Mixed Qs 1 Flashcards
What is an underlying cause of vulvovaginal candidiasis?
Decreased number of G+ve bacteria in vagina ( lactobacillus )
Cornynebacterium diphtheria acquired virulence to become pathogenic through what mechanism?
‘Phage conversion permits exotoxin production’
Lysogenic bacteriophage inserts tox gene allowing bacteria to express diptheria AB in toxin
Where does LT ventricular biventricular pacemaker leads lie?
Arteriovenous groove on posterior aspect of the heart
Where does LT ventricular biventricular pacemaker leads lie?
Arteriovenous groove on posterior aspect of the heart
What is the treatment for absence seizures?
Ethosuximide
(Sodium valproate 2nd in line)
How does Ethosuximide work?
MoA:Inhibits Ca channels in thalamic neurons
Use:- absence seizures
SE:- dizziness drowsiness
Effect of glucortocoids on glucose, cholesterol and TG?
Increase glucose
Increase Total cholesterol
Increase triglycerides
How does treatment with glucocorticoids affect the pituitary adrenal axis?
Decreased CRH
Decrease ACTH
Decreased Cortisol
Which adrenal zone is affected by ACEI?
Zona glomerulosa (aldosterone)
The adrenal cortex is derived from ?
Mesoderm
The adrenal medulla is derived from..?
Neural crest
How does sarcoidoses lead to high vitamin D
Activated macrophages in sarcoidoses express 1alpha hydroxylase leading to excess production of vitamin d and hypercalcaemia
Mechanism of hypoglycaemia in Type I DM?
Decreased glucagon secretion
How does chronic hyperglycaemia cause cataract ?
Glucose —> sorbitol—> fructose
Excess of sorbitol accumulates in lens cells leading to influx of water and osmotic cell injury.
Depletion of NADPH also increases oxidative risk
Subacute thyroiditis presentation?
Common in females
Fever, painful, tender goitre
Raised ESR
Initially high T3/T4
Low TSH
Follows viral illness
Diagnostic findings in subacute thryoiditis?
Raised T3/T4
Raised thyroglobulin
Low TSH
Low radioactive iodine uptake
Diffuse enlargement of gland with decreased bld flow on U/S
Thyroid blood levels if giving exogenous T3?
Increased T3
Decreased TSH ( -ve feedback)
Decreased T4
Decreased rT3
Hormone levels and changes seen in androgen abuse?
Low GnRH
Low FSH
Low LH
Low testosterone
High oestrogen
Impaired spermatogenesis
Testicular atrophy
Gynecomastia
5 alpha reductase deficiency presentation?
Ambiguous genitalia at birth typically masculinised at birth
Antibodies associated with Grave’s Disease are?
TSH receptor antibodies
Thyrotropin receptor antibodies
Which intracellular pathway is stimulated by GH?
JAK-STAT pathway
How does insulin promotes glycogen synthesis?
By autophosphorylation of tyrosine kinase receptor
Thyroid resistance is as result of ?
Decreased sensitivity of peripheral tissues to thyroid hormones due to a defect in the thyroid hormone receptor Beta
Thyroid hormone resistance presentation?
Non tender goitre
Sypmtoms of ADHD
High T3/T4
High TSH
Maple syrup urine disease characterised by what mutation?
Mutation in branched -chain alpha-keto acid dehydrogenase complex
What co-factors does Maple syrup urine disease mutation branched - chain alpha-ketoacid dehydrogenase need ?
Thiamine
Lipomata
Co enzymes A, FAD, NAD
Prolactin secretion is stimulated by ?
TRH
Antigen binding fragments vs full immunoglobulin
Fab smaller and have greater tissue penetration
Don’t have Fc receptor therefore cannot trigger killing via complement or phagocytosis
What is the abnormality in Hirschsprung disease?
Abnormal migration of neural crest cells during embryogenesis
Presentation of Hirshsprung disease?
Delayed passage of meconium in neonates
Chronic constipation
Abdominal distention
In Hirshsprung disease which structure is most likely to lack innervation?
Rectum is always involved
Test for Cystic Fibrosis?
Elevated sweat chloride levels
What factor is most important in a screening test?
