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1
Q

What is the treatment for malaria?

A

For plasmodium falciparum malaria, must give primaquine to kill gametocytes and hypnozoites. Prevents transmission. Artemisinin-based combination therapies possible too but is too expensive.

For plasmodium vivax, give chloroquine and primaquine. Primaquine targets dormant form of parasites.

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2
Q

Primaquine is contraindicated in which group of patients?

A

contraindicated in patients with G6PD deficiency and pregnant women

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3
Q

What is the treatment for severe malaria?

A

Artesunate and quinine

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4
Q

purulent vagina discharge is caused by what bacteria

A

Neisseria gonorrhoea, chlamydia

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5
Q

thick and white vagina discharge, what organism
e.g. cottage cheese

A

candidia

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6
Q

frothy, green yellow vaginal discharge, what organism?

A

trichomonas vaginalis

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7
Q

watery and grey vaginal discharge, what is it?

A

bacterial vaginosis, often caused by Gardnerella

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8
Q

genital ulcers, caused by what? differentials?

A

syphilis by treponema palladium causes painless chancres

chlamydia causes small painless ulcers

klebsiella causes painless granuloma inguinal

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9
Q

UTI community acquired most common bacteria?
opportunistic one?
nosocomial ones?

A
  1. E.coli
  2. Staphylococcus saprophyticus in young sexually active women

opportunistic: pseudomonas aeruginosa

nosocomial: enterococcus like proteus and klebsiella pneumoniae

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10
Q

for salmonella species, which one causes gastroenteritis and which one causes diarrhoea?

A

Salmonella typhi causes enteric fever (typhoid fever) and gastroenteritis but no diarrhoea

BUT salmonella enteritidis causes food poisoning leading to inflammatory diarrhoea.

There could be invasive infections too like osteomyelitis in sickle cell patientsand meningitis in neonates

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11
Q

what are the organisms that can cause neonatal meningitis and what is the treatment?

A

HLES
- haemophilus influenzae, listeria monocytogenes, E.coli and streptococcus agalactiae

antibiotics: ampicillin (for GBS and listeria) and Ceftriaxone for (E.coli)

for adults u need to add vancomycin to counter the MDR s.pneumoniae

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12
Q

examples of hospital acquired pnenumonia

treatment?

A

pseudomonas aeruginosa, E coli, klebsiella pneumoniae, acinetobacter baumannii, MRSA, legionella, viridans streptococcim S.epidermism C.diphtheriae

for gp, gn and atypical: 3rd gen fluoroquinolone like moxifloxacin and levofloxacin

for s.pneumoniae and h.influenzae: ceftiraxone

linezolid and vancomycin for MRSA

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13
Q

simple UTI is by E.coli
treatment?

A

co-trimoxazole
co-amoxiclav

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14
Q

causative organisms of food poisoning?

A

E.coli (EHEC, ETEC, EPEC)
campylobacter jejuni
shigella
salmonella

clostridium perfringens/botulinum

staphylococcal

entamoeba histolytica, trematodiasis, giardiasis in developing countries

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15
Q

Neisseria gonorrhoea treatment

A

Ceftriaxone
azithromycin

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16
Q

treatment for syphilis caused by treponema pallidum

A

IM penicillin G

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17
Q

treatment for pneumocystis pneumonia caused by pneumocystis jirovecii

A

co-trimoxazole

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18
Q

which bacteria causes ophthalmia neonatorum

A

N.gonorrhoeae or chlamydia trachoma’s

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19
Q

which antibiotics can counter MRSA

A

linezolid, vancomycin, clindamycin, Tigecycline, 5th gen cephalosporin like ceftabiprole and ceftaroline

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20
Q

what is metronidazole used for

A

amoebic infections by protozoa, anaerobes like bactericides species and clostridium difficile (CDAD)

helicobacter pylori
giardia
trichomonas vaginalis

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21
Q

Pneumocystis Jirovecii causes what organ infections in what group of people?
common in which specific gap?
Diagnosis?

A

lung infection in immunocompromised people, common in AIDS patients
Diagnosis is NAT-PCR, more sensitive. Microscopy; silver or fluorescent stains. more subjective
Grocott’s silver stain (black)/ immunofluorescence. Cannot use sputum sample and cannot culture.

Chest X-ray will see ground glass

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22
Q

define shock

A

shock is a state of inadequate perfusion of cells and tissues leading to hypoxic tissue injury and if prolonged enough can lead to irreversible cell and organ injury and death

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23
Q

what are the 4 types of shock?

A

distributive shock- generalised vasodilatation, septic shock, anaphylactic shock, neurogenic shock

cariogenic shock- pump failure

obstructive shock- pulmonary embolus and pericardial temponade

hypovolemic shock- consist of harmorrhagic shock, severe burns, vomiting, diarrhoea

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24
Q

Which drug is used to treat open angle glaucoma

what about narrow angle glaucoma?

