Mixede Qs 8 Flashcards

1
Q

Concentric left ventricular hypertrophy is due t o which substances

A

Due to Angiotensin II , endothelin

2o chronic untreated HTN

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2
Q

Pyruvate carboxylate Activator in gluconeogenesis

A

Acetyl-coA

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3
Q

MHC Class I structure

A

Single heavy/long chain and one short train beta 2 microglobulin

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4
Q

Chediak-Higashi syndrome

A

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

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5
Q

Interaction between nitrates and phosphodiesterase innhibitors ( sildenafil)

A

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

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6
Q

Frameshift mutation

A

Deletion/addition of a number of bases not divisible by 3 in the coding region of a gene

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7
Q

Marker of HBV transplacental transmission

A

HBeAg

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8
Q

Which medication works by binding to cytocolic receptor and inhibiting nuclear factor kappa B ( NF-KB)

A

Glucocorticoids

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9
Q

Where does the trigeminal nerve exit the brain stem

A

At mid pons level of middle cerebellar peduncle

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10
Q

EPO signal transduction is mediated by

A

Janus kinase 2/signal transducer and activator of transcription (JAK2/STAT) pathway

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11
Q

HLA and MHC II

A

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

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12
Q

HLA and MHC I

A

HLA-A, HLA-B and HLA-C encode for MHC II expressed in nucleated cells after cytosolic antigen transported into endoplasmic reticulum

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13
Q

Exercise induced hypoglycaemia in DM

A

Increased expression of GLUT4 in cell membrane —> increased muscle glucose uptake independent of insulin

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14
Q

MRSA is resistant to which ABx

A

Beta lactate ABx

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15
Q

Latanoprost

A

Topical Prostaglandin agonist

MoA:Increased outflow of aqueous humor

USE: glaucoma

SE:- pigmentation of iris and eye lashes

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16
Q

Aedes mosquito transmits which viruses

A

Dengue ( haemorrhagic symptoms, fever, Brazil travel)
Chikungunya
Zika
Yellow fever

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17
Q

Complication of nitroprusside

A

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

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18
Q

Wilson’s Disease

A

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

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19
Q

Spleen embryologic origin

A

Mesoderm
Like muscle, bone, kidney

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20
Q

ARR equation

A

ARR= Control rate - treatment rate

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21
Q

Heparin MoA

A

Bind to anti thrombin III

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22
Q

Mitochondrial vaculolisation is a sign of

A

Irreversible cell injury

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23
Q

Burkitts lymphoma Pathogenesis

A

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

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24
Q

Retinoblastoma

A

Presentation:- first 3 years of life
Leukocoria
Strabismus
Creamy white mass on fundoscopy

