Mixed Q’s 7 Flashcards
Organ least vulnerable to infarction
Liver
Stroke in young patient
Patent foramen ovale
2o failure of the atrial septum primum and secundum to fuse
Administration of IV fluids in hypovolumieic pt CVS changes
Increased Lt vent end diastolic volume
Increased preload
Increase end diastolic sarcomere length
Increased stroke volume
Increased C.O
Linkage disequilibrium
When a pair of alleles are inherited together due to close proximity
HBV replication cycle
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
Achalasia
Motility disorder 2o reduced inhibitory ganglion cells in oesophageal wall
Decreased strength of peristalsis
Incomplete relaxation of LES
Finasteride
5 alpha reductase inhibitor
MoA:- blocks conversion of testosterone to DHT in prostate . Decrease prostate volume
Use:BPH
SE: ED, decreased libido
Tamsulosin
Alpha 1 adrenergic antagonist
MoA:- relax smooth muscle in bladder neck
Use: BPH
SE:- othostatic HTN, dizziness
Dubin Johnson syndrome
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
CVS/ Renal SLE manifestation
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
Retroperitoneal haematoma likely due to damage to which organ
Pancrease
Drug target stops HIV viral fusion
Chemokine receptor CCR5 antagonist —>maraviroc
Phenoxybenzamine
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
Pathogenesis of type I and II DM MODY
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
Increased osteoclast activity
2o decreased osteoprotegerin
Increased RANK/RANKL
Increasing bone resporption
Fluphenazine / first gen antipsychotics
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
Statin MoA
Causes hepatocytes to increase their LDL receptor density
Apoprotein B-100
Apoprotein in VLDL and LDL
If VLDL/LDL decrease —> decrease in AP0B-100
Familial Dilated cardiomyopathy
AD mutation in the TTN gene coding for Titin protein
Presentation: -decompensated HF
Sudden death 2o ventricular arrhythmia
Path of venous catheter to LA
Iliac vein —> IVC—> RA —> intraatrial septum at the site of the foramen ovale —> LA
Pulsus paradoxus
Drop in SBP during inspiration / drop in pulse amplitude during inspiration
Abdominal aortic aneurysm Pathogenesis
Chronic inflammation and extracellular matrix degreadation of wall of aorta
WPW ecg triad
Short PR
Slurred upstroke of QRS - delta wave
QRS widening
Dobutamine
B adrenergic agonist
Weak alpha agonist
Stimulation of B1 reception —> increased production of cAMP and increased cytosolic Ca conc
Increased myocardial contractility
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
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
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
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
Complication of fermoral arter catheterisation above inguinal ligament
Retroperitoneal haemorrhage
Down syndrome complications
Early onset Alzheimers
ALL
Duodenal atresia 2o failure of duodenal recanalisation
Hypothyroidism
ASD/VSD
Hirschsprung disease
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
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
Pt with CF confused, lethargy vomiting likely electrolyte distrutabce
Hyponatraemia
Hypochloraemia
Aging changes in lung capacity
Decreased chest wall compliance
Lung compliance increases
Increase in RV
TLC unchanged
Decreased FVC
Decreased FEV1
Polio antibody level between IM and ORal
Oral - Sabin has more oropharygeal and duodenal luminal IgA
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
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
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)
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
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
Conversion disorder
Deficits os voluntary motor +/- sensory function incompatible with any neuro condition
Somatic symptoms disorder
1 or more unexplained symptoms, excessive thoughts health anxiety and preoccupation worth the symptoms
When does bld flow into the vascular beds of the left ventricle
During diastole
MEN2A
Mutation of RET
Medullary thyroid cancer > 95%
Phaeochromocytoma >50%
Parathyroid hyperplasia
Malaria in Brazil
P vivax
Has hyponozoite phase —> can reappear after weeks or ,months
Trophozoite phase:- rings in RBCs
Giardiasis Mgx
Diarrhoea in hikers/campers malabsorption, flatulence
