Questions Flashcards
Choice of drug for long term prevention of stroke in a fib patients?
Warfarin
RBC does not have what enzyme?
Alpha ketogluratate dehydrogenase
Valsalva maneuver and corresponding change in preload, afterload and SV?
As intrathoracic pressure increases, preload decreases and afterload increases, which causes stroke volume to decrease
Difference between dystrophic calcification and metastatic calcification?
Dystrophic calcification - inflamed or degenerative site undergoing localized calcification following injury or necrosis
Metastatic calcification - normal site undergoing diffused calcification following systemic hypercalcemia
Surface markers of B cells and T cells?
B cell - CD19, CD20, CD21, CD40
T cell - CD8, CD4, CD40L, CD25, CD28
Favorable prognostic factor for ALL
t(12:21)
Favourable prognostic factor for AML
t(8:21) - AML
t(15:17) - APML
Most common complication of Kawasaki disease?
Coronary artery aneurysm
What enzyme involved in TG synthesis is not present in adipose tissue but present in liver?
Glycerol kinase
Undercooked meat consumption; presents with fever, right leg pain and swelling, periorbital edema, conjunctival haemorrhage?
Trichinellosis (helminth infection), lives in the muscle
Consumption of dapsone, and now presenting with cyanosis and chocolate colored blood, Dx?
Methemoglobinemia
Ergot alkaloid therapy and upper urinary tract obstruction predisposes you to?
Retroperitoneal fibrosis
Left hemithorax at 4th IC space at midclavicular line puncture will affect what structure?
Upper lobe of left lung
Small child, bloody diarrhoea, microcytic anemia
Meckel’s diverticulum - ectopic gastric mucosa and/or pancreatic tissue on technetium 99m pertechnetate scan
Most common meningitis virus in children?
Echovirus
Pathophysiology of Chagas disease?
Caused by trypanosoma
Sx: inflammatory edema, painless edema of eyelids; cardiomyopathy, achalasia, megacolon
Confirm with giemsa dye
Treat with benznidazole
BUN/Cr ratio for pre-renal, intrarenal and post-renal
10:1 - 20:1: normal, postrenal cause
>=20:1 - prerenal cause
<=15:1 - intrarenal cause
AKI FeNa for pre-renal and intrarenal?
Low FeNa (<1%) - pre-renal cause
High FeNa (>2%) - intrarenal cause
How does urine osmolality and urine Na in CHF secondary to AKI?
Urine osmolarity is high, urine Na is low as RAAS activated and Na+ increase with water
Dipyridamole is used for?
Dilating coronary vessels, can catch coronary steal syndrome
For pharmacological stress testing
Asthma findings?
decreased breath sounds, hyper-resonant (due to pulmonary hyperinflation), symmetrical chest expansion
Lymph node and cell distribution?
Macrophages - medullary sinus
Plasma cells - medullary cords
Cortex - B cells
Paracortex - T cells
SLE symptoms
Joint pain, muscle aches, severe sunburns, multiple non-tender superficial ulcers on oral mucosa, malar rash, alopecia, chelitis, raynaud’s
MODY vs T1DM
MODY is dysfunctional beta cells of pancreas, so impaired secretion, whereas T1DM is autoimmune destruction of beta cells.
MODY II - glucokinase gene defect, MODY III - hepatocyte nuclear factor 1 alpha gene defect
MODY II - lifestyle modification, MODY III - must initiate sulfonylurea
congestive HF and renal arteriole changes?
Reduced renal perfusion, so stimulated RAAS, SNS and ADH, which will constrict efferent renal arterioles
Pyruvate dehydrogenase deficiency means you cannot take?
Glucogenic amino acids - alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, histidine, methionine, proline, serine, valine
Wernicke encephalopathy triad?
Oculomotor dysfunction, ataxia, confusion + alcoholic
Electrolyte changes for each diuretics
Loop - hypoK+, hypoMg2+, hypoCa2+
Thiazide - hypoK+, hyperCa2+
Aldo receptor antagonist - hyperK+
Types of incontinence?
