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Questions Flashcards

1
Q

Choice of drug for long term prevention of stroke in a fib patients?

A

Warfarin

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2
Q

RBC does not have what enzyme?

A

Alpha ketogluratate dehydrogenase

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3
Q

Valsalva maneuver and corresponding change in preload, afterload and SV?

A

As intrathoracic pressure increases, preload decreases and afterload increases, which causes stroke volume to decrease

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4
Q

Difference between dystrophic calcification and metastatic calcification?

A

Dystrophic calcification - inflamed or degenerative site undergoing localized calcification following injury or necrosis

Metastatic calcification - normal site undergoing diffused calcification following systemic hypercalcemia

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5
Q

Surface markers of B cells and T cells?

A

B cell - CD19, CD20, CD21, CD40

T cell - CD8, CD4, CD40L, CD25, CD28

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6
Q

Favorable prognostic factor for ALL

A

t(12:21)

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7
Q

Favourable prognostic factor for AML

A

t(8:21) - AML

t(15:17) - APML

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8
Q

Most common complication of Kawasaki disease?

A

Coronary artery aneurysm

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9
Q

What enzyme involved in TG synthesis is not present in adipose tissue but present in liver?

A

Glycerol kinase

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10
Q

Undercooked meat consumption; presents with fever, right leg pain and swelling, periorbital edema, conjunctival haemorrhage?

A

Trichinellosis (helminth infection), lives in the muscle

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11
Q

Consumption of dapsone, and now presenting with cyanosis and chocolate colored blood, Dx?

A

Methemoglobinemia

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12
Q

Ergot alkaloid therapy and upper urinary tract obstruction predisposes you to?

A

Retroperitoneal fibrosis

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13
Q

Left hemithorax at 4th IC space at midclavicular line puncture will affect what structure?

A

Upper lobe of left lung

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14
Q

Small child, bloody diarrhoea, microcytic anemia

A

Meckel’s diverticulum - ectopic gastric mucosa and/or pancreatic tissue on technetium 99m pertechnetate scan

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15
Q

Most common meningitis virus in children?

A

Echovirus

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16
Q

Pathophysiology of Chagas disease?

A

Caused by trypanosoma

Sx: inflammatory edema, painless edema of eyelids; cardiomyopathy, achalasia, megacolon

Confirm with giemsa dye

Treat with benznidazole

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17
Q

BUN/Cr ratio for pre-renal, intrarenal and post-renal

A

10:1 - 20:1: normal, postrenal cause
>=20:1 - prerenal cause
<=15:1 - intrarenal cause

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18
Q

AKI FeNa for pre-renal and intrarenal?

A

Low FeNa (<1%) - pre-renal cause
High FeNa (>2%) - intrarenal cause

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19
Q

How does urine osmolality and urine Na in CHF secondary to AKI?

A

Urine osmolarity is high, urine Na is low as RAAS activated and Na+ increase with water

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20
Q

Dipyridamole is used for?

A

Dilating coronary vessels, can catch coronary steal syndrome

For pharmacological stress testing

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21
Q

Asthma findings?

A

decreased breath sounds, hyper-resonant (due to pulmonary hyperinflation), symmetrical chest expansion

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22
Q

Lymph node and cell distribution?

A

Macrophages - medullary sinus
Plasma cells - medullary cords
Cortex - B cells
Paracortex - T cells

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23
Q

SLE symptoms

A

Joint pain, muscle aches, severe sunburns, multiple non-tender superficial ulcers on oral mucosa, malar rash, alopecia, chelitis, raynaud’s

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24
Q

MODY vs T1DM

A

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

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25
Q

congestive HF and renal arteriole changes?

A

Reduced renal perfusion, so stimulated RAAS, SNS and ADH, which will constrict efferent renal arterioles

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26
Q

Pyruvate dehydrogenase deficiency means you cannot take?

A

Glucogenic amino acids - alanine, asparagine, aspartate, cysteine, glutamate, glutamine, glycine, histidine, methionine, proline, serine, valine

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27
Q

Wernicke encephalopathy triad?

A

Oculomotor dysfunction, ataxia, confusion + alcoholic

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28
Q

Electrolyte changes for each diuretics

A

Loop - hypoK+, hypoMg2+, hypoCa2+

Thiazide - hypoK+, hyperCa2+

Aldo receptor antagonist - hyperK+

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29
Q

Types of incontinence?

A

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)

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30
Q

Simple cuboidal cells with smooth muscles in respiratory epithelium?

A

Simple cuboidal cell - bronchioles, smooth muscles - terminal bronchioles

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31
Q

Effacement of podocytes on electron microscopy, most likely finding on urinalysis?

A

MCD, fatty casts and albumin in urine

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32
Q

Rash and raised serum creatinine?

A

Allergic interstitial nephritis; urinary eosinophils seen

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33
Q

Increased D-dimer must always think of?

A

There is a clot that is being broken down

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34
Q

N. Meningitidis initial virulence factor

A

Adhesive pili

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35
Q

GCA Tx (glucocorticoids) can cause what changes to blood cells?

A

agranulocytosis and neutrophil leukocytosis

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36
Q

Dysgeusia (food tasting bland), alopecia, bulbous erythematous perioral plaques

A

Zinc deficiency, can cause acrodermatitis enteropathica

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37
Q

Injected conjunctivae, tender, erythematous nodules on both shins, bilateral hilar lymphadenopathy

A

Sarcoidosis, elevated CD4+ cell count due to non-caseating granuloma formation

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38
Q

TRALI pathophysiology?

A

Antibodies in donor activating host granulocytes (neutrophils)

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39
Q

If patient taking some meds take red wine, dried fruits, cured meat presents with HTN crisis, what meds?

A

MAO-I (I.e. Tranylcypromine), dangerous interactions with tyramine rich food

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40
Q

Esophageal epithelium?

A

Non-keratinised stratified squamous epithelium

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41
Q

Histo change during GERD?

A

Hyperplasia of esophagus and neutrophilic infiltrates

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42
Q

Maxillary prominence grow medially and fuse with lateral then medial nasal prominence - what is the underlying congenital defect?

A

Cleft lip

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43
Q

Systemic sclerosis symptoms and potential complications?

A

Symptoms - Sclerodactyly, raynaud’s, telangiectasia, GERD, dysphagia (esophageal smooth muscle fibrosis), myalgia, arthralgia, scleroderma

Complications - pulmonary fibrosis, P HTN, myocardial fibrosis, myocarditis, pericardial effusion

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44
Q

Why does increased hemoglobin breakdown cause H encephalopathy?

A

Hemoglobin breakdown increases production of ammonia and bilirubin, which all stresses liver

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45
Q

Vaginal discharge?

A

Malodorous grey, milky - bacterial vaginosis

Yellow green - trichomoniasis

Odourless and purulent - chlamydia, gonorrhoea

Thick white curd like - candidiasis

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46
Q

Fasting for 2 days. Primary energy source and most important enzymes?

A

Gluconeogenesis. PEPCK (phosphoenolpyruvate carboxykinase) is the most important enzyme.

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47
Q

Non-tender ulceration of penis followed by tender purulent nodules?

A

Lymphogranuloma venereum, caused by chlamydia

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48
Q

Lyme disease patient Abx?

A

Normal - tetracycline
Pregnant - penicillin

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49
Q

Oxaloacetate and acetyl-CoA will give citrate, require what vitamin?

A

Vitamin B5, pentothenic acid

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50
Q

Haemorrhoids blood supply and distributions?

A

External haemorrhoids - internal pudendal -> inferior rectal

Internal haemorrhoids - superior rectal

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51
Q

Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.

A

Shaken baby syndrome, shearing head injury - force that causes two layers to separate

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52
Q

Baby comes in with bulging anterior fontanelle, bilateral retinal haemorrhage, fractures of ribs.

A

Shaken baby syndrome, shearing head injury - force that causes two layers to separate

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53
Q

Opioid drugs MOA?

A

Close presynaptic Ca2+ channel, while opening postsynaptic K+ channel (hyperpolarise neurons)

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54
Q

crigler najjar syndrome lab findings?

A

Unconjugated bilirubin cross BBB, causing kernicterus

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55
Q

Function of GP120 protein on HIV?

A

Attach to CD4 receptor of T cells in host; this increases host range (can infect more)

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56
Q

SSRI predisposes patient to what condition?

A

SIADH

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57
Q

SIADH pathophysiology?