High sensitivity
Location of vestibular schwannoma is?
Cerebellopontine angle ( between cerebellum and lateral pons)
Vestibular schwannoma presentation?
*Ipsilateral sensorineural hearing loss (CN VIII)
*Tinnitus (CN VIII)
*Disequilibrium (CN VIII)
*Ipsilateral loss of facial sensation and diminished corneal reflex (compression of CN V)
*Ipsilateral facial muscle paralysis (compression of CN VII)
Neonatal abstinence syndrome presentation?
Due to withdrawal from heroin appears in first few days of life
Irritability
High-pitched cry
Poor sleeping
Tremors
Seizures
Sweating
Sneezing
Tachypnoea
Poor feeding, vomiting and diarrhoea
What effect will fluid loading have on a normal person?
Increased ANP and BNP due to myocardial wall stretch 2o increased intravascular volume
Leads to increases GFR
Increased NA excretion
Increased Fluid excretion
Characteristic immunofluorescence finding of anti-glomerular basement membrane disease?
Linear deposits of IgGand C3 along the glomerular basement membrane
Anti glomerular basement membrane disease light microscopy?
Glomerular crescents
Goodpasture’s syndrome is the combination of what 2 disease processes?
Glomerulonephritis and pulmonary haemorrhage in patients with anti-GBM (glomerular basement membrane) antibodies
Mutations of Vasopressin 2 receptor can cause ?
Congenital nephrogenic diabetes insipidus
Congenital nephrogenic diabetes insipidus findings?
Resistance to ADH —-> excessive urine water loss
- high serum osmolality
- High Na
- low urine osmolality (dilute urine after water deprivation)
- no response to desmopressin
Virulence of typhoidal strains of Salmonella ?
Capsular antigen (Vi) inhibit neutrophil phagocytosis. Is able to replicate in macrophages and spread.
Salmonella blood culture?
G-ve non lactose fermenting rods
Niemann-Pick presentation?
Deficiency:- sphingomyelinase
Accumulation:- sphyngomyelin
Hepatosplenomegaly,
Neurologic regression
Cherry red macular spot in infancy
Niemann-Pick is characterised by?
Sphingomyelinase deficiency
IV lipophyllic drug administration flow
1st to the well vascularised peripheral compartment
Brain, Kidney, Lungs, Liver, Heart
Then to poorly perfumed peripheral compartment
Skeletal muscle, fat and bone
Characteristics of Cocaine withdrawal?
Development of acute depression
Fatigue
Hypersomnia
Hyperphagia
Vivid dreams
Commonest SE of cytotoxic chemotherapy?
Myelosuppression —> pancytopenia
Commonest SE of cytotoxic chemotherapy?
Myelosuppression —> pancytopenia
Pts who undergo cytotoxic chemotherapy are at risk of ?
Bacterial infections with fever, chills, hypotension
NO purulence ( 2o lack of neutrophils)
Selective dorsal rhizotomy in cerebral palsy leads to ?
Decreased muscle tone
(by destroying the afferent sensory arm of the reflex arc)
Klinefelter presentation?
XXY
1o hypogonadisim
Small testes
Gynecomastia
Absent 2o sexual characteristics
Tall stature
Learning difficulties
Klinefelter presentation?
1o hypogonadisim
Small testes
Gynecomastia
Absent 2o sexual characteristics
Tall stature
Learning difficulties
Klinefelter hormone levels?
High LH/FSH
Low testosterone
High oestrogen
Ménière’s disease presentation?
Triad:- Vertigo
Sensorineural hearing loss
Tinnitus with aural fullness
Meniere’s diesase symptoms are due to ?
Increase volume and pressure of endolymphs in vestibular apparatus
Meniere’s diesase symptoms are due to ?
Increase volume and pressure of endolymphs in vestibular apparatus
Damage to Broca’s area presentation?
Motor non fluent aphasia
Damage to Broca’s area presentation?
Motor non fluent aphasia
Where is Broca’s area located?
Inferior frontal gurus of dominant hemisphere
How do competetive inhibitors affect enzymes?
Compete with enzymes therefore more substrate is needed to achieve same rate.
Does not affect enzyme function
Primary hyperparathyroidism levels?