Metronidazole
Ciprofloxacin is used to treat what kind of diarrhoeal illness
Inflammatory traveler’s diarrhoea ( blood and mucus in stool)
Diphtheria primary treatment
G+ve rod non spore forming
Diphtheria antitoxin to inactivate circulating toxins
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
Chancroid
2o Haemophilius ducreyi
Curved G-ve rods in a clumping pattern
Causes:- painful deep ulcer with ragged borders, gray exudate and inguinal lymphadenopathy
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
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
Common causes of intraabdominal infection
Bacterioides fragilis
E. Coli
Both part of the Normal colonic flora
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
Babesiosis
Babesia microti
Transmission:- deer tick
NE USA
Presentation:- fever, myalgia, flu like symptom
Anaemia, thrombocytopenia, spleenomegaly
Bld smear:- intraeythrocytic inclusion
How can Ethanol cause hypoglycaemia
Inhibiting gluconeogenesis
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
Benign neonatal hyperbilirubinaemia
Peak in first few days of life and self resolve
Raised bilirubin
Decreased bilirubin conjugation
Raised enterohepatic bilirubin circulation
What enzyme takes over in fructokinase deficiency
Hexokinase
Fructose ——> fructose -6-phosphate
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
Causes of 2o lactose intolerance
Inflammation —> coeliac
Infection —> giardiasis
Symptoms of vitamin C deficiency are due to which impairment
Impairment of collagen hydroxylation which occurs in the rough endoplasmic reticulum
Fluid loss in diabetes insidious
Hyperosmotic volume contraction
Osmolarity increased
Volume decreased in ECF and ICF
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 )
Maneuvers that increase/decrease HCM murmur
Increase:- standing, nitroglycerin administration, valsalva strain phase ( all decrease preload)
Decrease:- hand grip, passive leg raising, squatting
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
Presence of S3
Sign of systolic HF
Indicate severe MR
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
complication of lrge PE a
Increase RV pressure
RV cavity enlargement —> RV dysfunction — > decreased CO —> Rt HF / corpulmonale
Major contributor to AF
Atrial remodelling
Other risk factors :- age , HF, mitral valve diseae
Bicuspid aortic valve complication
Significant aortic stenosis age 50 ( >10 years sooner than normal aging)
Normally asymptomatic in childhood
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
Acute MR ventricular haemodynamics
Increase LT Vent EDV —> i.e increase preload
Decreased afterload
Increased Ejection fraction
Decrease SV
Failure of obliteration of ompahlomesentric duct
Meckels diverticulum
Intestinal malrotation
Presentation:- neonatal bilious vomiting
Pathology:- intestinal malrotation —> duodenal compression by Ladd bands
Midgut volvulus
Matching in case control studies is used to eliminate what type of bias
Confounding ( external unmeasured factors confounding the results)
Involvement of lactiferous ducts would lead to what symptom
Nipple discharge
Skin puckering in breast is due to involvement of which structure
Suspensory ligament
MoA of monoclonal antibodies in cancer immunotherapy
The Fc portion of antibody identified by NK cells which released perforins and granzymes to induce apoptosis
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
Persistent depressive disorder
Depressive disorder >= 2 years of
Adjustment disorder
Symptoms of sadness, distress, or functional impairment occur 3/12 or less from psychosocial stressor
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
Hypovoluemic shock
Reduced baroreceptor firing
Reduced stretch
Reduced ANP/ reduced PCWP
Increased Contractility
Increased SNS
Increase vasoconstriction
Increase HR
Stop codons
UAA
UAG
UGA
Signal termination of protein synthesis
Releasing factors MoA
Recognise stop codons and terminate protein synthesis
Lactose intolerance findings
Decreased stool pH
Increased breath hydrogen content
Increased stool osmolality
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
salbutamol/albuterol MoA
B adrenergic receptor agonists
Relaxation of bronchial smooth muscle
Via Gs protein receptor —> increase cAMP
