Uworld Printouts Flashcards
Eosinophil proloferation and activation during parasitic infection is stimulated by Interleukin ______ produced by _________. You
Interleukin 5 produced by TH2 and mast cells
How do Eosinophils play a role in a parasitic infection?
The mechanism is called ADCC.
Antibody-bound parasites bind to Fc receptors located on Eosinophil cell surface. This causes degranulation of eosinophils to release cytotoxic proteins to damage those antibody-bound parasites
Eosinophils has _______ color granules because it contains ________________.
RED, contains negatively charged Major Basic Protein.
Which phase of the action potential of Nodal cells is called the pacemaker current? What is the cause of pacemaker current?
Phase 4.
If( Funny Current) is the cause of pacemaker current. Autonomic Nervous System works at phase 4 of the Nodal Action potential
What is the type of Funny Current Na-Channels?
They are called HCN- Hyperpolarization-activated Cyclic Nucleotide-gated channel.
This means that this channel is activated by the hyperpolarization of nodal cells and then ir uses cAMP to open up and allow Na to get into cells.
Funny current is an INWARD Na-current.
Biceps reflex root value?
C5,6
Causes of REDUCED carpal tunnel Space that causes Carpal tunnel syndrome?(5 conditions)
- Pregnancy (Due to fluid accumulation)
- Hypothyroidism (Gag buildup)
- Diabetes Mellitus (Connective Tissue thickening)
- RA (Tendon inflammation)
- Long history of hemodialysis (deposition of B2 microglobulin also called dialysis-associated Amyloidosis)
The carpal tunnel is between the ____________ and ______________.
Carpal bones, transverse carpal ligament
Carpal tunnel syndrome results in sensory impairment/pain due to the compression of which nerve?
Median nerve.
What is the cause of symmetric peripheral polyneuropathy of Diabetes?
Vs
The cause of demyelination peripheral neuropathy of GBS?
Endoneural arteriole hyalinization
Vs
Endoneural inflammatory infiltration with multifocal demyelination
What is a spina bifida called when there is dura matter present in the outpouching?
Meningocele
What is a Myelomeningocele?
It has dura matter and part of spinal cord in the spina bifida outpouching.
Associated with Chiari 2.
What are two primary causes of lacunar infarcts?
Lipohyalinosis and Microaretheromas
What is the difference between lipohyalinosis and Microatheromas
Lipohyalinosis is VASCULAR WALL THICKENING, COLLAGEN SCLEROSIS, and accumulation of mural foamy macrophages.
Microatheromas is atherosclerotic accumulation of LIPID-LADEN MACROPHAGES WITHIN THE INTIMAL LAYER OF ARTERY.
In organophosphate poisoning, which two drugs can be given for Treatment?
Atropine and Pralidoxime
Out of the two drugs used for treatment of Organophosphate poisoning, which one should be given first? And why?
Atropine should always be given first.
Because pralidoxime causes transient Acetylcholinesterase inhibition that would worsen the symptoms for a while, SO CAN’T BE GIVEN FIRST.
Which Nephritic Syndrome Nephropathy has NORMAL SERUM COMPLEMENT LEVELS?
IgA Nephropathy.
What is the most common cause of Lobar Hemmorrhage in people above the age of 60?
Cerebral Amyloid Angiopathy
How does a person with glioblastoma usually die?
From Aspiration pneumonia or Septic Shock
Name two amino acids that take part in transamination reactions and what amino acids to they get converted into?
(UWORLD 1482)
Alanine gets transaminated into Glutamate
Glutamate is transaminated into Aspartate (and vice versa?
Which substance is a teratogen for Hox signaling pathways?
Retinoids/Vitamin A derivatives used for the treatment of acne
How would the teratogenic effect of interference with HOX Signalling pathway manifest as?
Branchial Arch Abnormalities
Retinoids affect the HOX Signalling Pathway
What is the difference in response type, when a polysaccaride vaccine is used as compared to when a polysaccaride-protein conjugate vaccine is used?
When a polysaccharide vaccine is given there is only B-cell response.
Whereas when a polysaccharide-protein conjugate vaccine is given, it ELICITS T-CELL DEPENDENT IMMUNE RESPONSE too. Hence, the response type is that of both B and T cell type. Hence, this provides immunogenicity in infancy whereas a simple polysaccharide vaccines doesn’t provide immunogenicity in infancy.