A

brimonidine (alpha 2 adrenoceptor agonist)

timolol and betaxolol

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25
which drug is used to treat congestive heart failure
dobutamine
26
which drug is used to treat overactive bladder
mirabegron relaxes detrusor muscle around bladder, bladder can hold more liquid and reduces the need to pee. When detrusor muscle contracts the bladder become smaller and push liquid out. recall detrusor muscle is the muscle found around the bladder not the ring that is the sphincter muscle
27
Type A ADR of aspirin a. diarrhoea b. rashes c. gastric ulcer
gastric ulcer. Recall aspirin is a irreversible cox 2 inhibitor and
28
Which is false about genital HSV? a. Can be isolated in cell culture from vesicle fluid b. PCR assays for detection are very sensitive c. IgG antibodies are present d. Tzank multinucleated giant cells are present e. Immunofluorescent antigen detection is used
E. yes u can use vesicle fluid, PCR and serology for anti-HSV lgM. lgG is already present. Thank multinucleate giant cells are present in HSV2!!!!
29
Tzank Multinucleated giant cells can be found in which HSV virus?
HSV II
30
drug that is used as nasal spray for allergic rhinitis
oxymetazoline and phenylephrine
31
low yield qn if dk j skip Why is E histolytica reported as E histolytica or E dispar? a. They are genetically identical b. They are indistinguishable by current detection methods c. One is the name of the trophozoite form and one is the name of the cyst form d. They are different names for the same organism e. None of the above
suggested answer is B but debatable
32
Which of the following statements is true? a. E coli is the main constituent of bowel flora b. Overgrowth of clostridium is harmless c. Blood culture contaminants often include anaerobes d. Vaginal flora fluctuates with age and hormonal status e. Staph aureus is carried in the anterior nares by 10% of the population
D. Yes vagina flora fluctuates with age and hormonal status (coz changes in glycogen content, lactobacilli decrease in prevalence) main constituent of bowel flora is obligate anaerobes overgrowth of clostridium will cause CDAD? staph aureus is in anterior nares of 30% of population
33
Why might azithromycin be used over ciprofloxacin for Traveler’s diarrhea a. No adequate coverage of atypicals b. Patient is a 9-year-old c. Ciprofloxacin causes severe gastric distress d. Patient has arrhythmia e. Patient has severe hepatic impairment
For fluoroquinolone contraindication is for children under 18 too because of arthropathy!!! ciprofloxacin can cover atypical! just that its not effective against MRSA and anaerobes and streptococci and enterococcus!! traveler's diarrhoea commonly caused by E.coli option c most drugs have that shit lol contraindication for patients with arrhythmia is only for 3rd gen fluoroquinolone like levofloxacin and moxifloxacin not ciprofloxacin so D is wrong!! for E the only fluoroquinolone metabolised in liver is moxifloxacin!
34
which 2 drugs treats vulvovaginal candidiasis and which one has significant DDI?
clotrimazole and fluconazole fluconazole has more DDI
35
which 2 bacteria causes pseudomembrane formation
clostridium difficile which causes pseudomembrane colitis and corynebacterium diphtheriae which causes pseudomembrane tonsils and bull neck
36
what is the benzodiazepine antagonist
FLUMAZENIL (short duration of action so need multiple doses) for large doses of benzodiazepines esp in elderly patients benzodiazepines potentiate GABAnergic inhibitor by increasing efficiency of GABA without directly activating GABA(a) receptors through increase in frequency of GABA gated chloride channel openings e..g diazepam, lorazepam, midazolam used for pre-anaesthetic medication and adjuvants during procedures performed under local anesthesia because of their sedative, anxiolytic and amnestic anesthesia. slower onset of CNS depressant effects compared to barbiturates high doses needed to achieve deep sedation prolongs post-anaesthetic recovery and may cause anterograde amnesia
37
Which general anaesthetic drug causes post-operation disorientation, illusions and dreams and can be given without lost of consciousness?
ketamine
38
least affective use of loratadine a. Anaphylaxis b. Allergic conjunctivitis c. Allergic urticaria d. Allergic rhinitis e. Mastocytosis
A. anaphylaxis all allergic reaction in b c d involves mast cell degranulation aka mastocytosis releasing histamine. loratadine is an antihistamine
39
1st gen antihistamines (inverse agonist) interacts with muscarinic cholinergic, alpha adrenergic and serotonin receptors?
yes
40
Which statement is true if ciprofloxacin is prescribed with warfarin? a. Decreased bleeding time as ciprofloxacin inhibits warfarin metabolism b. Increased bleeding time as ciprofloxacin decreases gut bacteria c. Decreased bleeding time as ciprofloxacin decreases gut bacteria d. Increased bleeding time as ciprofloxacin inhibits warfarin metabolism e. B and D
