Mixede Qs 8 Flashcards
Concentric left ventricular hypertrophy is due t o which substances
Due to Angiotensin II , endothelin
2o chronic untreated HTN
Pyruvate carboxylate Activator in gluconeogenesis
Acetyl-coA
MHC Class I structure
Single heavy/long chain and one short train beta 2 microglobulin
Chediak-Higashi syndrome
Defect in lysosomal trafficking
Defective phagolysosome formation
Presentation:- recurrent infections ( strep and staph aureus)
Oculcutaneous albinism ( fair skin, silvery hair)
Easy bruising
Neuropathy
Blood smear:-giant cytoplasmic granules in neutrophils
Interaction between nitrates and phosphodiesterase innhibitors ( sildenafil)
Presentation:- profound hypotension due to extreme vasodilation
Nitrates —> nitric oxide —-> increased Intracellular cGMP (2nd messenger)
Increased cGMP—-> vascular smooth muscle relaxation
Phosphodiesterase inhibitors inhibit breakdown of cGMP —> accumulation of cGMP—> ++vasodilation
Frameshift mutation
Deletion/addition of a number of bases not divisible by 3 in the coding region of a gene
Marker of HBV transplacental transmission
HBeAg
Which medication works by binding to cytocolic receptor and inhibiting nuclear factor kappa B ( NF-KB)
Glucocorticoids
Where does the trigeminal nerve exit the brain stem
At mid pons level of middle cerebellar peduncle
EPO signal transduction is mediated by
Janus kinase 2/signal transducer and activator of transcription (JAK2/STAT) pathway
HLA and MHC II
HLA-DP, HLA-D2 and HLA-DR encode for MHC II expressed on APC after antigen is processed in lysosome
Absent of MHC II impairs activation of B and T cells —> seen in SCID
HLA and MHC I
HLA-A, HLA-B and HLA-C encode for MHC II expressed in nucleated cells after cytosolic antigen transported into endoplasmic reticulum
Exercise induced hypoglycaemia in DM
Increased expression of GLUT4 in cell membrane —> increased muscle glucose uptake independent of insulin
MRSA is resistant to which ABx
Beta lactate ABx
Latanoprost
Topical Prostaglandin agonist
MoA:Increased outflow of aqueous humor
USE: glaucoma
SE:- pigmentation of iris and eye lashes
Aedes mosquito transmits which viruses
Dengue ( haemorrhagic symptoms, fever, Brazil travel)
Chikungunya
Zika
Yellow fever
Complication of nitroprusside
Cyanide poisioning 2o inhibition of the Electron transfer of O2** it poisons the electron chain **
Symptoms:- flushing, neuro dysfunction, seizures, high lactic acidosis
Risk factor:- high dose, prolonged infusion, renal insufficiency
Wilson’s Disease
Accumulation of copper in liver, brain, cornea
Presentation:- child/ YA
Neuropsychiatric symptoms
Depression
Mania
Gait disturbance
Dysarthria
Labs: Abnormal LFTs
Decreased caeruloplasmin
Increased urinary copper execration
Spleen embryologic origin
Mesoderm
Like muscle, bone, kidney
ARR equation
ARR= Control rate - treatment rate
Heparin MoA
Bind to anti thrombin III
Mitochondrial vaculolisation is a sign of
Irreversible cell injury
Burkitts lymphoma Pathogenesis
Assoc EBV
Translocation between c-Myc ongogene on ch 8 and IgA heavy chain on ch 14 —>over expression of c-Myc which is a transcription activator
Retinoblastoma
Presentation:- first 3 years of life
Leukocoria
Strabismus
Creamy white mass on fundoscopy
Retinitis pigmentosa
Progressive dystrophy of retinal pigmented epithelium and photoreceptors
Presentation;- night blindness
Loss of peripheral vision
Fudoscopy:- dark pigments and optic disc pallor
1o myelofibrosis
Malignancy stem cell- megakaryocytes
Presentation:- pancytopenia, hepatospleenomegaly, teardrop cells
Bone marrow biopsy:- dry tap
Fibrotic BM with clusters of atypical megakaryocytes
Testicular tumour
Solid firm/fixed nodule in the tunica albumin era non tender
Defence immunity against intracellular organisms like legionella and m to
Cell mediated
Th1 cells, IFN gamma and IL-2
Beta blockers affect
Reduce HR
Increase preload
Decrease LV contractility
Decrease end systolic volume
Mesothelioma histology