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)
Prostacyclin
Synthesised from prostaglandin H2
Released by vascular endothelial cells
Inhibits plt aggregation
Opposes thombaxane A2 ( plt aggregator)
Differential cyanosis
Cyanosis affecting only the lower body
Seen in PDA with RT to LT shunt
Usually 2o persistent pulmonary HTN of the newborn
Murmur of bicuspid aortic valve
Soft systolic ejection murmur at the RT 2nd intercostal
Cocaine MoA
Blocks presynaptic reuptake of catecholamines inc dopamine and NE
Toxicity can cause stroke / MI
In folate deficiency addiction of which substance can reduce apoptosis
Thymidine supplementation
Will bypass thymidylate synthase and reduce apoptosis
Common pathogens in acute otitis media
S Pneumoniae
H influenzae
Moraxella catarrhalis
Presbyopia
Far sighted related to age
Improves mild myopia
2o loss of lens elasticity due to decreased collagen synthesis 2o age like wrinkles
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
Transient global amnesia
Transient dysfunction in hippocampus
Presentation:- sudden onset prominent anterograde amnesia and repetitive question
Oriented to person
Disoriented to place
What happens in LN during an infection
In germinal centres B cells undergo isotope/ Ig switching to be able to produce antibodies
Bacterial cell wall
Main component peptidoglycan
Glycosyltransferase is a important enzyme in peptidoglycan synthesis
mycoplasma genus have on peptidoglycan cell wall
Primary amoebic meningoencephalitis
Caused by Naegleria Fowleri
Transmission:- warm water inhaled during water activities
Presentation:- meningoencephalitis, confusion
CSF:- motile trophozites
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)
Candida chorioretinitis
Transmission:- Haematogenous spreads in fungaemia
In hospitalised pts with indwelling central catheters, GI surgery
Presentation:- Unilateral floaters, progressive vision loss
Osteomyelitis Pathogens
In healthy children
1. S Aureus
2. Strep pyogens
Viral meningitis CSF features
Enterovirus commonest pathogen (coxsackievirus, echovirus, poliovirus)
CSF:- WBC <500, lymphocytic
Glucose level N or slightly reduced
Protein <150
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
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
Rotavirus
Segmented naked DsRNA
Presentation:- watery diarrhoea
Blinding of the villi in the duodenum and proximal jejunum
PCR
Used to amplify small fragments of DNA
Oculocutaneous albinism
AR
Tyrosin are mutation
Tyrosin—-X—-> DOPA
Impaired melanin synthesis
Abnormal optic nerve
White skin, hair
Lactic acidosis in septic shock is due to
Hypoxia which impairs oxidative phosphorylation
Lung lobes affected in aspiration pneumonia
Post segment of upper lobes.
Post segment of lower lobes lobes
Hartnup disease
Impaired transport of neutral amino acid in small intestine and PCT
Symptoms:- pellagra like skin eruptions
Cerebellar ataxia
2o niacin deficiency
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
Cancer cells use of glucose
Increase rate of glycolysis with excess lactate production
Due to Warburg effect Ca cells use anaerobic glycolysis
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
Digoxin toxicity
Colour vision changes
Anorexia
Vomiting
Confusion
Weakness
Arrhythmias
Class I antiarrhythmics
Na channel blockers
1C > 1A> 1B
1C :- Flecinide, propafenone (tachyarrhythmias)
1A:- Quinidine, procainamide, disopyramide
1B:- lidocaine, mexiletine ( ischaemic myodcardium)
Pts taking nitrates can develop
Tolerance therefore need go have nitrates free period
Hydralazine SE
Na and H2O retention via RAAS
Baroreceptors sense decrease in BP
SNS stimulated
Activate RAAS
Hypertensive emergency
Severe HTN with end organ damage
Fenoldopam
Dopa 1 receptor agonist
MoA:- increase cAMP —> vasodilation of arterial bed and increased renal perfusion
Use:- hypertensive emergency esp with renal insufficiency
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
B12 deficiency
Presentation:- paraesthesia, ataxic gait, weakness —> vibration and position sense ( subacute combined degeneration of the cord)
With megaloblastic anaemia
Vegan diet risk factor
Control selection In case control studies
Controls should be selected on disease status not on exposure status
Malformation
Defect in organogenesis e.g genetic or teratogenic
Deformation