Relative Risk nikaalnay kay liyay kya kertay hein?
DIVIDE
Levels of _______________ are higher in Pulmonary Vein than in Pulmonary Artery.
Angiotensin 2 (ACE is located in endothelium of small pulmonary vessels)
In a scenario of Intimate partner violence during pregnancy or postpartum. What will you suggest to patient out of the following:
- Advise the patient to stay with a relative for the duration of pregnancy.
- Provide information about Domestic Violence Program.
- Refer the patient and her partner to a couples’ counselling.
Provide information about Domestic Violence Program
Diminished pinprick and temperature sensation over a small area in the upper lateral arm and weak shoulder abduction. Which nerve is damaged?
Axillary Nerve is damaged.
Shoulder abduction is impaired because this nerve innervates DELTOID. Deltoid causes 15°-100° shoulder abduction
Which two muscles cause shoulder abduction for 0°-15° and 15°-100°?
For 0°-15° it is supraspinatus innervated by suprascapular Nerve.
For 15°-100° it is Deltoid innervated by axillary Nerve.
Leydig cells are analogous to female ______________ cells?
Theca Cells.
Sertoli cells are analogous to female _____________ cells.
Granulose cells.
Leydig cells produce ____________ in response to stimulation by _______________.
Leydig cells produce Testosterone in response to stimulation by LH.
Ladies are luetinized into Testosterone.
Sertoli cells produce the hormone ___________ in response to FSH.
Inhibin.
What will be the blood levels of Testosterone Inhibin FSH LH in a person with impairment of sertoli cell function?
Testosterone- Normal
Inhibin- Decreased
FSH-Increased
LH-Normal
What will be the blood levels of Testosterone Inhibin FSH LH in a person with Kallman Syndrome?
Testosterone-Decreased
Inhibin-Decreased
FSH Decreased
LH-Decreased
What will be the blood levels of Testosterone Inhibin FSH LH in a person with impairment of isolated Leydig cell function?
Testosterone- decreased
Inhibin-Normal
FSH-Normal
LH- increased
Treatment of Toxoplasmosis?
Pyrimethamine (MOA---> Inhibit dihydrofolate reductase like MTX, TMP---> Dtmp) and sulfadiazine, With leucovorin (Folinic Acid)
Two causes of ring-enhancing lesions of an HIV patient?
Toxoplasmosis (Multiple lesions)
Primary CNS Lymphoma/ Large B cell lymphoma/NHL (Most commonly solitary)- Caused by EBV so CSF is positive for EBV
PCSNL shows abnormal population of which cells?
uworld Qid 2083
B-Lymphocytes
CD55 and CD59 deficiency?
Paroxysmal Nocturnal Hemoglobinuria
What is the triad of PNH?
Negative Coomb’s test.
Pancytopenia
Hepatic vein thrombosis(Budd-Chiari Syndrome)
What is the mechanism of action of eculizumab used to treat PNH?
Targets terminal complement protein C5
What will a kidney biopsy of a patient of PNH show?
Hemosederosis in Kidney due to intrinsic hemolysis
Intracellular dehydration occurs during the pathogenesis of ______________ and ______________.
Sickle cell anemia
Spherocytosis
Buspirone used in the treatment of Generalized Anxiety Disorder has no risk of ___________ in contrast to the substantial risk associated with benzodiazepines.
No risk of dependance, and tolerance
The patient with eclampsia has decreased activity of what?
VEGF
In patients who develop preeclampsia, maternal spiral arteries that supply blood to the fetoplacental unit are abnormally underdeveloped and become (High/low) resistance, (high/low) perfusion vessels.
High resistance, low perfusion-This leads to chronic placental ischemia causing rise in BP
Serum Haptoglobin levels would (increase/decrease) in Vitamin B12 deficiency.
Decrease.
Vitamin B12 deficiency causes increased red cell breakdown due to ineffective erythropoeisis, resulting in the release of FREE HB that binds to haptoglobin.
A traveller who had already done Malaria prophylaxis with mefloquine, comes to you with symptoms of Malaria. What is the cause?
Mefloquine cannot kill schizonts in the liver and only in the blood.
To avoid this, the person should have taken mefloquine for 4 weeks after coming back from the trip as liver schizonts take 8-30 days to be released into blood.
