Practice Questions Flashcards
Leykocyte adhesion def is caused by what cd molecule
CD18
Aka intergin beta-2
Without it there is no adhesion dependent migration from vessel to outside
Hence no pus recurrent inf —-gm neg staph aureus and fungus
Delayed cord separation
Name the steps of neutrophil response in inflammation
Margination Rolling Adhesion Extravasation Chemotaxis
Name the steps of neutrophil response in inflammation with their mediators
Margination—-nitrous oxide and vasoactive substances
Rolling—-P & E Selectins and glycoproteins
Adhesion- CD18 intergin beta 2 ICAM PROTEINS
EXTRAVASATION- integrins and pseudopodia
Chemotaxis— interleukin 8, C5a, LtB4 and formly methionated proteins
cherry red spot in macula is a sign of
central retinal artery occlusion.
There is diffuse retinal ischemia and macula is spared.
since macula recieves its blood supply from choroid by long and short posterior ciliary arteries
JAK 2 gene mutations are associated with
polycythemia vera
primary myelofibrosis (increased megakaryocytes stimulate collagen release from other cells and cause myelofibrosis)
essential thyombocythemia
PRCA is seen with
thymic mass lesions
lymphocytic leukemia
due to autoimmune destruction by Cytotoxic T cells or IgG autoantibodies against RBC precursors only
herpes like vesicular excoriating lesions in extensor surfaces elbow and knees
in a patient with voluminous stools indicate
dermatitis herpatiformis in a patient with celiac disease
renal affection in patients with PNH
Hemolysis — hemosiderosis in kidney — proximal tubular function affected
Pts have vascular thrombosis at various sites.
In kidney too can lead to microvascular thrombosis leading to cortical infarcts and interstitial scarring.
ultimately — CRF.
proximal girdle muscle weakness with skin changes should prompt what diagnosis
muscle + skin = dermatomyositis – autoimmune disorder
causes of dermatomyositis
isolated
secondary autoimmune as paraneoplastic syndrome
malignancy— adeno ca of lung pancreas and ovary
skin manifestations of chronic HCV
- Prophyria cutanea tarda— skin blistering in sun exposed area
- Mixed cryoglobulinemic vasculitis — non blanching palpable purpura.
acanthosis nigrans is associated with
insulin resistance of anytype - DM, cortisol excess cushings, obesity
Visceral malignancy – stomach adenoca
myositis with normal CK levels
that is no myocyte damage is occuring
- GLUCOCORTICOID induced myositis (cushings- 24hr urinary cortisol is elevated, catabolic effect on muscle) Lower limbs affects. Condition is painless.
- POLYMYALGIA RHEUMATICA- Painfull stiffness of proximal upper limb and lower limb muscles.
Pain and weakness more on exercise or work and in morning.
myositis with elevated CK levels
Significamnt myocyte damage is occuring
- Statin induced myositis (history of statin intake)
- hypothyroid induced (delayed tendon reflexes and myoedema)
- Inflammatory myositis – DM and PM has rash and inflammatory arthritis.
- Inherited muscular dystrophies.
slow relaxation of ankle jerks
hypothyroidism
elevated pronormboblasts with intranuclear inclusions is a characteristic sign of
problem with maturation of erythyroid precursors
esp transient aplasia or parvovirus B19 infection
DIC is excessive activation of which coagulation pathway
extrinsic pathway (7a, 10a, thrombin, fibrin, crosslinked clot)
tissue factor wala.
like heat exhaustion causes tissue necrosis and hence DIC
or fetal death causes tissue factor release in blood and then DIC
what are changes of DIC In blood
thrombin and clots increase
Fibrinolysis increase to lyse those clots
Plasmin increase to lyse those clots
Fibrin degradation products produced from lysing of those clots increase– ie D dimer increase
Anticoagulants protein C and S and antithrombin thus gets consumed and depleted.
DIC effect of blood coagulation studies
Platelets consumed— Platelet count reduced
Coagulation factors consumed- PT and APTT increased
bleeding time is no longer done.
lysozymes and defensins are secreted by which intestinal epithelial cell
paneth cells at the base of intestinal crypt.
they are first line defense for mucosal infection
Shiga like toxin is secreted by which bacteria, infects which organ and damages which organ.
Remember all three answers are unique
Shiga like toxin is produced by GIT infection from E Coli O157 :H7
Toxin travels in blood and damages endothelial cells of kidney leading to uremia ARF.
Shigella infects what cells
gains access through Microfold cells (M cells ) in the peyers patch. Entry is through endocytosis.
multiplies, lyses the endosome and spreads laterally to other adjacent cells. Denudation, haemorrhagic diarrhoea ulceration.
RBC lacks mitochondria. so TCA krebs and ETC does not happen. How many ATP are generated for one molecule of glucose
4 generated two used- net is 2 ATP.
ATP producing steps are 1-3 BPG —> 3PG gives 2 ATP
and pyruvate kinase step PEP —–> pyruvate gives 2 ATP
Hence in pyruvate kinase deficiency RBC losses all ATP stops membrane function and rigid and undergoes extravascular hemolysis in splenic red pulp.
which patient would show pyruvate kinase deficiency
newborns – hemolytic anemia in newborn.
Have increased 23 BPG, HB releases Oxygen easily.
kids have anemia and splenomegaly.
Lab findings in von willebrands deficiency
Platelet count and function is normal.
Bleeding time is prolonged.
vWf carries and protects factor 8 which is starting point of intrinsic pathway. Hence APTT is prolonged because factor 8 is less or degraded more.
PT marker of extrinsic factor 7 and combined pathway is normal.
what type of bleeding occurs in uremia
GI bleeding. Uremic platelets are dysfunctional because they cannot produce enough thromboxane A2.
heparin induced thrombocytopenia and thrombosis is due to
heparin binding to platelet factor 4 and forming a complex on surface of platelet
An antibody response to this complex mounts the prothrombotic disease–positive feed back loop
called heparin induced thrombocytopenia
treatment of heparin induced thrombocytopenia and thrombosis
discontinue heparin,
dont give warfarin or platelet transfusion.. worsens
Give DTIs= direct thrombin inhibitors because thrombosis needs to be stopped.
DTIs approved are =arga-tro-ban and bivalirudins.
Indirect TI used are – fondaparinux and danaparuid.
causes of IgE independent mast cell degranulations
Drugs IV like
Opiates, Radiology contrast dyes and vancomycin
What is the pathogenesis of IgE independent mast cell degranulation
Activation of enzymes protein kinase A and PI3 kinase by drugs like opiates, radiocontrast dyes and vancomycin.
leflunomide inhibits which enzyme
It is used to treat
DHODH– dihydro-orotate dehydrogenase (pyrimidine synthesis- T cell proliferation)
Used in rheumatoid and psoriartic arthritis
absent cremasteric reflex
lapro surgery injury to genitofemoral nerve.
L1-L2
Calmodulin and myosin light chain kinase are associated with what type of muscle contraction
Smooth muscle contraction.
Effect of epinephrine action on skelatal muscles
Acts on B2 adrenergic receptors— increases skeletal muscle blood flow (flight needs to run)
Glycogenolyiss (energy for running in flight mode)
Lipolysis (energy for running in flight mode)
HENCE BLOOD FLOW, GLYCOGENOLYSIS AND LIPOLYSIS