Spindle cells that stain +ve for cytokeratin
SCLC histology
Small round cells +ve for chromogranin
Silicosis histology
Whorled collagen fibers and dust laden macrophages
Gilbert syndrome
Indirect hyperbilirubinaema due to decreased bilirubin conjugation. Can be triggered by stress
Bleeding between skull and periosteum
Cephalohaematoma
Over parietal / occipital bone
Small, non fluctuant and doesn’t not cross suture line
Bleeding between periosteum and galea apnoneurosis
Subgaleal haematoma
Diffuse, fluctuant swelling across scalp and neck , beyond suture lines
2o vacuum assisted delivery
Acute cholangitis
Triad:- fever, acute RUQ pain, jaundice
Hypotension and altered mental status
2o biliary obstruction
Typhoid fever
Caused by S typhir or paratyphi
Presentation:- escalating fever, abdominal pain, rose spots on chest/abdomen, constipation/ diarrhoea —> bowel perforation
Bradycardia
Transmission faeco-oral
Down syndrome and Alzheimer’s
Pt with trisomy 21 have 3 copies of amyloid precursor protein in Ch 21 —> increase in amyloid beta accumulating in brain
Amyloid A protein
Acute phase reactant
Assoc with systemic amyloidosis
Seen in RA, IBD
Maple syrup urine disease Mgx
Restrict leucine, isoleucine, valine
Diphertia immunisation generates
Protective IgG against exotoxin B subunit
Yersinia pestis infection
Bubonic plague
transmission:- rodent fleas
Presentation: rapid onset of symptoms
High fever
Chills
Weakness headache
Painful purulent regional lymphadenitis
Mgx:- aminoglycosides —> block protein synthesis by binding to 30S ribosomal subunit
Vancomycin MoA
Bind to D-Alanyl- D-alanyl terminus of peptidoglycan prevent elongation of peptidoglycan Chan in
Arbovirus
Small RNA virus
Transmission:- biting arthropods during summer months
Causes: encephalitis outbreaks
Meningitis
Flu like symptoms
Change in colour of bruise from blue to green is due to
Haem oxygenase converting haem to biliverdin
Measles rash
Koplik spots
Rash starts in face spreads to trunk and extremities
Spares palm and soles
Roseola infantum
HHV-6
High fever for 3-5/7
Followed by maculopapular rash starts on trunk then spreads to face and extremities
Self limited
Rubella rash
Starts on face then spreads to trunk and extremities Spares
Southern blotting is used to identify
Gene mutations using DNA fragments
Bacteria that produce IgA protease and can cleave IgA at hinge
N meningitidis
N gonorrhoea
S pneumonia
H influenzae
Help mucosal adherence of bacteria
Disseminated gonococcal infection presentation
Triad:-
Arthritis
Dermatitis
Tenosynovitis
In sexually active person
How does alcogel kill influenza virus /enveloped viruses
By dissolving the lipid bilayer membrane
Echinocandins e.g. caspofungin/micafungin
MoA inhibit synthesis of polysaccharide glucan
cell wall attack
Use against candida and aspergillus
Immune privilege
Occurs in eye and testes to protect the other side
If there’s a disruption —> T cells recongnising self antigens as foreign and launch attack on ‘normal’ side
Reverse transcriptase PCR
Used to detect and quantify mRNA
Used to diagnose CML
Meckel’s diverticulum
True diverticulum consists of all 3 layers
Outpouching from ileum with a fibrous band connected to umbilicus
Damage to the piriform recess can cause damage to which nerve
Internal laryngeal nerve —> affecting cough reflex
Campylobacter jejuni
G-ve oxidase +ve curved rod , grows in 42oC culture
Transmission:- undercooked poultry
Causes:- fever, abdominal pain and bloody diarrhoea
Complication:- Guillain barre
Vibrio cholera
G-ve oxidase positive curved rod, grows in alkaline culture
Causes: massive watery diarrhoea
Relative risk
Used for cohort studies to compare incidence between exposed and non exposed
Odds ratio
Used in case control studies
Frequency of exposure to risk factor is compared between control and cases to estimate association between risk and outcome
Beta thalassemia trait presentation
Mild microcytic Anaemia
Elevated HbA2
