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LopsNotes > Mixed Qs 1 > Flashcards

Mixed Qs 1 Flashcards

1
Q

What is an underlying cause of vulvovaginal candidiasis?

A

Decreased number of G+ve bacteria in vagina ( lactobacillus )

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2
Q

Cornynebacterium diphtheria acquired virulence to become pathogenic through what mechanism?

A

‘Phage conversion permits exotoxin production’
Lysogenic bacteriophage inserts tox gene allowing bacteria to express diptheria AB in toxin

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3
Q

Where does LT ventricular biventricular pacemaker leads lie?

A

Arteriovenous groove on posterior aspect of the heart

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4
Q

Where does LT ventricular biventricular pacemaker leads lie?

A

Arteriovenous groove on posterior aspect of the heart

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5
Q

What is the treatment for absence seizures?

A

Ethosuximide
(Sodium valproate 2nd in line)

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6
Q

How does Ethosuximide work?

A

Inhibits Ca channels in thalamic neurons

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7
Q

Effect of glucortocoids on glucose, cholesterol and TG?

A

Increase glucose
Increase Total cholesterol
Increase triglycerides

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8
Q

How does treatment with glucocorticoids affect the pituitary adrenal axis?

A

Decreased CRH
Decrease ACTH
Decreased Cortisol

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9
Q

Which adrenal zone is affected by ACEI?

A

Zona glomerulosa (aldosterone)

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10
Q

The adrenal cortex is derived from ?

A

Mesoderm

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11
Q

The adrenal medulla is derived from..?

A

Neural crest

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12
Q

How does sarcoidoses lead to high vitamin D

A

Activated macrophages in sarcoidoses express 1alpha hydroxylase leading to excess production of vitamin d and hypercalcaemia

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13
Q

Mechanism of hypoglycaemia in Type I DM?

A

Decreased glucagon secretion

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14
Q

How does chronic hyperglycaemia cause cataract ?

A

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

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15
Q

Subacute thyroiditis presentation?

A

Common in females
Fever, painful, tender goitre
Raised ESR
Initially high T3/T4
Low TSH
Follows viral illness

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16
Q

Diagnostic findings in subacute thryoiditis?

A

Raised T3/T4
Raised thyroglobulin
Low TSH
Low radioactive iodine uptake
Diffuse enlargement of gland with decreased bld flow on U/S

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17
Q

Thyroid blood levels if giving exogenous T3?

A

Increased T3
Decreased TSH ( -ve feedback)
Decreased T4
Decreased rT3

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18
Q

Hormone levels and changes seen in androgen abuse?

A

Low GnRH
Low FSH
Low LH
Low testosterone
High oestrogen
Impaired spermatogenesis
Testicular atrophy
Gynecomastia

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19
Q

5 alpha reductase deficiency presentation?

A

Ambiguous genitalia at birth typically masculinised at birth

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20
Q

Antibodies associated with Grave’s Disease are?

A

Thyrotropin receptor antibodies

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21
Q

Which intracellular pathway is stimulated by GH?

A

JAK-STAT pathway

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22
Q

How does insulin promotes glycogen synthesis?

A

By autophosphorylation of tyrosine kinase receptor

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23
Q

Thyroid resistance is as result of ?

A

Decreased sensitivity of peripheral tissues to thyroid hormones due to a defect in the thyroid hormone receptor Beta

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24
Q

Thyroid hormone resistance presentation?

A

Non tender goitre
Sypmtoms of ADHD
High T3/T4
High TSH

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25
Q

Maple syrup urine disease characterised by what mutation?

A

Mutation in branched -chain alpha-keto acid dehydrogenase complex

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26
Q

What co-factors does Maple syrup urine disease mutation branched - chain alpha-ketoacid dehydrogenase need ?

A

Thiamine
Lipomata
Co enzymes A, FAD, NAD

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27
Q

Prolactin secretion is stimulated by ?

A

TRH

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28
Q

Antigen binding fragments vs full immunoglobulin

A

Fab smaller and have greater tissue penetration

Don’t have Fc receptor therefore cannot trigger killing via complement or phagocytosis

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29
Q

What is the abnormality in Hirschsprung disease?

A

Abnormal migration of neural crest cells during embryogenesis

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30
Q

Presentation of Hirshsprung disease?

A

Delayed passage of meconium in neonates
Chronic constipation
Abdominal distention

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31
Q

In Hirshsprung disease which structure is most likely to lack innervation?

