DOPA Impaired melanin synthesis Abnormal optic nerve White skin, hair
112
Lactic acidosis in septic shock is due to
Hypoxia which impairs oxidative phosphorylation
113
Lung lobes affected in aspiration pneumonia
Post segment of upper lobes. Post segment of lower lobes lobes
114
Hartnup disease
Impaired transport of neutral amino acid in small intestine and PCT Symptoms:- pellagra like skin eruptions Cerebellar ataxia 2o niacin deficiency
115
Riboflavin deficiency
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
Cancer cells use of glucose
Increase rate of glycolysis with excess lactate production Due to Warburg effect Ca cells use anaerobic glycolysis
117
Spironolactone and Epleronone
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
Digoxin toxicity
Colour vision changes Anorexia Vomiting Confusion Weakness Arrhythmias
119
Class I antiarrhythmics
Na channel blockers 1C > 1A> 1B 1C :- Flecinide, propafenone (tachyarrhythmias) 1A:- Quinidine, procainamide, disopyramide 1B:- lidocaine, mexiletine ( ischaemic myodcardium)
120
Pts taking nitrates can develop
Tolerance therefore need go have nitrates free period
121
Hydralazine SE
Na and H2O retention via RAAS Baroreceptors sense decrease in BP SNS stimulated Activate RAAS
122
Hypertensive emergency
Severe HTN with end organ damage
123
Fenoldopam
Dopa 1 receptor agonist MoA:- increase cAMP —> vasodilation of arterial bed and increased renal perfusion Use:- hypertensive emergency esp with renal insufficiency
124
Verapamil
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
B12 deficiency
Presentation:- paraesthesia, ataxic gait, weakness —> vibration and position sense ( subacute combined degeneration of the cord) With megaloblastic anaemia Vegan diet risk factor
126
Control selection In case control studies
Controls should be selected on disease status not on exposure status
127
Malformation
Defect in organogenesis e.g genetic or teratogenic
128
Deformation
Mechanical forces alter shape/position of a structure that was previously developing normally
129
Vascular calcifications in CKD
2o high PO4 Hig Ca Chronic inflammation 2o uraemia, hyperlipidaemia Atherosclerosis
130
Heteroplasmy
Range of phenotypes
131
Physician burnout vs fatigue
Burnout:- jaded, emotionally exhausted make mistakes and don’t care Fatigue:- due to sleep deprivation
132
Tetanus
Clostridium tetani Presentation:- puncture injury —-> motor neuron —> spinal cord Increase painful muscle tone, spasm, lock jaw triggered by sensory stimuli
133
Cauda equina syndrome
Involvement of pelvic splanchinic nerves Constipation Difficultly urinating Saddle anesthesia Lower back pain
134
Multiple Myeloma presentation
Osteolytic lesions Hypercalcaemia Anaemia Acute renal injury Free light chains nephropathy
135
IVC formed by which vessels
Formed by the RT and LT iliac veins at L4-L5
136
Cephalosporin
MoA:- transpeptidase peptidoglycan cell wall inhibitor Resistance:- change in structure of protein preventing cephalosporin binding
137
Lab findings in bulimia
Hypokalaemia Metabolic alkalosis
138
Probability of a female sibling of a male affected with X linked recessive disease giving birth to affected child is
1/8
139
Correlation coefficient
Positive :- proportional —> strong closer to 1 weak closer to 0 Negative :- inversely proportional —-> strong relationship/ correlation closer to -1, weak closer to 0
140
Cytokines seen in sepsis
TNF alpha IL-1 I’ll-6
141
Incretins
GLP1 glucagon like peptide 1 GIP glucose independent insulinotropic peptide Stimulate pancreas to release insulin Effect PO>IV
142
Methemoglobin
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
Cutaneous Warts are caused by
HPB
144
H influenzae and staph aureus on same agar
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
Why is Hep C is genetically unstable
Because it lacks proof reading 3’—->5’
146
Bronchiolitis
RSV Presentation:- Children <2 nasal congestion, discharge, cough Wheezing/ crackles and resp distress
147
hook worms
Necator americanus and ancylostoma duodenale Transmission:- dermal penetration Complication: - pruruitis, serpiginous rash at time of dermal penetration microcytic iron deficiency Anaemia
148
Epidermal multinucleated giant cells seen with
HSV VZV
149
Nectortining kertinocytes in the epidermis seen in
Stevens Johnson syndrome 1-3/52 after infection (CMV, mycoplasma) Drug exposure
150
Artemisinin
Use:- plasmodium falciparum to avoid cholorquine resistance Also atovaquone-proguanil
151
Nifurtimox
Use:- trypanosomiasis ( tsetse )
152
Treatment for social anxiety disorder
SSRI/SNRI CBT B Blocker or benzos ( for specific performance only )
153
Pain and blurring vision in previously normal eye when other eye has undergone trauma
Eyes and testes have immune privilege After trauma T cells recognise self antigens in the N side as foreign and launch an attack
154
True negative equation
Specificity X total number of pts without the disease
155
False positive equation
1-Specificity X total number of pts without the disease
156
Homocystinuria defect and supplementation
Deficiency :- cystathionine synthase Supplement with B6 —> cofactors in metabolism Restrict:- methionine
157
Influenza virus depends on what to interact with host cells
Antigenic surface glycoprotein called haemaglutnin
158
COPD lung function parameters
increase RV Increase TLC RV/TLC ration increased Decreased FVC Decreased FEV1/FVC