Bld smear showing: - poikilocytosis —> spherocytes, target cells
Defect :- gene mutation in mRNA processing —> decreased beta globin chain
Spherocytosis
Hereditary haemolytic anaemia
Jaundice
Spleeomegaly
Abdo pain
Pigmented gallstones
Dark urine
Triggered by stress, fatigue , pregnancy
Doxycycline
MoA:- 30S ribosome subunits
Use:- chlamydia
Acute tubular necrosis location common
Can occur due to decreased renal perfusion
Affect the renal medulla which include
PCT and ascending loop of Henley ( most active parts)
Muddy brown casts pathognomic
Septic abortion
Presentation:- fever, abdo pain, uterine tenderness malodorous discharge
Pathogens: S aureus, group A strep, enterobacteriaceae
Separation anxiety
Excessive and distressing anxiety 2o separation from attachment figures
Children >4/54
Adults >6/12
Hx of cirrhosis, ascites and Rt pleural effusion
Hepatic hydrothorax 2o fluid passage through the diaphragm - transudative
Flutamide
Non steroid anti androgen
MoA:- competitive inhibitor of testosterone receptor
Use : prostate Ca with GnRH
Biospy for prostate Ca
Transrectal route multiple random biopsies
SVC embryonic origin
Common cardinals veins
Lithium
Mood stabiliser
Use:- manic and depressive features
SE: hypothyroidism, neprhogenic diabetes insipidus
Sepsis Hgb O2 assoc curve
Moves to the RT
Weaker HgB o2 bonding
Sepsis cellular features
Decreased mitochondrial oxidative phosphorylation
—> acumulation of lactic acid
Hypovoluaemia
Hypoxeamia
Vasodilation
Microthrombosis
Oedema
Sarcoidosis
Noncaeseating granuloma
Consisting of epithelioid macrophages and multinucleated giant cells
Septic shock haemodynamic mediators
Low vasopressin
Increased NO, IL-1, IOL-6, endotoxin
COPD lung function
FEV1/FVC low <0.7
High functional residual capacity
Increased residual volume
TLC increased
RV/TLC increased
DLCO decreased
BMPR2 gene mutation associated with which disease
PAH
Silicosis
Presentation:- dyspnoea and productive cough
Histo:- birefringent particles surrounded by collagen
CXR:- lots of small round nodules UL with eggshell calcification of hilar nodes
Increased risk of TB 2o impaired macrophages function
Small cell carcinoma of the lung
Highly aggressive
> males
Central
Histo:- sheets of blue cells with scant cytoplasm
Neuro endocrine origin —>marker:- neural crest adhesion molecule, chromogranin
Assoc: - SIADH, Cushing, Lambert Eaton syndrome
Ghon complex
Lesion Lower lob of lung, ipsilateral hilar lymph node in 1o TB
What mechanism is protective to lung against infarction as a complication of PE
Collateral circulation
What causes primary spontaneous pneumothorax
Apical subpleural bleb
Pulmonary alveolar proteinosis
Accumulation of surfactant in alveoli 2o impaired macrophage clearance
Histo:- granular proteinacious material in alveoli with normal alveolar architecture
Bronchopulmonary dysplasia
Chronic lung disease of prematurity
Few dilated alveoli, poor septation, dysmorphic capillaries
CF leads to deficiency in
Fat soluble vitamins
Vitamin A deficiency causes squamous metaplasia and kertainisation of pancreatic duct epithelium
TB 1o v 2o
1o is ghon foci affect lower lung
2o reactivating of TB —> apical cavitation lesion with haemoptysis
Adenocarcinoma of the lung
Commonest 1o lung ca
See in women and non smokers
Mutations:- EGFR and ALK
CXR: Located peripherally
Assoc:- clubbing and hypertrophic osteoarthropathy
Cause of hypercalcaemia in sarcoidosis
Activated macrophages express excess 1 alpha hydroxylase —> Parathyroid independent formation of 1,25 OH vitamin D
Low po4
Neonatal resp distress syndrome lung values
Increase surface tension
Decreased compliance
increase airway resistance
Decreased function residual capacity
Decreased TLC
Hypoxia
Increased work of breathing
Telomerase MoA
Prevents chromosomal shortening
RNA dependent DNA polymerase - keeps adding dna sequence at the end of telomeres
Proto-oncogenes MoA
Encode proteins involved in signal transduction responding to growth factors.