A

Rectum is always involved

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32
Q

Test for Cystic Fibrosis?

A

Elevated sweat chloride levels

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33
Q

What factor is most important in a screening test?

A

High sensitivity

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34
Q

Location of vestibular schwannoma is?

A

Cerebellopontine angle ( between cerebellum and lateral pons)

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35
Q

Vestibular schwannoma presentation?

A

*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)

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36
Q

Neonatal abstinence syndrome presentation?

A

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

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37
Q

What effect will fluid loading have on a normal person?

A

Increased ANP and BNP due to myocardial wall stretch 2o increased intravascular volume
Leads to increases GFR
Increased NA excretion
Increased Fluid excretion

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38
Q

Characteristic immunofluorescence finding of anti-glomerular basement membrane disease?

A

Linear deposits of IgGand C3 along the glomerular basement membrane

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39
Q

Anti glomerular basement membrane disease light microscopy?

A

Glomerular crescents

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40
Q

Goodpasture’s syndrome is the combination of what 2 disease processes?

A

Glomerulonephritis and pulmonary haemorrhage in patients with anti-GBM (glomerular basement membrane) antibodies

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41
Q

Mutations of Vasopressin 2 receptor can cause ?

A

Congenital nephrogenic diabetes insipidus

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42
Q

Congenital nephrogenic diabetes insipidus findings?

A

Resistance to ADH —-> excessive urine water loss

  • high serum osmolality
  • High Na
  • low urine osmolality (dilute urine after water deprivation)
  • no response to desmopressin
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43
Q

Virulence of typhoidal strains of Salmonella ?

A

Capsular antigen (Vi) inhibit neutrophil phagocytosis. Is able to replicate in macrophages and spread.

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44
Q

Salmonella blood culture?

A

G-ve non lactose fermenting rods

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45
Q

Niemann-Pick presentation?

A

Hepatosplenomegaly,
Neurologic regression
Cherry red macular spot in infancy

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46
Q

Niemann-Pick is characterised by?

A

Sphingomyelinase deficiency

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47
Q

IV lipophyllic drug administration flow

A

1st to the well vascularised peripheral compartment
Brain, Kidney, Lungs, Liver, Heart
Then to poorly perfumed peripheral compartment
Skeletal muscle, fat and bone

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48
Q

Characteristics of Cocaine withdrawal?

A

Development of acute depression
Fatigue
Hypersomnia
Hyperphagia
Vivid dreams

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49
Q

Commonest SE of cytotoxic chemotherapy?

A

Myelosuppression —> pancytopenia

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50
Q

Commonest SE of cytotoxic chemotherapy?

A

Myelosuppression —> pancytopenia

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51
Q

Pts who undergo cytotoxic chemotherapy are at risk of ?

A

Bacterial infections with fever, chills, hypotension
NO purulence ( 2o lack of neutrophils)

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52
Q

Selective dorsal rhizotomy in cerebral palsy leads to ?

A

Decreased muscle tone
(by destroying the afferent sensory arm of the reflex arc)

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53
Q

Klinefelter presentation?

A

1o hypogonadisim
Small testes
Gynecomastia
Absent 2o sexual characteristics
Tall stature
Learning difficulties

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54
Q

Klinefelter presentation?

A

1o hypogonadisim
Small testes
Gynecomastia
Absent 2o sexual characteristics
Tall stature
Learning difficulties

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55
Q

Klinefelter hormone levels?

A

High LH/FSH
Low testosterone
High oestrogen

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56
Q

Ménière’s disease presentation?

A

Triad:- Vertigo
Sensorineural hearing loss
Tinnitus with aural fullness

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57
Q

Meniere’s diesase symptoms are due to ?

A

Increase volume and pressure of endolymphs in vestibular apparatus

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58
Q

Meniere’s diesase symptoms are due to ?

A

Increase volume and pressure of endolymphs in vestibular apparatus

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59
Q

Damage to Broca’s area presentation?

A

Motor non fluent aphasia

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60
Q

Damage to Broca’s area presentation?

A

Motor non fluent aphasia

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61
Q

Where is Broca’s area located?

A

Inferior frontal gurus of dominant hemisphere

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62
Q

How do competetive inhibitors affect enzymes?

A

Compete with enzymes therefore more substrate is needed to achieve same rate.
Does not affect enzyme function

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63
Q

Primary hyperparathyroidism levels?