Urge - sudden urge to pee, then immediately peeing
Stress - coughing, laughing then pee leaks out
Overflow - obstruction causing urine build up until cannot handle, which causes overflowing (hesitancy and trickling)
Simple cuboidal cells with smooth muscles in respiratory epithelium?
Simple cuboidal cell - bronchioles, smooth muscles - terminal bronchioles
Effacement of podocytes on electron microscopy, most likely finding on urinalysis?
MCD, fatty casts and albumin in urine
Rash and raised serum creatinine?
Allergic interstitial nephritis; urinary eosinophils seen
Increased D-dimer must always think of?
There is a clot that is being broken down
N. Meningitidis initial virulence factor
Adhesive pili
GCA Tx (glucocorticoids) can cause what changes to blood cells?
agranulocytosis and neutrophil leukocytosis
Dysgeusia (food tasting bland), alopecia, bulbous erythematous perioral plaques
Zinc deficiency, can cause acrodermatitis enteropathica
Injected conjunctivae, tender, erythematous nodules on both shins, bilateral hilar lymphadenopathy
Sarcoidosis, elevated CD4+ cell count due to non-caseating granuloma formation
TRALI pathophysiology?
Antibodies in donor activating host granulocytes (neutrophils)
If patient taking some meds take red wine, dried fruits, cured meat presents with HTN crisis, what meds?
MAO-I (I.e. Tranylcypromine), dangerous interactions with tyramine rich food
Esophageal epithelium?
Non-keratinised stratified squamous epithelium
Histo change during GERD?
Hyperplasia of esophagus and neutrophilic infiltrates
Maxillary prominence grow medially and fuse with lateral then medial nasal prominence - what is the underlying congenital defect?
Cleft lip
Systemic sclerosis symptoms and potential complications?
Symptoms - Sclerodactyly, raynaud’s, telangiectasia, GERD, dysphagia (esophageal smooth muscle fibrosis), myalgia, arthralgia, scleroderma
Complications - pulmonary fibrosis, P HTN, myocardial fibrosis, myocarditis, pericardial effusion
Why does increased hemoglobin breakdown cause H encephalopathy?
Hemoglobin breakdown increases production of ammonia and bilirubin, which all stresses liver
Vaginal discharge?
Malodorous grey, milky - bacterial vaginosis
Yellow green - trichomoniasis
Odourless and purulent - chlamydia, gonorrhoea
Thick white curd like - candidiasis
Fasting for 2 days. Primary energy source and most important enzymes?
Gluconeogenesis. PEPCK (phosphoenolpyruvate carboxykinase) is the most important enzyme.
Non-tender ulceration of penis followed by tender purulent nodules?
Lymphogranuloma venereum, caused by chlamydia
Lyme disease patient Abx?
Normal - tetracycline
Pregnant - penicillin
Oxaloacetate and acetyl-CoA will give citrate, require what vitamin?
Vitamin B5, pentothenic acid
Haemorrhoids blood supply and distributions?
External haemorrhoids - internal pudendal -> inferior rectal
Internal haemorrhoids - superior rectal
Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.
Shaken baby syndrome, shearing head injury - force that causes two layers to separate
Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.
Shaken baby syndrome, shearing head injury - force that causes two layers to separate
Opioid drugs MOA?
Close presynaptic Ca2+ channel, while opening postsynaptic K+ channel (hyperpolarise neurons)
crigler najjar syndrome lab findings?
Unconjugated bilirubin cross BBB, causing kernicterus
Function of GP120 protein on HIV?
Attach to CD4 receptor of T cells in host; this increases host range (can infect more)
SSRI predisposes patient to what condition?
SIADH
SIADH pathophysiology?
Posterior pituitary gland produce ADH, which will increase water reabsorption. -> RAAS switch off, but not enough to counteract. Hence, very concentrated urine (Urine Na+ increases)
Topoisomerase II inhibitors function?
Prevent stabilizing of double stranded break in DNA
Hearing loss, odd-eye, patchy hair loss in baby?
Waardenburg syndrome, which is due to neural crest defect
Metyrapone stimulation test?
