Mixed Qs 10 Flashcards
Parinaud Syndrome
2o pineal gland mass ( commonest germinoma)
Presentation:- obstructive hydrocephalus
Limitation of upward gaze
Bilateral lid retraction
DRESS syndrome
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
How does phenytoin cause vitamin D deficiency
Increased catabolism of 25 hydroxyvitamin D to inactive metablolites by stimulating 24 hydroxylase
Entacapone
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
Topical capsicasin
MoA:- defunctionalisation of afferent pain fibres
Depletion of substance P
Pramiprexole
Dopamine receptor agonist
Juvenile myoclonic epilepsy
Generalised onset epilepsy
Familial
Worse with sleep deprivation
Treatment:- valproate
Ramelteon
Melatonin agonist
MOA:- bind to melatonin receptors in suprachiasmatic nucleus
SE low
Use:- sedative hypnotic - insomnia esp in elderly
Neuroleptic malignant syndrome
Similar to malignant hyperthermia but due to haloperidol
Treatment :- dantrolene
Inhibit ryanodine receptor and blocks Ca release from sarcoplasmic reticulum in skeletal muscle
Drug causing uterine relaxation and hypokalaemia
B2 receptor agonist
Sporotrichosis histology
Mixed granuloma and neutrophillic microabscesses
Glioblastoma
Poorly circumscribed
Necrotic and haemorrhagic
Cerebral hemispheres
Subdural haematoma is due to
Rupture of the cortical bridging veins
Alzheimer’s disease and acetylcholine
Low level of acetylcholine
2o deficiency of choline acetyltransferase
Most notable in nucleus basalis of Meynert
Referred pain to the shoulder
Phrenic nerve innervation
C3-5
Complication of SAH day 3-12
Vasospasm
Causing delayed cerebral ischaemia
CT unchanged
Subacute combined degeneration
2o vitamin B12 deficiency
Loss of vibratory and proprioception —> dorsal columns
UMN signs —> lateral corticospinal tract
Spinocerebellar tract
Peripheral nerves—> paraesthesia
Cavernous haemangioma
Vascular malformation occur in Brain parenchyma
Risk of intracerebral haemorrhage
Surgical treatment for Parkinson’s targets which structure
Subthallamic nucleus
Syringomyelia
UL —> loss of pain and temp sensation, weakness and hyporeflexia
LL —>weakness and hyperreflexia
Frontotemporal dementia changes seen in which part of the brain
Atrophy of the prefrontal cortex and then degeneration of the anterior temporal cortex
CJD
Prion disease
Rapidly progressive dementia
With myoclonus
Accumulation of protease resistant protein
Tabes dorsal is
Neurosyphillis
Sensory ataxia —> dorsal
Pain sharp and stabbing
Absent Deep tendon reflexes
Facial nerve palsy
Compression in post fossa
Taste to ant 1/3 of tongue
Ipsilateral facial paralysis
Loss of corneal reflex
Hyperacusis
Pelvic fracture, difficulty voiding with sensation of bladder fullness
Post urethral injury
Raphe nuclei
Anxiety
Sexuality
Mood
Serotogenic
Gancicolovir
Guanine nucleoside analogue
MOA:-stops DNA replication
Use:- CMV colitis / retinitis
SE :- neutropenia
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
Acute dystonic reaction
SE of haloperidol
Sudden involuntary contraction —> tongue protrusion, facial grimacing
Mgx:- diphenhydramine anticholinergic
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
Physical dependence on opioids
Developing withdrawal with abrupt cessation of
Rhinorrhea, lacrimation, vomiting
Opioid use disorder
Uncontrolled use despite harmful effects
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
Bipolar II disorder
Discrete episodes of hypo mania and major depression
Tourette
Multiple motor tics and > vocal tic > 1 year
Preceeeded by urge
Waxing and waning hx
Boys 6 -15 years
Stereotypic movement disorder
Simple repetitive movements —> rocking head banding
Seen in autism
REM sleep behaviour disorder
Re-enactment of dreams
Hypertonia
ADHD Mgx
Stimulant drugs:- methylphenidate and amphetamines
MoA:- block NE and dopamine reuptake in synapses in the prefrontal cortex
SE:- decreased appetite, insomnia
Buprenorphine
MoA:- partial agonist at the mu opioid receptor ( agonist/antagonist)
Can precipitate or treat opioid withdrawal
Use:- Opioid replacement therapy
Benzidiazepine withdrawal
Anxiety, tremor, insomnia, diaphoresis and palpitations , seizures , psychosis , death
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