159
Crohns disease complication
Gallstones 2o increased bile acid wasting leading to supersaturation of cholesterol in gallbladder
160
Chi square test
Association between qualitative variables
161
Anencephaly is due to defect in
Rostral ( anterior) neupore closure
162
Clearance of a substance equation
Cs= urine concentration of substance X urine flow rate / plasma concentration of substance
163
Filtration fraction equation
FF= GFR /RPF GFR estimated from creatinine clearance or inulin clearance RPF estimated from para-aminohippuric acid clearance
164
Vitamin C deficiency features
Perifollicular haemorrhage Petechia Periodontal diseae Subperiosteal haemorhage/ haematoma —> pain on walking esp in children
165
S Epidermidis virulence
G+ve cocci catalase +ve coagulase -ve, novobicin sensitive Virulence factor:= synthesis of extracellular polysaccharide matrix allowing it to produce adherent biofilm
166
Afferent pupillary defect
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
Schizotypal personality disorder
Eccentric, magical thinking odd beliefs, perceptual distortions and social anxiety despite familiarity
168
TAP mutation affects which process
Cytotoxic T cell activation by MHC class I molecules
169
Telomerase
Ribonucleoprotein reverse transcriptase that adds TTAGGG to the 3’ end of chromosomes Found in cells that constantly divide like skin
170
Finasteride
5 alpha reductase inhibitor MoA:- block conversion of testosterone to DHT Use:- BPH SE:- gynaecomastia (2o increased conversion of testosterone to estradiol)
171
Intensive endurance training affect on heart
Enlarged RT and LT ventricle Increase SV Increase CO Pulmonic flow murmur Unchanged LVEF
172
LAbetalol
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
Metoprolol
Cardioselective beta blocker Blocks B1>> B2 Mild reduction BP No change in SVR Decreased HR Decrease contractiliy
174
Milrinone
Phosphodiesterase -3 inhibitor MoA:- increase cAMP increase Ca influx Increase Contractility Causes: vasodilation Reduce preload Reduces Afterload Use: - systolic HF
175
Complete AV canal defect
ASD VSD Common AV valse Seen in trisomy 21
176
Paradoxical embolism is seen in
Patent foramen ovale ASD ( wide fixed splitting of S2) VSD Large pulmonary AV malformation
177
Treatment of S epidermidis
Vancomycin If methicillin sensitive Nafcillin / oxacillin
178
Acute myocarditis
Viral cause Myocyte necrosis with inflammatory mononuclear cell infiltrate Presentation:- asymptomatic Decompensated HF Dilated cardiomyopathy Sudden cardiac death
179
Diffusion limited gas exchange
Huge drop between alveolar PO2 and capillary pO2 High A-a gradient (normally 4-150
180
Cystic fibrosis mutation
AR Mutation F508 in the CF transmembrane regulator CFTR gene ATP gated chloride channel
181
Acute PE blood gas findings
hypoxia PH alkalosis Low PaCO2 Initially no HCO3 changes eventually HCO3 will be lost to balance resp alkalosis
182
Hypoxaemia causes
Alveolar hypoventilation V/Q mismatch —> dead space ventilation/ intrapulmonary shunt Diffusion impairment RT - Lt Shunt
183
Anaemia arterial bld sample results
PaO2 normal SaO2 normal Total arterial O2 content low
184
Interstitial lung disease LFT
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
Which chemoreceptors respond to O2 and CO2
Peripheral chemoreceptors respond to PaO2 sense hypoxia Central chemoreceptors in medulla —> response to CO2 / hypercapnia
186
High content of chlorid in RBC in venous bld
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
PE V/Q mismatch
Large perfusion defect without ventilation defect
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Auscultation findings in consolidation
Increased breath sounds Increased tactile fremitus Dull to percussion
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Ferruginous bodies
Seen in asbestosis Translucent fibres coated with iron containing material Histopathology:- diffuse interstitial fibrosis and ferruginous asbestos bodies Pleural plaques and effusions
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Neonatal resp distress
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
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Acute resp distress syndrome major contributor to lung damage
Release of reactive oxygen species and proteases by neutrophils
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Propionic acidaemia
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
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Colchicine
MoA:- microtubular polymeritsation —> leading to decreased chemotaxis, phagocytosis inhibit leukocyte migration Use:- acute gout SE :- nausea, diarrhoea
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Cutaneous neurofibromas are derived from which emnbryologic structure
Schwann cells —> from neural crest
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RNA splicing and alternative RNA splicing
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
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Maintenance of RV contractile function after MI is because
RV has higher ischaemic conditioning RV has more collateral circulation RV has lower resting O2 extraction RV is perfusion both systole and diastole
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Schizophrenia chemical imbalance
Increase dopamine in mesolimbic pathway