Mutations cause increased transcription factor stimulating cell proliferation
Nucleoside triphosphate co factor formed in TCA cycle used by phosphophenol —> oxaloacetate
GTP
Succinyl-CoA ——> succinate produces GTP
Western blot used to identify
Proteins
Northern blot used to identify
RNA sequences
Southern blot used to identify
DNA sequences
Wobble mutation
3rd nucleotide bonds aren’t strong and can wobble from CUC to CUU
What is the function of the protein encoded by MGMT gene
Repair DNA damage
PKU inheritance
AR
Increased protein concentration despite unchanged mRNA is due to
Decreased ubiquination
Ubiquination tags the protein for destruction by proteasome
1o nocturnal enuresis
Bed wetting >5 with no previous hx of nighttime urinary continence
Unilateral renal hypoperfusion features
Low perfusion in affected side —> increased RAAS —> increased renin
Angiotensin II then —> arteriolar vasoconstriction —> stimulate aldosterone synthesis increased pressure and perfusion for affected side
Decreased GFR
In unaffected kidney —> high pressure — > increased NA excretion to try and reduce volume. Suppressed renin
Selective efferent vasoconstriction effect on GFR and FF
GFR will increase 2o increase hydrostatic pressure buildup
FF increases with efferent vasoconstriction
Cause of Hypokalaemia following MI
Increased shift of K intracellularly
Filtration fraction equation
FF=GFR/RPlasma Flow
RPF = RBF x (1- HCT)
Changes in renal physiology in pregnancy
Vasodilation
Increased RPF
Increase GFR
Reduced crest
Complication of thyroid Tony
Damage or removal of parathyroid —-> post op hypocalcaemia, hypo po4 hypothyroid
Difference between creatinine clearance and pts true GFR
Creatinine clearance overestimates by 20%
Canagliflozin/ Dapagliflozin
SGLT-2 inhibitor
MoA:- reduce Na coupled glucose reabsoption in PCT
Use: DM
Renal clearance of which substance decreases after administration of vasopressin
Urea
Vasopressin increases urea reabsorption
Excess infusion of NACL solution IV
Normal anion gap acidosis
PH decreased
HCO3 decreased
Increased NA
Increased Cl
Diabetes insipidus desmopressin administration
Central —> increased following desmopression N urine osmolality
Partial nephrogenic DI —> slow rise but urine osmolality <500
Complete nephrogenic —> no response
Constriction of efferent arteriole in kidney
Decrease RPF
Increase FF
Increase GFR
Increase capillary hydrostatic pressure buildup
1o hyper parathyroidsim Ca and Po4
Hyper calcaemia by increased Ca renal reabsorption and increased bone resorption freeing Ca
Decreases Po4 reabsorption in PCT
Route of N meningitidis
Nasopharynx — > blood —-> choroidal plexus —-> meninges
Candida morphology
Pseudohypahe with blastoconidia (budding cells )
Entamoeba histolytica
Transmission:- contaminated food and water - faeco-oral
Presentation:- bloody mucus diarrhoea Abdo pain wt loss
Complication :- liver, brain pleural abscess
Histo:- flask shaped ulcers with trophozites
Stool:- cysts and trophozites
PCP
Pneumocystis jirovecii
Prominent cell wall on methamine silver stain
Presentation:- bilateral interstitial infiltrates, cough, dypnoea, wt loss
Mgx : - trimpethoprim sulfamethoxazole
Fibrates ( fenofibrate, gemfibrozil)
MoA:- inhibits cholesterol 7 alpha hydroxylase
Decrease synthesis bile acid
Complication:- cholesterol gall stones
Raised Homocysteine
Can lead to thrombotic event
Can be caused by decreased effect of methylene tetrahydrofolate reductase impairs
Homocysteine —- X —-> methionine
Hormone with Intracellular receptor that maintains glucose levels in fasting
Cortisol ( cytoplasmic receptors)
Glucagon and epinephrine, norepinephrine act on extracellular membrane receptors
1o carnitine deficiency
Muscle weakness
Cardiomyopathy
Hypoketotic hypoglucaemia
High TG
Deep inguinal ring is made of
Transversalis fascia
Superficial inguinal ring is made of
External oblique aponeurosis
Myotonic dystrophy mutant mRNA affect whic cells
Brain
Skeletal
Myocardium
Post translation in RER what happens to proinsulin
Cleaved into insulin and C peptide in secretory granules
N acetylcysteine
Treatment for paracetamol OD
MoA:- increase intrahepatic glutathione
Paracetamol uses up glutathione releases NAPQI - unconjugated type is toxic metabolite
Efficacy
Potency
Emax
ED50
Affinity
Efficacy :- how effective is the drug
Potency:- how much of the drug do we need to give to get an effect
Emax:- the maximum effect can we get from the drug