A

High PTH
High Ca
High Ca in urine
High urine PO4
Low serum PO4

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64
Q

Primary hyperparathyroidism levels?

A

High PTH
High Ca
High Ca in urine
High urine PO4
Low serum PO4

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65
Q

Normal PTH, mild increase Ca and low Ca urine, high Mg is seen in ?

A

Familial Hypocalcuric Hypercalcaemia
(G protein coupled receptor abnormality)

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66
Q

Albright hereditary osteodystrophy bld levels?

A

High PTH
Low Ca
High PO4

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67
Q

APS-I presentation

A

Mucocutaneous candidiasis
Autoimmune hypoparathyroidism ( low PTH, low Ca, high PO4
Addison’s disease

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68
Q

Where is 25 (OH)D converted to 1,25(OH)2 D ?

A

Proximal tubule
Tri to make D3 in the PCT

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69
Q

Where is 25 (OH)D converted to 1,25(OH)2 D ?

A

Proximal tubule
Tri to make D3 in the PCT

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70
Q

Affect of anabolic steroids abuse ( bld levels)?

A

Increased LDL
Decreased HDL
Increase Hb
Increase Hct
Decrease LH/FSH

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71
Q

Affect of finasteride on hormone bld levels?

A

increase testosterone
Decrease DHT
Increase oestrodiol

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72
Q

5 alpha reductase deficiency presentation?

A

Assigned female at birth
Clitoromegally at puberty
With no breast growth
+ve pubic hair
High testosterone
Low DHT
Low 17-OH progesterone

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73
Q

G+ve rods that form colonies resembling Medusa head ?

A

Bacillus Anthracis

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74
Q

Bacillus Anthracis bacterial virulence factor?

A

Antiphagocytic D glutamate poly peptide capsule

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75
Q

Positive predictive value equation?

A

a/a+b

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76
Q

Positive predictive value equation?

A

a/a+b

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77
Q

How does PTH act in kidneys?

A

Increase Ca reabsorption
Decrease PO4 reabsorption in proximal tubules

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78
Q

Which immune effector cell kills cells with decreased MHCI expression?

A

Natural killer cells (via apoptosis)

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79
Q

How does weight lifting help bones?

A

Osteocytes detect weight load in bones and communicate with each other through gap conjunctions to orchestrate bone remodeling

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80
Q

How does weight lifting help bones?

A

Osteocytes detect weight load in bow s and communicates with each other through gap conjunctions to orchestrate bone remodeling

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81
Q

Down regulation of which enzyme leads to improvement in symptoms of acute intermittent porphyria?

A

AlA synthase (aminolevulinate)

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82
Q

Mullerian Agenesis presentation?

A

1o Amenorrhea
Shortened vagina
Normal ovaries
Secondary sexual characteristics
Variable uterine development

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83
Q

Androgen to oestrogen ration in post menopause?

A

Increased

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84
Q

Effect of taking physiologic oestrogen replacement?

A

Raise SHBG
Raise HDL
Inc BMD
Dec LDL

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85
Q

Aromatase deficiency is associated with ?

A

High androgen
Low oestrogen

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86
Q

21 alpha hydroxylase deficiency hormone levels?

A

Clitoromegaly
High 17 OH progesterone
High testosterone
High androstenedione

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87
Q

21 alpha hydroxylase deficiency presentation?

A

Clitoromegaly
High 17 OH progesterone
High testosterone
High androstenedione

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88
Q

PCOS hormone profile ?

A

High LH:FSH ratio
Raised testosterone
Raised estrone
Low progesterone
Hyper insulinanemia

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89
Q

Pulsatile GnRH affect on LH and FSH?

A

Stimulates LH and FSH

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90
Q

Pulsatile GnRH used to treat?

A

Infertility to stimulate ovulation

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91
Q

Non pulsatile GnRH affect on LH/FSH?

A

Suppresses LH/FSH

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92
Q

Non pulsatile GnRH used in the treatment of ?

A

Prostate Cancer
Endometriosis
Precocious puberty
Premenopausal breast Ca

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93
Q

DKA K+ levels

A

N/Increased extracellular (serum) K+
Low total body ( intracellular ) K+

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94
Q

Insulin effect on Fructose 2,6 bisphosphonate and glucose metabolism?

A

Insulin increase production of fructose 2,6 bisphosphonate by phosphofructokinase 2 thereby stimulating glycolysis

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95
Q

Which mediator is responsible for the effects of glucagon, TSH,PTH?

