Mixed Qs 9 Flashcards
Iron absorption
Occurs in duodenum and proximal jejunum
Affected by gastrojejunostomy
Submucosal glands secreting alkaline secretions are
Submucosal Brunner glands located in the 1st part of the duodenum
V cholerae
G-ve comma shaped rod Oxidase +ve motile
Entertoxin causes severe watery diarrhoea
Thrives in alkaline medium
Reassortement
Aka genetic shift involves exchange of genomic segments
Only occurs in segmented viruses ( BOAR)
(bunyaviraus , othomyxovirus arenavirus and reovirus)
IL-2
Released by CD4, CD8 and Natureal killer cells
High dose IL-2 triggers proliferation of NK cells and increases their cytotoxic activity
Pulmonary alveolar proteinosis
Progressive resp dysfunction due to accumulation of surfactant debris in alveolar space.
Lipoproteinacious material PAS pink forming lamellar bodies
Surfactant produced by pneumocyte 2 and cleared by alveolar macrophages. Disturbance in balance causes disease
Meckels’ diverticulum
Failure of viteline duct obliteration
Presentation:- painless lower GI bleeding with anaemia
Ectopic gastric mucosa can cause ulceration of intestinal mucosa
SLE autoantibodies
Anti dsDNA
Anti Smith which is a snRNA ( small nuclear RNA) an essential part of spliceosomes which remove introns from mRNA to form mature RNA
Glucagon 2nd messenger
G protein coupled receptor using adenylate cyclist 2nd messenger
—> cAMP —-> protein kinase A
Along with TSH and PTH
Pyruvate dehydrogenase deficiency
Presentation:- lactic acidosis and neuro symptoms
Pyruvate —-X —-> acetyl coA
Supplement with lysine and leucine to avoid lactic acidosis accumulation
Bloody discharge nipple no mass no skin changes
Intraductal papilloma
Epithelial and myoepithelial cells lining fibrovascualr core in cysts wall or duct
Usually benign
AUG
Is the start codon
Initiates translation
If ther s is a mutation before then you cannot start translation
B thalassemia
Reduced beta globin chain synthesis
Resulting in
Hypochromic microcytics cells
Embryo formation of the uterus
Paramesoneprhic —> uterus, fallopian tubes,CX and upper vagina
Paramesonephric duct fuse laterally for form uterus
And vertically to form urogenital sinus
Ubiquination
Protein that undergoes attachement to other proteins and gets labeled for degradation by proteasomes.
Failure of this step is seen in Parkinson’s , Alzheimer’s with accumulation of misfolded proteins
Hormones and menustral cycle
Gradual rise of FSH growing follicle in follicular phase
LH signals ovulation and start of lueteal phase —> both go back to base line
Oestrogen gradual increase in proliferative phase
Spike just before ovulation to signal to GnRh to release LH
Progesterone increase in secretory phase until menustration happens both decrease
Ovulation can be triggered by hCG
Nitroglycerin
Venodilators
Increase peripheral venous capicitance
Decrease preload
Decrease LVEDP
High dose —> arteriolar dilation and decrease systemic vascular resistance
Viral myocarditis complication
Causes dilated cardiomyopathy
Pancarditis
Complication of acute rheumatic fever
Leading to new
MR
Aschoff body is pathognomic —‘interstitial myocardial granuoloma’
Why does appendicitis pain move
Initial pain at umbilicus is 2o afterent fibres entering spinal cord at T10
Later pain is RLQ 2o irritation of the parietal peritonuem
Intercostal brachial nerve
Can be Injured during a ill army LN dissection
Presentation:- burning, diminished sensation medial upper arm purely sensory dysfunction
The others cause motor deficit
Intercostal brachial nerve
Can be Injured during a ill army LN dissection
Presentation:- burning, diminished sensation medial upper arm purely sensory dysfunction
The others cause motor deficit
Ribosomes
Large complex contain protein and RNA found freely floating in endoplasmic reticulum
Synthesized in nucleolus
Ribosomal RNA is transcribed in nucleolus
CMV commonest congenital eye complication
CMV chorioretinitis
Rubella congenital eye complication
Congenital cataract
Tyrpsinogen
Is inactivated until it reaches the duodenal lumen
By trypsin and trypsin inhibitors (SPINK 1)
If a mutation occurs that prevents this inhibition it’ll lead to hereditary pancreatitis
What happens to area of the brain months after stroke
Wallerian degeneration
calcification of ischaemic infarction in brain is rare
Instead myelin degeneration occurs acutely and chronically persistent myelin debris
Hand clumsiness after falling and holding on to branch
Klumpke palsy
Injury to inferior truck (C8-T1)of brachial plexus —> paralysis intrinsic hand muscles
Intralveolar septal destruction with airspace enlargement
Emphysema
Hiatus hernia
Circumferential laxity of the phrenoesophageal membrane
PCP
NMDA receptor antagonist
Zollinger ellison syndrome
Cause by gastronomas
Prevention:- diarrhoea, wt loss
Increased gastric section —> ulcers in post bulbar duodenal and jejunal ulcers.
