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LopsNotes > Mixed Qs 9 > Flashcards

Mixed Qs 9 Flashcards

1
Q

Iron absorption

A

Occurs in duodenum and proximal jejunum

Affected by gastrojejunostomy

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2
Q

Submucosal glands secreting alkaline secretions are

A

Submucosal Brunner glands located in the 1st part of the duodenum

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3
Q

V cholerae

A

G-ve comma shaped rod Oxidase +ve motile

Entertoxin causes severe watery diarrhoea

Thrives in alkaline medium

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4
Q

Reassortement

A

Aka genetic shift involves exchange of genomic segments

Only occurs in segmented viruses ( BOAR)
(bunyaviraus , othomyxovirus arenavirus and reovirus)

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5
Q

IL-2

A

Released by CD4, CD8 and Natureal killer cells

High dose IL-2 triggers proliferation of NK cells and increases their cytotoxic activity

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6
Q

Pulmonary alveolar proteinosis

A

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

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7
Q

Meckels’ diverticulum

A

Failure of viteline duct obliteration

Presentation:- painless lower GI bleeding with anaemia
Ectopic gastric mucosa can cause ulceration of intestinal mucosa

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8
Q

SLE autoantibodies

A

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

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9
Q

Glucagon 2nd messenger

A

G protein coupled receptor using adenylate cyclist 2nd messenger
—> cAMP —-> protein kinase A

Along with TSH and PTH

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10
Q

Pyruvate dehydrogenase deficiency

A

Presentation:- lactic acidosis and neuro symptoms

Pyruvate —-X —-> acetyl coA

Supplement with lysine and leucine to avoid lactic acidosis accumulation

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11
Q

Bloody discharge nipple no mass no skin changes

A

Intraductal papilloma

Epithelial and myoepithelial cells lining fibrovascualr core in cysts wall or duct

Usually benign

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12
Q

AUG

A

Is the start codon
Initiates translation
If ther s is a mutation before then you cannot start translation

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13
Q

B thalassemia

A

Reduced beta globin chain synthesis
Resulting in
Hypochromic microcytics cells

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14
Q

Embryo formation of the uterus

A

Paramesoneprhic —> uterus, fallopian tubes,CX and upper vagina

Paramesonephric duct fuse laterally for form uterus
And vertically to form urogenital sinus

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15
Q

Ubiquination

A

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

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16
Q

Hormones and menustral cycle

A

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

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17
Q

Nitroglycerin

A

Venodilators

Increase peripheral venous capicitance
Decrease preload
Decrease LVEDP

High dose —> arteriolar dilation and decrease systemic vascular resistance

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18
Q

Viral myocarditis complication

A

Causes dilated cardiomyopathy

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19
Q

Pancarditis

A

Complication of acute rheumatic fever
Leading to new
MR
Aschoff body is pathognomic —‘interstitial myocardial granuoloma’

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20
Q

Why does appendicitis pain move

A

Initial pain at umbilicus is 2o afterent fibres entering spinal cord at T10

Later pain is RLQ 2o irritation of the parietal peritonuem

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21
Q

Intercostal brachial nerve

A

Can be Injured during a ill army LN dissection

Presentation:- burning, diminished sensation medial upper arm purely sensory dysfunction

The others cause motor deficit

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22
Q

Intercostal brachial nerve

A

Can be Injured during a ill army LN dissection

Presentation:- burning, diminished sensation medial upper arm purely sensory dysfunction

The others cause motor deficit

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23
Q

Ribosomes

A

Large complex contain protein and RNA found freely floating in endoplasmic reticulum

Synthesized in nucleolus

Ribosomal RNA is transcribed in nucleolus

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24
Q

CMV commonest congenital eye complication

A

CMV chorioretinitis

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25
Q

Rubella congenital eye complication

A

Congenital cataract

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26
Q

Tyrpsinogen

A

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

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27
Q

What happens to area of the brain months after stroke

A

Wallerian degeneration

calcification of ischaemic infarction in brain is rare

Instead myelin degeneration occurs acutely and chronically persistent myelin debris

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28
Q

Hand clumsiness after falling and holding on to branch

A

Klumpke palsy
Injury to inferior truck (C8-T1)of brachial plexus —> paralysis intrinsic hand muscles