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25
Retinitis pigmentosa
Progressive dystrophy of retinal pigmented epithelium and photoreceptors Presentation;- night blindness Loss of peripheral vision Fudoscopy:- dark pigments and optic disc pallor
26
1o myelofibrosis
Malignancy stem cell- megakaryocytes Presentation:- pancytopenia, hepatospleenomegaly, teardrop cells Bone marrow biopsy:- dry tap Fibrotic BM with clusters of atypical megakaryocytes
27
Testicular tumour
Solid firm/fixed nodule in the tunica albumin era non tender
28
Defence immunity against intracellular organisms like legionella and m to
Cell mediated Th1 cells, IFN gamma and IL-2
29
Beta blockers affect
Reduce HR Increase preload Decrease LV contractility Decrease end systolic volume
30
Mesothelioma histology
Spindle cells that stain +ve for cytokeratin
31
SCLC histology
Small round cells +ve for chromogranin
32
Silicosis histology
Whorled collagen fibers and dust laden macrophages
33
Gilbert syndrome
Indirect hyperbilirubinaema due to decreased bilirubin conjugation. Can be triggered by stress
34
Bleeding between skull and periosteum
Cephalohaematoma Over parietal / occipital bone Small, non fluctuant and doesn’t not cross suture line
35
Bleeding between periosteum and galea apnoneurosis
Subgaleal haematoma Diffuse, fluctuant swelling across scalp and neck , beyond suture lines 2o vacuum assisted delivery
36
Acute cholangitis
Triad:- fever, acute RUQ pain, jaundice Hypotension and altered mental status 2o biliary obstruction
37
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
38
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
39
Amyloid A protein
Acute phase reactant Assoc with systemic amyloidosis Seen in RA, IBD
40
Maple syrup urine disease Mgx
Restrict leucine, isoleucine, valine
41
Diphertia immunisation generates
Protective IgG against exotoxin B subunit
42
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
43
Vancomycin MoA
Bind to D-Alanyl- D-alanyl terminus of peptidoglycan prevent elongation of peptidoglycan Chan in
44
Arbovirus
Small RNA virus Transmission:- biting arthropods during summer months Causes: encephalitis outbreaks Meningitis Flu like symptoms
45
Change in colour of bruise from blue to green is due to
Haem oxygenase converting haem to biliverdin
46
Measles rash
Koplik spots Rash starts in face spreads to trunk and extremities Spares palm and soles
47
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
48
Rubella rash
Starts on face then spreads to trunk and extremities Spares
49
Southern blotting is used to identify
Gene mutations using DNA fragments
50
Bacteria that produce IgA protease and can cleave IgA at hinge
N meningitidis N gonorrhoea S pneumonia H influenzae Help mucosal adherence of bacteria
51
Disseminated gonococcal infection presentation
Triad:- Arthritis Dermatitis Tenosynovitis In sexually active person
52
How does alcogel kill influenza virus /enveloped viruses
By dissolving the lipid bilayer membrane
53
Echinocandins e.g. caspofungin/micafungin
MoA inhibit synthesis of polysaccharide glucan **cell wall attack** Use against candida and aspergillus
54
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
55
Reverse transcriptase PCR
Used to detect and quantify mRNA Used to diagnose CML
56
Meckel’s diverticulum
True diverticulum consists of all 3 layers Outpouching from ileum with a fibrous band connected to umbilicus
57
Damage to the piriform recess can cause damage to which nerve
Internal laryngeal nerve —> affecting cough reflex
58
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
59
Vibrio cholera
G-ve oxidase positive curved rod, grows in alkaline culture Causes: massive watery diarrhoea
60
Relative risk
Used for cohort studies to compare incidence between exposed and non exposed
61
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
62
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
63
Spherocytosis
Hereditary haemolytic anaemia Jaundice Spleeomegaly Abdo pain Pigmented gallstones Dark urine Triggered by stress, fatigue , pregnancy
64
Doxycycline
MoA:- 30S ribosome subunits Use:- chlamydia
65
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
66
Septic abortion
Presentation:- fever, abdo pain, uterine tenderness malodorous discharge Pathogens: S aureus, group A strep, enterobacteriaceae
67
Separation anxiety
Excessive and distressing anxiety 2o separation from attachment figures Children >4/54 Adults >6/12
68
Hx of cirrhosis, ascites and Rt pleural effusion
Hepatic hydrothorax 2o fluid passage through the diaphragm - transudative
69
Flutamide
Non steroid anti androgen MoA:- competitive inhibitor of testosterone receptor Use : prostate Ca with GnRH
70
Biospy for prostate Ca
Transrectal route multiple random biopsies
71
SVC embryonic origin
Common cardinals veins
72
Lithium