Inactivates pancreatic enzymes —> poor nutrient absorption
Glucagonoma
Newly diagnosed DM
Necrolytic migratory erythema esp in groin area
+/- diarrhoea
VIPoma
Vasoactive intestinal polypeptide
Tumour of pancreas
Presentation:- diarrhoea that continues with fasting
Hypokalaemia
Achlorhydria (bloating..etc)
Treatment of severe hypoglycaemia can be given by caregiver
Glucagon
MoA :- increase glycogenolysis
And increase hepatic glucose uptake
Conn syndrome
Bilateral adrenal hyperplasia or
Unilateral adrenal adenoma
++ aldosterone
HTN, hypokalaemia. Alkalosis
Low renin activity
Diuretic treatment in ascites 2o portal HTN with normal sodium levels
Spironolactone + furosemide
Doesn’t block RAAS
Risendronate
Bisphosophonate
MoA inhibits osteoclasts mediated bone resorption
West Nile virus
Enveloped RNA virus
In warm climates
Transmission:- replicates in birds and passed to mosquitoes
Presentation:- flu like illness, maculopapular rash, encephalitis +/- flaccid paralysis - fasciculations
CSF:- lymphocytes ++
Leukocyte adhesion deficiency
Defect in CD18 integrin
Recurrent skin and mucosal infection with NO pus
Delayed cord separation
Lab:- persistent leukocytosis and neutrophil is
X linked agammaglobulinaemia
Hypoplasia of tonsils and lymph nodes
Sinopulmonary infections
Meningioma features
Slow growing tumour
Headache, nausea + vomiting
Seizures
Psamoma bodies —> whorled pattern of cell grown
Non Hodgkin’s lymphoma
Presentation:- rapidly progressive splenogmegally, lymphadenopathy and B symptoms
LN h=biopsy:- expansion of lymphocytes
Associated with EBV with higher risk factor if pt has HIV
How does chin tuck maneuver help prevent aspiration
By superior displacement of the larynx
Tilting the epiglottis to block the airway
Vocal adduction
Primary active transport
Require ATP
Therefore anytime you see a pump that uses ATPase that is active transport
H/K ATPase blocked by PPI
Na/K ATPase blocked by spironolactone
Tetrodotoxin
Homer Simpson
Puffer fish neurotoxin
Blocks Na channel in cell membrane
Portal hypertension arrows
Low systemic perfusion
Increase ADH —> activate RAAS
Decreased urine Na and H2O
Increased total body volume
Low oncotic pressure
Low systemic vascular resistance
Low splanchinic vascular resistance
Low arterial blood volume
Normal capillary permeability
Hyperthyroidism bone disease
Hyperthyroidism increases bone turnover leading to osteoporosis
Increased bone resorption due to stimulation of osteoclasts
Calcitonin bone effect
Released by parafollicaular cells of the thyroid
Inhibits osteoclast activity
Leading to decreased bone resorption
Thyroid binding globulin deficiency
Low total T4
Normal free T4 and TSH
GLUT 4
Found in skeletal muscles
With excess exercise overtime —> increase amount of GLUT 4 —> low blood glucose with exercise
Increased glucose uptake regardless of insulin level
GLUT 2
Found in liver and beta cells of pancreas.