A

Protein kinase A via the G protein mediated adenylate cyclase 2nd messenger

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96
Q

Which mediator is responsible for the effects of glucagon, TSH,PTH?

A

Protein kinase A via the G protein mediated adenylate cyclase 2nd messenger

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97
Q

TSH resistance presentation?

A

Congenital hypothyroidism
High TSH
Low thyroxine
Normal thyroid gland size and location

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98
Q

Pituitary tumor presentation?

A

Headache
Bitemporal hemianopsia
Hypopituitarisim
Commonest functional adenomas are prolactinomas
Amenorrhoea and galactorhoea in women
Hypogonadisim, decreased libido men

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99
Q

Gaucher disease presentation?

A

Lysosomal storage disease
Increase buildup of glucocerebroside in lysosomes
Hepatosplenomegally
Cytopenia
Bone pain
Spasticity and loss of motor skills

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100
Q

Adrenal zones hormone production

A

Salt, sugar, sex
Zona glomerulosa aldosterone
Zona fasciculata cortisol
Zona reticularis androgens

ACTH is the major hormone of zona fasciculata and reticularis

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101
Q

How does COP treat hirsuitism?

A

Suppressing pituitary Lh secretion ==> decrease ovarian androgen production

102
Q

Secondary hyperthyroidism cause and presentation?

A

Caused by TSH secreting pituitary adenoma
High TSH
High T3/T4
Diffuse goiter

103
Q

Effect of taking propylthiouracil during pregnancy?

A

Congenital goitre with hypothyroidism
High TSH
Low T4

104
Q

How does hyperparathyroidism causer bone loss?

A

Increase bone resorption 2o paracrine stimulation of osteoclasts

105
Q

How is normal blood glucose maintained?

A

By opposing effects of insulin and glucagon

106
Q

ACTH supressed by high dose but not low dose dexamethasone cause ?

A

Cushing syndrome 2o ACTH secreting pituitary adenoma

107
Q

ACTH supressed by high dose but not low dose dexamethasone cause ?

A

Cushing syndrome 2o ACTH secreting pituitary adenoma

108
Q

Postpartum thyroiditis presentation?

A

Within 12/12 of pregnancy
Hyperthyroid -> hypo -> euthyroid
Diffuse non tender goitre
Lymphocytic infiltration with formation of germinal cells

109
Q

SIADH presentation?

A

Hyponatraemia
Hypotonicity
High urine osmolality

110
Q

Hyponatraemia following cerebral injury is commonly due to ?

A

SIADH

111
Q

Alkaptonuria presentation?

A

Black urine when exposed to air
Blue-black pigmentation in face
Arthropathy

112
Q

What is the defect in alkaptonuria?

A

AR disorder of Tyrosine metabolism
Deficiency of homogentisic acid
Prevents conversion of tyrosine to fumarate

113
Q

Congenital hypothyroidism presentation?

A

Asymptomatic at birth 2o maternal thyroxine
Lethargy, poor feeding
Enlarged Fontanelle
Protruding tongue
Constipation
Jaundice
Dry skin
Raised TSH
Low thyroxine

114
Q

Phaeochromocytoma presentation?

A

Episodic headache
Abrupt severe increase in bp
Diaphoresis
Tremor
Chest pain

115
Q

What is the Metyrapone stimulation test ?

A

Metyrapone inhibits production of cortisol
if hypothalamus-pituitary axis is intact there should be a surge of ACTH to stimulate cortisol production

116
Q

1o hyperaldosteronism presentation?

A

HTN
Low K
Metabolic alkalosis
Low plasma renin
High aldosterone

117
Q

Phaeochromocytoma derived from ?

A

Modified neuronal cells

118
Q

Adrenal crisis presentation>

A

Aka 2o adrenal insufficiency
Shock
Abdominal pain, nausea, vomiting
Confusion
Precipitating illness

119
Q

Adrenal crisis presentation?

A

Aka 2o adrenal insufficiency (Addison disease not enough aldosterone)
Shock
Hypotension, hypovoluaemia
Hyponatraemia
HyperKalaemia
Abdominal pain, nausea, vomiting
Confusion
Precipitating illness

120
Q

Initial treatment of adrenal crisis?

A

Glucocorticoid

121
Q

What does cosyntropin stim test test for?