High PTH
High Ca
High Ca in urine
High urine PO4
Low serum PO4
Primary hyperparathyroidism levels?
High PTH
High Ca
High Ca in urine
High urine PO4
Low serum PO4
Normal PTH, mild increase Ca and low Ca urine, high Mg is seen in ?
Familial Hypocalcuric Hypercalcaemia
(G protein coupled receptor abnormality)
Albright hereditary osteodystrophy bld levels?
High PTH
Low Ca
High PO4
APS-I presentation
Autoimmune polyendocrine syndrome
Aire gene mutation
Mucocutaneous candidiasis
Autoimmune hypoparathyroidism ( low PTH, low Ca, high PO4
Addison’s disease
Where is 25 (OH)D converted to 1,25(OH)2 D ?
Proximal tubule
Tri to make D3 in the PCT
Where is 25 (OH)D converted to 1,25(OH)2 D ?
Proximal tubule
Tri to make D3 in the PCT
Affect of anabolic steroids abuse ( bld levels)?
Increased LDL
Decreased HDL
Increase Hb
Increase Hct
Decrease LH/FSH
Affect of finasteride on hormone bld levels?
increase testosterone
Decrease DHT
Increase oestrodiol
5 alpha reductase deficiency presentation?
Assigned female at birth
Clitoromegally at puberty
With no breast growth
+ve pubic hair
High testosterone
Low DHT
Low 17-OH progesterone
G+ve rods that form colonies resembling Medusa head ?
Bacillus Anthracis
Bacillus Anthracis bacterial virulence factor?
Antiphagocytic D glutamate poly peptide capsule
Positive predictive value equation?
a/a+b
Positive predictive value equation?
a/a+b
How does PTH act in kidneys?
Increase Ca reabsorption
Decrease PO4 reabsorption in proximal tubules
Which immune effector cell kills cells with decreased MHCI expression?
Natural killer cells (via apoptosis)
How does weight lifting help bones?
Osteocytes detect weight load in bones and communicate with each other through gap conjunctions to orchestrate bone remodeling
How does weight lifting help bones?
Osteocytes detect weight load in bow s and communicates with each other through gap conjunctions to orchestrate bone remodeling
Down regulation of which enzyme leads to improvement in symptoms of acute intermittent porphyria?
AlA synthase (aminolevulinate)
Mullerian Agenesis presentation?
1o Amenorrhea
Shortened vagina
Normal ovaries
Secondary sexual characteristics
Variable uterine development
Androgen to oestrogen ration in post menopause?
Increased
Effect of taking physiologic oestrogen replacement?
Raise SHBG
Raise HDL
Inc BMD
Dec LDL
Aromatase deficiency is associated with ?
High androgen
Low oestrogen
21 alpha hydroxylase deficiency hormone levels?
Clitoromegaly
High 17 OH progesterone
High testosterone
High androstenedione
21 alpha hydroxylase deficiency presentation?
Clitoromegaly
High 17 OH progesterone
High testosterone
High androstenedione
PCOS hormone profile ?
High LH:FSH ratio
Raised testosterone
Raised estrone
Low progesterone
Hyper insulinanemia
Pulsatile GnRH affect on LH and FSH?
Stimulates LH and FSH
Pulsatile GnRH used to treat?
Infertility to stimulate ovulation
Non pulsatile GnRH affect on LH/FSH?
Suppresses LH/FSH
Non pulsatile GnRH used in the treatment of ?
Prostate Cancer
Endometriosis
Precocious puberty
Premenopausal breast Ca
DKA K+ levels
N/Increased extracellular (serum) K+
Low total body ( intracellular ) K+
Insulin effect on Fructose 2,6 bisphosphonate and glucose metabolism?
Insulin increase production of fructose 2,6 bisphosphonate by phosphofructokinase 2 thereby stimulating glycolysis
Which mediator is responsible for the effects of glucagon, TSH,PTH?
Protein kinase A via the G protein mediated adenylate cyclase 2nd messenger
Which mediator is responsible for the effects of glucagon, TSH,PTH?
Protein kinase A via the G protein mediated adenylate cyclase 2nd messenger
TSH resistance presentation?