Facilitates insulin dependent glucose uptake
Secondary hyperthyroidism
2o TSH secreting pituitary adenoma
High TSH
High T4
High T3
Thyroid peroxidase function
Tyrosine iodination
Glucagon like peptide 1
Stimulates insulin release following oral consumption on glucose
Causes of neonatal hypothyroidism with goitre
Maternal antithyroid medication —> propylthiouracil., methimazole
Genetic defect in thyroid hormone production
Excessive/ deficient maternal iodine
Neonatal hyperthyroidism common cause
Maternal Graves’ disease
TSH receptor antibodies cross the placenta
Low TSH
High T4
What happens to proinsulin products
Gives insulin and C peptide which are stored in secretory granules until secreted
Radial nerve injury in the forearm
Finger drop
Failure of finger and thumb to extend
Injury at the supinator
Usually due to excessive use ie screwdriver
Fas receptor
Initiates intrinsic pathway of T lymphocyte apoptosis
Treatment of gonococcal urethritis
If negative chlamydia —> ceftriaxone
If positive or unknown chlamydia status —> ceftriaxone + doxycycline
Donepezil
Acetylcholinesterase inhibitor ( donepezil, rivastigmine)
MoA:- decrease breakdown of Ach
SE:- increased parasympathetic effect
AV blocks, bradycardia
Decreased CO
Syncope
Terazosin
MoA:- alpha 1 blocker
Use:- BPH
Carcinoid syndrome
If localised don’t cause carcinoid syndrome
Only do that when metastasise to liver
Presentation:- flushing, diarrhoea, bronhchospasm, niacin deficiency, valvular lesion Rt > Lt
High 5 HIAA/ 24 hrs ( 5 hydroxyindoleacetic acid)
Bladder innervation
S2-S4
Correlation coeffecient (r)
R= >0 positive linear relationship
R=<0 negative linear relationship (ie - number)
Closer to 1 or -1 the stronger the linear relationship
Alpha cells release
Glucagon
self induced hypoglycaemia 2o sulphonylureas
Low/increased insulin
Low/increase C peptide
Low glucose
Improves when glucose corrected
Medical conditions with polygenic inheritance
Androgenetic alopecia
Epilepsy
Glaucoma
HTN
ischaemic heart disease
Schizophrenia
type II DM
Which viruses can be directly infection without translation
Purified SS +Ve RNA like
Rhinovirus (picornavirus)
LL superficial lymphatic drainage
Medial —> goes to superficial inguinal LN
Lateral —> popliteal LN and deep inguinal LN
Reperfusion injury
Troponin/ CK rise after restoring bld flow
Due to damage cell membrane by oxygen free radical and mitochondrial damage
Reperfusion related arrhythmia following Mgx for stem I is due to
Thrombolytic therapy
heparin is used to prevent progression of clot not thrombolysis
Amniotic fluid embolus syndrome
High CVP
Low PCWP
Low cardiac index
Increased Pulmonary arterial vasoconstriction
Increased pulmonary vascular resistance
High Rt atrial pressure
High Rt ventricular preload
Increased SVR
DIC
Weakness in dorsiflexion and Evers ion of foot
Compression of common peroneal nerve at the fibulae head
Sheehan syndrome
Panhypopituitarism
2o ischaemic necrosis of the pituitary gland due to peripartum hypotension
Presentation:- failure to lactate
Hypocorttisolism
Hypothyroidism
Vascular dementia
Focal neurological deficits
Progressive cognitive impairment
Affects activities of daily living
Mild cognitive impairment
Cognitive decline but able to maintain activities of daily living
Carbon tetrachloride
CCl4 oxidised by p450 oxidase in the liver
Causes free radical injury and lipid peroxidation —> fatty change in liver and necrosis
Restrictive lung disease FEV1/FVC
FEV1 and FVC both decreased leading to a normal or increased FEV1/FVC ration
Normal FEV1/FVC >0.7/70%
Sick sinus syndrome