Blocks conversion of cortisol
In normal people, sudden drop in cortisol will cause ACTH will increase
In adrenal insufficiency, already low cortisol so no change in ACTH
Rhinovirus virulence binds to what receptor in cell?
ICAM 1
Pneumothorax is associated with what physiological changes?
Shunting
Acanthosis nigricans associated with what conditions?
Obesity, PCOS, DM
Thayer-Martin agar is made of?
Heated sheep blood, vancomycin, nystatin, trimethoprim, colistin
Cardiac medication causing yellow vision with overdose?
Digoxin, causes hyperkalemia
Rash starting w head moving down to trunk, runny nose, cough, red crusty eyes (Coryza, cough, conjunctivitis)
Measles - Tx: symptomatic relief and Vitamin A
Alcoholic and diabetic patient, presenting with pneumonia with gram negative, catalase positive, capsulated bacteria.
Pseudomonas Aeruginosa
Recurrent infections, lymphadenopathy, inflammatory lesions caused by what disease?
Chronic granulomatous diseases; due to defective NADPH oxidase
Melanoma arises from what embryonic origin?
Neural crest
N gonorrhoea avoid immune response by?
Introducing variation of expressed adhesive pili protein
Upper UTO vs lower UTO Mx?
Upper UTO insert urethral stent; lower UTO place urethral catheter
Lung infection causes what changes?
Proliferation of TII pneumocytes
TNF alpha upregulation can cause what?
Increases risk of latent TB reactivation
snRNP will cause problems with what process?
Removal of introns
Sarcoidosis Tx?
Glucocorticoids (prednisone)
Patient presents with ataxia, orthostatic hypotension, livedo reticularis, peripheral edema after this drug toxicity . What is the drug?
Amantadine
MERRF pathophysiology?
Defective oxidative phosphorylation
Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?
Sand fly
Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?
Sand fly
Lactose intolerance will cause what physiological change?
Decreased pH, increased stool osmotic gap
Unilateral small kidney with HTN?
Renal artery stenosis
Renal artery stenosis causing activation of RAAS, which increases BP
Unvaccinated child with flaccid paralysis?
Polio
Acute Hep B Tx?
Symptomatic treatment
Secreting Abx require what kind of binding?
B cell activation, so CD40 to CD40L
Pt comes in with AVRNT. What kind of maneuvers can you do?
Carotid artery massage (stimulates CN IX) and valsalva maneuver
Bone healing involves what cytokines?
Macrophage colony stimulating factor
Well differentiated endometrial carcinoma with increased inhibin levels. Dx?
Granulosa cell tumour
Clustered amorphous microcalcification of breast. Dx?
Ductal carcinoma in situ
How does MRSA develop resistance to penicillin?
Alters PBP binding site to prevent penicillin from attaching to itself
Oligomenorrhoea with low progesterone levels for adolescent girl. Dx?
Anovulatory cycle due to immature hypothalamic -> pituitary -> gonadal axis
Wet AMD Tx that is also used to treat RCC?
Bevacizumab (prevents neovascularisation)
Mushroom consumption -> bloody diarrhoea, AST/ALT raised to a few thousand, inhibition of what is causing the Sx?
mRNA synthesis
Painless neck swelling that becomes painful with alcohol consumption, giant binucleate cells (owl eye)?
Hodgkin lymphoma
PCR requires what substance?
sequencing of 3’ end of DNA strand by primers
Blue stain on microscope showing dark blue specks on RBC. What is that blue speck?
Ribosomal RNA
Erythematous rash with yellow scales, erythematous throat and swollen tongue - deficiency of what?
Vitamin B2 (Riboflavin)
Cloudy joint fluid, normal leukocyte count, swollen, painful knee. Dx?
Pseudogout. Calcium pyrophosphate dehydrate crystal
Drug used to treat androgen sensitive prostate cancer that causes increase in testosterone and DHT, before reducing their lvls
Leuprolide
Tx for DI?
Central - desmopression
Nephorgenic - thiazides and NSAIDs
Hairy cell leukemia Tx?
Cladribine, resistant to breakdown by ADA
Painful circular ulcer, surrounding erythema and central black eschar causing organism and virulence factors?