A

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)

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58
Q

Topoisomerase II inhibitors function?

A

Prevent stabilizing of double stranded break in DNA

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59
Q

Hearing loss, odd-eye, patchy hair loss in baby?

A

Waardenburg syndrome, which is due to neural crest defect

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60
Q

Metyrapone stimulation test?

A

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

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61
Q

Rhinovirus virulence binds to what receptor in cell?

A

ICAM 1

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62
Q

Pneumothorax is associated with what physiological changes?

A

Shunting

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63
Q

Acanthosis nigricans associated with what conditions?

A

Obesity, PCOS, DM

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64
Q

Thayer-Martin agar is made of?

A

Heated sheep blood, vancomycin, nystatin, trimethoprim, colistin

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65
Q

Cardiac medication causing yellow vision with overdose?

A

Digoxin, causes hyperkalemia

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66
Q

Rash starting w head moving down to trunk, runny nose, cough, red crusty eyes (Coryza, cough, conjunctivitis)

A

Measles - Tx: symptomatic relief and Vitamin A

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67
Q

Alcoholic and diabetic patient, presenting with pneumonia with gram negative, catalase positive, capsulated bacteria.

A

Pseudomonas Aeruginosa

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68
Q

Recurrent infections, lymphadenopathy, inflammatory lesions caused by what disease?

A

Chronic granulomatous diseases; due to defective NADPH oxidase

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69
Q

Melanoma arises from what embryonic origin?

A

Neural crest

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70
Q

N gonorrhoea avoid immune response by?

A

Introducing variation of expressed adhesive pili protein

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71
Q

Upper UTO vs lower UTO Mx?

A

Upper UTO insert urethral stent; lower UTO place urethral catheter

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72
Q

Lung infection causes what changes?

A

Proliferation of TII pneumocytes

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73
Q

TNF alpha upregulation can cause what?

A

Increases risk of latent TB reactivation

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74
Q

snRNP will cause problems with what process?

A

Removal of introns

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75
Q

Sarcoidosis Tx?

A

Glucocorticoids (prednisone)

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76
Q

Patient presents with ataxia, orthostatic hypotension, livedo reticularis, peripheral edema after this drug toxicity . What is the drug?

A

Amantadine

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77
Q

MERRF pathophysiology?

A

Defective oxidative phosphorylation

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78
Q

Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?

A

Sand fly

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79
Q

Weight loss, recurrent fever, lymphadenopathy and HSM after coming back from Africa. Where did he get the disease from?

A

Sand fly

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80
Q

Lactose intolerance will cause what physiological change?

A

Decreased pH, increased stool osmotic gap

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81
Q

Unilateral small kidney with HTN?

A

Renal artery stenosis

Renal artery stenosis causing activation of RAAS, which increases BP

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82
Q

Unvaccinated child with flaccid paralysis?

A

Polio

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83
Q

Acute Hep B Tx?

A

Symptomatic treatment

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84
Q

Secreting Abx require what kind of binding?

A

B cell activation, so CD40 to CD40L

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85
Q

Pt comes in with AVRNT. What kind of maneuvers can you do?

A

Carotid artery massage (stimulates CN IX) and valsalva maneuver

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86
Q

Bone healing involves what cytokines?

A

Macrophage colony stimulating factor

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87
Q

Well differentiated endometrial carcinoma with increased inhibin levels. Dx?

A

Granulosa cell tumour

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88
Q

Clustered amorphous microcalcification of breast. Dx?

A

Ductal carcinoma in situ

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89
Q

How does MRSA develop resistance to penicillin?

A

Alters PBP binding site to prevent penicillin from attaching to itself

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90
Q

Oligomenorrhoea with low progesterone levels for adolescent girl. Dx?

A

Anovulatory cycle due to immature hypothalamic -> pituitary -> gonadal axis

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91
Q

Wet AMD Tx that is also used to treat RCC?

A

Bevacizumab (prevents neovascularisation)

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92
Q

Mushroom consumption -> bloody diarrhoea, AST/ALT raised to a few thousand, inhibition of what is causing the Sx?

A

mRNA synthesis

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93
Q

Painless neck swelling that becomes painful with alcohol consumption, giant binucleate cells (owl eye)?

A

Hodgkin lymphoma

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94
Q

PCR requires what substance?

A

sequencing of 3’ end of DNA strand by primers

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95
Q

Blue stain on microscope showing dark blue specks on RBC. What is that blue speck?

A

Ribosomal RNA

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96
Q

Erythematous rash with yellow scales, erythematous throat and swollen tongue - deficiency of what?

A

Vitamin B2 (Riboflavin)

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97
Q

Cloudy joint fluid, normal leukocyte count, swollen, painful knee. Dx?

A

Pseudogout. Calcium pyrophosphate dehydrate crystal

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98
Q

Drug used to treat androgen sensitive prostate cancer that causes increase in testosterone and DHT, before reducing their lvls

A

Leuprolide

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99
Q

Tx for DI?

A

Central - desmopression
Nephorgenic - thiazides and NSAIDs

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100
Q

Hairy cell leukemia Tx?

A

Cladribine, resistant to breakdown by ADA

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101
Q

Painful circular ulcer, surrounding erythema and central black eschar causing organism and virulence factors?

A

Pseudomonas aeruginosa, exotoxin A

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102
Q

Negative nikolsky, pruritic bullae

A

Bulbous pemphigoid, affects dermoepidermal junction

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103
Q

Male characteristics, undescended testes, ambiguous genitalia -> male genitalia during puberty?

A

5 alpha reductase deficiency

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104
Q

Glucocorticoids MOA?

A

Inhibits transcription factors like nuclear factor kappa B

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105
Q

Miultiple myeloma causes renal failure by?

A

Excessive precipitation of Ig light chains

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106
Q

Multiple sclerosis findings on microscope?

A

Eosinophilic intracytoplasmic inclusion body

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107
Q

BMPR2 gene

A

Pulmonary arterial HTN

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108
Q

Viral encephalopathy causing neuro Sx?

A

HSV

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109
Q

Itchy rash and weight loss, palpable lymph nodes?

A

Cutaneous T cell lymphoma - CD4+ ce;;s with cerebriform nuclei

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110
Q

Small round blue cells, lytic lesions in diaphysis of femur and surrounding cortex covered by several layers of new bones

A

Ewing sarcoma

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111
Q

Chocolate agar

A

H influenzae

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112
Q

Wuchereria bancrofti etiology?

A

Deposition of larvae into skin by female mosquito; causes elephantiasis

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113
Q

Infundibular stalk obstruction will cause what hormone changes?

A

Block in GnRH, CRH, TRH, GHRH, somatostatin, dopamine

This will result in rise of GH and prolactin

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114
Q

Immune cells that lyse abnormal cells without needing to opsonise, prime or activate?

A

NK cells

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115
Q

HOCM presentation

A

Mitral valve systolic anterior motion, asymmetrical septal hypertrophy, septal wall thickness of >15mm

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116
Q

PTH hormone MOA on bone resorption?

A

RANKL expression of osteoblast; induced IL-1 expression of osteoblast, which both activates osteoclast

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117
Q

Most commonly injured site in prostatectomy?

A

Cavernous nerve

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118
Q

Most common illness causing MS?

A

RHD, which is an antibody cross reactivity (type 2 hypersensitivity)

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119
Q

Mass seen after overuse?

A

Myositis ossificans

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120
Q

RA patient comes in with mouth ulcers, what could be the cause?

A

Methotrexate use, which causes folate deficiency, which results in deficient nitrogenous base production and megaloblastic anemia

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121
Q

Clustered cuboidal foamy appearing cells in lungs

A

Type 2 pneumocytes

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122
Q

Transmembrane efflux pump protein causing reduced intracellular concentration of chemotherapy drugs?

A

Multidrug resistant protein 1 (P-glycoprotein)

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123
Q

Middle meningeal artery enters from what foramen?

A

Foramen spinosum

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124
Q

Patient increased fetal loss risk, super high platelets, Hx of DVT

A

Essential thrombocythemia

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125
Q

Drug that inhibits both factor Xa and thrombin

A

Heparin (activates antithrombin)

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126
Q

CMV can cause what complications in immunocompromised individuals?

A

Linear ulcers at lower esophageal sphincter

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127
Q

Painful genital ulcers + tender inguinal lymphadenopathy

A

Haemophilus ducreyi

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128
Q

Azathioprine will not be as effective in patients with what enzyme deficiency?