Bradycardia
Dropped P wave / delayed P wave
Age related sonoatrial node degeneration
SA node located in RT atrial wall
Strep galloglyticus
Non enterococcal group D strep
Normal gut flora
Causes subacute bacterial endocarditis And bacteraemia assoc with colonic malignancy
Vibrio cholera
G-ve comma shaped oxidase +ve found in salt water
Transmission:- contaminated shell fish
Non inflammatory toxin mediated diarrhoea
Stool sample :- some mucus no RBC/WBC
ANtimullerian hormone deficiency
Suspect in a genotypic male with internal female structures
Placenta accreta spectrum
Placenta accreta —> attaches to myometrium
Placenta increases —> invasion of the myometrium
Placental percreta —> invasions through the myometrium and uterine serous to extrauterine structures e.g. bladder
Increase in arterial resistance leads to decrease in O2 content is seen in which organ
Lung
Hypoxic vasoconstriction to direct bld and therefore O2 away from underventilated areas to more well ventilated areas
Multiple myeloma
> 10% plasma cells in bone marrow suggestive
Affects B cell development
Decreases production of functional Ig
Leading to recurrent bacterial infection , UTI, lungs and sinuses
Gentamicin
Aminoglycoside
MoA:- binds ribosomal 30s preventing protein synthesis affecting mRNA genetic cod reading
SE:- ototoxic, nephrotoxic
Penicillamine treatment for wilson
Chelating agent
Increased urinary copper excretion
Duodenal ulcer disease
Most caused by H pylori
More common in pts from Asia / S America
Best Treatment of nausea and vomiting 2o GI irritation
5HT3 antagonist best for N+V 2o GI disturbance, chemo, gen anaesthesia
Effect of acute alcohol on acetaminophen
Acute alcohol is cyp450 inhibitor —> decreased metabolism of acetominophen and therefore less toxic metabolite NAPQI
Polyethylene glycol
Osmotic laxative
Increase fluid load in intestinal wall stimulate peristalsis
PPIs
MoA :- H/K Atpase inhibitor
Use:- GERD
SE:- high gastri pH
Increase risk of clostridium difficile
Nutritional deficiency —> Mg, Ca, iron
What are Mg and aluminium hydroxide given together for reflux
To reduce side effects
Aluminium causes constipation
Mg causes osmotic diarrhoea
MoA in reflux:- increase gastric pH
Octrotide
Synthetic somatostatin analog
Shuts down many hormones
used to control symptoms oif carcinoid syndrome
Complication of PPI withdrawal
Rebound gastric acid hypersecretion
High gastric pH leads to increase gastrin sectretion —>
2o hypertrophy of ECL and parietal cells.
When PPI stopped gastric acid secreted by hyper functioning parietal cells
Simvastatin and cholestyramine effect on cholesterol level
Statin decreased cholesterol production
Cholestyrmaine increased cholesterol and bile acid synthesis
Medical treatment for cholesterol gallstones
Bile acid e.g ursodeoxycholic acid
Increase cholesterol solubility —> reduce cholesterol sectreted into nail
Ghrelin
Produced in the stomach in response to fasting
Level increases before meals and fall after eagling
Stilmulates appetite and promotes wt gain
Gastrectomy —> lower ghrelin levels
Purpose of glucose in ORS
Enhance Na absorption
PPI and lipase given for pancreatic enzyme replacement
Lipase inactivated by acidic environment
So PPI increases lipase activity —>imcrease fat absorption
Loperamide
Opioid agonist
MoA:- bind to Mu opiate receptors in colonic myenteric plexus—> inhibit Ach release —> slows peristalsis
Doesn’t cross bld brain barrier
Use:- anti diarrhoetic
Methynaltrexone
MoA:- mu opioid receptor antagonist in GIT
Reverses antiperistaltic effect of opioids
Use:- refractory opioid induced constipation