E. ciprofloxacin is an antibiotic, kills gut bacteria reduce plasma vitamin K levels and increase anticoagulant effect of warfarin and increases bleeding time too. ciprofloxacin is also a CYP inhibitor so warfarin remains in plasma for a longer period
41
80. Which is the most appropriate to give a patient with amoxicillin allergy for the treatment of Pseudomonas aeruginosa? a. Piperacillin + tazobactam b. Ceftazidime c. Vancomycin d. Aztreonam e. Tigecycline
D pseudomonas aeruginosa, usually treat with tobramycin, ORAL ciprofloxacin, tazocin, cephalosporin and carbapenems except ertapenem and aztreonam and piperacillin. cannot give beta lactams bcos of allergy so cephalosporins like ceftazidime, anti-pseudomonal penicillin like piperacillin tigecycline is not even in the list and is inadequate against proteus and pseudomonas
42
Which is NOT a characteristic of dendritic cells that make them efficiently carry out their function as a sentinel of the immune system? a. Higher levels of cytokines released b. Migrates to T cell zones in lymph nodes c. Higher levels of MHC II d. Higher levels of costimulatory proteins e. More active endocytic machinery
A/E debatable
43
Listeria monocytogenes is an intracellular bacteria. part 1 Which cell kills this bacteria part 2 corticosteroids affects what cells hence allowing influenza to attack? A. CD8+ T cell B. CD4+ T cell C. neutrophils D. NK cells
part 1: D. natural killer cells involved in killing intracellular bacteria part 2: A. CD8+ cytotoxic T cells involved in killing viruses
44
57. Patient has recurrent viral infection due to CD40+ deficiency. Which is least likely to be affected? A. B cells B. Mast cells C. NK cells D. CD4+ T cells E. CD8+ T cells
co-stimulatory molecule b7 on dendritic cells bind to CD28 on naive T cell. other molecules includes CD40 which binds to CD40L on naive T cell so recall the whole pathway from APC to B cell, option A,C,D,E involved except mast cell which is just.. there for degranulation natural killer cells and B cells have CD40+ T cells have CD40L ans: B
45
is candidia neoformans germ tube positive? is candidia Albicans germ tube positive?
no yes. Only candidia Albicans is germ tube positive. The rest, ALL CANDIDIA SPECIES ARE GERM TUBE NEGATIVE
46
Which cytokine is used for immunotherapy for influenza? a. TGF-beta b. IL-10 c. IL-2 d. INF-gamma e. IF-alpha
ANSWER IS E. INTERFERON ALPHA NOT C INTERLEUKIN 2 I understand that IL-2 is for T cell proliferation and clonal expansion but always recall that influenza is a virus. when u see virus think of IFN-alpha, which is the KING and CD8+ T cells after that.
47
what is the difference between polyclonal and monoclonal antibodies what are the examples of polyclonal antibodies and monoclonal antibodies
polyclonal antibodies targets multiples different epitopes on the same antigen with mixture of antibodies. Example is Hepatitis B immunoglobulin HBIG and intravenous immunoglobulin IVIG purified from serum monoclonal antibodies targets a single epitope on antigen with single antibody e.g. CAMPATH anti-human CD52 but fails because of immune system seeing mouse antibody as foreign protein antigen and produces human anti-mouse antibody HAMA e.g. chimerization and humanised antibody. names end with -ximab and -zumab respectively. for chimerization is u cut and paste variable domains but for humanisation is u cut and paste complementarity determining region onto human antibody scaffold.
48
Which is characteristic of allergic reactions? a. Binding of IgE-coated allergens to Fc receptors on mast cells b. Binding of IgA-coated allergens to Fc receptors on mast cells c. Binding of IgG-coated allergens to Fc receptors on mast cells d. Binding of IgM-coated allergens to Fc receptors on mast cells e. Binding of IgD-coated allergens to Fc receptors on mast cells
answer is A lg E don't get trick u fuck nOT lgG. mast cell and allergy is is lgE
49
In the liver, a defect in which CD4+ T cell conveys the most increased chance of poor prognosis? a. Th1 b. Tfh c. Treg d. Th17 e. Th2
this is new to you since u havent learn hep b yet and many would have chose E as the answer but Th1 is actually the answer which is A. Th1 is surprisingly involved in immunity against HepB and HepC!
50
what is the most direct precursor to breast carcinoma? Ductal carcinoma Nipple papilloma Intraductal papilloma Fibroadenoma Phyllodes
A. ductal carinoma
51
Which cellular process stops regeneration when the wound is covered? a. Cell fusion b. Multinucleation c. Apoptosis d. Contact inhibition e. Metaplasia
D. contact inhibition!!! recall jc bio
52