Mechanical forces alter shape/position of a structure that was previously developing normally
Vascular calcifications in CKD
2o high PO4
Hig Ca
Chronic inflammation 2o uraemia, hyperlipidaemia
Atherosclerosis
Heteroplasmy
Range of phenotypes
Physician burnout vs fatigue
Burnout:- jaded, emotionally exhausted make mistakes and don’t care
Fatigue:- due to sleep deprivation
Tetanus
Clostridium tetani
Presentation:-
puncture injury —-> motor neuron —> spinal cord
Increase painful muscle tone, spasm, lock jaw triggered by sensory stimuli
Cauda equina syndrome
Involvement of pelvic splanchinic nerves
Constipation
Difficultly urinating
Saddle anesthesia
Lower back pain
Multiple Myeloma presentation
Osteolytic lesions
Hypercalcaemia
Anaemia
Acute renal injury
Free light chains nephropathy
IVC formed by which vessels
Formed by the RT and LT iliac veins at L4-L5
Cephalosporin
MoA:- transpeptidase peptidoglycan cell wall inhibitor
Resistance:- change in structure of protein preventing cephalosporin binding
Lab findings in bulimia
Hypokalaemia
Metabolic alkalosis
Probability of a female sibling of a male affected with X linked recessive disease giving birth to affected child is
1/8
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
Cytokines seen in sepsis
TNF alpha
IL-1
I’ll-6
Incretins
GLP1 glucagon like peptide 1
GIP glucose independent insulinotropic peptide
Stimulate pancreas to release insulin
Effect PO>IV
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
Cutaneous Warts are caused by
HPB
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
Why is Hep C is genetically unstable
Because it lacks proof reading 3’—->5’
Bronchiolitis
RSV
Presentation:- Children <2
nasal congestion, discharge, cough
Wheezing/ crackles and resp distress
hook worms
Necator americanus and ancylostoma duodenale
Transmission:- dermal penetration
Complication: - pruruitis, serpiginous rash at time of dermal penetration
microcytic iron deficiency Anaemia
Epidermal multinucleated giant cells seen with
HSV
VZV
Nectortining kertinocytes in the epidermis seen in
Stevens Johnson syndrome
1-3/52 after infection (CMV, mycoplasma)
Drug exposure
Artemisinin
Use:- plasmodium falciparum to avoid cholorquine resistance
Also atovaquone-proguanil
Nifurtimox
Use:- trypanosomiasis ( tsetse )
Treatment for social anxiety disorder
SSRI/SNRI
CBT
B Blocker or benzos ( for specific performance only )
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
True negative equation
Specificity X total number of pts without the disease
False positive equation
1-Specificity X total number of pts without the disease
Homocystinuria defect and supplementation
Deficiency :- cystathionine synthase
Supplement with B6 —> cofactors in metabolism
Restrict:- methionine
Influenza virus depends on what to interact with host cells
Antigenic surface glycoprotein called haemaglutnin
COPD lung function parameters
increase RV
Increase TLC
RV/TLC ration increased
Decreased FVC
Decreased FEV1/FVC
Crohns disease complication
Gallstones 2o increased bile acid wasting leading to supersaturation of cholesterol in gallbladder
Chi square test
Association between qualitative variables
Anencephaly is due to defect in
Rostral ( anterior) neupore closure
Clearance of a substance equation
Cs= urine concentration of substance X urine flow rate / plasma concentration of substance
Filtration fraction equation
FF= GFR /RPF
GFR estimated from creatinine clearance or inulin clearance
RPF estimated from para-aminohippuric acid clearance
Vitamin C deficiency features
Perifollicular haemorrhage
Petechia
Periodontal diseae
Subperiosteal haemorhage/ haematoma —> pain on walking esp in children
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
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
Schizotypal personality disorder
Eccentric, magical thinking odd beliefs, perceptual distortions and social anxiety despite familiarity
TAP mutation affects which process
Cytotoxic T cell activation by MHC class I molecules
Telomerase
Ribonucleoprotein reverse transcriptase that adds TTAGGG to the 3’ end of chromosomes
Found in cells that constantly divide like skin
Finasteride
5 alpha reductase inhibitor
MoA:- block conversion of testosterone to DHT
Use:- BPH
SE:- gynaecomastia (2o increased conversion of testosterone to estradiol)