Congenital hypothyroidism
High TSH
Low thyroxine
Normal thyroid gland size and location
Pituitary tumor presentation?
Headache
Bitemporal hemianopsia
Hypopituitarisim
Commonest functional adenomas are prolactinomas
Amenorrhoea and galactorhoea in women
Hypogonadisim, decreased libido men
Gaucher disease presentation?
Lysosomal storage disease
Increase buildup of glucocerebroside in lysosomes
Hepatosplenomegally
Cytopenia
Bone pain
Spasticity and loss of motor skills
Adrenal zones hormone production
Salt, sugar, sex
Zona glomerulosa aldosterone
Zona fasciculata cortisol
Zona reticularis androgens
ACTH action is the major hormone of zona fasciculata and reticularis
How does COP treat hirsuitism?
Suppressing pituitary Lh secretion ==> decrease ovarian androgen production
Secondary hyperthyroidism cause and presentation?
Caused by TSH secreting pituitary adenoma
High TSH
High T3/T4
Diffuse goiter
Effect of taking propylthiouracil during pregnancy?
Congenital goitre with hypothyroidism
High TSH
Low T4
How does hyperparathyroidism causer bone loss?
Increase bone resorption 2o paracrine stimulation of osteoclasts
How is normal blood glucose maintained?
By opposing effects of insulin and glucagon
ACTH supressed by high dose but not low dose dexamethasone cause ?
Cushing syndrome 2o ACTH secreting pituitary adenoma
ACTH supressed by high dose but not low dose dexamethasone cause ?
Cushing syndrome 2o ACTH secreting pituitary adenoma
Postpartum thyroiditis presentation?
Within 12/12 of pregnancy
Hyperthyroid -> hypo -> euthyroid
Diffuse non tender goitre
Lymphocytic infiltration with formation of germinal cells
SIADH presentation?
Hyponatraemia
Hypotonicity
High urine osmolality
Hyponatraemia following cerebral injury is commonly due to ?
SIADH
Alkaptonuria presentation?
Black urine when exposed to air
Blue-black pigmentation in face
Arthropathy
What is the defect in alkaptonuria?
AR disorder of Tyrosine metabolism
Deficiency of homogentisic acid
Prevents conversion of tyrosine to fumarate
Congenital hypothyroidism presentation?
Asymptomatic at birth 2o maternal thyroxine
Lethargy, poor feeding
Enlarged Fontanelle
Protruding tongue
Constipation
Jaundice
Dry skin
Raised TSH
Low thyroxine
Phaeochromocytoma presentation?
Episodic headache
Abrupt severe increase in bp
Diaphoresis
Tremor
Chest pain
What is the Metyrapone stimulation test ?
Metyrapone inhibits production of cortisol
if hypothalamus-pituitary axis is intact there should be a surge of ACTH to stimulate cortisol production
1o hyperaldosteronism presentation?
HTN
Low K
Metabolic alkalosis
Low plasma renin
High aldosterone
Phaeochromocytoma derived from ?
Modified neuronal cells
Adrenal crisis presentation>
Aka 2o adrenal insufficiency
Shock
Abdominal pain, nausea, vomiting
Confusion
Precipitating illness
Adrenal crisis presentation?
Aka 2o adrenal insufficiency (Addison disease not enough aldosterone)
Shock
Hypotension, hypovoluaemia
Hyponatraemia
HyperKalaemia
Abdominal pain, nausea, vomiting
Confusion
Precipitating illness
Initial treatment of adrenal crisis?
Glucocorticoid
What does cosyntropin stim test test for?
N—> increase of cortisol to 18 after administration
In adrenal insufficiency—> baseline cortisol low and no significant increase after administration of cosyntropin (synthetic ACTH)
Addison’s disease (1o adrenal insufficiency) blood levels ?
High ACTH
Low cortisol
Low aldosterone
Low Na
High K
SE of ketoconazole ?
Gynaecomatia by inhibiting androgen synthesis
Cushing’s Disease bld levels?
High ACTH
High Cortisol
Cushing’s disease result low and high dexamethasone test?
Low dexamethasone test elevated cortisol
High dexamethason test il Cushing syndrome ACTH dependent pituitary tumor or independent
Low dose dexamethasone suppression test interpretation of results?