A

HGPRT

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129
Q

Diffuse eosinophilic scarring of terminal bronchioles + luminal obliteration by granulation tissue

A

Bronchiolitis obliterans (chronic graft rejection)

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130
Q

T1DM inheritance pattern

A

Polygenic

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131
Q

Actinic keratoses increases risk of what?

A

Squamous cell carcinoma

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132
Q

Goodpasture’s disease is type what hypersensitivity?

A

Type 2 hypersensitivity

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133
Q

Bartonella gives rise to what disease?

A

Bacillary angiomatosis and cat scratch disease

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134
Q

Central stellate scar renal cancer?

A

Oncocytoma

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135
Q

Diabetic neuropathy pathophysiology?

A

Increased protein deposition on endoneural vessel walls

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136
Q

Recurrent blood transfusion can lead to what?

A

Macrophages with cytoplasmic granules that stain golden yellow with hematoxylin (hemosiderin deposits - too much blood cells dying)

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137
Q

If patient cannot tolerate first line antipsychotics (i.e. haloperidol, fluphrenazine), second line?

A

Chlorpromazine, thioridazine

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138
Q

Long head of the bicep femoris + semitendinosus origin

A

Ischial tuberosity

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139
Q

Peutz-Jeghers syndrome associated with?

A

Gastric cancer, small intestine and colon CA, together with pancreatic CA

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140
Q

Spindle shaped cells for ovarian tumour

A

Ovarian fibroma

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141
Q

Kentucky fungus

A

Blastomycosis

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142
Q

What allows for cancer metastasis?

A

Overproduction of proteases like collagenase and metalloproteinase

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143
Q

Post menopausal woman, breast CA, vaginal dryness, bone density drop

A

Aromatase inhibitor (exemestane, anastrozole, letrozole)

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144
Q

Kenya migration, splenomegaly, SCC of bladder, diagnosis?

A

Schistosomiasis, also can cause lung complication (pulmonary HTN)

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145
Q

What other hormones are secreted together with melanin secreting hormones?

A

ACTH and endorphins

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146
Q

Patients undergoing Whipple procedure at highest risk of what deficiency?

A

Iron deficiency, so can present with microcytic anemia

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147
Q

Why can rapid recovery happen with short acting sedatives?

A

Redistribution to body

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148
Q

HIV and HHV8 lesions means?

A

Kaposi sarcoma, which presents with spindle cells with lymphocytic infiltration

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149
Q

Sensation to the ear

A

CN X

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150
Q

Hilar lymphadenopathy and well defined nodules + central calcifications. Basophilic, crescent shaped nuclei with pericellular halos in macrophages.

A

Histoplasma capsulatum; check for bat dropping exposure

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151
Q

Acute on chronic hip pain, restricted internal rotation and abduction

A

Slipped capital femoral epiphysis (unstable proximal femoral growth plate)

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152
Q

Mumps complications

A

Parotidomegaly, orchitis

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153
Q

Cocaine during pregnancy can cause?

A

Premature delivery

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154
Q

RPGN crescent cell pathophysiology?

A

Too much fibrin deposit

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155
Q

APML treatment?

A

Trans-retinoic acid

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156
Q

Patient just has all sorts of infections

A

SCID, caused by IL-2 receptor gamma chain defect

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157
Q

TB drug that targets intra-macrophage TB

A

Pyrazinamide

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158
Q

Why is there an increased lactic acid due to shock?

A

Anaerobic respiration happens due to NADH accumulation

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159
Q

Difference between measles and rubella presentation?

A

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)

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160
Q

Polymyositis pathophysiology

A

Sarcolemmal MHC-I overexpression with CD8+ lymphocytic infiltration

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161
Q

Toxic shock syndrome by Staph A

A

Binds to Fc region of IgG

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162
Q

Neutropenia predisposes to what infections?

A

Enteric bacterial infections

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163
Q

Patient with cancer, present with hematuria

A

Tumour lysis syndrome; treat with recombinant uricase (oxidation to allantoin)

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164
Q

Deteriorating hearing, vision, motor ability and cognition with other people in the family having same issues

A

Adenoleukodystrophy (Peroxisomal ATP-binding cassette transporter deficiency)

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165
Q

DM in pregnant women

A

Give insulin (Binds to tyrosine kinase receptor)

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166
Q

DM and HTN arteriolosclerosis

A

DM - hyaline arteriolosclerosis
HTN - hyperplastic arteriolosclerosis

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167
Q

Petting zoo causative organism?

A

Campylobacter jejuni (gram neg, flagellated bacteria that does not ferment lactose)

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168
Q

Fusion of host cell and HIV cells require?

A

CD4 receptor and CCR5 or CXCR4

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169
Q

Most common cause of death in cystic fibrosis patients?

A

Pulmonary infections

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170
Q

Congenital adrenal hyperplasia, what enzyme is the patient deficient in?

A

11 beta-hydroxylase deficiency; which converts 11-deoxycorticosterone to corticosterone

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171
Q

Adrexal mass + hyperthyroidism

A

Germ cell tumour

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172
Q

Prostate cancer treatment that also help with hair regrowth

A

Finasteride; 5 alpha reductase inhibitor

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173
Q

Recurrent respi patho + GI patho for a young child signifies?

A

IgA deficiency; puts the child at risk to HSR to transfusion

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174
Q

DM drug that prevents carbohydrate bond breaking?

A

Miglitol, acarbose

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175
Q

Turner syndrome pregnancy success rate?

A

With donor oocytes, same as those with primary ovarian failure

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176
Q

HIV prophylaxis prenatally

A

Zidovudine

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177
Q

Pre-eclampsia pathophysiology

A

Abnormal spiral artery remodelling

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178
Q

Lung scar tissue increases risk of what lung malignancy?

A

Adenocarcinoma

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179
Q

Headache, muscle pain, recurrent fever spikes without pattern

A

Plasmodium falciparum (Malaria)

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180
Q

Beyond a certain amount of PAH, effective renal flow of PAH will fall. This is because?

A

There is a decreased clearance of PAH

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181
Q

Aplastic anemia

A

Fat deposition in the bone marrow

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182
Q

HIV patient with multiple firm violaceous nodule causative organism?

A

Bartonella henselae (bacillary angiomatosis)

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183
Q

IVDA and hepatitis, two organisms (One double stranded DNA genome, one single stranded RNA genome)

A

Deltavirus (HBV and HDV)

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184
Q

Scarlet fever pathophysiology?

A

Erythrogenic toxin induced cytokine release

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185
Q

Karyotypical female presents with ambiguous genitalia

A

Aromatase deficiency

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186
Q

Leukocytosis, elevated leukocyte alkaline phosphatase, elevated myeloid lineage cells

A

Leukemoid reaction

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187
Q

GBS spinal CSF tap

A

Very high protein without changes in WBC, glucose or opening pressure

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188
Q

Swallowing innervation?

A

CN X

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189
Q

How to confirm primary hypercortisolism?

A

CT abdomen

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190
Q

Congenital hypothyroidism presents with?

A

Poor feeding and lethargy, hoarse cry, jaundice, macroglossia, hypotonia

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191
Q

Decreased libido, secondary amenorrhoea, vision loss, hyperprolactinemia. Dx?

A

Prolactinoma, which can be treated by bromocriptine

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192
Q

Hep C drug therapy

A

Interferon alpha and inosine monophosphate dehydrogenase (ribavirin)

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193
Q

Shigella causes bloody diarrhoea by?

A

Invading colonic microfold cells

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194
Q

Retinal haemorrhage, blurred vision and flashing light in immunocompromised patient

A

CMV; treat with foscarnet

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195
Q

Adverse effects of chemotherapy

A

Kills off rapidly dividing cells (i.e. intestinal epithelial cell, hematopoietic stem cell, gonadal germ cells)

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196
Q

Multiple myeloma is associated with

A

Amyloidosis

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197
Q

IL-6 function is to?

A

Stimulate synthesis and secretion of positive acute phase protein like fibrinogen

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198
Q

How to fix spastic neurogenic bladder? (Internal sphincter and detrusor contract same time)

A

Prazosin

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199
Q

Aortic stenosis most common cause

A

Below 70: bicuspid aortic valve
Above 70: calcification

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200
Q

Kidney dialysis patient presenting with bleeding problem

A

Uremia - platelet aggregation dysfunction

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201
Q

Right heart hypertrophy with familial symptoms

A

Pulmonary arteries hypertension (BMPR2 gene mutation)

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202
Q

Pus in abscess primary IL involvement?