Intensive endurance training affect on heart
Enlarged RT and LT ventricle
Increase SV
Increase CO
Pulmonic flow murmur
Unchanged LVEF
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)
Metoprolol
Cardioselective beta blocker
Blocks B1» B2
Mild reduction BP
No change in SVR
Decreased HR
Decrease contractiliy
Milrinone
Phosphodiesterase -3 inhibitor
MoA:- increase cAMP increase Ca influx
Increase Contractility
Causes: vasodilation
Reduce preload
Reduces Afterload
Use: - systolic HF
Complete AV canal defect
ASD
VSD
Common AV valse
Seen in trisomy 21
Paradoxical embolism is seen in
Patent foramen ovale
ASD ( wide fixed splitting of S2)
VSD
Large pulmonary AV malformation
Treatment of S epidermidis
Vancomycin
If methicillin sensitive
Nafcillin / oxacillin
Acute myocarditis
Viral cause
Myocyte necrosis with inflammatory mononuclear cell infiltrate
Presentation:- asymptomatic
Decompensated HF
Dilated cardiomyopathy
Sudden cardiac death
Diffusion limited gas exchange
Huge drop between alveolar PO2 and capillary pO2
High A-a gradient (normally 4-150
Cystic fibrosis mutation
AR
Mutation F508 in the CF transmembrane regulator CFTR gene
ATP gated chloride channel
Acute PE blood gas findings
hypoxia
PH alkalosis
Low PaCO2
Initially no HCO3 changes eventually HCO3 will be lost to balance resp alkalosis
Hypoxaemia causes
Alveolar hypoventilation
V/Q mismatch —> dead space ventilation/ intrapulmonary shunt
Diffusion impairment
RT - Lt Shunt
Anaemia arterial bld sample results
PaO2 normal
SaO2 normal
Total arterial O2 content low
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
Which chemoreceptors respond to O2 and CO2
Peripheral chemoreceptors respond to PaO2 sense hypoxia
Central chemoreceptors in medulla —> response to CO2 / hypercapnia
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
PE V/Q mismatch
Large perfusion defect without ventilation defect
Auscultation findings in consolidation
Increased breath sounds
Increased tactile fremitus
Dull to percussion
Ferruginous bodies
Seen in asbestosis
Translucent fibres coated with iron containing material
Histopathology:- diffuse interstitial fibrosis and ferruginous asbestos bodies
Pleural plaques and effusions
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
Acute resp distress syndrome major contributor to lung damage
Release of reactive oxygen species and proteases by neutrophils
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
Colchicine
MoA:- microtubular polymeritsation —> leading to decreased chemotaxis, phagocytosis inhibit leukocyte migration
Use:- acute gout
SE :- nausea, diarrhoea
Cutaneous neurofibromas are derived from which emnbryologic structure
Schwann cells —> from neural crest
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
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
Schizophrenia chemical imbalance
Increase dopamine in mesolimbic pathway
Detrusor muscle
Involuntary smooth muscle of the bladder
Responsible for urine expulsion
Overactive in urge incontinence
Bulbosongiosus muscle
Contracts the vaginalis orifice
Levator ani Muscle complex
Targeted in kegel exercises
Murmur of AR best hear with which maneuvers
Decrescendo diastolic murmur
Sitting up and leaning forward
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
Familial chylonmicronaemia
LPL deficiency
High chylomicrons
Complication:- a true pancreatitis, lipaemia retinalis, erutptive xanthomas
Disseminated gonococcal infection
N gonorrhoea
Polyarthralgia
Tenosynovitis
Dermatitis ( painless pustules on extremities)
Isolated on chocolate agar infused with ABx ( Thayer martin agar)
Complication of long term use of glucocorticoids
Suppression of hypothalamic pituitary adrenal axis
Leading to bilateral adrenocoritcal atrophy
Adrenal crisis
Massive life threatnening haemoptysis in hx of bronchiectasis/CF
2o bleeding from hypertrophied bronchial arteries
Complication of hand foot and mouth disease
Myocarditis
Aseptic meningitis
Caused by coxsackie virus - enterovirus
Burkhlderia cepacia
G-ve rod lactose negative oxidase +ve
Causes CF exacerbation
CI for lung transplant
Common pathogens for CF exacerbations
Staph Aureus
H Influenza
Pseudomonas aeruginosa
Burkholderia cepacia
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
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
Homocystinuria