ED50:- how much of the drug do we need to give to get 50% effect
Affinity:- how much love does the drug have for the receptor. Proportional to potency
Sentinel event
Unexpected occurrence involving death or serious injury requires immediate investigation
Preventable medical error
Harm to pt occurs as an act of omission due to failure to follow best practice guidelines
Treatment of neonatal abstinence syndrome
Morphine
Methadone
TATa box
Promoter region
Works on transcription initiation
Binds polymerase II
Located 25 bases
1o myelofibrosis
Dry Tap
Massive spleenomegaly
Hepatomegaly
Bld smear:- uncleared red cells, immature granulocyte, tear drop ( dacrocytes)
Histopathology:- large islands of haemopoietic progenitor cells
Hyper IgE
Non inflammatory ‘cold’ abscess
Recurrent sinopulmonary infections
Chronic atopic dermatitis
Impaired neutrophil activation and migration
Defect in T helper cell type 17 cells
Pleural effusion days after Cx LN removal is due to
Chylothorax 2o damage to thoracic duct
Mirabegron
MoA :- selective B3 agonist
Use:- urgency incontinence —> relaxes detrusor smooth muscle
Oxybutynin
MoA :- antimuscuranic —> M3 block
Prevent detrusor contraction
Caution in pts with cognitive impairment can worsen
Acetozolamide given with loop diuretics
To off set the metabolic alkalosis with loop diuretics
Iithium SE kidney
Lithium induced diabetes insipidus
Blocks affect of ADH on the collecting tubule
Concentrated urine osmolality
Vaptans
Vasopressin V2 antagonist
MoA increase free water excretion no effect on Na/ K
Use to treat hyponatraemia
SIADH
Increase plasma osmolality and increase urine output
Low urine osmolality
What happens to pts with renal artery stenosis when given ACEI
ACE I causes efferent vasoconstriction
Decreased systemic pressure
Decreasing renal blood flow
Decreased GFR
Decrease FF
Sevelamer
Oral Po4 binder
MoA :- decreased intestinal po4 absorption
Blood results in overuse/abuse of loop/thiazide diuretics
Hypokalaemia, hypochloremic metabolic alkalosis
Mannitol
MoA osmotic diuretics on descending loop of Henley
H20 from cell to plasma
Increase plasma osmolality
Decrease serum Na
Increase renal blood flow
Increase GFR
Increase renal tubular flow
Hyperosmolar glomerular filtrate ( freely filtered but not reabsorbed by renal tubule)
Patiromer
Non absorbable cation exchange resin
MoA:- traps K in exchange for Ca and poops it out
Use treat hyperkalaemia
Furosemide SE
Ototoxicity
With high dose
When given with aminoglycoside, salicylate, cisplatin
CKD
SIADH cause medications
Carbamazepine
SSRI
NSAIDs
Focal segmental glomerulosclerosis
Causes nephrotic syndrome
2o direct ie drugs injury
Indirect ie glomerular hyperfiltration podocyte injury
Membranous neprhopathy
Nephrotic syndrome
Assoc IgG4 antibodies to phopsholipase A2 receptor (PLA2R)
Pathognomic for membranous nephropathy
Causes of acute tubular necrosis
Ischaemic
Antibiotics —> aminoglycosides ( gentamicin), vancomycin
Antivirals —> foscarnet
Radiographic dyes
++ muddy/ epithelial casts FENA >2%
Acute interstitial nephritis presentation
Fever, rash , pyuria and WBC casts 2o intro of new drug
Leukocytic infiltration of the interstitium and capillaries
Membranous neprhopathy histology
EM —> irregular subepithelial immune deposits in GBM with moderate effacement of foot process
IF—-> diffuse granular pattern of IgG along capillary loops
Osteitis fibrosa cystica features
CKD with chronic hyper parathyroidism
High PTH
High PO4
High ALP
Increased activity of osteoclasts> osteoblasts
—> demineralization of bone
Renal papillary necrosis
Gross haematuria
Flank pain
Passage of tissue fragments in urine
Common causes:- sickle cell disease or trait
DM
Analgesic neprhopathy
Severe obstructive pyelonephritis
Hypokalaemic hypochloremic metabolic alkalosis
Causes:- gastric suction
Severe vomiting
Loop or thiazide diuretics
Low Na, Cl, K and alkalosis
Hx of RA with nephrotic syndrome presentation cause
AA amyloidosis
Light microscopy:- amorphous pink deposits with applie green birefringence on Congo red stain
BPH and CKD
BPH can lead to bladder outlet obstruction —-> increase urinary pressure —> hydro-nephrotic and renal parenchymal atrophy and scarring
Scleroderma renal crisis
Systemic sclerosis
Acute renal failure
Severe HTN
2o immune mediate injury to small renal vessel —> decreased renal perfusion and vasc narrowing and obliteration
Minimal change disease