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29
Q

Intralveolar septal destruction with airspace enlargement

A

Emphysema

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30
Q

Hiatus hernia

A

Circumferential laxity of the phrenoesophageal membrane

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31
Q

PCP

A

NMDA receptor antagonist

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32
Q

Zollinger ellison syndrome

A

Cause by gastronomas
Prevention:- diarrhoea, wt loss

Increased gastric section —> ulcers in post bulbar duodenal and jejunal ulcers.
Inactivates pancreatic enzymes —> poor nutrient absorption

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33
Q

Glucagonoma

A

Newly diagnosed DM
Necrolytic migratory erythema esp in groin area
+/- diarrhoea

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34
Q

VIPoma

A

Vasoactive intestinal polypeptide
Tumour of pancreas

Presentation:- diarrhoea that continues with fasting
Hypokalaemia
Achlorhydria (bloating..etc)

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35
Q

Treatment of severe hypoglycaemia can be given by caregiver

A

Glucagon
MoA :- increase glycogenolysis
And increase hepatic glucose uptake

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36
Q

Conn syndrome

A

Bilateral adrenal hyperplasia or
Unilateral adrenal adenoma

++ aldosterone
HTN, hypokalaemia. Alkalosis
Low renin activity

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37
Q

Diuretic treatment in ascites 2o portal HTN with normal sodium levels

A

Spironolactone + furosemide

Doesn’t block RAAS

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38
Q

Risendronate

A

Bisphosophonate

MoA inhibits osteoclasts mediated bone resorption

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39
Q

West Nile virus

A

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 ++

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40
Q

Leukocyte adhesion deficiency

A

Defect in CD18 integrin

Recurrent skin and mucosal infection with NO pus
Delayed cord separation

Lab:- persistent leukocytosis and neutrophil is

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41
Q

X linked agammaglobulinaemia

A

Hypoplasia of tonsils and lymph nodes

Sinopulmonary infections

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42
Q

Meningioma features

A

Slow growing tumour
Headache, nausea + vomiting
Seizures

Psamoma bodies —> whorled pattern of cell grown

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43
Q

Non Hodgkin’s lymphoma

A

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

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44
Q

How does chin tuck maneuver help prevent aspiration

A

By superior displacement of the larynx
Tilting the epiglottis to block the airway
Vocal adduction

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45
Q

Primary active transport

A

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

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46
Q

Tetrodotoxin

A

Homer Simpson

Puffer fish neurotoxin
Blocks Na channel in cell membrane

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47
Q

Portal hypertension arrows

A

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

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48
Q

Hyperthyroidism bone disease

A

Hyperthyroidism increases bone turnover leading to osteoporosis

Increased bone resorption due to stimulation of osteoclasts

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49
Q

Calcitonin bone effect

A

Released by parafollicaular cells of the thyroid
Inhibits osteoclast activity
Leading to decreased bone resorption

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50
Q

Thyroid binding globulin deficiency

A

Low total T4
Normal free T4 and TSH

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51
Q

GLUT 4

A

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

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52
Q

GLUT 2

A

Found in liver and beta cells of pancreas.
Facilitates insulin dependent glucose uptake

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53
Q

Secondary hyperthyroidism

A

2o TSH secreting pituitary adenoma

High TSH
High T4
High T3

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54
Q

Thyroid peroxidase function

A

Tyrosine iodination

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55
Q

Glucagon like peptide 1

A

Stimulates insulin release following oral consumption on glucose

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56
Q

Causes of neonatal hypothyroidism with goitre

A

Maternal antithyroid medication —> propylthiouracil., methimazole
Genetic defect in thyroid hormone production
Excessive/ deficient maternal iodine

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57
Q

Neonatal hyperthyroidism common cause

A

Maternal Graves’ disease
TSH receptor antibodies cross the placenta
Low TSH
High T4

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58
Q

What happens to proinsulin products

A

Gives insulin and C peptide which are stored in secretory granules until secreted

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59
Q

Radial nerve injury in the forearm

A

Finger drop
Failure of finger and thumb to extend
Injury at the supinator
Usually due to excessive use ie screwdriver

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60
Q

Fas receptor

A

Initiates intrinsic pathway of T lymphocyte apoptosis

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61
Q

Treatment of gonococcal urethritis

A

If negative chlamydia —> ceftriaxone

If positive or unknown chlamydia status —> ceftriaxone + doxycycline

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62
Q

Donepezil

A

Acetylcholinesterase inhibitor ( donepezil, rivastigmine)