A

IL-8

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203
Q

Foul smelling, dark red, currant jelly sputum, gram negative rods

A

Capsular polysaccharide

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204
Q

Remyelination process

A

Increased transmembrane resistance, which allows for increased length constant

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205
Q

Naegleria fowleri route of infection (Hot spring - warm freshwater)

A

Penetration of cribiform plate

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206
Q

HSV is what type of virus

A

Enveloped, double stranded, linear DNA

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207
Q

Angular cheilitis and pica (keep eating non-nutritious substance)

A

Iron-deficiency anemia; also presents with spoon shaped nails (Koilonychia)

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208
Q

Virus retains own genetic material but coated with surface protein of different coinfecting virus

A

Phenotypic mixing

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209
Q

Nephrotic syndrome, HSM, Crohn’s, carpal tunnel syndrome

A

Amyloidosis

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210
Q

AUG -> UUG

A

Affects binding of met-tRNA to 60S complex (Stop codon -> start codon)

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211
Q

bluish brown sclerae, dark sweat stain, thickening of ear cartilage (Ochronosis)

A

Alkaptonuria (Tyrosine metabolism disorder)

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212
Q

6-MP and what drug when administered together can cause toxicity?

A

Febuxostat

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213
Q

Goblet cell function?

A

Increased mucous secretion

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214
Q

Neurofibromatosis type II presents with?

A

Meningioma, bilateral vestibular schwannoma, spinal tumour

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215
Q

Baby with hypoxia, rapid breathing, ground glass opacities

A

Neonatal respiratory distress syndrome - Hyaline membrane lining alveoli on lung biopsy

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216
Q

Substance abuse causing patient to be irritable, rapid breathing, dilated pupils

A

Activation of SNS, so amphetamine

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217
Q

Patient taking azithromycin sudden palpitation

A

Prolonged QT - torsades de pointes

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218
Q

Nonproductive cough showing disc-shaped yeast cells

A

Toxoplasmosis

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219
Q

Porphyria cutanea tarda

A

Uroporphyrinogen III decarboxylase

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220
Q

Bladder cancer calcium issue

A

Due to PTHrH secretion, Ca2+ increases and phosphate decreases

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221
Q

Schistocyte will cause what in serum to rise

A

Lactate dehydrogenase

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222
Q

Osteosarcoma and sensorineural hearing loss

A

Paget’s disease of the bone

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223
Q

Hep B virus with high infectivity

A

Tenofovir

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224
Q

CMV pharmacotherapy?

A

Valganciclovir

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225
Q

CMV pharmacotherapy?

A

Valganciclovir

226
Q

Clostridium perfringens virulence

A

Alpha toxin that degrades cell membrane w phospholipase

227
Q

Ulcers, sore throat, fever and neutropenia after dual antiplatelet medication

A

Ticlopidine

228
Q

Pancreas pseudocyst consists of?

A

Granulation tissue

229
Q

Holosystolic murmur and diastolic rumble best heard at apex?

A

VSD; which will lead to RVH -> reversed shunt -> hypoxemia (clubbing)

230
Q

Bortezomib MOA

A

Accumulation of ubiquitinated proteins

231
Q

Livedo reticularis, erythematous, tender subcutaneous nodules on LL, renal artery stenosis. DDx?

A

Polyarteritis nodosa - transmural inflammation with fibrinoid necrosis on arterial biopsy

232
Q

Koilocytes are indicative of?

A

HPV infections - Cervical cancer; condyloma acuminatum etc.

233
Q

Main glucose source after 24 hours of fasting onwards

A

Hepatic gluconeogenesis; involved enzyme: pyruvate carboxylase (which needs Acetyl CoA)

234
Q

DLCO is increased by?

A

exercise, supine position, pregnancy, obesity

235
Q

Preterm infant; chorioamnionitis; Bulging anterior fontanelle, hypotonia, changes in eye movement, sluggish pupillary reaction

A

Intraventricular haemorrhage (Germinal matrix!!!)

236
Q

VHL disease associated with

A

Hemangioblastoma, bilateral RCC, pheochromocytoma, renal/pancreatic cysts

237
Q

Chloramphenicol can cause?

A

Aplastic anemia; it inhibits peptidyltransferase at 50s subunit

238
Q

Septate hyphae that branch at 45 degrees?

A

Aspergillus

239
Q

Asthma, eosinophils, IgE, septate hyphae branching at 45 degrees?

A

ABPA - IL-4 mediated (IgE)

240
Q

Increased leukocyte count without rise in monocytes?

A

Filgrastim

241
Q

Common peroneal nerve innervates?

A

Dorsiflexion of foot

242
Q

Numbness and tingling everywhere

A

Paraneoplastic syndrome

243
Q

Where does Ca2+ ion bind to myocyte actin filament?

A

Troponin C

244
Q

Arteries that branch

A

L1 - SMA
L2 - gonadal arteries
L3 - IMA
L4 - bifurcation of common iliac

245
Q

HSV drug?

A

Acyclovir - can cause crystalline nephropathy

246
Q

Protect effectively against photoaging?

A

Zinc oxide / titanium oxide

247
Q

Late complication of T2DM?

A

Incomplete bladder emptying (diabetic autonomic neuropathy)

248
Q

What works on both thymine and uracil?

A

DNA polymerase I

249
Q

Thermoregulator in body?

A

Preoptic nucleus in anterior hypothalamus

250
Q

Viral infection, the present with enlarged cardiac silhouette

A

Elevated BNP concentration on serum studies (viral myocarditis)

251
Q

Flank pain and muscle involvement

A

Most likely psoas major

252
Q

Tetracycline MOA?

A

Aminoacyl-tRNA to mRNA-ribosome complex

253
Q

Fracture at sphenoid bone cause which CN nerve lesion?

A

CN6 ( inward deviation of eye)

254
Q

Adolescent athlete with knee pain (overuse)

A

Traction apophysitis of tibial tubercle

255
Q

Acute rheumatic fever

256
Q

Streptomycin resistance

A

Alteration of 30S ribosomal subunit

257
Q

What requires uracil to function?

258
Q

LEMS pathophysiology?

A

Anti-presynaptic Ca2+ channel Ab in serum

259
Q

Thymoma is mostly present in?

A

Patients with MG - ACh receptor Ab used to check for MG

260
Q

H influenza prophylaxis?

261
Q

Chronic mucotaneous candidiasis

A

AIRE gene mutation; T cell dysfunction

262
Q

Urinary incontinence due to nerve damage will be followed by what symptoms?

A

Absent reflex erection; perineal hyperesthesia, absent anal sphincter contraction

263
Q

Primary sclerosing cholangitis will show what kind of liver biopsy specimen?

A

Periductal concentric scarring and fibrosis of bile duct

264
Q

Hyperacute graft rejection

A

Antibody against HLA class I molecules

265
Q

Hyperacute and chronic transplant rejection type of tissue change?

A

Hyperacute: fibrinoid necrosis
Chronic: interstitial fibrosis

266
Q

Gardener present with pustules that becomes nodules and ulcers

A

Sporothrix schenckii

267
Q

Lipofuscin granules

A

Caused by wear and tear; cellular pigment that results from deposition of lipid containing, lysosomal degradation product in tissue (increases with age and cause yellow brown deposits on histopathologic exam)

Secreted in apocrine gland lead to chromhidrosis

268
Q

Hypoesthetic, hypopigmented macular lesion from a patient in developing country

A

Leprosy (Mycobacterium leprae)

269
Q

JVP elevation, headache, dysphagia, dyspnoea

A

SVCO due to lymphoma

270
Q

Rheumatoid factor is?

A

IgM autoantibodies that bind to Fc region of IgG

271
Q

Hip pain and decreased hearing

A

Paget disease of the bone - also known as osteitis deformans

272
Q

Cervical cancer mets?

A

To nearby structures - i.e. bladder (postrenal azotemia)

273
Q

Carfilzomab

A

Proteasome inhibitor - decrease activation of CD8+ T cells

274
Q

MEN1

A

Pituitary adenoma (infertility treated with bromocriptine), parathyroid adenoma, gastrinoma

275
Q

Spinal cord degeneration, hypertrophic cardiomyopathy, insulin dependence

A

Friedreich ataxia (GAA on chromosome 9)

276
Q

Km vs Vmax

A

Km - substrate concentration when reaction rate is half of Vmax
Vmax - maximum rate of an enzyme catalysed reaction when enzyme is fully saturated with substrate

277
Q

Pure Vmax increase?