Cystathionine synthase deficiency
Methionine…—->Homocysteine —-X—-> cysteine
Elevated methionine
Prothrombosis
Ectopic lentis
Intellectual disability
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
Pulmonary arterial hypertension Mgx
Bosentan —> competitive antagonist of endothelin receptor
Prolonged neuromuscular paralysis with succinylcholine is due to
Pseudocholinesterase deficiency
Ketamine
NMDA antagonist
Sympathomimetic
Used for anaesthesia induction
SE:- increase cathecholamine release —> bronchodilation, increase HR increase contractility
Increase risk CV event
Idiopathic pulmonary fibrosis Mgx
Slowing progression of fibrosis
Inhibiting
transforming growth factor Beta
PDGF
VEGF
Succinylcholine
MoA depolarizing neuromuscular blocking agent
Use:- rapid sequence induction
Initial train of four sequence global reduction then gradual fade
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
Drug used to test for asthma when Spirometry is normal
Methacholine
Ipratropium
MoA anticholinergic agent
Blockers acetylcholine at muscarinic receptor /PSNS
Prevents bronchoconstriction
Reduced mucus secretion
Corticosteroids in asthma
Anti inflammatory
Up regulate beta 2 receptors on bronchial smooth muscles
Increase beta 2 receptor responsiveness
Increase surfactant
Rifampin
MoA inhibits bacterial RNA synthesis —-> RNA polymerase 2
Use:- TB
SE:- turns bodily fluids red
Stimulates P450
First and second pharyngeal arches give rise to
Zygoma, mandible, muscles of mastication, stapes and lesser horn of hyoid
Treacher Collin’s syndrome
Abnormal 1st and 2nd pharyngeal arches give rise
Abnormal zygoma mandible and conductive hearing loss
Phenytoin SE
Gingivial hypertrophy 2o increased expression of PDGF
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
Chance of a sibling being an HLA match
1/4 identical match
1/2 haploidentical match
1/4 mismatch
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
Cardiac features of Marfans
Myxomatous degeneration and prolapse of the mitral valve with associated regurgitation
Acute mountain sickness
Hypoxia
Hypo CO2 2o hyperventilation
Increased HcO3 excretion
Increased 2,3 BPG
Resp alkalosis
Increased peripheral receptor firing
Pulmonary vasoconstriction
posterior cerebral artery infarct presentation
Occipital lobe Infarct
Contralateral homonymous hemianopia with macula sparing
Contralateral hermisensory loss face, trunk and limbs
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
Leuprolide affects on GnRH FSH and oestrogen non pulsatile
Day 3 high FH, oestrogen and normal GnrH
Day 60 all are low
Osgood shclatter disease
Repetitive traction of the tibial tubercle by quad leading to allusion and fragmmentation
Toxoplasmosis triad
Chorioretinitis
Hydrocephalus
Diffuse intracranial calcifications
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
Displacement
Emotions transferred from the person causing the negative feelings to a neutral less threatening person or object
Projection
Attributes unconscious feelings to someone else
Work of breathing in restrictive disease
Rapid shallow breathing to minimize the WOB
Head and neck squamous carcoinomas spread first to
Anterior cervical/ jugular LN
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
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
Clostridium difficilie infection
Diarrhoea, Abdo pain
Histology pseudomembranes made up of neutrophil predominant inflammatory infiltrate, fibrin, bacteria and necrotic epithelium
Complication toxicity megacolon
Relative risk interpretation
RR <1.0 exposure decreases risk of disease
RR 1.0 exposure has no effect
RR >1.0 exposure increases risk
Cells responsible for repopulation in wound healing by 2o intention are
Keratinocytes =—> cell proliferates until it touch other keratinocytes then stops
Contact inhibition
Zika in utero infection
Impaired brain development
Microcephaly, micropthalmia, cleft lip and omphalopcele
Cutis aplasia characteristic
Trisomy 13
Holoprosencephaly ( failure of forebrain to divide into Rt and Lt hemispheres)
Cleft lip
Cyclopia
Rocker bottom feet
Omphalocele
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
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
Leukotreine B4 function
Stimulates neutrophil migration
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
