Mixed Qs 10 Flashcards

1
Q

Parinaud Syndrome

A

2o pineal gland mass ( commonest germinoma)

Presentation:- obstructive hydrocephalus
Limitation of upward gaze
Bilateral lid retraction

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2
Q

DRESS syndrome

A

Drug reaction with eosinophilia and systemic symptoms

Presentation:- 2-8/52 after exposure to
Phenytoin, carbamazepine
Allopurinol
Sulfasalazine
Minocycline and vancomycin

Fever, gen lymphadenopathy, facial oedema, diffuse skin rash, eosinophila and internal organ dysfunction

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3
Q

How does phenytoin cause vitamin D deficiency

A

Increased catabolism of 25 hydroxyvitamin D to inactive metablolites by stimulating 24 hydroxylase

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4
Q

Entacapone

A

COMT inhibitor
Works on blood side
Prevents levodopa from being broken down into 3-OMD in blood and allows more levodopa to travel to brain

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5
Q

Topical capsicasin

A

MoA:- defunctionalisation of afferent pain fibres
Depletion of substance P

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6
Q

Pramiprexole

A

Dopamine receptor agonist

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7
Q

Juvenile myoclonic epilepsy

A

Generalised onset epilepsy
Familial
Worse with sleep deprivation

Treatment:- valproate

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8
Q

Ramelteon

A

Melatonin agonist

MOA:- bind to melatonin receptors in suprachiasmatic nucleus

SE low

Use:- sedative hypnotic - insomnia esp in elderly

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9
Q

Neuroleptic malignant syndrome

A

Similar to malignant hyperthermia but due to haloperidol

Treatment :- dantrolene

Inhibit ryanodine receptor and blocks Ca release from sarcoplasmic reticulum in skeletal muscle

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10
Q

Drug causing uterine relaxation and hypokalaemia

A

B2 receptor agonist

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11
Q

Sporotrichosis histology

A

Mixed granuloma and neutrophillic microabscesses

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12
Q

Glioblastoma

A

Poorly circumscribed
Necrotic and haemorrhagic
Cerebral hemispheres

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13
Q

Subdural haematoma is due to

A

Rupture of the cortical bridging veins

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14
Q

Alzheimer’s disease and acetylcholine

A

Low level of acetylcholine
2o deficiency of choline acetyltransferase
Most notable in nucleus basalis of Meynert

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15
Q

Referred pain to the shoulder

A

Phrenic nerve innervation
C3-5

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16
Q

Complication of SAH day 3-12

A

Vasospasm
Causing delayed cerebral ischaemia
CT unchanged

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17
Q

Subacute combined degeneration

A

2o vitamin B12 deficiency

Loss of vibratory and proprioception —> dorsal columns
UMN signs —> lateral corticospinal tract
Spinocerebellar tract
Peripheral nerves—> paraesthesia

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18
Q

Cavernous haemangioma

A

Vascular malformation occur in Brain parenchyma

Risk of intracerebral haemorrhage

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19
Q

Surgical treatment for Parkinson’s targets which structure

A

Subthallamic nucleus

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20
Q

Syringomyelia

A

UL —> loss of pain and temp sensation, weakness and hyporeflexia

LL —>weakness and hyperreflexia

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21
Q

Frontotemporal dementia changes seen in which part of the brain

A

Atrophy of the prefrontal cortex and then degeneration of the anterior temporal cortex

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22
Q

CJD

A

Prion disease
Rapidly progressive dementia
With myoclonus

Accumulation of protease resistant protein

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23
Q

Tabes dorsal is

A

Neurosyphillis
Sensory ataxia —> dorsal
Pain sharp and stabbing
Absent Deep tendon reflexes

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24
Q

Facial nerve palsy

A

Compression in post fossa

Taste to ant 1/3 of tongue
Ipsilateral facial paralysis
Loss of corneal reflex
Hyperacusis