A

Increase in enzyme concentration

278
Q

Anaplasia

A

Loss of function of cell - so original cell is no longer there

279
Q

Depressed patient suddenly showing manic symptoms after starting this drug?

A

Venlafaxine

280
Q

Cartilage regeneration occurs in the?

A

Perichondrium

281
Q

High calcium, low PTH hormones, low urinary calcium level

A

Familial hypocalcinuria hypercalcemia - defect in calcium sensing receptors

282
Q

Baby presenting with hypopigmentation, seizures, hypotonia, eczema, musty odour

A

Phenylketonuria (PKU); phenylalanine hydroxylase

283
Q

DKA patient with rhino-orbital-cerebral infection

A

Rhizopus microsporus

284
Q

High pitch problem arises with which muscle?

A

Cricothyroid - 4th arch

285
Q

Binding of what to myosin heads lead to myosin detachment from actin?

286
Q

T2DM neuropathy pathogenesis

A

Accumulation of islet amyloid polypeptide

287
Q

Accidental disclosure of patient info to investigators

A

Pygmalion effect

288
Q

What is the cushing triad

A

Bradycardia, respi depression and HTN

289
Q

Mannitol can lead to what adverse effects?

290
Q

Patient went to Oklahoma, flu like symptoms and neurological symptoms, leukopenia, thrombocytopenia

A

Ehrlichia chaffeensis

291
Q

PCT damage after chemo agent reversed by?

A

amifostine

292
Q

Hairy cell leukemia

A

Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase

293
Q

Fc region of IgG antibody is responsible for?

A

Complement fixing

294
Q

Turner syndrome most common complications

A

Osteoporosis

295
Q

High AFP and AChE in baby, polyhydroamniosis

A

Anencephaly

296
Q

Low grade fever, slapped cheek, lacy maculopapular rash

A

Parvovirus B19 - erythema infectiosum

297
Q

What anti-inflammatory arrests chromosomes in metaphase?

A

Colchicine

298
Q

Leukocyte count elevated and seizures

A

Viral encephalitis, necrosis of temporal lobes

299
Q

Administration of insulin will cause what kind of biochemical change?

A

Dephosphorylation of FBP

300
Q

Left heart failure vs right heart failure - pulmonary arterial pressure and PCWP

A

LHF: P arterial pressure elevated, elevated PCWP
RHF: P arterial pressure elevated, normal PCWP

301
Q

Snake venom exposure; fever, itchy rash, proteinuria

A

Serum sickness, would see hypocomplementemia

302
Q

Walls are growing, flowers seem bright, not oriented to time

A

Lysergic acid diethylamide (LSD)

303
Q

Early wound healing vs late would healing

A

Early wound healing - type III collagen (reticular fibres)
Late wound healing - type I collagen (lens, dentin, cornea etc.)

304
Q

GCA treatment if refractory to corticosteroids?

A

Tocilizumab (IL-6 receptor inhibitors)

305
Q

Combined oral contraceptive pills protective effect

A

Ovarian tumour

306
Q

Gram negative rod that ferment lactose

A

E coli - heat labile toxin

307
Q

D-xylose test functions

A

Differentiate between small intestinal absorption and differentiate between mucosal malabsorption
- normal (pancreatic insufficiency) vs low (intestinal mucosa issue)

308
Q

Sclerosis, cortical destruction and new bone formation; spiculae formation

A

Osteosarcoma in the periosteum (sunburst appearance)

309
Q

Pioglitazone MOA?

A

Increased transcription of adipokines (PPAR-gamma)

310
Q

Intra-abdominal adhesion and dilatation of renal pelvis and proximal ureters bilaterally

A

Increased hydrostatic pressure of tubules leading to decreased GFR

311
Q

What process occurs in germinal centre?

A

Isotype switching

312
Q

Invasive ductal carcinoma overexpression of what gene?

313
Q

Why is carbidopa always administered together with levodopa?

A

Prevent orthostatic hypotension

314
Q

Breast mets to spine via

A

Azygous vein

315
Q

Isotretinoin works similarly to drug fixing what?

A

APML - uses all-trans retinoic acid

316
Q

Upper GI tumour staining positive for CD20 antigen?

A

MALT - risk factor: H pylori

317
Q

Elderly pt anemia, leukopenia, splenomegaly and teardrop cells, JAK2 mutation

A

Primary myelofibrosis - Fibrosis of bone marrow

318
Q

Sickle cell disease findings in RBC

A

Nuclear remnants in erythrocytes

319
Q

MEN2B symptoms

A

Marfanoid habitus, medullary thyroid carcinoma, mucosal neuroma, pheochromocytoma

320
Q

Mucoid grey-white colonies; Eosin methylene blue agar grows purple colonies with no metallic green sheen

A

Klebsiella pneumoniae

321
Q

Parrot disease

A

Chlamydia psittaci

322
Q

SCLC will stain positive for?

A

Neuron specific enolase

323
Q

Macroglossia, hypotonia and cardiomegaly in infant

A

Pompe disease; lack of acid maltase

324
Q

Elastin’s elastic properties are contributed by?

A

Crosslinking of lysine residue

325
Q

Hypoglycemia, hepatomegaly, hypercholesterolemia, hyperuricemia, lactic acidosis

A

Von Gierke disease

326
Q

Lyme carditis treatment?

A

Ceftriaxone

327
Q

Bronchiectasis features

A

Tram track opacities, honeycombing, copious sputum, digital clubbing

328
Q

Guatemala travel, macrophages with amastigotes

A

Leishmania braziliensis

329
Q

Why is there ventricular dilation in alzheimer’s patients?

A

Atrophy of cortex, so ventricles expand to fill volume occupied by cortex

330
Q

Fatigue, irregular menses, recurrent sinus infections, hirsutism, hypopigmented linear striation, hyperNa+, hypoK+, metabolic alkalosis, cortisol and ACTH elevated. Dx?

A

Endogenous hypercortisolism

331
Q

Cancer patients presenting with temporal wasting

A

Cachexia, due to proteasome-ubiquitin protein degradation

332
Q

Cancer drug that causes ototoxicity?

A

Platinum based drugs - cause DNA cross-linking

333
Q

Acute tubular necrosis attacks the straight segment or convoluted segment first?

A

straight segment

334
Q

Klinefelter syndrome blood smear shows?

A

Barr body, which is methylation of cytosine nucleotide

335
Q

Appendix testis is formed by?

A

Sertoli cells

336
Q

Pseudomonas aeruginosa first line Abx?

A

Cefepime and levofloxacin

337
Q

Rocky mountain spotted fever symptoms?

A

Tick borne disease, caused by rickettsia rickettsii, macular and petechial rash on ankles and wrists

338
Q

What drug increases IP3 concentration in arteriolar smooth muscle cells and increase cAMP concentration in cardiac myocytes? Negligible effect on cAMP concentration in bronchial smooth muscle cells.

A

Norepinephrine

339
Q

PCOS symptoms?

A

Hirsutism, acne, weight gain, elevated testosterone, LH: FSH ratio > 2:1

340
Q

First line Tx for PCOS?

A

Clomiphene, which is a hypothalamic estrogen receptor inhibitor

341
Q

ANP and BNP function?

A

Opposite of RAAS, decreased reabsorption of sodium (natriuresis and diuresis - increases Na+ and water excretion), inhibits renin secretion

342
Q

HIV infection Tx indinavir adverse effect

A

Urolithiasis

343
Q

Well-demarcated, homogeneous, hyperechoic mass on liver US

A

Cavernous hemangioma

344
Q

Cavernous hemangioma biopsy adverse effect?

A

Intraperitoneal haemorrhage

345
Q

Acute Hep A finding

A

Councilman bodies (apoptotic hepatocytes - shrunken, eosinophilic cytoplasm and pyknotic nuclei)

346
Q

Bleomycin acts on which phase of cell cycle?

347
Q

Hemolytic anemia in child with extramedullary haematopoiesis?

A

Beta thalassemia

348
Q

Obese patient with lateral hip pain?

A

Greater trochanteric pain syndrome

349
Q

Giemsa stain positive pneumonia causing agent?