Mood stabiliser Use:- manic and depressive features SE: hypothyroidism, neprhogenic diabetes insipidus
73
Sepsis Hgb O2 assoc curve
Moves to the RT Weaker HgB o2 bonding
74
Sepsis cellular features
Decreased mitochondrial oxidative phosphorylation —> acumulation of lactic acid Hypovoluaemia Hypoxeamia Vasodilation Microthrombosis Oedema
75
Sarcoidosis
Noncaeseating granuloma Consisting of epithelioid macrophages and multinucleated giant cells
76
Septic shock haemodynamic mediators
Low vasopressin Increased NO, IL-1, IOL-6, endotoxin
77
COPD lung function
FEV1/FVC low <0.7 High functional residual capacity Increased residual volume TLC increased RV/TLC increased DLCO decreased
78
BMPR2 gene mutation associated with which disease
PAH
79
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
80
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
81
Ghon complex
Lesion Lower lob of lung, ipsilateral hilar lymph node in 1o TB
82
What mechanism is protective to lung against infarction as a complication of PE
Collateral circulation
83
What causes primary spontaneous pneumothorax
Apical subpleural bleb
84
Pulmonary alveolar proteinosis
Accumulation of surfactant in alveoli 2o impaired macrophage clearance Histo:- granular proteinacious material in alveoli with normal alveolar architecture
85
Bronchopulmonary dysplasia
Chronic lung disease of prematurity Few dilated alveoli, poor septation, dysmorphic capillaries
86
CF leads to deficiency in
Fat soluble vitamins Vitamin A deficiency causes squamous metaplasia and kertainisation of pancreatic duct epithelium
87
TB 1o v 2o
1o is ghon foci affect lower lung 2o reactivating of TB —> apical cavitation lesion with haemoptysis
88
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
89
Cause of hypercalcaemia in sarcoidosis
Activated macrophages express excess 1 alpha hydroxylase —> Parathyroid independent formation of 1,25 OH vitamin D Low po4
90
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
91
Telomerase MoA
Prevents chromosomal shortening RNA dependent DNA polymerase - keeps adding dna sequence at the end of telomeres
92
Proto-oncogenes MoA
Encode proteins involved in signal transduction responding to growth factors. Mutations cause increased transcription factor stimulating cell proliferation
93
Nucleoside triphosphate co factor formed in TCA cycle used by phosphophenol —> oxaloacetate
GTP Succinyl-CoA ——> succinate produces GTP
94
Western blot used to identify
Proteins
95
Northern blot used to identify
RNA sequences
96
Southern blot used to identify
DNA sequences
97
Wobble mutation
3rd nucleotide bonds aren’t strong and can wobble from CUC to CUU
98
What is the function of the protein encoded by MGMT gene
Repair DNA damage
99
PKU inheritance
AR
100
Increased protein concentration despite unchanged mRNA is due to
Decreased ubiquination Ubiquination tags the protein for destruction by proteasome
101
1o nocturnal enuresis
Bed wetting >5 with no previous hx of nighttime urinary continence
102
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
103
Selective efferent vasoconstriction effect on GFR and FF
GFR will increase 2o increase hydrostatic pressure buildup FF increases with efferent vasoconstriction
104
Cause of Hypokalaemia following MI
Increased shift of K intracellularly
105
Filtration fraction equation
FF=GFR/RPlasma Flow RPF = RBF x (1- HCT)
106
Changes in renal physiology in pregnancy
Vasodilation Increased RPF Increase GFR Reduced crest
107
Complication of thyroid Tony
Damage or removal of parathyroid —-> post op hypocalcaemia, hypo po4 hypothyroid
108
Difference between creatinine clearance and pts true GFR
Creatinine clearance overestimates by 20%
109
Canagliflozin/ Dapagliflozin
SGLT-2 inhibitor MoA:- reduce Na coupled glucose reabsoption in PCT Use: DM
110
Renal clearance of which substance decreases after administration of vasopressin
Urea Vasopressin increases urea reabsorption
111
Excess infusion of NACL solution IV
Normal anion gap acidosis PH decreased HCO3 decreased Increased NA Increased Cl
112
Diabetes insipidus desmopressin administration
Central —> increased following desmopression N urine osmolality Partial nephrogenic DI —> slow rise but urine osmolality <500 Complete nephrogenic —> no response
113
Constriction of efferent arteriole in kidney
Decrease RPF Increase FF Increase GFR Increase capillary hydrostatic pressure buildup
114
1o hyper parathyroidsim Ca and Po4
Hyper calcaemia by increased Ca renal reabsorption and increased bone resorption freeing Ca Decreases Po4 reabsorption in PCT
115
Route of N meningitidis
Nasopharynx — > blood —-> choroidal plexus —-> meninges
116
Candida morphology
Pseudohypahe with blastoconidia (budding cells )
117
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
118
PCP