Down syndrome prenatal test results
Low alpha fetoprotein
Low oestriol
High B hCG
High inhibin A
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
Clostridium perfringes toxin action
Phospholipase C mimetic -0–> splits phospholipids —-> cell lysis and necrosis
Generalised macular rash, lymphadenopathy, corkscrew shaped organism suggest
Secondary syphiullis
Mgx:- penicillin —> moa disrupts cell wall linking and inhibiting transpeptidase
Aplastic anaemia arrows
High EPO
Low retics
Normal MCV
Normal Haptoglobin (sign of intravascular haemolysis)
Bone marrow shows abundance of lipids
Pancytopenia
Blood supply of distal and proximal ureter
Proximal ureter —-> renal artery
Distal ureter —-> vesicular artery
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
Infants of HBeAg mothers will show
HBeAg in their blood
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
Cephalosporin resistant organisms
Listeria
MRSA
Enterococci
2o resistant penicillin binding proteins
Atypical no cell will e.g chlamydia, mycoplasma
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
thiamine dependent co factor step in critic acid cycle
Alpha ketoglutarate ——> succinyl CoA
Ipsilateral loss of vibration and position
Contra lateral loss of pain and temp below lesion
Brown sequard syndrome
Hemisection of the cord
Bilateral Loss of motor function and loss of pain an temp below the lesion
UMN at lesion LMN below lesion
Anterior spinal artery syndrome
ADPKD chromosome affected
Ch 16
Tuberous sclerosis chromosomes affected
Ch 9 and 16
Vincristine
Taxane
Chemotheraputic
Moa:- inhibit micro tubule depolymerisation
Arrests on metaphase. Doesn’t allow mitotic spindle to separate
Estrodiol release is stimulated by
FSH
FFP USED TO TREAT
Dic
TTP
warfarin OD
Desmopressjn
ADH analog
Can be used in vWF disease
TMP-SMX
Inhibitors incorporation of presiding and para- aminobenzoic acid in nucleotide
Ehlers Danlos affects which collagen
Collagen III
Complication of chronic granulomatous disease
Perirectal abscess
GM-CSF
Increase number of myeloid stem cells (neutrophils, eosinophils, basophils, monocytes, plts)
Pharochromocytoma
Homovanillic
Metanephrine
Vanillylmabdelic high
Carcinoid syndrome triad
Rt side murmurs
Diarrhoea
Flushing
Normal vanillymandellic
Schizophrenia pathology location
Increase dopamine
Mesolimbic pathway (positive)
Mescortical (negative)
Amandadine
Increase dopamine availability
Use:- Parkinson’s
SE: anticholinergic like se
Livedo retucularis
Ductus arteriosus originates from which arch
Lt 6th aortic arch
Maple syrup urine disease presentation
Poor feeding
Vomiting
Irritability
Dystonia
Wallenberg syndrome/ lateral medullary syndrome
Infarction of PICA
Ipsilateral numbness of face
Contralateral loss of pain and temp torso
Vertigo
Ipsilateral Horner
Ewing sarcoma chromosome translocation
T: 11:22
Projectile vomiting in newborn boy
Pyloric stenosis
Clozapine
Atypical antipsychotic
Moa:- block D2 receptor
SE:- agranulocytosis
Patau syndrome is a result of
Maternal nondisjunction
Bleeding following abx use and high pt and aptt
Vit k deficiency
Causing factor 2 deficiency
RA assoc cytokine
Transforming growth factor B
Fabry’s disease presentation
Reddish black papules on body
Intermittent peripheral paraesthesia
Heat intolerance
Deficiency:- alpha galactose
Accumulation ceramide trihexoside
T cells locator. In LN
Paracortex
Warfarin
Inhibits activity of vitamin K
MoA:- inhibition of gamma carboxylation of vitamin K clotting factor
Organisms involved in CGD
Staph aureus
Burkolhedria
Serratia
Nocardia
Aspergilus
Colchicine
MoA:- inhibits mirotubule formation
Use: -gout
SE:- vomiting diarrhoea
Cytokines assoc with ankylosing spondylitis
IL-17, TNF alpha and prostaglandin
Ankylosing spondylitis complication
Reduced chest wall expansion —-> hypoventilation
Reduced spinal mobility
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
What is dystrophin mutation in duchenne
Mutation affecting a sarcolemma - cytoskeleton linker protein
Drugs what reduce Uric acid excretion
Diuretics —> thiazides, furosemide
Salicylates
Ace inhibitors
Cyclosporine
Blood supply femoral head
Medial circumflex femoral artery
Emicizumab
Monoclonal antibody