Normal —> cortisol levels will be low 2o suppression of ACTH
Cushing’s syndrome —> elevated cortisol levels
High dose dexamethasone suppression test interpretation?
If cortisol decreases —> ACTH dependent pituitary tumour
If cortisol unchanged ( high) —> ACTH independent I.e. ectopic
First bld test for a patient with raised cortisol?
ACTH level
High ACTH —> ACTH dependent pituitary tumor
Low ACTH —-> ACTH independent I.e exogenous steroids or adrenal tumor
Cushing’s Syndrome presentation?
HTN
Hyperglycaemia
DM
Increase insulin
Decrease FSH/LH
Female newborn, ambiguous genitalia, volume depletion and hyperkalaemia, spot diagnosis>
21 alpha hydroxylase deficiency
Congenital adrenal hyperplasia 21 alpha hydroxylase deficiency blood levels?
Low aldosterone
High 17 hydroxyprogesterone
High progesterone
Low 11 deoxycortisol
Low cortisol
Low Na
High K
Volume depletion
High androstenedione , low LH
Female: ambiguous genitalia
Male:- N
11 B hydroxylase deficiency presentation ?
Hypertension
Hypokalaemia
Increase 11 deoxycortisone
Precocious puberty males
No testicular enlargement
Low LH
Ambiguous genitalia females
17 alpha hydroxylase deficiency?
HTN
Hypokalaemia
Low cortisol
High ACTH
High deoxycorticosterone
Low androgen
Low oestrogen
Male :- ambiguous genitalia and undescended testes
Female:- appear N at birth —> 1o amenorrhoea
3 B hydroxysteroid dehydrogenase deficiency presentation?
Symptoms assoc with Impaired synthesis of all adrenal steroid hormones
Failure to thrive
Vomiting, volume depletion
Hyponatremia
Hyperkalaemia
Male:- ambiguous genitalia
Female 1o amenorrhoea
Which insulin reversibly binds to albumin?
Detemir
Which insulin reversibly binds to albumin?
Detemir
What is the duration of action of rapid acting insulin?
2-4 hrs
What is the duration of action of rapid acting insulin?
2-4 hrs
Which insulin precipitates at body temperature?
Glargine
Duration of action of NPH insulin?
12-16 hrs
Insulin effect on K+?
Can decrease level
Metformin effect on lipid level?
Increase lactate
Decrease free fatty acid
Decrease TG
Decrease LDL
Increase HDL
Metformin effect on lipid level?
Increase lactate
Decrease free fatty acid
Decrease TG
Decrease LDL
Increase HDL
HbA1c level and initial Mgx of new Type 2 DM?
If HbA1c <7.5% at diagnosis lifestyle mods
If HbA1c >7.5% pharmacalogic agents at diagnosis
HbA1c level and initial Mgx of new Type 2 DM?
If HbA1c <7.5% at diagnosis lifestyle mods
If HbA1c >7.5% pharmacalogic agents at diagnosis
Location of action of sodium glucose co transporter 2 (SGLT-2)?
Proximal tubule
Location of action of sodium glucose co transporter 2 (SGLT-2)?
Proximal tubule
chlorpropramide SE?
- Disulfiram reaction when taking alcohol.
Flushing , tachycardia, nausea - Hyponatremia
chlorpropramide SE?
- Disulfiram reaction when taking alcohol.
Flushing , tachycardia, nausea - Hyponatremia
Mechanism of action of sulphonylureas?
Closure of K channels in beta cells
Alpha glucosidase inhibitors common SE?
Diarrhoea
Flatulence
Biospy of Dysfunctional uterine bleeding will show ?
Endometrial hyperplasia
Skeletal muscle cellular changes in hypertrophy ?
Increase in actin
Increase in myosin
If endurance training increase in mitochondria
What process is responsible for muscle atrophy?
Ubiquination
Cellular changes seen in BPH?
Increase in number of glandular cells
Increase total protein content
Increas total DNA content
Abuse of exogenous thyroxine will lead to what cellular process occurring in thyroid?
Atrophy 2o to TSH suppression
Common cause of cardiac myocyte hypertrophy?