A

N—> increase of cortisol to 18 after administration
In adrenal insufficiency—> baseline cortisol low and no significant increase after administration of cosyntropin (synthetic ACTH)

122
Q

Addison’s disease (1o adrenal insufficiency) blood levels ?

A

High ACTH
Low cortisol
Low aldosterone
Low Na
High K

123
Q

SE of ketoconazole ?

A

Gynaecomatia by inhibiting androgen synthesis

124
Q

Cushing’s Disease bld levels?

A

High ACTH
High Cortisol

125
Q

Cushing’s disease result low and high dexamethasone test?

A

Low dexamethasone test elevated cortisol
High dexamethason test il Cushing syndrome ACTH dependent pituitary tumor or independent

126
Q

Low dose dexamethasone suppression test interpretation of results?

A

Normal —> cortisol levels will be low 2o suppression of ACTH
Cushing’s syndrome —> elevated cortisol levels

127
Q

High dose dexamethasone suppression test interpretation?

A

If cortisol decreases —> ACTH dependent pituitary tumour
If cortisol unchanged ( high) —> ACTH independent I.e. ectopic

128
Q

First bld test for a patient with raised cortisol?

A

ACTH level
High ACTH —> ACTH dependent pituitary tumor
Low ACTH —-> ACTH independent I.e exogenous steroids or adrenal tumor

129
Q

Cushing’s Syndrome presentation?

A

HTN
Hyperglycaemia
DM
Increase insulin
Decrease FSH/LH

130
Q

Female newborn, ambiguous genitalia, volume depletion and hyperkalaemia, spot diagnosis>

A

21 alpha hydroxylase deficiency

131
Q

Congenital adrenal hyperplasia 21 alpha hydroxylase deficiency blood levels?

A

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

132
Q

11 B hydroxylase deficiency presentation ?

A

Hypertension
Hypokalaemia
Increase 11 deoxycortisone
Precocious puberty males
No testicular enlargement
Low LH
Ambiguous genitalia females

133
Q

17 alpha hydroxylase deficiency?

A

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

134
Q

3 B hydroxysteroid dehydrogenase deficiency presentation?

A

Symptoms assoc with Impaired synthesis of all adrenal steroid hormones
Failure to thrive
Vomiting, volume depletion
Hyponatremia
Hyperkalaemia
Male:- ambiguous genitalia
Female 1o amenorrhoea

135
Q

Which insulin reversibly binds to albumin?

A

Detemir

136
Q

Which insulin reversibly binds to albumin?

A

Detemir

137
Q

What is the duration of action of rapid acting insulin?

A

2-4 hrs

138
Q

What is the duration of action of rapid acting insulin?

A

2-4 hrs

139
Q

Which insulin precipitates at body temperature?

A

Glargine

140
Q

Duration of action of NPH insulin?

A

12-16 hrs

141
Q

Insulin effect on K+?

A

Can decrease level

142
Q

Metformin effect on lipid level?

A

Increase lactate
Decrease free fatty acid
Decrease TG
Decrease LDL
Increase HDL

143
Q

Metformin effect on lipid level?

A

Increase lactate
Decrease free fatty acid
Decrease TG
Decrease LDL
Increase HDL

144
Q

HbA1c level and initial Mgx of new Type 2 DM?

A

If HbA1c <7.5% at diagnosis lifestyle mods
If HbA1c >7.5% pharmacalogic agents at diagnosis

145
Q

HbA1c level and initial Mgx of new Type 2 DM?

A

If HbA1c <7.5% at diagnosis lifestyle mods
If HbA1c >7.5% pharmacalogic agents at diagnosis

146
Q

Location of action of sodium glucose co transporter 2 (SGLT-2)?

A

Proximal tubule

147
Q

Location of action of sodium glucose co transporter 2 (SGLT-2)?

A

Proximal tubule

148
Q

chlorpropramide SE?

A
  1. Disulfiram reaction when taking alcohol.
    Flushing , tachycardia, nausea
  2. Hyponatremia
149
Q

chlorpropramide SE?

A
  1. Disulfiram reaction when taking alcohol.
    Flushing , tachycardia, nausea
  2. Hyponatremia
150
Q

Mechanism of action of sulphonylureas?

A

Closure of K channels in beta cells

151
Q

Alpha glucosidase inhibitors common SE?

A

Diarrhoea
Flatulence

152
Q

Biospy of Dysfunctional uterine bleeding will show ?

A

Endometrial hyperplasia

153
Q

Skeletal muscle cellular changes in hypertrophy ?