Pneumocystis jirovecii Prominent cell wall on methamine silver stain Presentation:- bilateral interstitial infiltrates, cough, dypnoea, wt loss Mgx : - trimpethoprim sulfamethoxazole
119
Fibrates ( fenofibrate, gemfibrozil)
MoA:- inhibits cholesterol 7 alpha hydroxylase Decrease synthesis bile acid Complication:- cholesterol gall stones
120
Raised Homocysteine
Can lead to thrombotic event Can be caused by decreased effect of methylene tetrahydrofolate reductase impairs Homocysteine —- X —-> methionine
121
Hormone with Intracellular receptor that maintains glucose levels in fasting
Cortisol ( cytoplasmic receptors) Glucagon and epinephrine, norepinephrine act on extracellular membrane receptors
122
1o carnitine deficiency
Muscle weakness Cardiomyopathy Hypoketotic hypoglucaemia High TG
123
Deep inguinal ring is made of
Transversalis fascia
124
Superficial inguinal ring is made of
External oblique aponeurosis
125
Myotonic dystrophy mutant mRNA affect whic cells
Brain Skeletal Myocardium
126
Post translation in RER what happens to proinsulin
Cleaved into insulin and C peptide in secretory granules
127
N acetylcysteine
Treatment for paracetamol OD MoA:- increase intrahepatic glutathione Paracetamol uses up glutathione releases NAPQI - unconjugated type is toxic metabolite
128
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
129
Sentinel event
Unexpected occurrence involving death or serious injury requires immediate investigation
130
Preventable medical error
Harm to pt occurs as an act of omission due to failure to follow best practice guidelines
131
Treatment of neonatal abstinence syndrome
Morphine Methadone
132
TATa box
Promoter region Works on transcription initiation Binds polymerase II Located 25 bases
133
1o myelofibrosis
Dry Tap Massive spleenomegaly Hepatomegaly Bld smear:- uncleared red cells, immature granulocyte, tear drop ( dacrocytes) Histopathology:- large islands of haemopoietic progenitor cells
134
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
135
Pleural effusion days after Cx LN removal is due to
Chylothorax 2o damage to thoracic duct
136
Mirabegron
MoA :- selective B3 agonist Use:- urgency incontinence —> relaxes detrusor smooth muscle
137
Oxybutynin
MoA :- antimuscuranic —> M3 block Prevent detrusor contraction Caution in pts with cognitive impairment can worsen
138
Acetozolamide given with loop diuretics
To off set the metabolic alkalosis with loop diuretics
139
Iithium SE kidney
Lithium induced diabetes insipidus Blocks affect of ADH on the collecting tubule Concentrated urine osmolality
140
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
141
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
142
Sevelamer
Oral Po4 binder MoA :- decreased intestinal po4 absorption
143
Blood results in overuse/abuse of loop/thiazide diuretics
Hypokalaemia, hypochloremic metabolic alkalosis
144
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)
145
Patiromer
Non absorbable cation exchange resin MoA:- traps K in exchange for Ca and poops it out Use treat hyperkalaemia
146
Furosemide SE
Ototoxicity With high dose When given with aminoglycoside, salicylate, cisplatin CKD
147
SIADH cause medications
Carbamazepine SSRI NSAIDs
148
Focal segmental glomerulosclerosis
Causes nephrotic syndrome 2o direct ie drugs injury Indirect ie glomerular hyperfiltration podocyte injury
149
Membranous neprhopathy
Nephrotic syndrome Assoc IgG4 antibodies to phopsholipase A2 receptor (PLA2R) Pathognomic for membranous nephropathy
150
Causes of acute tubular necrosis
Ischaemic Antibiotics —> aminoglycosides ( gentamicin), vancomycin Antivirals —> foscarnet Radiographic dyes ++ muddy/ epithelial casts FENA >2%
151
Acute interstitial nephritis presentation
Fever, rash , pyuria and WBC casts 2o intro of new drug Leukocytic infiltration of the interstitium and capillaries
152
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
153
Osteitis fibrosa cystica features
CKD with chronic hyper parathyroidism High PTH High PO4 High ALP Increased activity of osteoclasts> osteoblasts —> demineralization of bone
154
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
155
Hypokalaemic hypochloremic metabolic alkalosis
Causes:- gastric suction Severe vomiting Loop or thiazide diuretics Low Na, Cl, K and alkalosis
156
Hx of RA with nephrotic syndrome presentation cause
AA amyloidosis Light microscopy:- amorphous pink deposits with applie green birefringence on Congo red stain
157
BPH and CKD
BPH can lead to bladder outlet obstruction —-> increase urinary pressure —> hydro-nephrotic and renal parenchymal atrophy and scarring
158
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
159
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
160
ADPCKD
Mutation PKD-1 PKD-2 Occurs later in life 40-50s Present flank pain and HTN
161
ARPCKD
Presents at birth or during the first year of life Bilateral flank masses Cysts formed by dilated distal and collecting tubules