HTN
MI serum testing abnormalities?
Increase CK
Increase troponin
Ca influx 2o hypoxia damage
Cell changes seen in necrosis?
Karyolysis ( nuclear fading)
Pyknosis ( nuclear shrinkage)
Karyorrhexis ( nuclear fragmentation)
Cellular swelling
NAFLD is an example of which kind of cell injury?
Reversible
NAFLD is an example of which kind of cell injury?
Reversible
G6PD is assoc with decreased levels of ?
NADPH
Glutathione
How will deficiency of myeloperoxidase affect neutrophil killing?
Decreased production of hypochlorous acid in respiratory burst
Cell damage from reperfusion is due to?
Membrane lipid peroxidation
How can acetaminophen cause damage to the liver?
Free radicals
Metabolised to NAPQI which is a reactive oxygen species
Features of dystrophic calcification?
Normal Ca+ Po4
Depositing on inflammed or dead tissue
What is calciphylxis ?
Complication of CKD 2o hyperphosphataemia
Po4 binds to Ca causing hypocalcaemia
And deposits of calcium phosphate crystals in skin
Causing painful progressive skin lesion
Glucocorticoids induce apoptosis in lymphocytes via?
Caspases (intrinsic pathway)
Glucocorticoids induce apoptosis in lymphocytes via?
Caspases (intrinsic pathway)
Glucocorticoids induce apoptosis in lymphocytes via?
Caspases (intrinsic pathway)
BAX and BAK are?
Pro-apoptosis
Apoptosis in acute hepatitis B is via?
Extrinsic pathway
T cell mediated Fasl-Fas CD95 apoptosis c
Apoptosis in acute hepatitis B is via?
Extrinsic pathway
T cell mediated Fasl-Fas CD95 apoptosis c
Autoimmune lymphoproliferative syndrome presentation
Child with longstanding lymphadenopathy and new onset of hemolytic anaemia
Low HCT
High bilirubin
Positive direct Coombs test
DNA damage leads to ?
Phosphorylation of p53 protein
What does phosphorylation of p53 do?
Arrests cells cycle to allow for DNA repair (e.g in radiation therapy causing damage to DNA)if not repaired will continue to apoptosis
ALPS presentation can be explained by which apoptosis pathway?
Extrinsic FAS-FAS ligand binding
Pancreatic lipase can lead to what type of necrosis ?
Fat necrosis to peripancreatic fat
Klebsiella pneumonia is assoc with what type of necrosis?
Liquefactive as it can cause lung abscess
What is the main cause of cellular damage to liver in hepatitis B?
Apoptosis of hepatocytes but CD8+ T cells
What is the main cause of damage to liver in hepatitis B?
Apoptosis of hepatocytes but CD8+ T cells
Polyarteritis Nodosa presentation?
Evidence of systemic inflammation ( fever, raised WBC, raised ESR)
Skin rash
Neurologic symptoms (parasthesia, weakness)
Renal failure
Polyarteritis Nodosa is which type of hypersensitivity?
Type III hypersensitivity
Histologic findings of Polyarteritis Nodosa?
Fibrinoid necrosis
Viral causes of exacerbation of COPD?
Influenza
RSV
Human rhinovirus
Intracellular changes see with administration of phenylepinephrine?
Alpha 1 agonist
Stimulates PNS inhibits SNS
Increase BP
Increase inositol triphosphate (IP3) in vascular smooth muscle
Peripheral vasoconstriction
Decreased cAMP => decreased HR, contractility
Decreased Ca current in SA node
Pleural fluid findings in HF?
Transudate
High hydrostatic capillary pressure
High lymphatic outflow
N oncotic pressure
N vascular permeability
Strep pneumoniae is a ?
G+ve cocci in pairs (diplococci)
Partial haemolysis in bld agar
Optochin sensitive
Bile salt soluble
Strep pneumoniae virulence factor?
Resists phagocytosis via polysaccharide capsule
C.O. Equations?
C.O = HR x Stroke volume
C.O = rate of O2 consumption / arteriovenous O2 content difference
Group B streptococcus features?