Pseudomonas aeruginosa, exotoxin A
Negative nikolsky, pruritic bullae
Bulbous pemphigoid, affects dermoepidermal junction
Male characteristics, undescended testes, ambiguous genitalia -> male genitalia during puberty?
5 alpha reductase deficiency
Glucocorticoids MOA?
Inhibits transcription factors like nuclear factor kappa B
Miultiple myeloma causes renal failure by?
Excessive precipitation of Ig light chains
Multiple sclerosis findings on microscope?
Eosinophilic intracytoplasmic inclusion body
BMPR2 gene
Pulmonary arterial HTN
Viral encephalopathy causing neuro Sx?
HSV
Itchy rash and weight loss, palpable lymph nodes?
Cutaneous T cell lymphoma - CD4+ ce;;s with cerebriform nuclei
Small round blue cells, lytic lesions in diaphysis of femur and surrounding cortex covered by several layers of new bones
Ewing sarcoma
Chocolate agar
H influenzae
Wuchereria bancrofti etiology?
Deposition of larvae into skin by female mosquito; causes elephantiasis
Infundibular stalk obstruction will cause what hormone changes?
Block in GnRH, CRH, TRH, GHRH, somatostatin, dopamine
This will result in rise of GH and prolactin
Immune cells that lyse abnormal cells without needing to opsonise, prime or activate?
NK cells
HOCM presentation
Mitral valve systolic anterior motion, asymmetrical septal hypertrophy, septal wall thickness of >15mm
PTH hormone MOA on bone resorption?
RANKL expression of osteoblast; induced IL-1 expression of osteoblast, which both activates osteoclast
Most commonly injured site in prostatectomy?
Cavernous nerve
Most common illness causing MS?
RHD, which is an antibody cross reactivity (type 2 hypersensitivity)
Mass seen after overuse?
Myositis ossificans
RA patient comes in with mouth ulcers, what could be the cause?
Methotrexate use, which causes folate deficiency, which results in deficient nitrogenous base production and megaloblastic anemia
Clustered cuboidal foamy appearing cells in lungs
Type 2 pneumocytes
Transmembrane efflux pump protein causing reduced intracellular concentration of chemotherapy drugs?
Multidrug resistant protein 1 (P-glycoprotein)
Middle meningeal artery enters from what foramen?
Foramen spinosum
Patient increased fetal loss risk, super high platelets, Hx of DVT
Essential thrombocythemia
Drug that inhibits both factor Xa and thrombin
Heparin (activates antithrombin)
CMV can cause what complications in immunocompromised individuals?
Linear ulcers at lower esophageal sphincter
Painful genital ulcers + tender inguinal lymphadenopathy
Haemophilus ducreyi
Azathioprine will not be as effective in patients with what enzyme deficiency?
HGPRT
Diffuse eosinophilic scarring of terminal bronchioles + luminal obliteration by granulation tissue
Bronchiolitis obliterans (chronic graft rejection)
T1DM inheritance pattern
Polygenic
Actinic keratoses increases risk of what?
Squamous cell carcinoma
Goodpasture’s disease is type what hypersensitivity?
Type 2 hypersensitivity
Bartonella gives rise to what disease?
Bacillary angiomatosis and cat scratch disease
Central stellate scar renal cancer?
Oncocytoma
Diabetic neuropathy pathophysiology?
Increased protein deposition on endoneural vessel walls
Recurrent blood transfusion can lead to what?
Macrophages with cytoplasmic granules that stain golden yellow with hematoxylin (hemosiderin deposits - too much blood cells dying)
If patient cannot tolerate first line antipsychotics (i.e. haloperidol, fluphrenazine), second line?
Chlorpromazine, thioridazine
Long head of the bicep femoris + semitendinosus origin
Ischial tuberosity
Peutz-Jeghers syndrome associated with?
Gastric cancer, small intestine and colon CA, together with pancreatic CA
Spindle shaped cells for ovarian tumour
Ovarian fibroma
Kentucky fungus
Blastomycosis
What allows for cancer metastasis?