MoA:- mimics factor VIII by binding both IXa and X to allow for X activation
Bacillary angiomatosis
Bartonella henselae
Malignant Otitis externa
Pseudomonas aeruginosa
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
Bortezomib
Protease inhibitor
MOA:- stops proteasome degrading pro-apoptotics —> apoptosis
SE:- peripheral neuropathy
Deactivation of herpes zoster
USE:- B cell malignancies
IgA deficiency
Recurrent sinopulmonary infections
GI infections —> giardia
Conconmitant autoimmune illness —> coeliac disease
Anaphylaxis with bld transfusion
Clostridium perfringes cause gas gangrene and
Transient watery diarrhoea and Abdo pain
Late onset food poisoning
Aplastic anaemia bone marrow biopsy
Hypocellular marrow with abundance of stroma and fat
Maternal high AFP screening
Neural tube defect
Ventral wall defect ( omphalocele, gastroschisis)
Multiple gestation
Wrong gestational date
Low maternal AFP screening
Trisomy 21, 18
Methylmalonic acidemia
Metabolic acidosis
Hypoglycemia
+ ketones
Hyperammonemia
High urine proprionic acid
Round oval intracellular protozoa with rod shaped kinetoplast
Leishmaniasis — sand fly
Secondary syphillis non treponemal antibodies
Has antibody to cardiolipin- cholesterol - lecithin AG
Listeria in neonates
Can cause neonatal sepsis, meningitis
Ovarian torsion blood vessel involved
Ovarian artery —> infundibulopelvic ligament ( suspension ligament of the ovary)
Drugs that inhibit adenosine conversion to inosine
Inhibit adenosine deaminase
Prevent adenosine eventual conversion to Uric acid
Causes lymphocytes apoptosis
USE :- hairy cell leukaemia
Endonuclease
Responsible for nucleotide excision repair
Acute otitis media can affect which structure
Facial nerve
Lateral medullary syndrome is caused by which vessel
Vertebral artery
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
Chelating agents that reduce drug bioavailability
Iron
Calcium
Magnesium
Aluminium
Affect tetracyclines, fluoroquinolones and levothyroxine
Test for malabsorption
Sudan III stain
Rituximab
Mab against Cd20
Pembrolizumab
Manblock programmed death ligand 1 PD -1
Promote tumour cell apoptosis
Increase CD 8 lymphocyte infiltration
Amphotericin B toxicity
Nephrotoxic —> hypokalemia —> weakness and arrhythmias
Germline Mutation in ovarian and breast cancer
Defective DNA break repair
West Nile viurus
Warm climate
Summer
Mosquito bite
Fever, headache , rash , flaccid paralysis
Meningitis, encephalitis
Parkinsonian symptoms —> tremor, dyskinesia
Flavivirus RNA
Obstructing hydrocephalus at the level of cerebral aqueduct
Enlarged lateral and 3rd ventricles
4th ventricle spared
Obstructive hydrocephalus affecting all ventricles
Obstruction at the level of median foramen of magendie or lateral foramina of Luschka
CN V3 mandibular emerges from brain through
Foramen ovale
Acute opioid toxicity triad
Decreased RR
Constricted pupils
Depressed GCS
Also
Decreased TV
Hypothermia
Hypotension
Acute viral hepatitis buzzword
Eosinophilic round bodies —> councilman bodies
2o cytotoxic T cell hepatocytes apoptosis
Exercise associated collapse
Reduced venous return
Reduced cardiac preload
When stopping exercise
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
Imatinib
Inbitior of BCR-ABL
USE:- CML
Abciximab
MoA:- MAB against GPIIb/IIIa
Rituximab
Rituximab
MoA- targets CD20
USE:- some lymphoma
Thrombocytopenia and throb=mbosis in pt started on heparin
Heparin induced thrombocytopenia type 2
IgG against heaprin —-> plt aggregation
Plt removal but splenic macrophages
Aspirin moa
Irreversible inhibitor of COX -1
Decreases thrombaxane A2
P glycoprotein
Assoc with chemotherapeutic drug resistance
By decreasing the drugs Intracellular concentration
Functions via ATP dependent efflux pump
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
Sirolimus
Inhibits mTOR
Interrupts IL-2 signal
Anaphylaxis what is released from mast cells
Histamine and tryptase
APML
T15:17
PML:RARA ( retinoic acid receptor alpha)
Assoc with DIC
Excessive CD 20
CML
Accumulation of mature B cells in BM and peripheral blood
Cyclical neutropenia
Absolute neutropenia < 500
Cyclical decrease
Mucositosis
Bone marrow shows signs of apoptosis
Necrotic, ulcers, surrounding erythema in immunocompromised —>organism
Pseudomonas