What drug should be added to kill liver Hypnozoites?
Primaquine
A child comes with rectal prolapse. What is the disease associated with this?
Cystic Fibrosis.
Cystic fibrosis—> Meconium ileus.
Meconium—> Inspissated stool.
Meconium Ileus—-> Dehydrated/inspissated stool stuck in the small bowel/Distal ileum. (As compared to Hirshprung’s disease–> rectosigmoid is the level of obstruction, dilation proximal to the site of hirshprung’s disease)
Rectal tone is going to be NORMAL. (High yield)
Name two conditions in which the diarrhea is of secretory type?
Crohn’s and Carcinoid Syndrome
Osmotic Diarrhea cause?
Lactose intolerance.
(Brush border enzyme deficiency/Lack of disaccaridase)
Lactose Intolerance (Intestinal Biopsy is going to be normal, in people who have primary lactose intolerance)—>
>High osmotic gap (Short chain fatty acids increased, undigested lactose)—-> (Opposite to VIPOMA which has low osmotic gap)
> Ph of Stool—-> Acidic.
> Lactose intolerance—> Remember the word fermentation—> Production of H2 (H2 breath test)
> Low glucose after lactose load. (Lactase is not converting lactose into glucose and galactose)
The mechanism of action of polythene glycol in a patient is similar to the pathophysiology of which disorder?
Lactase Deficiency.
Most common cause of chronic pancreatitis is?
Ethanol Abuse
A patient of chronic pancreatitis due to alcoholism has megaloblastic anemia. Which of the following is most likely responsible for patients anemia?
A) Diminished Thymidine Synthesis
B) Impaired pyruvate decarboxylase
C) Low rate of of intracellular transamination reaction
A) Diminished Thymidine Synthesis- CORRECT.
(Vitamin B9/Folic acid deficiency—-> Defect in Thymidine production to be incorporated DNA–> impaired DNA synthesis/replication)
B) Impaired pyruvate decarboxylase (Biotin/Vitamin B7----> IS ESSENTIAL for carboxylase enzymes--> Pyruvate CARBOXYLASE.)----> It is deficient in people who eat raw egg whites. Pyruvate carboxylase is important to convert pyruvate into oxaloacetate. (Gluconeogenesis)--> Uworld. Acetyle CoA Carboxylase (converts Acetyl CoA into Malonyl-CoA.--> FA synthesis.) Propionyl CoA (converts propionyl CoA into Methylmalonyl CoA--> FA oxidation)
Which drugs if used simultaneously with methadone, can cause opioid toxicity?
Fluconazole, Voriconazole, ketoconazole,
Clarithromycin, Ciprofloxacin
Cimetidine
Fluvoxamine
Dapsone is C/I in which disease?
G6PD Deficiency.
Ocular side effects of PDE5 inhibitors?
Blue discoloration of vision
Nonarteritic anterior ischemic optic neuropathy (monocular vision loss with an afferent pupillary defect)
Root value of nerve compressed in Meralgia Paresthetica?
Lateral Femoral Cutaneous Nerve (L2, L3)
Guyon’s canal is between which two bones?
Hook of Hamate and Pisiform Bone
Which condition is associated with mutations in KIT receptor tyrosine Kinase?
Systemic mastocytosis. I.e clonal proliferation mast cells in skin and other organs.
Due to increased mast cells—-> increased histamine———> hypersecretion of gastric acid———>Gastric ulcer
Systemic mastocytosis will cause
Pruritis, urticaria, and increased gastric acid secretion.
Mast Cell proliferation is associated with mutations in?
KIT receptor Kinase
C-KIT receptor kinase mutation is found in?
KIT is a GROWTH FACTOR RECEPTOR KINASE
GI stromal tumours
Tell the Gene product of HER2 gene?
Transmembrane Receptor that has tyrosine kinase activity and an intracellular domain.
That’s why, on page 225 it is written “Receptor Tyrosine Kinase”
Her2 gene mutated, what is the most likely function of the protein produced by this gene?
Accelerates cell proliferation
uworld Qid 2093
Why is there hypercalcemia in Sarcoidosis?
Activated macrophages ectopically produce 1-alpha hydroxylase.