G+ve coccus in chains
Narrow haemolysis in bld agar
Catalase negative
Causes neonatal sepsis
Signs of aortic regurgitation?
Decrescendo diastolic murmur in LSB 3-4th intercostal space
Wide pulse pressure
De Musset sign ( head bobbing)
Water hammer pulse
Favourable prognositic factors in schizophrenia?
Later onset
Female
Acute onset with precipitant
Predominantly +ve symptoms
No Fhx
Short duration of active symptoms
Amiodarone changes in ECG?
Prolonged QT ( main class III K+ blocking effect)
Prolonged QRS ( some class I Na blocking effect)
Prolonged PR and decreased HR ( class II beta blocker and IV Ca channel blocker )
Drugs that have a non IgE mediated effect on mast cell degranulation ( mimic IgE mediated hypersensitivity/ pseudo allergic)?
Opioids esp morphine, meperidine
Vancomycin
Radioiodine contrast
Drugs that have a non IgE mediated effect on mast cell degranulation ( mimic IgE mediated hypersensitivity/ pseudo allergic)?
Opioids esp morphine, meperidine
Vancomycin
Radioiodine contrast
When is correlative analysis used?
Used to describe the strength and direction of a linear relationship between 2 quantitative variables
What are toll like receptors?
A type of pattern recognition receptors on dendritic cells that recognise lipopolysaccharide and release inflammatory cytokines IL1,6,12 via NF-kB
Phases of cardiac myocyte action potential?
Phase 0 rapid depolarisation (Na influx)
Phase 1 initial rapid repolarisation ( Na channels close)
Phase 2 Plateau ( Ca influx)
Phase 3 late rapid repolarisation ( Ca channel closure + K efflux)
Phase 4 resting potential/ diastole ) K efflux
Ureter route in relation to bld vessels?
Ureter passes posterior to gonadal vessels then crosses anterior to the external and internal iliac arteries then posterior to the uterine artery (water under the bridge)
Ureter route in relation to bld vessels?
Ureter passes posterior to gonadal vessels then crosses anterior to the external and internal iliac arteries then posterior to the uterine artery (water under the bridge)
Hypercalcaemia with malignancy is associated with increase secretion of…?
Secretion of PTHrP ( parathyroid hormone related peptide)
Hypercalcaemia with malignancy is commonly due to ?
Secretion of PTHrP ( parathyroid hormone related peptide)
Causes of constipation in pregnancy?
Effect of progesterone on colonic smooth muscle contractions
Late stage radiation dermatitis histologic findings?
Fibroblast proliferation
Homogenisation of dermal collagen ( fibrosis)
Vascular abnormalities
Late stage radiation dermatitis presentation?
Pigment changes
Telengectasia
Chronic ulceration
Patau syndrome ( Trisomy 13) findings ?
Defective prechordal mesoderm fusion causing midline defects
Holoprosencephaly (cyclops)
Microphthalmia
Cleft clip/palate
Polydactyly
Cutis aplasia
Varices in gastric fundus are due to?
Splenic vein thrombosis (chronic pancreatitis/pancreatic Ca) increasing pressure on the short gastric veins (short gastric veins normal drain from fundus into splenic vein)
Bacterial vaginosis is commonly due to ?
Gardnerella vaginalis - anaerobic gram variable rod
Mechanism of acute simple cystitis?
Ascending infection
Defects in primary neuralation present as ?
Raised maternal alpha fetoprotein
Complex cystic mass over the lower spine of fetus
Venmtriculomegally
In SLE pt have antibodies directed at which cellular function?
At snRNAs (small nuculear RNA) which remove introns from preMRNA to form mature mRNA
Activation of bradykinin leads to ?
Increase vasodilation
Increase vascular permeability
Increase pain
What are the major cytokines of acute inflammation
1 alpha 6
IL1
TNF alpha
IL6
What cytokines are involved in chronic inflammation?
‘Gamma twelve’
IFN gamma
IL12
What is an important mediator of fever?
PGE2
Light’s criteria
Exudate if
Pleural protein/serum protein >0.5
Pleural LDH/serum LDH >0.6
Pleural LDH greater that 2/3 upper limits normal LDH
Leukemoid reaction is?