MoA:- decrease breakdown of Ach

SE:- increased parasympathetic effect
AV blocks, bradycardia
Decreased CO
Syncope

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63
Q

Terazosin

A

MoA:- alpha 1 blocker

Use:- BPH

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64
Q

Carcinoid syndrome

A

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)

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65
Q

Bladder innervation

A

S2-S4

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66
Q

Correlation coeffecient (r)

A

R= >0 positive linear relationship
R=<0 negative linear relationship (ie - number)
Closer to 1 or -1 the stronger the linear relationship

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67
Q

Alpha cells release

A

Glucagon

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68
Q

self induced hypoglycaemia 2o sulphonylureas

A

Low/increased insulin
Low/increase C peptide
Low glucose
Improves when glucose corrected

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69
Q

Medical conditions with polygenic inheritance

A

Androgenetic alopecia
Epilepsy
Glaucoma
HTN
ischaemic heart disease
Schizophrenia
type II DM

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70
Q

Which viruses can be directly infection without translation

A

Purified SS +Ve RNA like

Rhinovirus (picornavirus)

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71
Q

LL superficial lymphatic drainage

A

Medial —> goes to superficial inguinal LN

Lateral —> popliteal LN and deep inguinal LN

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72
Q

Reperfusion injury

A

Troponin/ CK rise after restoring bld flow
Due to damage cell membrane by oxygen free radical and mitochondrial damage

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73
Q

Reperfusion related arrhythmia following Mgx for stem I is due to

A

Thrombolytic therapy

heparin is used to prevent progression of clot not thrombolysis

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74
Q

Amniotic fluid embolus syndrome

A

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

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75
Q

Weakness in dorsiflexion and Evers ion of foot

A

Compression of common peroneal nerve at the fibulae head

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76
Q

Sheehan syndrome

A

Panhypopituitarism
2o ischaemic necrosis of the pituitary gland due to peripartum hypotension

Presentation:- failure to lactate
Hypocorttisolism
Hypothyroidism

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77
Q

Vascular dementia

A

Focal neurological deficits
Progressive cognitive impairment
Affects activities of daily living

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78
Q

Mild cognitive impairment

A

Cognitive decline but able to maintain activities of daily living

79
Q

Carbon tetrachloride

A

CCl4 oxidised by p450 oxidase in the liver
Causes free radical injury and lipid peroxidation —> fatty change in liver and necrosis

80
Q

Restrictive lung disease FEV1/FVC

A

FEV1 and FVC both decreased leading to a normal or increased FEV1/FVC ration

Normal FEV1/FVC >0.7/70%

81
Q

Sick sinus syndrome

A

Bradycardia
Dropped P wave / delayed P wave
Age related sonoatrial node degeneration
SA node located in RT atrial wall

82
Q

Strep galloglyticus

A

Non enterococcal group D strep

Normal gut flora

Causes subacute bacterial endocarditis And bacteraemia assoc with colonic malignancy

83
Q

Vibrio cholera

A

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

84
Q

ANtimullerian hormone deficiency

A

Suspect in a genotypic male with internal female structures

85
Q

Placenta accreta spectrum

A

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

86
Q

Increase in arterial resistance leads to decrease in O2 content is seen in which organ

A

Lung

Hypoxic vasoconstriction to direct bld and therefore O2 away from underventilated areas to more well ventilated areas

87
Q

Multiple myeloma

A

> 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

88
Q

Gentamicin

A

Aminoglycoside

MoA:- binds ribosomal 30s preventing protein synthesis affecting mRNA genetic cod reading

SE:- ototoxic, nephrotoxic

89
Q

Penicillamine treatment for wilson

A

Chelating agent
Increased urinary copper excretion

90
Q

Duodenal ulcer disease

A

Most caused by H pylori

More common in pts from Asia / S America

91
Q

Best Treatment of nausea and vomiting 2o GI irritation

A

5HT3 antagonist best for N+V 2o GI disturbance, chemo, gen anaesthesia

92
Q

Effect of acute alcohol on acetaminophen

A

Acute alcohol is cyp450 inhibitor —> decreased metabolism of acetominophen and therefore less toxic metabolite NAPQI