A

Chlamydophila pneumoniae

350
Q

SvO2 low means?

A

Pulmonary artery oxygen saturation is low, mostly seen in anemia

351
Q

Blood vessels and lymph nodes are derived from?

352
Q

Pregnant women with low milk production and low TSH and T4?

A

Pituitary ischemia

353
Q

Fluoxetine cannot be taken with what cough medicine?

A

Dextromethorphan, as it is a serotonergic agent

354
Q

Anidulafungin, caspofungin, micafungin MOA?

A

Decreased glucan synthesis

355
Q

Why does tertian malaria keep recurring?

A

Reactivation of dormant liver stage

356
Q

Nocardia strongest predisposing factor?

A

Exposure to contaminated soil

357
Q

Pus is made of?

A

Lysosomal enzymes made from neutrophils and macrophages

358
Q

Cold AIHA patients most exposed to what LRTI organism?

A

Mycoplasma pneumoniae

359
Q

Difference between IgA transfusion hypersensitivity vs acute hemolytic transfusion reactions

A

IgA - type 1 so would have things like urticaria, angioedema
AHTR - positive direct coombs test; donor RBC lysis due to preformed antibodies in patient serum

360
Q

Leukocyte adhesion deficiency type 1

A

Autosomal recessive defect in CD18 (beta-2 integrin)

361
Q

Bile acid sequestrants cause what changes in LDL, HDL and TG levels?

A

LDL decreases, HDL increases, TG increases

362
Q

Hep B infection and p-ANCA negative vasculitis?

A

Polyarteritis nodosa

363
Q

aggregation of globoid cells and loss of glial cells

A

Krabbe disease

364
Q

single strand positive sense RNA virus

365
Q

What kind of cells does HIV infect?

A

affects langerhans cells

366
Q

most common meningitis causing bacteria?

A

Strep pneumo

367
Q

Homonymous hemianopsia occurs in damage to?

A

Optic tract

368
Q

pregnant woman overuse of HTN drug causing headache, tachycardia, pitting edema of both lower extremities

A

hydralazine (direct arteriole dilation)

369
Q

where is the site of injury in the urethra when you hit the genitals?

A

bulbous urethra

370
Q

Meiosis to resume and loss of gap junction between the granulosa cells and oocytes refers to?

371
Q

Drug that promotes ovulation?

A

Human chorionic gonadotropin

372
Q

During hysterectomy, which vessel should be ligated to achieve hemostasis? And where is this vessel located in?

A

Uterine artery, located in cardinal ligament

373
Q

Why is there higher insulin resistance with high lipid diet?

A

There is an increased activity serine kinases

374
Q

Abx that causes unpleasant metallic taste in mouth?

A

Metronidazole

375
Q

Metronidazole covers for which STI?

A

Trichomonas vaginalis

376
Q

A lot of superficial ulcers in distal esophagus in HIV patients?

A

Esophagitis caused by HSV

377
Q

Most common cause of death of patients with FA?

A

Heart failure

378
Q

Patient BPH but have HTN, give what drug?

379
Q

Anosmia and delayed puberty due to what pathophysiology?

A

Kallmann syndrome, impaired migration of GnRH neurons during embryogenesis

380
Q

Diabetes and neuropathy syndrome stem should always be

A

Polyneuropathy

381
Q

Chvostek sign is?

A

Tapping on cheeks causing contraction of facial muscles, usually seen by hypocalcemia patients

382
Q

How does massive blood transfusions lead to hypocalcemia?

A

Blood transfusion will lead to chelation of calcium, as there is a lot of citrate in transfusion blood

383
Q

Valganciclovir adverse effects?

A

Bone marrow suppression (pancytopenia)

384
Q

Acyclovir adverse effect

A

Crystal nephropathy

385
Q

How do I reach R bronchial artery from thoracic artery?

A

Thoracic artery -> posterior intercostal artery -> bronchial artery

386
Q

Restrictive lung disease with hyperCa2+

A

Sarcoidosis

387
Q

Sarcoidosis will lead to high ACE activity as?

A

Noncaseating granuloma in the lungs will secrete ACE

388
Q

Pancytosis is seen in what blood disorder?

A

Polycythemia vera

389
Q

JAK2 gene encodes for?

A

Nonreceptor tyrosine kinase

390
Q

Mild hemophilia A is treated with

A

Desmopressin (vasopressin analogue)

391
Q

Yersinia enterocolitica transmission via

A

Undercooked pork, unpasteurised milk product, unfiltered water, pet faeces

392
Q

Raloxifene adverse effects?

A

Pulmonary embolism

393
Q

Buzzword - atypical lymphocytes; amoxicillin rash

A

Infective mono due to EBV

394
Q

How do you diagnose infective mono?

A

EBV is diagnosed by anti-VCA IgM

395
Q

Salmonella antibiotic therapy will lead to?

A

Prolonged excretion of pathogen

396
Q

What is released during type 1 hypersensitivity reactions?

A

Histamine, tryptase, heparin, eosinophil chemotactic factors

397
Q

Alzheimer disease treatments are rivastigmine, donepezil and galantamine, which are all?

A

AChE inhibitors, so to reverse their adverse effects, you must add atropine

398
Q

Wrinkled paper like mononuclear cells

A

Gaucher disease, which is glucocerebrosidase deficiency

399
Q

Anorexia can result in what changes in thyroid hormones

A

Decreased T3

400
Q

Lorazepam MOA?

A

Allosteric activation of GABA-A receptors to increase frequency of GABA release

401
Q

Hypothyroidism Sx?

A

Myopathy, weight gain, amenorrhoea, cold, dry skin

402
Q

Aspiration pneumonia area

A

Superior of R lower lobe

403
Q

Hepatic lesion with hyperemic rim (surrounding edema and inflammation)

A

Liver abscess

404
Q

Beta-pleated linear sheet infiltration

A

Amyloidosis

405
Q

Amyloid deposit in seniors

A

Transthyretin

406
Q

Newborn present with asymmetry of the thigh most likely due to?

A

Abnormal development of acetabulum

407
Q

Lung air fluid level, most common organism?

A

Lung abscess mostly caused by S aureus

408
Q

Increased resting and squeezing tone of anus. DDx?

A

Voluntary relaxation of levator ani (pubococcygeus, iliococcygeus and puborectalis) muscle issue

409
Q

Lipodystrophy causing HIV drug?

410
Q

How do you end up having pneumobilia?

A

If there is chronic inflammation of gallbladder, there is adhesion between intestine and gallbladder

411
Q

What Abx does resistance develop with phosphorylation, acetylation or adenylation?

A

Aminoglycosides

412
Q

Increased propionic acid in urine

A

Maple syrup urine disease, caused by increased breakdown of branched chain AA

413
Q

Genetic disease showing ragged red fibres?

A

Mitochondrial Encephalomyopathy, Lactic Acidosis, Stroke-like episodes (MELAS)
- could show milder presentation with hetero mitochondrial DNA
- ragged red fibres are due to compensatory proliferation of mitochondria

414
Q

Patients cannot restart OCPs if they are?

A

Thrombotic - Smokers (above 35 smoking above 15 sticks), IHD, severe HTN, coagulopathy, breast cancer, cirrhosis

**have migraines with aura

415
Q

RSV treatment

A

Rivabirin and palivizumab

416
Q

Spontaneous bacterial peritonitis treatment

A

Cephalosporin - bacterial peptidoglycan cross-linking inhibitors

417
Q

Stabbed in left thigh, present with pulsatile mass, thrill and bruit

A

Atrioventricular fistula - could lead to high output cardiac failure

418
Q

Lithium toxicity can be precipitated by?

A

Renal impairment (ACE-I, NSAIDs, CKD) or volume depletion

419
Q

Most common cause of CN3 palsy?

A

PCA aneurysm

420
Q

Homocysteinuria patients Tx?

A

B6 supplement

421
Q

Heparin + thrombocytopenia is due to?

A

Formation of antibodies against heparin-PF4 complex

422
Q

Pyelonephritis first line Tx?

A

Fluoroquinolones (topoisomerase II and IV inhibitors)

423
Q

ATP mostly works in where in muscle cells?

424
Q

Hyperacute rejection, acute rejection and chronic rejection of organ transplant

A

Hyperacute - antibody
Acute - CD8+ T cells
Chronic - CD4+ T cells

425
Q

Burr cells (echinocytes - jagged RBC) and newborn showing jaundice

A

Pyruvate kinase deficiency (reduction of ATP generation due to less conversion of PEP to pyruvate; in this process ADP -> ATP)

426
Q

For AST and ALT, what enzymes are important for transamination?