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25
Pelvic fracture, difficulty voiding with sensation of bladder fullness
Post urethral injury
26
Raphe nuclei
Anxiety Sexuality Mood Serotogenic
27
Gancicolovir
Guanine nucleoside analogue MOA:-stops DNA replication Use:- CMV colitis / retinitis SE :- neutropenia
28
Bupropion
Antidepressant MoA:- inhibits reuptake of NE and dopamine Use:- major dear-resinous SE:-seizures > risk in eating disorder or high dose CI:- in bulimia/ anorexia
29
Acute dystonic reaction
SE of haloperidol Sudden involuntary contraction —> tongue protrusion, facial grimacing Mgx:- diphenhydramine anticholinergic
30
Serotonin syndrome
Presentation:- mental status change ( agitation, confusion) Autonomic instability ( hyperthermia, diaphoresis) Neuromuscular hyperactivity ( tremor, myoclonus) 24 hrs after change in serotogenic medication Can occur with co-administration of tramadol and SSRIs
31
Physical dependence on opioids
Developing withdrawal with abrupt cessation of Rhinorrhea, lacrimation, vomiting
32
Opioid use disorder
Uncontrolled use despite harmful effects
33
Borderline personality disorder
Unstable self image Feeling of emptiness Unstable relationships Mood instability Abandonment fears Recurrent suicide attempts/ self injury Begins in teen or YA Mood reactivity to interpersonal stresses
34
Bipolar II disorder
Discrete episodes of hypo mania and major depression
35
Tourette
Multiple motor tics and > vocal tic > 1 year Preceeeded by urge Waxing and waning hx Boys 6 -15 years
36
Stereotypic movement disorder
Simple repetitive movements —> rocking head banding Seen in autism
37
REM sleep behaviour disorder
Re-enactment of dreams Hypertonia
38
ADHD Mgx
Stimulant drugs:- methylphenidate and amphetamines MoA:- block NE and dopamine reuptake in synapses in the prefrontal cortex SE:- decreased appetite, insomnia
39
Buprenorphine
MoA:- partial agonist at the mu opioid receptor ( agonist/antagonist) Can precipitate or treat opioid withdrawal Use:- Opioid replacement therapy
40
Benzidiazepine withdrawal
Anxiety, tremor, insomnia, diaphoresis and palpitations , seizures , psychosis , death
41
Tibial nerve injury
2o penetrating trauma or knee surgery At level of popliteal fossa Presentation:- weakness on planter flexion, foot inversion and toe flexion with sensory loss over the sole
42
Down syndrome prenatal test results
Low alpha fetoprotein Low oestriol High B hCG High inhibin A
43
Why is tetanus toxoid added to haemophilus influenza vaccine
Proteins conjugation causes a T cell mediated immune response leads to long term immunity through memory b cell production Aka conjugated vaccine
44
Clostridium perfringes toxin action
Phospholipase C mimetic -0–> splits phospholipids —-> cell lysis and necrosis
45
Generalised macular rash, lymphadenopathy, corkscrew shaped organism suggest
Secondary syphiullis Mgx:- penicillin —> moa disrupts cell wall linking and inhibiting transpeptidase
46
Aplastic anaemia arrows
High EPO Low retics Normal MCV Normal Haptoglobin (sign of intravascular haemolysis) Bone marrow shows abundance of lipids Pancytopenia
47
Blood supply of distal and proximal ureter
Proximal ureter —-> renal artery Distal ureter —-> vesicular artery
48
Vasospastic angina
AKA Prinzmetal angina Intermittent coronary artery spasm leadin to MI 2o hyper reactive arterial smooth muscle Presentation:- recurrent chest pain early morning or during sleep in young <50 pts, no risk factors angio clear despite ST elevation
49
Infants of HBeAg mothers will show
HBeAg in their blood
50
Mayo based salads buzz word
Enterotoxigeneic Staph aureus diarrhoea illness Prevent by proper refrigeration of food Presentiotn:- fast acting, vomiting mild dirarrhoea, abdominal pain pain
51
Cephalosporin resistant organisms
Listeria MRSA Enterococci 2o resistant penicillin binding proteins Atypical no cell will e.g chlamydia, mycoplasma
52
I cell
Coarse faceless Developmental delay Cloudy cornea Recurrent resp infection Problem with the prostranslational modification leading to inappropriate trafficking of acid hydrolyse to extracellular space instead of lysosome
53