A

Increase in actin
Increase in myosin
If endurance training increase in mitochondria

154
Q

What process is responsible for muscle atrophy?

A

Ubiquination

155
Q

Cellular changes seen in BPH?

A

Increase in number of glandular cells
Increase total protein content
Increas total DNA content

156
Q

Abuse of exogenous thyroxine will lead to what cellular process occurring in thyroid?

A

Atrophy 2o to TSH suppression

157
Q

Common cause of cardiac myocyte hypertrophy?

A

HTN

158
Q

MI serum testing abnormalities?

A

Increase CK
Increase troponin
Ca influx 2o hypoxia damage

159
Q

Cell changes seen in necrosis?

A

Karyolysis ( nuclear fading)
Pyknosis ( nuclear shrinkage)
Karyorrhexis ( nuclear fragmentation)
Cellular swelling

160
Q

NAFLD is an example of which kind of cell injury?

A

Reversible

161
Q

NAFLD is an example of which kind of cell injury?

A

Reversible

162
Q

G6PD is assoc with decreased levels of ?

A

NADPH
Glutathione

163
Q

How will deficiency of myeloperoxidase affect neutrophil killing?

A

Decreased production of hypochlorous acid in respiratory burst

164
Q

Cell damage from reperfusion is due to?

A

Membrane lipid peroxidation

165
Q

How can acetaminophen cause damage to the liver?

A

Free radicals
Metabolised to NAPQI which is a reactive oxygen species

166
Q

Features of dystrophic calcification?

A

Normal Ca+ Po4
Depositing on inflammed or dead tissue

167
Q

What is calciphylxis ?

A

Complication of CKD 2o hyperphosphataemia
Po4 binds to Ca causing hypocalcaemia
And deposits of calcium phosphate crystals in skin
Causing painful progressive skin lesion

168
Q

Glucocorticoids induce apoptosis in lymphocytes via?

A

Caspases (intrinsic pathway)

169
Q

Glucocorticoids induce apoptosis in lymphocytes via?

A

Caspases (intrinsic pathway)

170
Q

Glucocorticoids induce apoptosis in lymphocytes via?

A

Caspases (intrinsic pathway)

171
Q

BAX and BAK are?

A

Pro-apoptosis

172
Q

Apoptosis in acute hepatitis B is via?

A

Extrinsic pathway
T cell mediated Fasl-Fas CD95 apoptosis c

173
Q

Apoptosis in acute hepatitis B is via?

A

Extrinsic pathway
T cell mediated Fasl-Fas CD95 apoptosis c

174
Q

Autoimmune lymphoproliferative syndrome presentation

A

Child with longstanding lymphadenopathy and new onset of hemolytic anaemia
Low HCT
High bilirubin
Positive direct Coombs test

175
Q

DNA damage leads to ?

A

Phosphorylation of p53 protein

176
Q

What does phosphorylation of p53 do?

A

Arrests cells cycle to allow for DNA repair (e.g in radiation therapy causing damage to DNA)if not repaired will continue to apoptosis

177
Q

ALPS presentation can be explained by which apoptosis pathway?

A

Extrinsic FAS-FAS ligand binding

178
Q

Pancreatic lipase can lead to what type of necrosis ?

A

Fat necrosis to peripancreatic fat

179
Q

Klebsiella pneumonia is assoc with what type of necrosis?

A

Liquefactive as it can cause lung abscess

180
Q

What is the main cause of cellular damage to liver in hepatitis B?

A

Apoptosis of hepatocytes but CD8+ T cells

181
Q

What is the main cause of damage to liver in hepatitis B?

A

Apoptosis of hepatocytes but CD8+ T cells

182
Q

Polyarteritis Nodosa presentation?

A

Evidence of systemic inflammation ( fever, raised WBC, raised ESR)
Skin rash
Neurologic symptoms (parasthesia, weakness)
Renal failure

183
Q

Polyarteritis Nodosa is which type of hypersensitivity?

A

Type III hypersensitivity

184
Q

Histologic findings of Polyarteritis Nodosa?

A

Fibrinoid necrosis

185
Q

Viral causes of exacerbation of COPD?

A

Influenza
RSV
Human rhinovirus

186
Q

Intracellular changes see with administration of phenylepinephrine?

A

(Acts on alpha cells)
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

187
Q

Pleural fluid findings in HF?