162
Complication of athroembolic disease
Blue toe - livedo riticularis Renal infarct —> partial or complete obstruction of arterial lumen with cholesterol cleft Stroke Bowel ischaemia
163
Kidney stones in a young pt
Cystinuria Aka aminoaciduria Hexagon cystine crystals Na cyanide test positive ( red discolouration) Treatment acetazolamide
164
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
165
BPH increases risk of
Recurrent UTI Bladder hypertrophy Hydronephrosis Hydroureter Obstructive uropathy It DOES NOT increase risk of prostatic CA or bladder Ca
166
Late Complication of prostate radiation therapy on kidneys
Urethral Fibrosis and stricture —> obstructive uropathy
167
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
168
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
169
B12 deficiency
Megaloblastic anaemia Peripheral neuropathy
170
B1 deficiency
Wet beri beri —> peripheral neuropathy and heart failure Dry beri beri —-> peripheral neuropathy * no megaloblastic Anaemia Wernike korsakoff syndrome
171
Alkaptonuria
Deficiency in homogentisic acid dioxygenase Arthritis in adult life Blue black deposits in sclera and ear cartilage Urine turns dark on standing
172
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
173
Methamine silver buzz word
PCP 2o impaired cell mediated immunity
174
Anterior pituitary is derived from which embryonic layer
Surface ectoderm
175
Attributable risk percentage equation
ARP = 100X (RR-1) / RR Measures excess risk in an exposed population that can be attributed to that risk
176
Chlamydia urinanalysis
Sterile Pyuria
177
What structure must be lighted during oophrectomy
Suspensory ligament of the ovary Contains the ovarian artery, vein, lymphatic and nerves
178
Down syndrome defect in karyotype
Commonest Meiotic non disjunction - trisomy 21 Less common translocation Down syndrome —> Robersonian translocation t14:21
179
Sick sinus syndrome
Age related degeneration of the conduction system
180
Causes of long QT
Macrolides and fluoroquinolones Ondansetron Fluconazole Methadone, oxycodone SSRI Class I and III antiarrhythimis Low Mg,. K, Ca
181
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
182
Amphotericin B
MoA :- binds ergosterol fungal membrane like nystatin SE:- acute infusion reaction —> fever, chills, hypotension Dose dependent nephrotoxicity Anaemia
183
Griseofulvin
MoA binding of microtublar protein
184
Age related changes in liver
Smaller size Decreased hepatic blood flow Decreased Cyt P450 Reduced hepatic regeneration UNCHANGED :—-> aminotransferase levels
185
Impingement syndrome
Impingement of supraspinatus between humerus and acromion during abduction Rotator cuff muscles are supraspinatus infraspinatus Ters minor and subscapularis
186
IBD colorectal malignancy is usually
Multi focal Younger pts Non polypoid Poorly differentiated
187
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
188
What is fibrin polymer
End result of coagulation cascade
189
Treatment of hyper ammonia in hepatic encephalopathy
Rifaxamin =-> decreases intestinal production and absorption of ammonia Lactulose —-> increases conversion of ammonia to ammonium
190
Measles presentation
Cough, fever, rhinorrhea, conjuctivitis Maculopapular rash from face and then to trunk Koplik spots pathognomic
191
Intraperitoneal free fluid following blunt trauma to abdomen with suprapubic tenderness is due to
Bladder dome injury —> only part intraperitoneal
192
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
193
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)
194
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)
195
Hyperthyroid bone loss pathology
Increase bone turnover/ increase stimulation of osteoclasts —> bone resorption and resulting in bone loss
196
Decreased mineralization of bone matrix is due to
Vitamin D deficiency
197
Symptomatic hypoglyacaemia in a pt with CKD is due to
Decreased renal clearance of insulin
198
Brown adipose
Located in supraclavicular area and around major vessels and Abdo organs Preterm have less —> impaired thermogenesis Contains multiple lipid droplets and mitochondria
199
1o hypothyroidism
High TSH Low T4 Normal T3
200
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
201
LH and testosterone
LH stimulates reslease of testosterone from the leydig cell of the testes testosterone has negative feedback on LH and GnRH
202
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
203
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)
204
Graves’ disease autoantibodies
Thyroropin receptor antibody
205
Subacute thyroiditis
Post viral inflammatory response Painful tender goitre Fever High T4 low TSh initially High thyroglobulin High ESR Low radioiodine uptake
206
Increased thyroid binding globulin
Seen in pregnancy Clinically euthyroid High total T3, T4 Normal TSH