thiamine dependent co factor step in critic acid cycle
Alpha ketoglutarate ——> succinyl CoA
54
Ipsilateral loss of vibration and position Contra lateral loss of pain and temp below lesion
Brown sequard syndrome Hemisection of the cord
55
Bilateral Loss of motor function and loss of pain an temp below the lesion UMN at lesion LMN below lesion
Anterior spinal artery syndrome
56
ADPKD chromosome affected
Ch 16
57
Tuberous sclerosis chromosomes affected
Ch 9 and 16
58
Vincristine
Taxane Chemotheraputic Moa:- inhibit micro tubule depolymerisation Arrests on metaphase. Doesn’t allow mitotic spindle to separate
59
Estrodiol release is stimulated by
FSH
60
FFP USED TO TREAT
Dic TTP warfarin OD
61
Desmopressjn
ADH analog Can be used in vWF disease
62
TMP-SMX
Inhibitors incorporation of presiding and para- aminobenzoic acid in nucleotide
63
Ehlers Danlos affects which collagen
Collagen III
64
Complication of chronic granulomatous disease
Perirectal abscess
65
GM-CSF
Increase number of myeloid stem cells (neutrophils, eosinophils, basophils, monocytes, plts)
66
Pharochromocytoma
Homovanillic Metanephrine Vanillylmabdelic high
67
Carcinoid syndrome triad
Rt side murmurs Diarrhoea Flushing Normal vanillymandellic
68
Schizophrenia pathology location
Increase dopamine Mesolimbic pathway (positive) Mescortical (negative)
69
Amandadine
Increase dopamine availability Use:- Parkinson’s SE: anticholinergic like se Livedo retucularis
70
Ductus arteriosus originates from which arch
Lt 6th aortic arch
71
Maple syrup urine disease presentation
Poor feeding Vomiting Irritability Dystonia
72
Wallenberg syndrome/ lateral medullary syndrome
Infarction of PICA Ipsilateral numbness of face Contralateral loss of pain and temp torso Vertigo Ipsilateral Horner
73
Ewing sarcoma chromosome translocation
T: 11:22
74
Projectile vomiting in newborn boy
Pyloric stenosis
75
Clozapine
Atypical antipsychotic Moa:- block D2 receptor SE:- agranulocytosis
76
Patau syndrome is a result of
Maternal nondisjunction
77
Bleeding following abx use and high pt and aptt
Vit k deficiency Causing factor 2 deficiency
78
RA assoc cytokine
Transforming growth factor B
79
Fabry’s disease presentation
Reddish black papules on body Intermittent peripheral paraesthesia Heat intolerance Deficiency:- alpha galactose Accumulation ceramide trihexoside
80
T cells locator. In LN
Paracortex
81
Warfarin
Inhibits activity of vitamin K MoA:- inhibition of gamma carboxylation of vitamin K clotting factor
82
Organisms involved in CGD
Staph aureus Burkolhedria Serratia Nocardia Aspergilus
83
Colchicine
MoA:- inhibits mirotubule formation Use: -gout SE:- vomiting diarrhoea
84
Cytokines assoc with ankylosing spondylitis
IL-17, TNF alpha and prostaglandin
85
Ankylosing spondylitis complication
Reduced chest wall expansion —-> hypoventilation Reduced spinal mobility
86
Paget’s disease of bone
Bowing of legs Focal warmth Bone pain High alk phos Nonrmal Ca, Po4, PTH X-ray—> thickening in of cortical and trabecuar bone
87
What is dystrophin mutation in duchenne
Mutation affecting a sarcolemma - cytoskeleton linker protein
88
Drugs what reduce Uric acid excretion
Diuretics —> thiazides, furosemide Salicylates Ace inhibitors Cyclosporine
89
Blood supply femoral head
Medial circumflex femoral artery
90
Emicizumab
Monoclonal antibody MoA:- mimics factor VIII by binding both IXa and X to allow for X activation
91
Bacillary angiomatosis
Bartonella henselae
92
Malignant Otitis externa
Pseudomonas aeruginosa
93
Lenalimide
MOA:- increases intracellular degradation by protea some Increase binding of E3 ubiquities lipase complex to transcription factors —> destruction by proteasome USE:- multiple myeloma, other B cell malignancies SE:- diarrhoea
94
Bortezomib
Protease inhibitor MOA:- stops proteasome degrading pro-apoptotics —> apoptosis SE:- peripheral neuropathy Deactivation of herpes zoster USE:- B cell malignancies
95
IgA deficiency
Recurrent sinopulmonary infections GI infections —> giardia Conconmitant autoimmune illness —> coeliac disease Anaphylaxis with bld transfusion
96
Clostridium perfringes cause gas gangrene and
Transient watery diarrhoea and Abdo pain Late onset food poisoning