Commonest cause of nephrotic syndrome in children
Can be triggered by NSAIDs , hodgkins, immunization
T cell mediated injury to podocytes —> changes anionic charge of GBM—-> albumin loss in urine
ADPCKD
Mutation PKD-1 PKD-2
Occurs later in life 40-50s
Present flank pain and HTN
ARPCKD
Presents at birth or during the first year of life
Bilateral flank masses
Cysts formed by dilated distal and collecting tubules
Complication of athroembolic disease
Blue toe - livedo riticularis
Renal infarct —> partial or complete obstruction of arterial lumen with cholesterol cleft
Stroke
Bowel ischaemia
Kidney stones in a young pt
Cystinuria
Aka aminoaciduria
Hexagon cystine crystals
Na cyanide test positive ( red discolouration)
Treatment acetazolamide
Chronic interstitial nephritis
2o chronic analgesia overuse
Mild proteinuria
Mild creat elevation
Patchy interstitial inflammation
Papillary necrosis and scarring
Bilateral shrunken kidneys, irregular contour and distortion
BPH increases risk of
Recurrent UTI
Bladder hypertrophy
Hydronephrosis
Hydroureter
Obstructive uropathy
It DOES NOT increase risk of prostatic CA or bladder Ca
Late Complication of prostate radiation therapy on kidneys
Urethral Fibrosis and stricture
—> obstructive uropathy
Mobile G+ve bacteria with narrow zone of haemolysis can grow in refrigerated temps
Listeria monocytogenes
Intracellular and therefore eliminated with cell mediated immune response
G-ve rod motile, non lactose fermenting, oxidase positive causing ++ ear pain with discharge and granulation tissue in ear canal
Pseudomonas aeruginosa causing malignant otitis externa
Commonly seen in diabetics
B12 deficiency
Megaloblastic anaemia
Peripheral neuropathy
B1 deficiency
Wet beri beri —> peripheral neuropathy and heart failure
Dry beri beri —-> peripheral neuropathy * no megaloblastic Anaemia
Wernike korsakoff syndrome
Alkaptonuria
Deficiency in homogentisic acid dioxygenase
Arthritis in adult life
Blue black deposits in sclera and ear cartilage
Urine turns dark on standing
Why is skeletal muscle resistance to verapamil
Skeletal muscle has mechanical coupling begtween the L type ca channel and the RyR ca channel and there for doesn’t need ca influx to be stimulated
Therefore verapamil block l type ca channel doesn’t affect it
Methamine silver buzz word
PCP
2o impaired cell mediated immunity
Anterior pituitary is derived from which embryonic layer
Surface ectoderm
Attributable risk percentage equation
ARP = 100X (RR-1) / RR
Measures excess risk in an exposed population that can be attributed to that risk
Chlamydia urinanalysis
Sterile Pyuria
What structure must be lighted during oophrectomy
Suspensory ligament of the ovary
Contains the ovarian artery, vein, lymphatic and nerves
Down syndrome defect in karyotype
Commonest Meiotic non disjunction - trisomy 21
Less common translocation Down syndrome —> Robersonian translocation t14:21
Sick sinus syndrome
Age related degeneration of the conduction system
Causes of long QT
Macrolides and fluoroquinolones
Ondansetron
Fluconazole
Methadone, oxycodone
SSRI
Class I and III antiarrhythimis
Low Mg,. K, Ca
Lacunar infarcts
Small ischaemic infarcts due to HTN arteriolar sclerosis
Affect small perpetrating arterioles that supply deep brain structure
Can be missed acutely and appear as necrotic cavity weeks leather
Amphotericin B
MoA :- binds ergosterol fungal membrane like nystatin
SE:- acute infusion reaction —> fever, chills, hypotension
Dose dependent nephrotoxicity
Anaemia
Griseofulvin
MoA binding of microtublar protein
Age related changes in liver
Smaller size
Decreased hepatic blood flow
Decreased Cyt P450
Reduced hepatic regeneration
UNCHANGED :—-> aminotransferase levels
Impingement syndrome
Impingement of supraspinatus between humerus and acromion during abduction
Rotator cuff muscles are supraspinatus infraspinatus Ters minor and subscapularis
IBD colorectal malignancy is usually
Multi focal
Younger pts
Non polypoid
Poorly differentiated
VWF action
Helps plts adhesion binds to GpIb and exposed collagen
Protective carrier for factor VIII in absence of vWF factor VIII will be used up quicker
What is fibrin polymer
End result of coagulation cascade
Treatment of hyper ammonia in hepatic encephalopathy
Rifaxamin =-> decreases intestinal production and absorption of ammonia
Lactulose —-> increases conversion of ammonia to ammonium
Measles presentation