Doesn’t cross bld brain barrierSE: rare
Gemfibrozil
Fibrate
MoA:- reduce bile acid production, —> decreased cholesterol solubility
Upregulte LPL
Use:- hyertrygliceridaemia
SE :- gall stones
Myopathy with concurrent statin use
Croons disease first line therapy
Anti TNF alpha agents
Infliximab
Adalimumab
Schizophreniform disorder
> 1/12 <6/12
Psychotic symptoms of schizophrenia
MS - mild
Mid to late systolic murmur
> LT side at end of expiration
S1 —> suggest mild disease
contractility normal , LV diastolic volume , after load all normal until MS severe
RRR equation
Risk in control - risk in treatment / risk in control
What prevents re infection with some strains of influenza
Previous infection with same strain or vaccination
2o
Humoral response with antibodies agaeinst haemagglutinin
(Haemagglutinin binds to cell to start the infection
Neuroaminidase cleaves the sialic acid to release the virus and complete the infection)
Oculmoter nerve injury
Dropping of the lid
Dilatation of the eye down and out
Loss of pupil dialtation and loss of accommodation
Ipsilateral efferent pupillary defect
Presence of Hinge in immunoglobulin
Means the Ig has more avidity to the antigen
Can reach multiple sites in the antigen
Also makes it more susceptible to protease
Found in IgG,IgA and IgD
spina bifida occulta pathology
Defect in vertebral arch fusion
It’s a closed neural tube defect
Depersonalisation/ derealisation
A dissociative disorder feeling detached from your body or surroundings / feelings of unreality
Dissociative identity disorder
Rare
Severe trauma leads to garment ration of identity — aka multiple personality disorder
Post thyroidectomy injury to structure when lighting superior thyroid artery causing hoarse voice
Injury to external laryngeal
Affecting the cricothryoid muscle
Recurrent laryngeal injury post thryoirdectomy
Hoarse voice ++
Affect PLOTT atyneoid muscles
Anaphylaxis causing hypotension cause
Chemical ( chemokines e.g. histamine , prostaglandins, leukotreines) cause vasodilation and increase vascular permeability
Turner’s syndrome chromosomal abnormality
XO
2o meitotic non disjunction
Succinylcholine not waking up quickly
Competetive agonist of nicotinic acetylcholine receptor
2o pseudocholinesterase deficiency
Rapidly hydrolysed by plasma pseudocholinesterase
Recurrent resp infection and dextrocardia. Diagnosis
Kartagener’s syndrome ( situs inversus, bronchiectasis, chronic sinusitis)
1o ciliary dyskinesia
Failure of dyenin arms of the cilia reducing their motility
Additional features infertility
Hypertensive emergency renal pathology
Fibrinoid necrosis o the small arteriolar wall
Parvovirus B 19
Causes fifth disease
Erythema infectious - lace like reticular rash on trunk and limbs
Slapped cheek rash
Replicates in erythrocytes precursors in bone marrow
Staghorm calculi
Large renal stone - take on shape of renal calyces
Formed of stuvite ( magnesium ammonium po4)
and assoc with klebsiella and proteus infections - preferring alkaline urine
Pisiformis muscle
Arises from sacrum
Passes through greater sciatic foramen
Inserts into greater trochanter
Action:- ext rotate thigh when extended
Abduct thigh when flexed
Injury can cause sciatica like symptoms
Prolactionma affect on hormones in male
High prolactin inhibit GnRH —> low LH and testosterone
Omalizumab
IgE binding monoclonal antibody
Reduces airway inflammation
Prevents release of pro inflammatory chemokines
Adalimumab
Human recombinant IgG TNF alpha
Given s/c
Use:- crohns
Resistance:- antibodies can form against Adalimumab and block interaction with TNF alpha decreasing function of drug