Overproduction of proteases like collagenase and metalloproteinase
Post menopausal woman, breast CA, vaginal dryness, bone density drop
Aromatase inhibitor (exemestane, anastrozole, letrozole)
Kenya migration, splenomegaly, SCC of bladder, diagnosis?
Schistosomiasis, also can cause lung complication (pulmonary HTN)
What other hormones are secreted together with melanin secreting hormones?
ACTH and endorphins
Patients undergoing Whipple procedure at highest risk of what deficiency?
Iron deficiency, so can present with microcytic anemia
Why can rapid recovery happen with short acting sedatives?
Redistribution to body
HIV and HHV8 lesions means?
Kaposi sarcoma, which presents with spindle cells with lymphocytic infiltration
Sensation to the ear
CN X
Hilar lymphadenopathy and well defined nodules + central calcifications. Basophilic, crescent shaped nuclei with pericellular halos in macrophages.
Histoplasma capsulatum; check for bat dropping exposure
Acute on chronic hip pain, restricted internal rotation and abduction
Slipped capital femoral epiphysis (unstable proximal femoral growth plate)
Mumps complications
Parotidomegaly, orchitis
Cocaine during pregnancy can cause?
Premature delivery
RPGN crescent cell pathophysiology?
Too much fibrin deposit
APML treatment?
Trans-retinoic acid
Patient just has all sorts of infections
SCID, caused by IL-2 receptor gamma chain defect
TB drug that targets intra-macrophage TB
Pyrazinamide
Why is there an increased lactic acid due to shock?
Anaerobic respiration happens due to NADH accumulation
Difference between measles and rubella presentation?
Measles - high fever, runny nose, conjunctivitis, koplik spot
Rubella - Retroauricular rash, pink eye, headache, rash behind ears that developed into maculopapular exanthem, lymphadenopathy (postauricular and occipital)
Polymyositis pathophysiology
Sarcolemmal MHC-I overexpression with CD8+ lymphocytic infiltration
Toxic shock syndrome by Staph A
Binds to Fc region of IgG
Neutropenia predisposes to what infections?
Enteric bacterial infections
Patient with cancer, present with hematuria
Tumour lysis syndrome; treat with recombinant uricase (oxidation to allantoin)
Deteriorating hearing, vision, motor ability and cognition with other people in the family having same issues
Adenoleukodystrophy (Peroxisomal ATP-binding cassette transporter deficiency)
DM in pregnant women
Give insulin (Binds to tyrosine kinase receptor)
DM and HTN arteriolosclerosis
DM - hyaline arteriolosclerosis
HTN - hyperplastic arteriolosclerosis
Petting zoo causative organism?
Campylobacter jejuni (gram neg, flagellated bacteria that does not ferment lactose)
Fusion of host cell and HIV cells require?
CD4 receptor and CCR5 or CXCR4
Most common cause of death in cystic fibrosis patients?
Pulmonary infections
Congenital adrenal hyperplasia, what enzyme is the patient deficient in?
11 beta-hydroxylase deficiency; which converts 11-deoxycorticosterone to corticosterone
Adrexal mass + hyperthyroidism
Germ cell tumour
Prostate cancer treatment that also help with hair regrowth
Finasteride; 5 alpha reductase inhibitor
Recurrent respi patho + GI patho for a young child signifies?
IgA deficiency; puts the child at risk to HSR to transfusion
DM drug that prevents carbohydrate bond breaking?
Miglitol, acarbose
Turner syndrome pregnancy success rate?
With donor oocytes, same as those with primary ovarian failure
HIV prophylaxis prenatally
Zidovudine
Pre-eclampsia pathophysiology
Abnormal spiral artery remodelling
Lung scar tissue increases risk of what lung malignancy?
Adenocarcinoma
Headache, muscle pain, recurrent fever spikes without pattern
Plasmodium falciparum (Malaria)
Beyond a certain amount of PAH, effective renal flow of PAH will fall. This is because?
There is a decreased clearance of PAH
Aplastic anemia
Fat deposition in the bone marrow
HIV patient with multiple firm violaceous nodule causative organism?