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Detrusor muscle
Involuntary smooth muscle of the bladder Responsible for urine expulsion Overactive in urge incontinence
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Bulbosongiosus muscle
Contracts the vaginalis orifice
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Levator ani Muscle complex
Targeted in kegel exercises
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Murmur of AR best hear with which maneuvers
Decrescendo diastolic murmur Sitting up and leaning forward
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Direct compression of gonadotrope cells
Low LH N prolactin Low testosterone symptoms of hypogonadism Symptoms suggesting pituitary mass Feminization 2o persistent aromatisation of adrenal oestrogen precursors
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Familial chylonmicronaemia
LPL deficiency High chylomicrons Complication:- a true pancreatitis, lipaemia retinalis, erutptive xanthomas
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Disseminated gonococcal infection
N gonorrhoea Polyarthralgia Tenosynovitis Dermatitis ( painless pustules on extremities) Isolated on chocolate agar infused with ABx ( Thayer martin agar)
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Complication of long term use of glucocorticoids
Suppression of hypothalamic pituitary adrenal axis Leading to bilateral adrenocoritcal atrophy Adrenal crisis
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Massive life threatnening haemoptysis in hx of bronchiectasis/CF
2o bleeding from hypertrophied bronchial arteries
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Complication of hand foot and mouth disease
Myocarditis Aseptic meningitis Caused by coxsackie virus - enterovirus
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Burkhlderia cepacia
G-ve rod lactose negative oxidase +ve Causes CF exacerbation CI for lung transplant
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Common pathogens for CF exacerbations
Staph Aureus H Influenza Pseudomonas aeruginosa Burkholderia cepacia
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Rocky Mountain spot tent fever
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
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Lac operon
Consists of Regulatory gene, a promoter gene and operator gene. The operator gene codes for galactosidase responsible for hydrolysis of lactose to glucose
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Homocystinuria
Cystathionine synthase deficiency Methionine…—->Homocysteine —-X—-> cysteine Elevated methionine Prothrombosis Ectopic lentis Intellectual disability
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Which enzymes maintain blood glucose but produce ketones in starvation
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
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Pulmonary arterial hypertension Mgx
Bosentan —> competitive antagonist of endothelin receptor
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Prolonged neuromuscular paralysis with succinylcholine is due to
Pseudocholinesterase deficiency
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Ketamine
NMDA antagonist Sympathomimetic Used for anaesthesia induction SE:- increase cathecholamine release —> bronchodilation, increase HR increase contractility Increase risk CV event
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Idiopathic pulmonary fibrosis Mgx
Slowing progression of fibrosis Inhibiting transforming growth factor Beta PDGF VEGF
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Succinylcholine
MoA depolarizing neuromuscular blocking agent Use:- rapid sequence induction Initial train of four sequence global reduction then gradual fade
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Pulmonary disease risk in pts with alcohol abuse disorder
Lung abscess 2o anaerobic and aerobic organisms Due to aspiration of oral flora during periods of unconsciousness
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Drug used to test for asthma when Spirometry is normal
Methacholine
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Ipratropium
MoA anticholinergic agent Blockers acetylcholine at muscarinic receptor /PSNS Prevents bronchoconstriction Reduced mucus secretion
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Corticosteroids in asthma
Anti inflammatory Up regulate beta 2 receptors on bronchial smooth muscles Increase beta 2 receptor responsiveness Increase surfactant
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Rifampin
MoA inhibits bacterial RNA synthesis —-> RNA polymerase 2 Use:- TB SE:- turns bodily fluids red Stimulates P450
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First and second pharyngeal arches give rise to
Zygoma, mandible, muscles of mastication, stapes and lesser horn of hyoid
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Treacher Collin’s syndrome
Abnormal 1st and 2nd pharyngeal arches give rise Abnormal zygoma mandible and conductive hearing loss
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Phenytoin SE
Gingivial hypertrophy 2o increased expression of PDGF
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Which complement pathways are affected in recurrent neisseria infections
All pathways Recurrent neiserria/ encapsulated bacteria —> deficit of MAC ( composed of c 5-9) All complement pathways end in MAC