Cough, fever, rhinorrhea, conjuctivitis
Maculopapular rash from face and then to trunk
Koplik spots pathognomic
Intraperitoneal free fluid following blunt trauma to abdomen with suprapubic tenderness is due to
Bladder dome injury —> only part intraperitoneal
Toxic shock syndrome
Presentation:- fever, vomiting, muscle pain and erythrocytes
TSSToxin produced by Staph aureus
SuperAg interact with MHC on macrophages and T lymphocytes —> activation of T lymphocytes and release of IL-2 from T cells, In-1 and TNF from macrophages
In period of extreme dieting which hormones will be affected
Decreased insulin ( decrease appetite)
Decreased leptin ( decrease appetite)
Increased Ghrelin (stimulates appetite promote wt gain)
Euthyroid sick syndrome
Seen in severely ill pts
Low T3
Normal T4
Normal TSH
High rT3
2o decreased peripheral conversion of T4-T3 — due to inhibition of 5’deiodinase by TNF alpha, IL1 and IFN beta)
Hyperthyroid bone loss pathology
Increase bone turnover/ increase stimulation of osteoclasts —> bone resorption and resulting in bone loss
Decreased mineralization of bone matrix is due to
Vitamin D deficiency
Symptomatic hypoglyacaemia in a pt with CKD is due to
Decreased renal clearance of insulin
Brown adipose
Located in supraclavicular area and around major vessels and Abdo organs
Preterm have less —> impaired thermogenesis
Contains multiple lipid droplets and mitochondria
1o hypothyroidism
High TSH
Low T4
Normal T3
FSH, inhibin relationship
FSH stimulates release of inhibin B from Sertoli cells
Inhibin has negative feedback on FSH
Responsible for spermatogenesis
Sertoli cells heat sensitive. Undescended testes will lead to decreased inhibin B and increased FSH
LH and testosterone
LH stimulates reslease of testosterone from the leydig cell of the testes
testosterone has negative feedback on LH and GnRH
Normal TSH, normal free T4 and low total T4 in newborn
Thryroxine binding globulin deficiency
X linked
Circulation T4 usually bond to TBG —> if deficiency —> more circulating T4 but less bound T4 = less total T4
Usually euthyroid
High prolactin in 1o hypothyroidism cause
Stimulation of lactotrophs by TRH
High TSH
Low T4
High TRH
High prolactin
High antithyroid peroxidase AB ( chronic immune thyroiditis/ hashimotos — commonest cause)
Graves’ disease autoantibodies
Thyroropin receptor antibody
Subacute thyroiditis
Post viral inflammatory response
Painful tender goitre
Fever
High T4 low TSh initially
High thyroglobulin
High ESR
Low radioiodine uptake
Increased thyroid binding globulin
Seen in pregnancy
Clinically euthyroid
High total T3, T4
Normal TSH
Thyroid hormone resistance
Decreased sensitivity of peripheral tissues to thyroid hormones
Presentation:- ADHD like symptoms
High T4
High T3
High TSH
Hypoglycaemia in type I DM
Due to decreased glucagon secretion —> decreased hepatic gluconeogenesis, glycogenolysis —> higher risk of hypoglyceamia
Supplementation with liothyroinine TFT results
High T3
Low TSH
Low T4
Low T3
Unilateral orchiectomy findings
Normal erectile function
Normal libido
Decreased sperm count
Acute febrile illness, thrombocytopenia, haemolytic anaemia, abnormal LFT and intraerythrocytic inclusions showing Maltese cross and ring shaped. Travel to NE ].Organism?
Babesia microti
Babesiosis
Increased risk with asplenia
Can have co infection with lymes disease
Recombination
Gene exchange occurs through crossing over. Progeny has traits of both parents
Occurs with double stranded non segmented DNA
Reassortment
Segmented viruses
Changes occur when cells infected with 2 segmented virus. Result is alterations in surface antigen of progeny
Organisms causing non bulbous impetigo
Staph aureus
Group A strep
Food borne botulism commonly due to which foods
Home Canning
Undercooked shrimp organisms
Vibrio vulnificus
Severe diarrhoea
L5 -S1 compression causes
Weakness of dorsiflexion
Female LH androgen and oestrogen synthesis
Theca interna
Cholesterol ——> androgen and progesterone +ve feedback LH
Granulosa
Androgen —— aromatase enzyme —-> oestrogen +ve feedback FSH
Clostridium botulinum
Spore forming G+Ve anaerobic bacillus
Toxin:- botulinum prevents presynaptic release of AcH
Tuberous sclerosis defect
Tuberin-hamartin complex
Reciprocal induction occurs where
Between metanephric blastema and ureteric bud
Between lens and optic vesicle and surface ectoderm
Nature T cells found in the
Paracortex of lymph nodes
Melanoma colour changes cause