Gestational thrombocytopenia
Haemodilution 2o plasma volume expansions —> thrombocytopenia
Sequestration/consumption of plts ( taken out of circulation in plts)
Common in 3rd trimester
Usually asymptomatic normal clotting
Rt ovarian thrombus can extend to
IVC
Mycophenolate
Immunosuppressive drug
MoA:- inhibits inosine 5’ monophosphate dehyrdogenase in purine salvage pathway
Stops IMP from becoming GMP
Suppresses lymphocytes proliferation
SE:- diarrhoea and lymphopenia
Gallstone causes
Supersaturation of cholesterol ( increased synthesis, obesity)
Gallbladder stasis ( pregnancy, spinal cord injury, prolonged fasting)
Decreased bile synthesis ( fibrates, crohns )
Increase Ca/ mucin: - Rapid wt loss
Diarrhoea, wt loss and epigastric calcifications in a pt with chronic alcohol use
Chronic pancreatitis with digestive enzyme deficiency
Alcohol induced Liver steatosis is due to
Excess ethanol metabolisation in liver produces excess NADH/NAD —> Inhibits free fatty oxidation favouring TG synthesis
Infantile vitamin K deficient bleeding
Day 2-7 life up to 6/12
Exclusive breast feeding
Easy bruising
Intracranial haemorrhage
Increase PT and PTT
Normal platelet
Will lead to impaired gamma carboxylation of vitamin K depended Coag factors
Barretts oesopahagus risk for
Oesophageal adeonocarcinoma
Normal stratified squamous epithelium —> coloumnar epithelium
Which test will be normal after pancreatectomy in pt with chronic pancreatitis
Intestinal D xylose absorption
D-xylophone and other monosaccharides are absorbed directly without need for pancreatic enzymes
Used to test brush border absorption independent of pancreatic function
Enzymes affected by pancreas
Trypsiongen
Lipase
Trypsin
Pancreatic Carcinoma
Most common is pancreatic duct all adeocarcinoma
Presentation:- epigastric pain, wt loss , jaundice (head)
Back pain ( tail/ body)
Ill defined lesion in the pancreatic parenchyma
Which supplement helps in measles
Vitamin A
Can prevent ocular complication
Reduce recovery time
Reduce length of hospital stay
Lung abscess
Weeks of fever
Foul smelling sputum
Leukocytosis
2o aspiration of oropharyngeal bacteria
CXR cavity with air fluid level
Rubella
Enveloped SS RNA
VZV
Enveloped DS DNA
Parvovirus
SS DNA virus
Common:- school outbreaks
Adult presentation:- arthralgia/ arthritis hands, knees, wrists +/- rash
Fetus:- hydrous fetalis
Fetal CCF ascites, pleural and pericardial effusion
Substance with the Fastest rate of metabolisation in glycolytic pathway
Fructose -1-phosphatase
Joins glycolysis o pathway at gyceraldehyde 3 phosphate after the rate limiting step
Transketolase step in Pentose phosphate pathway
Ribose -5- phosphate ——-> glyceraldehyde 3 phosphate
Hereditary vitamin D resistant rickets arrow as
Mutation inactivation vitamin D receptor
Low Ca
Low PO4
High 2o PTH (—> activate 1 alpha hydroxylase)
Normal 25 hydroxy
High 1,25 OH vitamin D
MODY
Maturity onset Diabetes of the young
2o mutations in glucokinase
Presentation:- mild hyperglycaemia
Worse in pregnancy
Younger non obese pt
Non progressive
Renal ammoniagenesis
Uses glutamine —-> glutamate to generate ammonium and bicarbonate
Getting rid of ammonium with H in the urine
Mechanism seen in metabolic acidosis to help compensate
PPV NPV and prevalence
The higher the prevalence the higher the PPV ( higher true positive in higher prevalence)
The lower the prevalence the higher the NPV ( more true negative in a lower prevalence)
S3
Early Diastolic sound Heard after S2
2o passivefilling
Heard in nomrmal children and YA