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Chance of a sibling being an HLA match
1/4 identical match 1/2 haploidentical match 1/4 mismatch
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Acute intermittent porphyria
Porphobilinogen delaminase deficiency Porphobilinogen —-X—-> hydroxymethlbilane Increased Aminolevulinic acid Increased Porphobilinogen Treatment: - ALA synthase inhibitor Avoid CyP450 stimulant —> smoking, tobacco Heme and glucose down regulate ALA synthase Presentation:- Abdo pain, vomiting, neuropsychological symptoms, red brown urine
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Cardiac features of Marfans
Myxomatous degeneration and prolapse of the mitral valve with associated regurgitation
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Acute mountain sickness
Hypoxia Hypo CO2 2o hyperventilation Increased HcO3 excretion Increased 2,3 BPG Resp alkalosis Increased peripheral receptor firing Pulmonary vasoconstriction
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posterior cerebral artery infarct presentation
Occipital lobe Infarct Contralateral homonymous hemianopia with macula sparing Contralateral hermisensory loss face, trunk and limbs
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Trigeminal neuralgia
Paroxysmal neuropathic pain Unilaterally affecting mandible/maxilla Triggered by chewing brushing teeth, allodynia —light touch No other neuro signs 2o compression of the trigeminal nerve —> demyelination and atrophy of nerve by abnormal vessel loop
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Leuprolide affects on GnRH FSH and oestrogen non pulsatile
Day 3 high FH, oestrogen and normal GnrH Day 60 all are low
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Osgood shclatter disease
Repetitive traction of the tibial tubercle by quad leading to allusion and fragmmentation
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Toxoplasmosis triad
Chorioretinitis Hydrocephalus Diffuse intracranial calcifications
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B blocker withdrawal syndrome
Off beta blockers after being on them for a period of time abrupt cessation will lead to up regulation of beta adrenergic receptors Presentation:- high BP, tachy, palpitations angina pain
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Displacement
Emotions transferred from the person causing the negative feelings to a neutral less threatening person or object
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Projection
Attributes unconscious feelings to someone else
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Work of breathing in restrictive disease
Rapid shallow breathing to minimize the WOB
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Head and neck squamous carcoinomas spread first to
Anterior cervical/ jugular LN
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Insulin second messenger system
Uses Tyrosine kinase as a second messenger increases synthesis of glycogen , fatty acid, nucleic acid and protein. Tyrosine kinase/phosphatidylinositol 3 kinase activates protein phophotase —> activates glycogen synthase
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Maple syrup urine disease
Deficiency of a branched chain alpha keto acid dehydrogenase Can’t break down isoleucine, leucine and valine Co enzymes required :- Thiamine, lipoate con enzymes A, FAD and NAD
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Clostridium difficilie infection
Diarrhoea, Abdo pain Histology pseudomembranes made up of neutrophil predominant inflammatory infiltrate, fibrin, bacteria and necrotic epithelium Complication toxicity megacolon
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Relative risk interpretation
RR <1.0 exposure decreases risk of disease RR 1.0 exposure has no effect RR >1.0 exposure increases risk
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Cells responsible for repopulation in wound healing by 2o intention are
Keratinocytes =—> cell proliferates until it touch other keratinocytes then stops Contact inhibition
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Zika in utero infection
Impaired brain development Microcephaly, micropthalmia, cleft lip and omphalopcele Cutis aplasia characteristic
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Trisomy 13
Holoprosencephaly ( failure of forebrain to divide into Rt and Lt hemispheres) Cleft lip Cyclopia Rocker bottom feet Omphalocele
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C7 spinal injury effect on respiration
Inspiration wont be affected ( diaphragm c3-c5) Passive expiration unaffected - requires no innervation Active experiation needs intercostals and Abdo muscles -> decreased
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Oogenesis
Oocyte arrested in prophase meiosis I from 5/40 until puberty (1o oocyte) From puberty —> before fertilization arrested in metaphase meiosis II (2o oocyte) Mature oocyte telophase II
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Leukotreine B4 function
Stimulates neutrophil migration
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Mature mRNA
A fully processed mRNA that has a poly a tail ( chain of adenine residues) Allows mature RNA to be more stable and prevent degradation. Deoxythymidine binds with adenine