93
Q

Polyethylene glycol

A

Osmotic laxative
Increase fluid load in intestinal wall stimulate peristalsis

94
Q

PPIs

A

MoA :- H/K Atpase inhibitor

Use:- GERD

SE:- high gastri pH
Increase risk of clostridium difficile
Nutritional deficiency —> Mg, Ca, iron

95
Q

What are Mg and aluminium hydroxide given together for reflux

A

To reduce side effects

Aluminium causes constipation
Mg causes osmotic diarrhoea

MoA in reflux:- increase gastric pH

96
Q

Octrotide

A

Synthetic somatostatin analog
Shuts down many hormones

used to control symptoms oif carcinoid syndrome

97
Q

Complication of PPI withdrawal

A

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

98
Q

Simvastatin and cholestyramine effect on cholesterol level

A

Statin decreased cholesterol production

Cholestyrmaine increased cholesterol and bile acid synthesis

99
Q

Medical treatment for cholesterol gallstones

A

Bile acid e.g ursodeoxycholic acid
Increase cholesterol solubility —> reduce cholesterol sectreted into nail

100
Q

Ghrelin

A

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

101
Q

Purpose of glucose in ORS

A

Enhance Na absorption

102
Q

PPI and lipase given for pancreatic enzyme replacement

A

Lipase inactivated by acidic environment

So PPI increases lipase activity —>imcrease fat absorption

103
Q

Loperamide

A

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

104
Q

Methynaltrexone

A

MoA:- mu opioid receptor antagonist in GIT
Reverses antiperistaltic effect of opioids

Use:- refractory opioid induced constipation

Doesn’t cross bld brain barrierSE: rare

105
Q

Gemfibrozil

A

Fibrate
MoA:- reduce bile acid production, —> decreased cholesterol solubility
Upregulte LPL

Use:- hyertrygliceridaemia

SE :- gall stones
Myopathy with concurrent statin use

106
Q

Croons disease first line therapy

A

Anti TNF alpha agents

Infliximab
Adalimumab

107
Q

Schizophreniform disorder

A

> 1/12 <6/12
Psychotic symptoms of schizophrenia

108
Q

MS - mild

A

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

109
Q

RRR equation

A

Risk in control - risk in treatment / risk in control

110
Q

What prevents re infection with some strains of influenza

A

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)

111
Q

Oculmoter nerve injury

A

Dropping of the lid
Dilatation of the eye down and out
Loss of pupil dialtation and loss of accommodation
Ipsilateral efferent pupillary defect

112
Q

Presence of Hinge in immunoglobulin

A

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

113
Q

spina bifida occulta pathology

A

Defect in vertebral arch fusion
It’s a closed neural tube defect

114
Q

Depersonalisation/ derealisation

A

A dissociative disorder feeling detached from your body or surroundings / feelings of unreality

115
Q

Dissociative identity disorder

A

Rare
Severe trauma leads to garment ration of identity — aka multiple personality disorder

116
Q

Post thyroidectomy injury to structure when lighting superior thyroid artery causing hoarse voice

A

Injury to external laryngeal
Affecting the cricothryoid muscle

117
Q

Recurrent laryngeal injury post thryoirdectomy

A

Hoarse voice ++
Affect PLOTT atyneoid muscles

118
Q

Anaphylaxis causing hypotension cause

A

Chemical ( chemokines e.g. histamine , prostaglandins, leukotreines) cause vasodilation and increase vascular permeability

119
Q

Turner’s syndrome chromosomal abnormality

A

XO
2o meitotic non disjunction

120
Q

Succinylcholine not waking up quickly

A

Competetive agonist of nicotinic acetylcholine receptor
2o pseudocholinesterase deficiency

Rapidly hydrolysed by plasma pseudocholinesterase

121
Q

Recurrent resp infection and dextrocardia. Diagnosis

A

Kartagener’s syndrome ( situs inversus, bronchiectasis, chronic sinusitis)

1o ciliary dyskinesia

Failure of dyenin arms of the cilia reducing their motility

Additional features infertility

122
Q

Hypertensive emergency renal pathology

A

Fibrinoid necrosis o the small arteriolar wall

123
Q

Parvovirus B 19

A

Causes fifth disease
Erythema infectious - lace like reticular rash on trunk and limbs
Slapped cheek rash