Also headed in dilated cardiomyopathy Ischaemic HD
Best heard end of expiration
Allergic bronchopulmonary aspergillosis
Hx of asthma/ CF
CXR :- bronchiectasis
Diagnosis:- positive aspergillus skin test or IgE
Elevated serum IgE
Eosinophilia
Barr body
Deactivated X chromosome condensed into heterochromatin located in the periphery of the nucleus
Low transcriptional activity
Composed of heavily methylated DNA
Paroxysmal nocturnal haemoglobinuria
Leads to formation of MAC on erythrocytes
Treatment with monoclonal abs against C5 prevents mac formation but leaves pt susceptible to infections with encapsulated bacteria
Neisseria meningitidis , strep pneumoniae (need vaccination)
Flecanide
Class III antiarrhythimic
Use dependent —> higher heart rate the more they kick in
Prolongs QRS ( Na influx) and no effect on QT (ca in flux/ K efflux)
Iliohypogastric
Arises from L1
Provides sensation to the suprapubic and gluteal region and motor to anterolateral abdominal wall muscles
Injured during appendicectomy
Which drug can be used to prevent SE of cyclophosphamide
SE of cyclophosphamide is haemorrhaging cystitis
Drug to prevent is MESNA ( 2 mercaptoethanesulfonate)
Neurophysins
Are proteins that carry vasopressin/ADH and oxytocin
Released from the post pituitary
Winging of the scapula
Long thoracic nerve injury
Occurs with mastectomy and axillary clearance
Mature neutrophils with hypersegmented nuclei
Sign of megaloblastic anaemia
Leukemoid reaction
Occurs with severe. infections, haemorrhage, tumours
Leukocytes > 50,000
Basophilic oval inclusions (Dohle bodies) in mature netutrophils
Increased leukocyte alkaline phosphatase
Ilioinguinal
Follows the spermatic cord in men and round ligament in women
Enters inguinal canal
Supplies labia majors, mons pubis, and medial thigh
Supplies ant scrotum, base of the penis and med thigh
Monoclonal prolieferatioin of mycocytes and fibroblasts
Fibroid
Transposition of the great arteries initially management
Widen foramen ovale
Keep PDA patent - prostaglandin E1
Allowing mixing of oxygenated and deoxygenated bld
Sacubitril
Neprilysin inhibitor
Neprilysin Inhibits breakdown of ANP/BNP and angiotensin II
Sacubitirl is combined with ARB inhibitors to stop the effects of ++ angiotensin II
Vasodilation
Increase excretion of H2O and Na
Reduced cardiac work
Improve CO
Neonatal meningitis causative organism
GBS
Virulence; polysaccharide capsule with sialic acid
Primary site in the nucleolus
RNA polymerase 1
Function is to transcribe
Failure to acidify lysosomes will cause deficiency in expression of what in T cells
MHC II
Tricyclic antidepressant overdose
Amitryptilline ,nortriptyline
Inhibit serotonin and noreepinephrine reuptake
Inhibit fast NA channel conduction
Can cause arrhythmias
Dilated pupils, flushing
Urine retension
Peripheral vasodilation
Seizures
Sedation
Loss of appetite
Tricyclic antidepressant overdose
Amitryptilline ,nortriptyline
Inhibit serotonin and noreepinephrine reuptake
Inhibit fast NA channel conduction
Can cause arrhythmias
Dilated pupils, flushing
Urine retension
Peripheral vasodilation
Seizures
Sedation
Loss of appetite
Homocysteine and folate
Needed to convert homocysteine to methionine
Increased homocysteine
Decreased methionine
No change in methlymalonic ( only needs b12)
Arginase deficiency
Presentation:- spastic diplegia
Growth delay
Abnormal movements
No hyperammonnemia
High arginine levels
Urea cycle enzyme
Familial hypercalcaemic hypercalciuria
Defect Ca sensing receptors in the parathyroid gland and kidneys
G protein coupled membrane bound receptors.