A

Transudate
High hydrostatic capillary pressure
High lymphatic outflow
N oncotic pressure
N vascular permeability

188
Q

Strep pneumoniae is a ?

A

G+ve cocci in pairs (diplococci)
Partial haemolysis in bld agar
Optochin sensitive
Bile salt soluble

189
Q

Strep pneumoniae virulence factor?

A

Resists phagocytosis via polysaccharide capsule

190
Q

C.O. Equations?

A

C.O = HR x Stroke volume
C.O = rate of O2 consumption / arteriovenous O2 content difference

191
Q

Group B streptococcus features?

A

G+ve coccus in chains
Narrow zone of haemolysis in bld agar
Catalase negative
Causes neonatal sepsis

192
Q

Signs of aortic regurgitation?

A

Decrescendo diastolic murmur in LSB 3-4th intercostal space
Wide pulse pressure
De Musset sign ( head bobbing)
Water hammer pulse

193
Q

Favourable prognositic factors in schizophrenia?

A

Later onset
Female
Acute onset with precipitant
Predominantly +ve symptoms
No Fhx
Short duration of active symptoms

194
Q

Amiodarone changes in ECG?

A

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 )

195
Q

Drugs that have a non IgE mediated effect on mast cell degranulation ( mimic IgE mediated hypersensitivity/ pseudo allergic)?

A

Opioids esp morphine, meperidine
Vancomycin
Radioiodine contrast

196
Q

Drugs that have a non IgE mediated effect on mast cell degranulation ( mimic IgE mediated hypersensitivity/ pseudo allergic)?

A

Opioids esp morphine, meperidine
Vancomycin
Radioiodine contrast

197
Q

When is correlative analysis used?

A

Used to describe the strength and direction of a linear relationship between 2 quantitative variables

198
Q

What are toll like receptors?

A

A type of pattern recognition receptors on dendritic cells that recognise lipopolysaccharide and release inflammatory cytokines IL1,6,12 via NF-kB

199
Q

Phases of cardiac myocyte action potential?

A

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

200
Q

Ureter route in relation to bld vessels?

A

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)

201
Q

Ureter route in relation to bld vessels?

A

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)

202
Q

Hypercalcaemia with malignancy is associated with increase secretion of…?

A

Secretion of PTHrP ( parathyroid hormone related peptide)

203
Q

Hypercalcaemia with malignancy is commonly due to ?

A

Secretion of PTHrP ( parathyroid hormone related peptide)

204
Q

Causes of constipation in pregnancy?

A

Effect of progesterone on colonic smooth muscle contractions

205
Q

Late stage radiation dermatitis histologic findings?

A

Fibroblast proliferation
Homogenisation of dermal collagen ( fibrosis)
Vascular abnormalities

206
Q

Late stage radiation dermatitis presentation?

A

Pigment changes
Telengectasia
Chronic ulceration

207
Q

Patau syndrome ( Trisomy 13) findings ?

A

Defective prechordal mesoderm fusion causing midline defects
Holoprosencephaly (cyclops)
Microphthalmia
Cleft clip/palate
Polydactyly
Cutis aplasia

208
Q

Varices in gastric fundus are due to?

A

Splenic vein thrombosis (chronic pancreatitis/pancreatic Ca) increasing pressure on the short gastric veins (short gastric veins normal drain from fundus into splenic vein)

209
Q

Bacterial vaginosis is commonly due to ?

A

Gardnerella vaginalis - anaerobic gram variable rod

210
Q

Mechanism of acute simple cystitis?

A

Ascending infection

211
Q

Defects in primary neuralation present as ?

A

Raised maternal alpha fetoprotein
Complex cystic mass over the lower spine of fetus
Venmtriculomegally

212
Q

In SLE pt have antibodies directed at which cellular function?

A

At snRNAs (small nuculear RNA) which remove introns from preMRNA to form mature mRNA

213
Q

Activation of bradykinin leads to ?

A

Increase vasodilation
Increase vascular permeability
Increase pain

214
Q

What are the major cytokines of acute inflammation

A

1 alpha 6
IL1
TNF alpha
IL6

215
Q

What cytokines are involved in chronic inflammation?

A

‘Gamma twelve’
IFN gamma
IL12

216
Q

What is an important mediator of fever?

A

PGE2

217
Q

Light’s criteria

A

Exudate if
Pleural protein/serum protein >0.5
Pleural LDH/serum LDH >0.6
Pleural LDH greater that 2/3 upper limits normal LDH

218
Q

Leukemoid reaction is?