Replicates in erythrocytes precursors in bone marrow

124
Q

Staghorm calculi

A

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

125
Q

Pisiformis muscle

A

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

126
Q

Prolactionma affect on hormones in male

A

High prolactin inhibit GnRH —> low LH and testosterone

127
Q

Omalizumab

A

IgE binding monoclonal antibody

Reduces airway inflammation
Prevents release of pro inflammatory chemokines

128
Q

Adalimumab

A

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

129
Q

Gestational thrombocytopenia

A

Haemodilution 2o plasma volume expansions —> thrombocytopenia

Sequestration/consumption of plts ( taken out of circulation in plts)

Common in 3rd trimester
Usually asymptomatic normal clotting

130
Q

Rt ovarian thrombus can extend to

A

IVC

131
Q

Mycophenolate

A

Immunosuppressive drug

MoA:- inhibits inosine 5’ monophosphate dehyrdogenase in purine salvage pathway

Stops IMP from becoming GMP

Suppresses lymphocytes proliferation

SE:- diarrhoea and lymphopenia

132
Q

Gallstone causes

A

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

133
Q

Diarrhoea, wt loss and epigastric calcifications in a pt with chronic alcohol use

A

Chronic pancreatitis with digestive enzyme deficiency

134
Q

Alcohol induced Liver steatosis is due to

A

Excess ethanol metabolisation in liver produces excess NADH/NAD —> Inhibits free fatty oxidation favouring TG synthesis

135
Q

Infantile vitamin K deficient bleeding

A

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

136
Q

Barretts oesopahagus risk for

A

Oesophageal adeonocarcinoma

Normal stratified squamous epithelium —> coloumnar epithelium

137
Q

Which test will be normal after pancreatectomy in pt with chronic pancreatitis

A

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

138
Q

Enzymes affected by pancreas

A

Trypsiongen
Lipase
Trypsin

139
Q

Pancreatic Carcinoma

A

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

140
Q

Which supplement helps in measles

A

Vitamin A

Can prevent ocular complication
Reduce recovery time
Reduce length of hospital stay

141
Q

Lung abscess

A

Weeks of fever
Foul smelling sputum
Leukocytosis

2o aspiration of oropharyngeal bacteria

CXR cavity with air fluid level

142
Q

Rubella

A

Enveloped SS RNA

143
Q

VZV

A

Enveloped DS DNA

144
Q

Parvovirus

A

SS DNA virus

Common:- school outbreaks

Adult presentation:- arthralgia/ arthritis hands, knees, wrists +/- rash

Fetus:- hydrous fetalis
Fetal CCF ascites, pleural and pericardial effusion

145
Q

Substance with the Fastest rate of metabolisation in glycolytic pathway

A

Fructose -1-phosphatase

Joins glycolysis o pathway at gyceraldehyde 3 phosphate after the rate limiting step

146
Q

Transketolase step in Pentose phosphate pathway

A

Ribose -5- phosphate ——-> glyceraldehyde 3 phosphate

147
Q

Hereditary vitamin D resistant rickets arrow as

A

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

148
Q

MODY

A

Maturity onset Diabetes of the young

2o mutations in glucokinase

Presentation:- mild hyperglycaemia
Worse in pregnancy
Younger non obese pt
Non progressive

149
Q

Renal ammoniagenesis

A

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

150
Q

PPV NPV and prevalence

A

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)

151
Q

S3

A

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

152
Q

Allergic bronchopulmonary aspergillosis

A

Hx of asthma/ CF

CXR :- bronchiectasis

Diagnosis:- positive aspergillus skin test or IgE
Elevated serum IgE
Eosinophilia

153
Q

Barr body

A

Deactivated X chromosome condensed into heterochromatin located in the periphery of the nucleus
Low transcriptional activity
Composed of heavily methylated DNA

154
Q

Paroxysmal nocturnal haemoglobinuria

A

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)

155
Q

Flecanide

A

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)

156
Q

Iliohypogastric

A

Arises from L1
Provides sensation to the suprapubic and gluteal region and motor to anterolateral abdominal wall muscles

Injured during appendicectomy

157
Q

Which drug can be used to prevent SE of cyclophosphamide

A

SE of cyclophosphamide is haemorrhaging cystitis

Drug to prevent is MESNA ( 2 mercaptoethanesulfonate)