V high WBC
Immature neutrophils (band forms)
In background of focal infection symptoms
The following are acute phase reactants?
Ferritin
Fibrinogen
Serum amyloid A
CRP
Hepcidin
What are inflammasomes?
Multi protein complex that assembles in the cytoplasm of cells in response to cellular damage or infection.
Inflammasomes activate which enzyme in an inflammatory response?
IL-1
What activates classically activated macrophages?
IFN gamma
Function of classically activated macrophages (M1)?
Destruction of pathogens by generating reactive o2 species and lysosomal enzymes.
Function of alternative pathway (M2) macrophages?
Tissue repair
Activated by IL-4 and IL-13
Hallmark cells of chronic inflammation?
‘Mononuclear cells’
Macrophages
T cells
B cells
Plasma cells
E.Coli are what kind of bacteria?
G-ve rods
Granulomatous inflammation involves which cytokines?
IFN gamma + IL-2
Cytokine released by activated macrophages
TNF alpha (maintains granuloma in Granulomatous inflammation)
Chronic Granulomatous disease is due to a deficiency in ?
NADPH oxidase
Chronic Granulomatous disease presentation?
Recurrent infection with catalase +ve organisms
Staph aureus
Nocarida
Aspergillus
Pseudomonas aerignosa
Serratia marcescens
The first 24 hours after surgery the scar is dominated by?
Clot formation and neutrophil invasion
What is happening in the surgical wound on day 3-7?
Neutorphils are replaced by macrophages
Granulation tissue fills the space
Angiogenesis starts
Fibroblasts infiltrate the wound
Collagen synthesis begins
What is happening in the surgical wound on day 3-7?
Neutorphils are replaced by macrophages
Granulation tissue fills the space
Angiogenesis starts
Fibroblasts infiltrate the wound
Collagen synthesis begins
What is happening in a surgical wound 1 month after surgery?
Inflammatory cells are absent
Only fibroblasts remain
Surgical scar 6/12 to a year after surgery?
Collagen remodelling including cross linking of collagen
Wound strength is at its max when?
All collagen is Type I
No type III collagen or fibronectin
In wound healing Vascular endothelial growth factor is at highest when?
3-14/7
Cell type appearance in wound healing in order?
Platelets
Neutrophils
Macrophages
Lymphocytes
Fibroblasts
Causes of delayed wound healing ?
Infection
Diabetes
Glucocorticoid therapy
Poor nutritional status
What is the Warburg effect?
Malignant cells metabolise glucose via aerobic glycolysis.
Produce less ATP
Produce excess lactic acid
Breast cancer increases synthesis of …… that allows it to keep replicating ?
Telomerase allowing it to divide indefinitely
Hallmarks of malignant cells
Autonomous growth
Ability to evade death (not recognized by natural killer cells, under regulate MHC II)
Unltd ability to replicate
Angiogenesis
Ability to invade tissue and spread
Characteristics of pulmonary hamartoma?
Slow growth
Disorganised but normal tissue ( fat, epithelial cells, fibrous tissue, cartilage, +/- calcification )
Post transplantation lymphoproliferative disorder characteristics?
Occurs in pts with solid organ or stem cell transplant taking high dose immunosuppressive meds
2o EBV
Mononucleosis like symptoms ( fever, hepatosplenomegaly, lymphadenopathy)
Polylclonal or monoclonal B cell proliferation
Which antioxidant enzymes neutralize reactive oxygen species?
Superoxide —> superoxide dismutase —> H2O2 —> catalase/ glutathione peroxidase —> H2O
Superoxide dismutase
Glutathione peroxidase
Catalase
Hereditary breast cancer is associated with mutations in ?
BRAC1
BRAC2
Tumour suppressor genes mutation cause malignancy because?
Tumour suppressor genes are involved in DNA repair - a mutation will disrupt that
Path of progression from adenomatous polyp to malignancy?
Normal mucosa to adenomatous polyp —>2o APC
Increase in size of adenoma —>KRAS
Malignant transformation —> TP53
Which cells are responsible for symptoms in Meckel’s diverticulum ?
Parietal cells
Which cells are responsible for symptoms in Meckel’s diverticulum ?
Parietal cells