Bartonella henselae (bacillary angiomatosis)
IVDA and hepatitis, two organisms (One double stranded DNA genome, one single stranded RNA genome)
Deltavirus (HBV and HDV)
Scarlet fever pathophysiology?
Erythrogenic toxin induced cytokine release
Karyotypical female presents with ambiguous genitalia
Aromatase deficiency
Leukocytosis, elevated leukocyte alkaline phosphatase, elevated myeloid lineage cells
Leukemoid reaction
GBS spinal CSF tap
Very high protein without changes in WBC, glucose or opening pressure
Swallowing innervation?
CN X
How to confirm primary hypercortisolism?
CT abdomen
Congenital hypothyroidism presents with?
Poor feeding and lethargy, hoarse cry, jaundice, macroglossia, hypotonia
Decreased libido, secondary amenorrhoea, vision loss, hyperprolactinemia. Dx?
Prolactinoma, which can be treated by bromocriptine
Hep C drug therapy
Interferon alpha and inosine monophosphate dehydrogenase (ribavirin)
Shigella causes bloody diarrhoea by?
Invading colonic microfold cells
Retinal haemorrhage, blurred vision and flashing light in immunocompromised patient
CMV; treat with foscarnet
Adverse effects of chemotherapy
Kills off rapidly dividing cells (i.e. intestinal epithelial cell, hematopoietic stem cell, gonadal germ cells)
Multiple myeloma is associated with
Amyloidosis
IL-6 function is to?
Stimulate synthesis and secretion of positive acute phase protein like fibrinogen
How to fix spastic neurogenic bladder? (Internal sphincter and detrusor contract same time)
Prazosin
Aortic stenosis most common cause
Below 70: bicuspid aortic valve
Above 70: calcification
Kidney dialysis patient presenting with bleeding problem
Uremia - platelet aggregation dysfunction
Right heart hypertrophy with familial symptoms
Pulmonary arteries hypertension (BMPR2 gene mutation)
Pus in abscess primary IL involvement?
IL-8
Foul smelling, dark red, currant jelly sputum, gram negative rods
Capsular polysaccharide
Remyelination process
Increased transmembrane resistance, which allows for increased length constant
Naegleria fowleri route of infection (Hot spring - warm freshwater)
Penetration of cribiform plate
HSV is what type of virus
Enveloped, double stranded, linear DNA
Angular cheilitis and pica (keep eating non-nutritious substance)
Iron-deficiency anemia; also presents with spoon shaped nails (Koilonychia)
Virus retains own genetic material but coated with surface protein of different coinfecting virus
Phenotypic mixing
Nephrotic syndrome, HSM, Crohn’s, carpal tunnel syndrome
Amyloidosis
AUG -> UUG
Affects binding of met-tRNA to 60S complex (Stop codon -> start codon)
bluish brown sclerae, dark sweat stain, thickening of ear cartilage (Ochronosis)
Alkaptonuria (Tyrosine metabolism disorder)
6-MP and what drug when administered together can cause toxicity?
Febuxostat
Goblet cell function?
Increased mucous secretion
Neurofibromatosis type II presents with?
Meningioma, bilateral vestibular schwannoma, spinal tumour
Baby with hypoxia, rapid breathing, ground glass opacities
Neonatal respiratory distress syndrome - Hyaline membrane lining alveoli on lung biopsy
Substance abuse causing patient to be irritable, rapid breathing, dilated pupils
Activation of SNS, so amphetamine
Patient taking azithromycin sudden palpitation
Prolonged QT - torsades de pointes
Nonproductive cough showing disc-shaped yeast cells
Toxoplasmosis
Porphyria cutanea tarda
Uroporphyrinogen III decarboxylase
Bladder cancer calcium issue
Due to PTHrH secretion, Ca2+ increases and phosphate decreases
Schistocyte will cause what in serum to rise
Lactate dehydrogenase
Osteosarcoma and sensorineural hearing loss
Paget’s disease of the bone
Hep B virus with high infectivity
Tenofovir
CMV pharmacotherapy?
Valganciclovir