Integrin interacts with
Fibronectin
Collagen
Laminin
KRAS is active when bound to
GTP
Rabies Mgx
Rabies vaccine - inactivated
Rabies immunoglobulin
Double stranded circular DNA with a enzyme in its virion that has RNA dependent DNA polymerase activity
Hep B
Has reverse transcriptase
Fever in malaria caused by
Lysis of infected erythrocytes
C Diff toxin Moa
Toxins A and B stimulate an inflammatory reaction and disrupt the cytoskeleton —> pseudomembranous colitis
Shiga toxin
Inactivates 60S ribosomal subunit and inhibits protein synthesis
Type 2 error (beta)
Concluding that there is no difference when one exists
Power equation
Power= 1- Beta error
Probability of seeing a difference when there is one
Hypertensive hypertrophic heart failure changes
Decreased lt vent compliance
Increased cardiac myosin heavy chain beta expression
Increased signalling for angiotensin II
Reduced SV
Increased LV contractility and EF
S4
DPP4 inhibitors
MoA :- stop degradation of GLP1
Increased glucose dependent insulin secretion
Gliptins
Metformin
MOA : - inhibit mitochondrial end for gluconeogenesis
Increase peripheral glucose uptake by increasing insulin sensitivity
GLP1
MoA increase glucose dependent insulin release
Decrease glucagon secretion
Decrease gastric emptying
Acarbose
Alpha glycosides inhibitor
MoA :- decreased dietary carbohydrate digestion
GLUT 2 inhibitors
Gliflozin
Decrease reapportion of glucose in pct
Histological findings in 1o biliary cholangitis
Dense lymphocytic portal tract inflammation with Granulomatous destruction of interlobular bile ducts
Frameshift mutation
Base pair deletion that is no divisible by 3
Alters the genetic code
In frame deletion
Deletion of base divisible by 3
Blood smear in megaloblastic anaemia
Macrocytic erythrocytes
Hypersegmented neutrophils
Prone to haemolysis will have high bilirubin, and LDH
Strep pneumoniae transformation
Can take exogenous DNA fragments
Non virulent strain can take dna from dead neighbouring cells and transform to virulent strain
Neuroblastoma
Childhood Ca < 2
Arises from neural crest cells
Involves Adrenal medulla
Abdo mass
Periorbital bruising
Opsoclonus-myoclonus syndrome
High catecholamine metabolites
N-Myc poor prognosis
Monoclonal antibodies can block which cell surface receptors on T cells to improve killing ability
PD1 — programmed cell death protein 1
Which normally downregulates immune response by inhibits cytotoxic T cells
Heart failure haemodynamic changes
Decreased CO
Triggers
Increase SNS
Increase RAAS
BNP/ANP/ is overpowered by RAAS
Meningitis vaccine is against
Antibodies against the polysaccharide capsule
Alternative splicing
Different combinations of DNA coding regions actively included or excluded from a mature mRNA
It’s posttranslational
Finasteride
5 alpha reductive inhibitor
Moa:- inhibit conversion of testosterone to DHT
Works on epithelium of prostate
Alpha 1 blockers work on smooth muscles
Abiraterone
17 alpha hydroxylase inhibitor
Used to treat prosthetic Ca that is not suitable for surgery
Decreased androgen level
How does spironolactone cause gynaecomastia
Decrease testosterone synthesis
Inhibition of testosterone receptor
Lithium teratogenic effects
Ebstein’s anomaly
Apical displacement of the tricuspid valve
Decreased volume of RT ventricle
Atrialisation of the Rt ventricle
Bicalutamide
MoA:- androgen receptor inhibitor
USE:- prevent the surge in androgen when starting buserlin for medical orchiectomy
Buserlin
MOA:- GnRH analogue
USE:- prostate Ca
DNA binding proteins
Transcription factors
Steroid hormones
Thryoid hormone receptor
Fat soluble vitamins
Similarities between vitamin E deficiency and Friedrichs ataxia
Ataxia —-> spinocerebellar tract degeneration
Loss of position and vibration sense —> dorsal coloumn degeneration
Weakness and hyporeflexia ( peripheral nerve degeneration)
Similarities between vitamin E deficiency and Friedrichs ataxia
Ataxia —-> spinocerebellar tract degeneration
Loss of position and vibration sense —> dorsal coloumn degeneration
Weakness and hyporeflexia ( peripheral nerve degeneration)
Different neuropathies
Demyelinating —> slower conduction -> problem with Schwan cells
Atonal —> less amplitude —> problem with neuronal axons ( DM, toxins, vasculitis)
Malignant hyperthermia
Exposure to halothane, succinylcholine
Increased Ca passing from sarcoplasmic reticulum to intracellular space leading to
Increased and sustained muscle contraction 2o myocyte breakdown
Muscle rigidity and hyperthermia
Which substances if measured would be abnormal in narcolepsy
Hypocretin 1
Hypocren 2
Both undetectable
Promote wakefulness
Uneasy epigastric feeling, burning smell, lip smacking and blank stare
Temporal epilepsy
2o hippocampal sclerosis
Tetanus toxin blocks
Glycine
And GABA
Botulinum blocks
Ach