158
Q

Neurophysins

A

Are proteins that carry vasopressin/ADH and oxytocin

Released from the post pituitary

159
Q

Winging of the scapula

A

Long thoracic nerve injury

Occurs with mastectomy and axillary clearance

160
Q

Mature neutrophils with hypersegmented nuclei

A

Sign of megaloblastic anaemia

161
Q

Leukemoid reaction

A

Occurs with severe. infections, haemorrhage, tumours

Leukocytes > 50,000
Basophilic oval inclusions (Dohle bodies) in mature netutrophils

Increased leukocyte alkaline phosphatase

162
Q

Ilioinguinal

A

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

163
Q

Monoclonal prolieferatioin of mycocytes and fibroblasts

A

Fibroid

164
Q

Transposition of the great arteries initially management

A

Widen foramen ovale
Keep PDA patent - prostaglandin E1

Allowing mixing of oxygenated and deoxygenated bld

165
Q

Sacubitril

A

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

166
Q

Neonatal meningitis causative organism

A

GBS

Virulence; polysaccharide capsule with sialic acid

167
Q

Primary site in the nucleolus

A

RNA polymerase 1
Function is to transcribe

168
Q

Failure to acidify lysosomes will cause deficiency in expression of what in T cells

A

MHC II

169
Q

Tricyclic antidepressant overdose

A

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

170
Q

Tricyclic antidepressant overdose

A

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

171
Q

Homocysteine and folate

A

Needed to convert homocysteine to methionine

Increased homocysteine
Decreased methionine
No change in methlymalonic ( only needs b12)

172
Q

Arginase deficiency

A

Presentation:- spastic diplegia
Growth delay
Abnormal movements
No hyperammonnemia
High arginine levels

Urea cycle enzyme

173
Q

Familial hypercalcaemic hypercalciuria

A

Defect Ca sensing receptors in the parathyroid gland and kidneys
G protein coupled membrane bound receptors.

174
Q

Integrin interacts with

A

Fibronectin
Collagen
Laminin

175
Q

KRAS is active when bound to

A

GTP

176
Q

Rabies Mgx

A

Rabies vaccine - inactivated
Rabies immunoglobulin

177
Q

Double stranded circular DNA with a enzyme in its virion that has RNA dependent DNA polymerase activity

A

Hep B

Has reverse transcriptase

178
Q

Fever in malaria caused by

A

Lysis of infected erythrocytes

179
Q

C Diff toxin Moa

A

Toxins A and B stimulate an inflammatory reaction and disrupt the cytoskeleton —> pseudomembranous colitis

180
Q

Shiga toxin

A

Inactivates 60S ribosomal subunit and inhibits protein synthesis

181
Q

Type 2 error (beta)

A

Concluding that there is no difference when one exists

182
Q

Power equation

A

Power= 1- Beta error
Probability of seeing a difference when there is one

183
Q

Hypertensive hypertrophic heart failure changes

A

Decreased lt vent compliance
Increased cardiac myosin heavy chain beta expression
Increased signalling for angiotensin II

Reduced SV
Increased LV contractility and EF

S4

184
Q

DPP4 inhibitors

A

MoA :- stop degradation of GLP1
Increased glucose dependent insulin secretion

Gliptins

185
Q

Metformin

A

MOA : - inhibit mitochondrial end for gluconeogenesis

Increase peripheral glucose uptake by increasing insulin sensitivity

186
Q

GLP1

A

MoA increase glucose dependent insulin release
Decrease glucagon secretion
Decrease gastric emptying

187
Q

Acarbose

A

Alpha glycosides inhibitor
MoA :- decreased dietary carbohydrate digestion

188
Q

GLUT 2 inhibitors

A

Gliflozin

Decrease reapportion of glucose in pct

189
Q

Histological findings in 1o biliary cholangitis

A

Dense lymphocytic portal tract inflammation with Granulomatous destruction of interlobular bile ducts

190
Q

Frameshift mutation

A

Base pair deletion that is no divisible by 3

Alters the genetic code

191
Q

In frame deletion

A

Deletion of base divisible by 3

192
Q

Blood smear in megaloblastic anaemia

A

Macrocytic erythrocytes
Hypersegmented neutrophils

Prone to haemolysis will have high bilirubin, and LDH

193
Q

Strep pneumoniae transformation

A

Can take exogenous DNA fragments

Non virulent strain can take dna from dead neighbouring cells and transform to virulent strain

LopsNotes (17 decks)

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