207
Thyroid hormone resistance
Decreased sensitivity of peripheral tissues to thyroid hormones Presentation:- ADHD like symptoms High T4 High T3 High TSH
208
Hypoglycaemia in type I DM
Due to decreased glucagon secretion —> decreased hepatic gluconeogenesis, glycogenolysis —> higher risk of hypoglyceamia
209
Supplementation with liothyroinine TFT results
High T3 Low TSH Low T4 Low T3
210
Unilateral orchiectomy findings
Normal erectile function Normal libido Decreased sperm count
211
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
212
Recombination
Gene exchange occurs through crossing over. Progeny has traits of both parents Occurs with double stranded non segmented DNA
213
Reassortment
Segmented viruses Changes occur when cells infected with 2 segmented virus. Result is alterations in surface antigen of progeny
214
Organisms causing non bulbous impetigo
Staph aureus Group A strep
215
Food borne botulism commonly due to which foods
Home Canning
216
Undercooked shrimp organisms
Vibrio vulnificus Severe diarrhoea
217
L5 -S1 compression causes
Weakness of dorsiflexion
218
Female LH androgen and oestrogen synthesis
Theca interna Cholesterol ——> androgen and progesterone +ve feedback LH Granulosa Androgen —— aromatase enzyme —-> oestrogen +ve feedback FSH
219
Clostridium botulinum
Spore forming G+Ve anaerobic bacillus Toxin:- botulinum prevents presynaptic release of AcH
220
Tuberous sclerosis defect
Tuberin-hamartin complex
221
Reciprocal induction occurs where
Between metanephric blastema and ureteric bud Between lens and optic vesicle and surface ectoderm
222
Nature T cells found in the
Paracortex of lymph nodes
223
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
224
Melanoma colour changes cause
Red —> vessel ectasia White—-> melanocyte regression die to T cell lymphocyte induced apoptosis Black/brown —-> proliferation of neoplastic cells
225
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
226
Alpha 2 adrenergic receptor affect on insulin
Decreased insulin secretion
227
Post op treatment of hypoparathyroidism with hypocalcaemia
Calcitriol -> active vitamin d And calcium
228
Cinacalcet
Activates calcium sensing receptor in parathyroid gland Use:- 2o hyperparathyroidsim in pts with dialysis
229
Fibrates
Activates peroxisome proliferator activated receptor alpha (PPAR alpha) Increase LPL Use:- triglyceridaemia
230
Methimazole
Thoionamide group Inhibits tyroperoxidase Use hyperthyroidism effect takes weeks SE: drug induced neutropenia
231
Fastest relief for symptoms of hyperthyroidism
B blockers
232
Anastrozole
Aromatase inhibitor Anastrazole/letrozole/ exemestane MoA:- Decrease synthesis of oestrogen from androgen USE:- Slowing progression of oestrogen positive tumours
233
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
234
Subcutaneous regular insulin
Works within 30 mins Peaks 2-4 hrs Lasts 4-6hrs Human recombinant insulin with no modification Can be given IV
235
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
236
Bile acid binding resin
Cholestyramine, colestipol, colesevelam MoA:- bind bile acid in GI decrease hepatic cholesterol synthesis SE: - can increase TG levels
237
Bile acid binding resin
Cholestyramine, colestipol, colesevelam MoA:- bind bile acid in GI decrease hepatic cholesterol synthesis SE: - can increase TG levels
238
5 alpha reducase inhibitors
Finasteride MoA:- decrease conversion of testosterone to DHT SE:- decreased libido, erectile dysfunction, decreased ejaculate volume
239
Long term pred affect on bone
Inhibits osteoblasts replication and differentiation Increase osteoclasts activity Leading to osteoporosis
240
SE of highly active antiretroviral therapy
Redistribution of fat Lipoatrophy in face and limbs Central fat deposition
241
GLP1 agonist
MoA GLP 1 agonist in intestine Slows gastric emptying Increase glucose dependent insulin release Works through cAMP
242
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
243
Diabetic gatroparesis
Autonomic neuropathy Delayed gastric emptying no mechanical obstruction Metoclopramide can help. SE:- dystonia Erythromycin:- has prokinetic effect —> activation of the motlin receptor
244
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
245
Beta blocker affect on Blood glucose
Increase risk of hypoglycaemia Mask hypoglycaemic symptoms By blocking epinephrine/norepinephrie
246
Hot tub follicular is
Pseudomonas aeruginosa Gram -ve oxidase positive non lactose fermenting rods Produce green pigment Presentation:- pruritic papulopustular rash Transmission:- pool water
247
Splenectomy will leave pts susceptible to
Infection with SHiN encapsulated bacteria Due to reduced systemic bacterial clearance
248
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
249
Schistosoma vector
Freshwater snails
250
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