A

B6 (pyridoxine)

427
Q

Young boy present with seizure, cardiac issue, multinodular, calcified lesion in retina, ash leaf spot

A

Tuberous sclerosis (chromosome 9 and 16)

428
Q

First physiological response to excessive blood loss?

A

Increase of HR

429
Q

Local anaesthetics MOA

A

Bind to voltage gated Na+ channels and reversibly block Na+ channels, inhibit nerve excitation

430
Q

Dimorphic fungus that is hyphal form at 25 degrees, cigar shaped budding yeast at 37 degrees

A

Sporotrichosis

431
Q

Fluoroquinolones cannot be administered together with?

A

Multivitamins (have metals inside)

432
Q

Sickle cell disease drug that can cause macrocytosis?

A

Hydroxyurea, inhibits ribonucleotide reductase that causes cell cycle arrest in S phase

433
Q

Granuloma pathophysiology? (either sarcoidosis or TB)

A

CD4+ cells activated, which secretes Th1 cytokines (IFN gamma), causing macrophage to secrete TNF alpha
- just know that TB is caused by infection, and sarcoid is abnormal CD4+ cell

434
Q

Uncal herniation will lead to?

A

Ipsilateral oculomotor nerve compression, cortical blindness, contralateral homonymous hemianopsia, ipsilateral paralysis

435
Q

Tonsillar herniation

A

Altered mental status, cardiorespi depression

436
Q

Subfalcine herniation Sx?

A

Contralateral LL weakness

437
Q

Central transtentorial herniation

A

Extensor posturing (decerebrate posture), altered mental status

438
Q

Extracranial herniation

A

Skull fracture and focal neurological defects

439
Q

Paget disease of the bone

A

Normal Ca2+, normal Phosphate, elevated ALP and normal PTH

440
Q

Pseudomonas produces what substance?

A

Pyoverdine and pyocyanin

441
Q

Different stones in the gall bladder pathophysiology (cholesterol, black pigment, brown pigment)

A

Cholesterol stones - due to abnormal cholesterol metabolism
Black pigment stones - excessive hemolysis
Brown pigment stones - due to biliary infection or infestation, increased beta glucuronidase

442
Q

Young boy with heme disorder passed down, increased RCDW and MCHC

A

Hereditary spherocytosis - diagnosed by eosin-5-maleimide binding test

443
Q

CNVII muscle innervation

A

Facial muscle, platysma, posterior belly of digastric, stylohyoid, stapedius

444
Q

Systemic sclerosis Sx?

A

Calcinosis cutis
Raynaud’s
Esophageal hypomotility
Sclerodactyly
Telangiectasia

+ pulmonary fibrosis, myocardial fibrosis, renal arterial HTN, renal insufficiency

445
Q

Sertoli cell insufficiency means?

A

Decreased inhibin B concentration - usually seen in cryptorchidism

446
Q

Most common cause of SIADH is?

A

Medication effect (SSRI, carbamazepine, cyclophosphamide)

447
Q

CLL marker

A

Smudge cells

448
Q

Teardrop cells are seen in?

A

Extramedullary erythropoiesis

449
Q

Multiple myeloma markers

A

Rouleaux formation (stack of coin appearance)
Hypergammaglobulinemia

450
Q

Bilateral non-pitting edema is a buzzword for?

A

Lymphedema

451
Q

Lymph description

A

Lipid rich, protein rich fluid

452
Q

CHF will cause what change to lungs?

A

Decrease compliance of lungs

453
Q

Normal markers of osmolality in the nephron

454
Q

Arsenic poisoning antidote?

A

Dimercaprol

455
Q

Severe otitis externa in immunocompromised patients

A

Pseudomonas, produces exotoxin A that inhibits EF2 and kills host cells

456
Q

Pregnancy UTI drugs?

A

Erythromycin

457
Q

Serum sample from the patient fails to fluorescence after incubation with dihydrorhodamine

A

Chronic granulomatous disease

458
Q

What are patients with CGD most prone to?

A

Catalase positive organism infections
- inclusive of S aureus, serratia, nocardia, aspergillus, B. Cepacia

459
Q

What does 21 hydroxylase do?

A

Convert progesterone to aldosterone and convert progesterone to cortisol

460
Q

What does 17 hydroxyprogesterone elevation indicates?

A

Intermediate to testosterone converting pathway, so indicate that there is congenital adrenal hyperplasia

461
Q

After overdosing this drug, patient presents with hyperglycemia and hypokalemia

A

Theophylline

462
Q

Gingivitis followed by cough productive of blood tinged sputum with yellow granules?

A

Actonomycosis, treat with pen G

463
Q

What cells are responsible for COPD symptoms?

A

Neutrophils

464
Q

Ovarian torsion is most affected by which ligament?

A

Suspensory ligament, also known as infundibulopelvic ligament

465
Q

Mitotically active endothelial cells with small calibre vessel lumina that contain RBC

A

Congenital strawberry hemangiomas

466
Q

High riding prostate means?

A

Posterior urethra tearing

467
Q

Fever, chills, limping, increased ESR in children

A

Osteomyelitis, most common site of lesion is proximal metaphysis of femur

468
Q

C difficile must be sterilised by?

469
Q

Direct inhibition of gastric acid secretion?

A

Omeprazole - proton pump inhibitor

470
Q

Long thoracic nerve arises from?

471
Q

Lytic skull lesions, skin rash, recurrent otitis media, S-100 positive, eosinophilic granuloma

A

Langerhans cell histiocytosis

472
Q

Virulence factor of a gram negative, oxidase negative rods that form greenish colonies on eosin-methylene blue agar

A

Fimbriae (UPEC)

473
Q

Small testes and inflammatory papular eruptions of face, back and chest (steroid acne), and hypertension

A

Anabolic steroid use

474
Q

Meningitis antibiotics

A

Ceftriaxone, ampicillin, vancomycin

475
Q

KNCQ1 gene mutation

A

Jervell and Lange-Nielsen syndrome - cause of arrhythmias (prolonged QT interval) and sensorineural deafness

476
Q

Spinal bifida caused by?

A

Failure of fusion of vertebral arches

477
Q

Liver cyst formation after working with animals

A

Echinococcus granulosus

478
Q

Elevated leukocytes with basophilic granules are

A

Mast cells

479
Q

KIT mutation, pruritis, flushing, gastric acid secretion?

A

Systemic mastocytosis

480
Q

Fat malabsorption and RBCs with irregular spiny projections of varying size?

A

Abetalipoproteinemia, which can also give rise to post-prandial lipid laden enterocytes

481
Q

Alzheimer’s disease neurofibrillary tangles are made of?

A

Hyperphosphorylated tau

482
Q

Some priapism causing drugs?

A

Sildenafil, trazodone, fluoxetine, risperidone, prazosin

483
Q

HIV infection and ring enhancing lesions

A

Does he take TMP-SMX? If yes, then most likely primary cerebral lymphoma, if not, then most likely cerebral toxoplasmosis

Is he EBV positive? If yes, then primary cerebral lymphoma, if not then toxoplasmosis

484
Q

Hx of Crohn’s and now presenting with bone lesions + decreased vibration sensation

A

Osteomalacia due to Vit D absorption problem

485
Q

Drug that has in-vitro activity against HIV and HBV

A

Foscarnet - usually used when ganciclovir fails

486
Q

PCOS pathophysiology

A

Insulin resistance -> increases insulin, which increases androgen (further increased by sex hormone-binding globulin), which increases LH and causes disruption in ovulation

487
Q

Esophageal candidiasis most appropriate Tx?

A

Fluconazole, which prevents ergosterol synthesis

488
Q

RAI treatment efficacy depends on?

A

Transmembrane carrier (sodium/iodine symporter)

489
Q

Femoral hernia strangulation is caused by impingement between?

A

femoral vein and lacunar ligament

490
Q

Ventricle pathways

A

Lateral -> foramen of monro (interventricular foramen) -> third -> cerebral aqueduct -> fourth

491
Q

What is the difference between PAH and inulin

A

PAH - filtration and secretion, but no reabsorption
Inulin - filtration ONLY
(Filtration is proportional to plasma concentration, secretion is proportional to transporter saturation)

492
Q

Type I and II error difference?