A

V high WBC
Immature neutrophils (band forms)
In background of focal infection symptoms

219
Q

The following are acute phase reactants?

A

Ferritin
Fibrinogen
Serum amyloid A
CRP
Hepcidin

220
Q

What are inflammasomes?

A

Multi protein complex that assembles in the cytoplasm of cells in response to cellular damage or infection.

221
Q

Inflammasomes activate which enzyme in an inflammatory response?

A

IL-1

222
Q

What activates classically activated macrophages?

A

IFN gamma

223
Q

Function of classically activated macrophages (M1)?

A

Destruction of pathogens by generating reactive o2 species and lysosomal enzymes.

224
Q

Function of alternative pathway (M2) macrophages?

A

Tissue repair
Activated by IL-4 and IL-13

225
Q

Hallmark cells of chronic inflammation?

A

‘Mononuclear cells’
Macrophages
T cells
B cells
Plasma cells

226
Q

E.Coli are what kind of bacteria?

A

G-ve rods

227
Q

Granulomatous inflammation involves which cytokines?

A

IFN gamma + IL-2

228
Q

Cytokine released by activated macrophages

A

TNF alpha (maintains granuloma in Granulomatous inflammation)

229
Q

Chronic Granulomatous disease is due to a deficiency in ?

A

NADPH oxidase

230
Q

Chronic Granulomatous disease presentation?

A

Recurrent infection with catalase +ve organisms
Staph aureus
Nocarida
Aspergillus
Pseudomonas aerignosa
Serratia marcescens

231
Q

The first 24 hours after surgery the scar is dominated by?

A

Clot formation and neutrophil invasion

232
Q

What is happening in the surgical wound on day 3-7?

A

Neutorphils are replaced by macrophages
Granulation tissue fills the space
Angiogenesis starts
Fibroblasts infiltrate the wound
Collagen synthesis begins

233
Q

What is happening in the surgical wound on day 3-7?

A

Neutorphils are replaced by macrophages
Granulation tissue fills the space
Angiogenesis starts
Fibroblasts infiltrate the wound
Collagen synthesis begins

234
Q

What is happening in a surgical wound 1 month after surgery?

A

Inflammatory cells are absent
Only fibroblasts remain

235
Q

Surgical scar 6/12 to a year after surgery?

A

Collagen remodelling including cross linking of collagen

236
Q

Wound strength is at its max when?

A

All collagen is Type I
No type III collagen or fibronectin

237
Q

In wound healing Vascular endothelial growth factor is at highest when?

A

3-14/7

238
Q

Cell type appearance in wound healing in order?

A

Platelets
Neutrophils
Macrophages
Lymphocytes
Fibroblasts

239
Q

Causes of delayed wound healing ?

A

Infection
Diabetes
Glucocorticoid therapy
Poor nutritional status

240
Q

What is the Warburg effect?

A

Malignant cells metabolise glucose via aerobic glycolysis.
Produce less ATP
Produce excess lactic acid

241
Q

Breast cancer increases synthesis of …… that allows it to keep replicating ?

A

Telomerase allowing it to divide indefinitely

242
Q

Hallmarks of malignant cells

A

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

243
Q

Characteristics of pulmonary hamartoma?

A

Slow growth
Disorganised but normal tissue ( fat, epithelial cells, fibrous tissue, cartilage, +/- calcification )

244
Q

Post transplantation lymphoproliferative disorder characteristics?

A

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

245
Q

Which antioxidant enzymes neutralize reactive oxygen species?

A

Superoxide —> superoxide dismutase —> H2O2 —> catalase/ glutathione peroxidase —> H2O
Superoxide dismutase
Glutathione peroxidase
Catalase

246
Q

Hereditary breast cancer is associated with mutations in ?

A

BRAC1
BRAC2

247
Q

Tumour suppressor genes mutation cause malignancy because?

A

Tumour suppressor genes are involved in DNA repair - a mutation will disrupt that

248
Q

Path of progression from adenomatous polyp to malignancy?

A

Normal mucosa to adenomatous polyp —>2o APC
Increase in size of adenoma —>KRAS
Malignant transformation —> TP53

249
Q

Which cells are responsible for symptoms in Meckel’s diverticulum ?

A

Parietal cells

250
Q

Which cells are responsible for symptoms in Meckel’s diverticulum ?

A

Parietal cells

LopsNotes (12 decks)

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