A sailor is shipwrecked on an abandoned island and survives 13 months on just spring water and rabbits. When found, he had loose teeth, bruising around his joints, and bleeding gums. Which is the most likely cause for his condition? a. Defect in collagen function b. Poor oral health c. Protein malnutrition d. Defect in blood coagulation e. Vitamin B3 defect
ans: A defect in collagen function!!
53
Coagulative necrosis of the heart occurs. Assuming the patient survives, what can be observed on a 3-year follow-up? a. Chronic inflammation b. Scarring c. Regeneration d. Granulation tissue e. Granulomatous inflammation
B scarring!!!
54
Earliest morphological manifestation of cellular injury a. Mitochondrial densities b. Cytoplasmic eosinophilia c. Cell swelling d. Nuclear pyknosis e. Nuclear karyolysis
C.is the answer. cell (cytoplasm) mitochondria, ER swells is early phase late phase which is irreversible is d and e mitochondrial densities doesn't mean swelling!! means jackshit basically
55
13. Most important for granulation tissue formation a. Angiogenesis b. Neutrophil infiltrates c. Exudate formation d. Persistence of infective agent e. Mast cell infiltrates
A. granulation is NOT the same as granulomatous inflammation which will be D. granulation is the vascularised tissue that forms as chronic inflammation evolves. It is formed during proliferative stage of wound healing. New capillaries make the tissue appear pink and granular hence the name
56
What is characteristic of granulomatous inflammation? a. Collection of lymphocytes b. Collections of neutrophils c. Necrotic material d. Capillaries e. Histiocytes
E. don't get tricked!! A is vague, should be lymphocytes surrounding!! not a collection of it!!
57
what is disease aetiology??
causative agents
58
40yo w/ high fever, severe headache. Localised cavitary lesion. Head biopsy of lesion contains neutrophils dead and dying. a. Thrombus b. Malignancy c. Non-caseous granuloma d. Abscess e. Granuloma
abscess only mention neutrophils, means acute inflammation, abscess since it is dying
59
alcoholic patient presents with hepatic steatosis. Where does lipid accumulate? cytoplasm of hepatocytes or intercellular space?
cytoplasm of hepatocytes
60
which antibiotics can cause CDAD
clindamycin cephalosporin amoxicillin tigecycline penicillin CCATP
61
which drugs can treat CDAD
metrodinazole and ORAL vancomycin
62
which drugs prolongs QT intervals
3rd gen fluoroquinolone like levofloxacin and moxifloxacin macrolides triazoles 3gFluMacTria
63
which drugs causes bone marrow suppression
LA5A linezolid amphotetricin B 5 flucytosine azathioprine
64
drug that causes thrombophlebitis
cephalosporins vancomycin amphotericin B
65
which drug when taken predisposes someone to superinfection like CDAD, oral thrush (candidiasis)
tigecycline
66
which one is an anti-inflammatory mediator - thromboxane a1 - leukotriene b4 - Lipoxin a4 - histamine - interferon gamma
Lipoxin A4
67
least common cancer in sg male 1. lung 2. prostate 3. bladder 4. colorectal 5. stomach
bladder
68
most common receptor for PAMPS?
TLR-4
69
A woman just underwent treatment for breast CA, and that resulted in left arm swelling as the lymphatic drainage is affected. Doctor warned her abt recurrent infection due to disruption of lymphatic surveillance in the affected arm. Which is the most likely reason? 1. Decreased processing of antigen by dendritic cells 2. Decreased ability of dendritic cell migration to lymph nodes 3. Decreased entry of T cells into lymph nodes 4. Decreased capturing of antigens by dendritic cells 5. Decreased expression of co-stimulators by dendritic cells
2 recall it is the dendritic cell that is the APC, will move into the T cell zone of lymph node to do antigen presentation
70
IL-4 is for production of what antibody TGF-Beta is for production of what antibody IFN-gamma is for production of what antibody
IL-4 is for production of lgG and lgE TGF-beta is for production of lgG IFN-gamma is for production of lgG and lgA
71
A clinical trial involving antibody treatment against a cell surface antigen in tumour cells of breast cancer was carried out. 20% of the patients stopped responding to treatment. What cell type is responsible for the response against tumour cells in this treatment? 1. NK cell 2. CD8 T cell 3. macrophages 4. B cell 5. Mast cell
NK cell is involved in immunotherapy!! ADCC for antibody therapy targeting tumour surface antigens
72
lab testing approach for malaria should be?
rapid diagnostic test and microscopic examination of blood smears
73
most common side effects of NSAIDS 1. pseudo allergic reaction 2. hypersensitivity 3. bronchospasm 4. hypertension 5. lgE allergic rat
4. hypertension is part of the GIT side effects and renal side effects pseudoallergic rxt is classified under 'others' in notes and is not as common
74
which route of administration? amphotericin B 5-flucytosine echinocandins triazoles
IV Oral IV Oral

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