A

Type I - false negative
Type II - false positive

493
Q

What helps to maintain temperature when hypothermic?

494
Q

Lysed bacteria to living bacteria gene process

A

Transformation

495
Q

Rhabtidiform larvae and eosinophilia, travel Hx to SEA?

A

Strongyloides stercoralis, could cause perianal serpiginous rash

496
Q

Down syndrome lab test

A

Beta-hCG and inhibin A elevated, AFP and estriol decreased

497
Q

Microcytic anemia with parasitic eggs

A

Necator americanus

498
Q

Biphosphonate side effect

A

Erosive esophagitis, esophageal cancer

499
Q

Sweet smelling odour in wound, aerobic gram neg rod

A

Pseudomonas aeruginosa

500
Q

Gout causing HLD drug

A

Niacin; inhibits hepatic VLDL synthesis

501
Q

Metronidazole MOA?

A

Creation of free radical within bacteria

502
Q

Pitting edema + prominent rugae of fundus

A

Menetrier disease - proliferation of gastric mucus producing cells

503
Q

Basophilic stippling in young child with abdominal pain and developmental delay

A

Lead poisoning

504
Q

Lead poisoning enzyme issue

A

ALAD, so conversion from ALA to porphobilinogen is reduced

505
Q

MAHA, thrombocytopenia, renal failure, fever, neurological Sx

506
Q

Depression patient with anorexia

A

Mirtazapine (alpha-2 adrenergic receptor antagonist)

507
Q

H pylori lives in?

A

Gastric antrum

508
Q

Spindle shaped endothelial cell and lymphocytes infiltration in HIV patients with pinkish brown papules

A

Kaposi sarcoma

509
Q

A lot of jumping will cause pain to?

A

Patellar ligament

510
Q

Which viruses get their envelope from nucleus membrane of host cells?

A

Herpes viruses

511
Q

COVID-19 virus binds to

A

ACE2 membrane protein

512
Q

Papule on finger or toes that is painful when cold

A

Glomus tumour, proliferation of smooth muscle cells

513
Q

Reactive arthritis Sx

A

Arthritis, urethritis, uveitis - most common trigger is being HLA-B27 genotype

514
Q

Hepatitis contracted with blood transfusion

A

Hepatitis C - lacks proofreading ability so will mutate

515
Q

Allergic interstitial nephritis Sx

A

Sterile pyuria, eosinophiluria, interstitial T cell and monocyte infiltration

516
Q

Antibiotic that causes teeth discolouration in babies

A

Tetracycline

517
Q

Vestibular schwannoma histology

A

Hypercellular area of spindle cells, hypocellular area of myxoid stroma

518
Q

Mutation in FOXP3 gene

A

IPEX syndrome (immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome)
- eczema, enteropathy, T1DM, autoimmune thyroid disease

519
Q

Crossover of chromosomes happens at

A

Prophase I

520
Q

Wobble hypothesis describes what property of genetic code?

A

Degeneracy

521
Q

Peau d orange pathophysiology

A

tumour invade the lymph vessels, block lymph flow, tissue will swell but connective tissue will be pulled back

522
Q

Ascaris lumbricoides Sx and Tx?

A

Dry cough and diarrhoea with weight loss, travel Hx to SEA, Tx with albendazole

523
Q

What cofactor is required to convert DOPA to dopamine?

524
Q

Acute liver failure due to panadol : explain the metabolites

A

Overdose will cause a buildup of NAPQI, and is treated by giving N-acetylcysteine

525
Q

Why is ampicillin and gentamicin given together?

A

Ampicillin will help to increase the intracellular uptake of gentamicin

526
Q

Chronic bronchitis will result in

A

Increased serum hematocrit

527
Q

Protein that carries hormones from paraventricular nucleus and supraoptic nucleus?

A

Neurophysins, carry oxytocin and ADH

528
Q

Patient migrate from nigeria, ocular disease and pruritic papular dermatitis with secondary changes to skin due to itching

A

Onchocerciasis

529
Q

What bacteria does not have a cell wall?

A

Ureaplasma urealyticum

530
Q

C difficile Tx?

A

Fidaxomicin for non-severe cases - acts by inhibiting sigma subunit of RNA polymerase
Vancomycin
Metronidazole (second line)

531
Q

X linked agammaglobinemia

A

Mutation in tyrosine kinase gene - respi and GI infection in young child with B cell deficiency

532
Q

TSST is caused by?

A

Polyclonal T cell activation

533
Q

Internal rotation of arm

A

Subscapularis

534
Q

Idarucizumab

A

Reversal of dabigatran

535
Q

Why does curling ulcer form in burn patients

A

They have reduced gastric blood flow

536
Q

No change in any tumour markers but there is a testicular mass

537
Q

Why is there a stronger hypolipidemic effect by using statin and cholestyramine together than separately?

A

Using cholestyramine and statin together increases LDL receptor expression

538
Q

Unilateral lower limb swelling and ulceration, together with Hx of DVT

A

Postthrombotic syndrome

539
Q

MAC and blood gas partition coefficient

A

MAC is inversely proportional to potency
Blood gas partition coefficient is directly proportional to solubility in blood, inversely proportional to lipid solubility

540
Q

Which structures release glucose to blood after 24 hours of starving?

A

Liver and renal cortex

541
Q

How do you differentiate beta thalassemia and sickle cell disease?

A

Sickle cell disease will lead to bone pain and vaso-occlusive crisis, whereas thalassemia will not

542
Q

OCP MOA

A

Extra estrogen and progesterone, so negative feedback to GnRH, which will prevent secretion of LH and prevent ovulation

543
Q

What does the HIV patient presentation with at early stages of HIV?

A

Kaposi sarcoma, only when CD4 <200 will there be esophageal candidiasis and cerebral toxoplasmosis, primary CNS lymphoma, CMV etc.

544
Q

What accounts for the difference between minute ventilation and alveolar ventilation?

A

Physiological dead space

545
Q

Shunt vs dead space

A

Shunt is where there is blood flow but there is poor ventilation, dead space is there is ventilation but no perfusion

546
Q

Cortisol increases production of which fight or flight hormone

A

Epinephrine

547
Q

Vertical transmission of HBV will result in mostly chronic hepatitis B as?

A

Newborns lack cytotoxic T cells that mediate hepatocyte damage

548
Q

Lower limb pain with sudden increase in activity

A

Medial tibial stress syndrome

549
Q

Superior orbital fissure contains which nerves?

A

CNIII, CNIV, CNV1, CNVI
- lead to absent corneal reflex

550
Q

HIV patient with low CD4 count pneumonia causative agent?

A

Pneumocystis jirovecii, on silver staining will give disc shsaped cysts

551
Q

Violaceous rash on eyelid, erythematous papule on hands, muscle weakness

A

Dermatomyositis - increase risk of malignancy like cervix, lungs, ovarian and bladder adenocarcinoma

552
Q

Sinus and crescent shaped glomeruli

A

Pauci immune (granulomatosis with polyangiitis) - no deposits

553
Q

Texas, painless wound that is reddening and blistering, lesion turns blue with blackish discolouration at the centre. Causative organism?

A

Brown recluse spider

554
Q

Aspirin toxicity findings

A

Respi alkalosis (initially), which progresses to high anion gap metabolic acidosis

555
Q

Anti-Yo antibodies are associated with?

A

Breast carcinoma (most common), ovary, endometrium and fallopian tube carcinoma

556
Q

Injury here will lead to laxity of knee joint when knee is flexed, laxity when abduction is applied?

A

Medial collateral ligament

557
Q

Difference between disruption, malformation and deformation

A

Disruption - breakdown of normal fetal tissue
Deformation - external force causing failure to develop
Malformation - intrinsic toxin causing failure to develop

558
Q

Ethambutol MOA?

A

Causes impaired synthesis of cell wall polysaccharides

559
Q

Alcohols are effective in what type of viruses?

A

Enveloped viruses - HSV etc.

560
Q

Alzheimer’s is associated with decreased production of?

561
Q

Adenosine side effects

A

Chest pain as it causes transient AV block by increasing potassium efflux from cells

562
Q

Physiologic stress like surgery or exercise causing transient rise in unconj bilirubin

A

Gilbert’s syndrome - impaired bilirubin conjugation as decreased UDP-glucuronosyltransferase

**more severe Gilbert syndrome - Crigler Najjar syndrome

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