Red —> vessel ectasia and inflammation
White—-> melanocyte regression die to T cell lymphocyte induced apoptosis
Black/brown —-> proliferation of neoplastic melanocytes
Melanoma colour changes cause
Red —> vessel ectasia
White—-> melanocyte regression die to T cell lymphocyte induced apoptosis
Black/brown —-> proliferation of neoplastic cells
Tuberous sclerosis
Mutation TSC1, TSC2 tumour suppressor gene
Defect tuberin hamartin complex
Presentation:- ash leaf spots, hypopigmented lesions
Subependymal nodules, seizures, intellectual disability
Enhanced signaling mTOR pathway —> unrestricted proliferation
Alpha 2 adrenergic receptor affect on insulin
Decreased insulin secretion
Post op treatment of hypoparathyroidism with hypocalcaemia
Calcitriol -> active vitamin d
And calcium
Cinacalcet
Activates calcium sensing receptor in parathyroid gland
Use:- 2o hyperparathyroidsim in pts with dialysis
Fibrates
Activates peroxisome proliferator activated receptor alpha (PPAR alpha)
Increase LPL
Use:- triglyceridaemia
Methimazole
Thoionamide group
Inhibits tyroperoxidase
Use hyperthyroidism effect takes weeks
SE: drug induced neutropenia
Fastest relief for symptoms of hyperthyroidism
B blockers
Anastrozole
Aromatase inhibitor
Anastrazole/letrozole/ exemestane
MoA:- Decrease synthesis of oestrogen from androgen
USE:- Slowing progression of oestrogen positive tumours
SGLT-2 inhibitors
Canagliflozin, dapagliflozin
MoA:- decrease renal glucose and Na reabsorption in PCT
Osmotic diuresis
USE:- DM
Decrease BP
Lower mortality HF
Slow diabetic nephropathy
Subcutaneous regular insulin
Works within 30 mins
Peaks 2-4 hrs
Lasts 4-6hrs
Human recombinant insulin with no modification
Can be given IV
Sulphonylurea
Glyburide, glimepride
MoA:- inhibit ATP sensitive K channel —> ca Bucky x and exocytosis of insulin. Independent of bld glucose
SE:- persistent hypoglycaemia
Increase C - peptide level indicating endogenous insulin secretion
Bile acid binding resin
Cholestyramine, colestipol, colesevelam
MoA:- bind bile acid in GI decrease hepatic cholesterol synthesis
SE: - can increase TG levels
Bile acid binding resin
Cholestyramine, colestipol, colesevelam
MoA:- bind bile acid in GI decrease hepatic cholesterol synthesis
SE: - can increase TG levels
5 alpha reducase inhibitors
Finasteride
MoA:- decrease conversion of testosterone to DHT
SE:- decreased libido, erectile dysfunction, decreased ejaculate volume
Long term pred affect on bone
Inhibits osteoblasts replication and differentiation
Increase osteoclasts activity
Leading to osteoporosis
SE of highly active antiretroviral therapy
Redistribution of fat
Lipoatrophy in face and limbs
Central fat deposition
GLP1 agonist
MoA GLP 1 agonist in intestine
Slows gastric emptying
Increase glucose dependent insulin release
Works through cAMP
Metformin
MoA:- inhibits mitochondrial glycerophosphate dehydrogenase
Decreased hepatic gluconeogenesis
Decreased intestinal glucose absorption
SE:- lactic acidosis esp in renal insufficiency
Long term B12 deficiency
Check renal function before starting
Diabetic gatroparesis
Autonomic neuropathy
Delayed gastric emptying no mechanical obstruction
Metoclopramide can help. SE:- dystonia
Erythromycin:- has prokinetic effect —> activation of the motlin receptor
SGLT 2 inhibitor MoA
Decrease renal glucose absorption
Decrease NA absorption
Increase urinary glucose EnVe ion
Leading to natriuresis and osmotic diuresis
Decrease ECF volume
Beta blocker affect on Blood glucose
Increase risk of hypoglycaemia
Mask hypoglycaemic symptoms
By blocking epinephrine/norepinephrie
Hot tub follicular is
Pseudomonas aeruginosa
Gram -ve oxidase positive non lactose fermenting rods
Produce green pigment
Presentation:- pruritic papulopustular rash
Transmission:- pool water
Splenectomy will leave pts susceptible to
Infection with SHiN encapsulated bacteria
Due to reduced systemic bacterial clearance
Chagas disease
Typansoma cruzi
S AMerica
Vector:- triatome bug
In thatched roofs
Presentation:- fever, malaise swelling/inflamation at site of inoculation. Trypomastigotes on bld micro
Complication:- chagas cardiomyopathy —> arrhythmias, ventricular aneurysm
Schistosoma vector
Freshwater snails
Q fever
Coxiella burentii
Transmission:- inhalation of bacteria from air contaminated by animal waste
Presentation:- fever >10/7 fatigue, myalgia, headache retroorbital pain and photophobia
Pneumonia, thrombocytopenia