97
Aplastic anaemia bone marrow biopsy
Hypocellular marrow with abundance of stroma and fat
98
Maternal high AFP screening
Neural tube defect Ventral wall defect ( omphalocele, gastroschisis) Multiple gestation Wrong gestational date
99
Low maternal AFP screening
Trisomy 21, 18
100
Methylmalonic acidemia
Metabolic acidosis Hypoglycemia + ketones Hyperammonemia High urine proprionic acid
101
Round oval intracellular protozoa with rod shaped kinetoplast
Leishmaniasis — sand fly
102
Secondary syphillis non treponemal antibodies
Has antibody to cardiolipin- cholesterol - lecithin AG
103
Listeria in neonates
Can cause neonatal sepsis, meningitis
104
Ovarian torsion blood vessel involved
Ovarian artery —> infundibulopelvic ligament ( suspension ligament of the ovary)
105
Drugs that inhibit adenosine conversion to inosine
Inhibit adenosine deaminase Prevent adenosine eventual conversion to Uric acid Causes lymphocytes apoptosis USE :- hairy cell leukaemia
106
Endonuclease
Responsible for nucleotide excision repair
107
Acute otitis media can affect which structure
Facial nerve
108
Lateral medullary syndrome is caused by which vessel
Vertebral artery
109
Portal triad occlusion
Occlusion of hepatodudenal ligament Made up of hepatic artery, portal vein and common bile duct If continues to bleed source is IVC
110
Chelating agents that reduce drug bioavailability
Iron Calcium Magnesium Aluminium Affect tetracyclines, fluoroquinolones and levothyroxine
111
Test for malabsorption
Sudan III stain
112
Rituximab
Mab against Cd20
113
Pembrolizumab
Manblock programmed death ligand 1 PD -1 Promote tumour cell apoptosis Increase CD 8 lymphocyte infiltration
114
Amphotericin B toxicity
Nephrotoxic —> hypokalemia —> weakness and arrhythmias
115
Germline Mutation in ovarian and breast cancer
Defective DNA break repair
116
West Nile viurus
Warm climate Summer Mosquito bite Fever, headache , rash , flaccid paralysis Meningitis, encephalitis Parkinsonian symptoms —> tremor, dyskinesia Flavivirus RNA
117
Obstructing hydrocephalus at the level of cerebral aqueduct
Enlarged lateral and 3rd ventricles 4th ventricle spared
118
Obstructive hydrocephalus affecting all ventricles
Obstruction at the level of median foramen of magendie or lateral foramina of Luschka
119
CN V3 mandibular emerges from brain through
Foramen ovale
120
Acute opioid toxicity triad
Decreased RR Constricted pupils Depressed GCS Also Decreased TV Hypothermia Hypotension
121
Acute viral hepatitis buzzword
Eosinophilic round bodies —> councilman bodies 2o cytotoxic T cell hepatocytes apoptosis
122
Exercise associated collapse
Reduced venous return Reduced cardiac preload When stopping exercise
123
Lyme disease stages
Early —> rash - target and flu like symptoms Second stage :- facial palsy, AV block Late stage:- chronic asymmetric ( often single knee ) arthritis , encephalopathy Mgx:- doxycycline, ceftriaxone
124
Imatinib
Inbitior of BCR-ABL USE:- CML
125
Abciximab
MoA:- MAB against GPIIb/IIIa
126
Rituximab
127
Rituximab
MoA- targets CD20 USE:- some lymphoma
128
Thrombocytopenia and throb=mbosis in pt started on heparin
Heparin induced thrombocytopenia type 2 IgG against heaprin —-> plt aggregation Plt removal but splenic macrophages
129
Aspirin moa
Irreversible inhibitor of COX -1 Decreases thrombaxane A2
130
P glycoprotein
Assoc with chemotherapeutic drug resistance By decreasing the drugs Intracellular concentration Functions via ATP dependent efflux pump
131
Graft vs host disease
Donor T cells agains graft MHC antigens Transplant of BM or lymphocyte rich organ eg liver Affects skin desquamating rash, liver and GI tract
132
Sirolimus
Inhibits mTOR Interrupts IL-2 signal
133
Anaphylaxis what is released from mast cells
Histamine and tryptase
134
APML
T15:17 PML:RARA ( retinoic acid receptor alpha) Assoc with DIC
135
Excessive CD 20
CML Accumulation of mature B cells in BM and peripheral blood
136
Cyclical neutropenia
Absolute neutropenia < 500 Cyclical decrease Mucositosis Bone marrow shows signs of apoptosis
137
Necrotic, ulcers, surrounding erythema in immunocompromised —>organism
Pseudomonas
138