1-alpha hydroxylase increases production of 1,15 Dihydroxycholecalciferol causing hypercalcemia
What can be seen in Bronchioalveolar lavage in patients with sarcoidosis?
High CD4+/CD8+ ratio
More than 2:1
A patient with predominance of CD8+ cells in Bronchioalveolar lavage has which disease?
Hypersensitivity pneumonitis
Name two rotator cuff muscles that cause external rotation of arm?
Infraspinatus and Teres Minor
MRI of a patient reveals complete tear of infraspinatus muscle. The absence of weakness in this patient is best explained by the compensatory hypertrophy of which muscle?
Teres Minor.
Both of these muscles cause external rotation
Name two rotator cuff muscles that internally rotate the arm?
Lattissmus dorsi and Subscapularis
What is the mnemonic for structure of an immunoglobulin?
V—ch—-Fc
Vich Fc
What is the complement attachment site on an immunoglobulin?
Ch2
Mnemonic for rotator cuff mucles that cause internal rotation and external rotation of the arm?
Instagram per sab latte hein, per external duniya mein minors inferior hein
Tertiary care hospital didn’t prescribe an important medication to the patient. What will you say to them?
Your primary physician sent you to me because he is concerned about your blood pressure given your previous heart attacks. Let’s see what can we do to optimize your current medication
Isosorbide dinitrate therapy has low bioavailability because of?
High first-pass metabolism
Alpha thallassemia major, has Barts Hemoglobin. What Globin chains is it made of?
4 gamma chains.
MRI of lower spine reveals partial destruction of the anterior portion of the L1-L3 vertebral bodies and a FLUID COLLECTION beneath the anterior longitudinal ligament?
TB- Pott Disease. Yaad rakho kay fluid bhee accumulate ho sakta hai Pott’s Disease mein!
Why is there hypophophatemia when upon refeeding malnourished people?
Increased insulin secretion, causes stimulation of REDISTRIBUTION OF PHOSPHATE FROM SERUM INTO MUSCLE AND HEPATIC CELLS FOR USE DURING GLYCOLYSIS
Perianal anesthesia or anocutaneous reflex root value?
S2-S4
What does Chagas disease manifest as on Peripheral blood smear?
Trypomastigotes can be seen on Peripheral blood smear.
Trypomastigotes look like blue hooks. Picture in gallery. GO LOOK OR FIND.
What’s a bizzare yet common complication of Chagas Disease?
Cardiac arrhythmias and Ventricular Aneurysm
Premature ejaculation’s diagnostic criteria?
Ejaculation within one minute of penetration occuring most of the time for atleast 6 months.
Masturbation is NORMAL.
MOA of a patient being resistant to Nafcillin?
Poor interaction with binding proteins
Referred otalgia
Tumour in hypopharynx causes referred otalgia via which nerve?
Tumour in Upper pharynx and base of tongue causes referred otalgia via which nerve?
Vagus Nerve
Glossopharyngeal Nerve
Zenker’s diverticulam is due to ______________ motor dysfuntion.
Cricopharyngeal
A person taking a medication for runny nose, sneezing and watery eyes. He also has FLUSHED CHEEKS AND DILATED PUPILS?
Which medicine is he on and what is the MOA of these S/E?
He is on DIPHENHYDRAMINE.
Diphenhydramine also has muscarinic receptors antagonism, and hence cause these side effects
A patient on Amitriptyline can come to you with what symptoms due to its property of muscarinic receptor antagonism/anticholinergic toxicity?
Confusion and Urinary retention
Hypoplasia of Mandibular prominence results in what and happens in which disease?
It results in MICROGNATHIA and occurs in pierre-Robin Sequence
What two structures fail to fuse for a unilateral cleft lip to happen?
Failure of Fusion of maxillary prominence with intermaxillary segment
What is the lab manifestation of pure red cell aplasia?
Anemia with low retic count
What are the 2 possible causes of pure red cell aplasia?
Thymoma or recent Parvovirus B19 infection (Can be detected by Anti-B19 IgM antibodies in serum)
Which of the following secondary changes can be found in a patient of nephrotic syndrome?
A) Decreased Liver albumin Synthesis
B) Increased Capillary oncotic pressure
C) Increased Liver Lipoprotein synthesis
C) Increased Liver Lipoprotein synthesis
(low intravasculat oncotic pressur and decreased lipoprotein lipase STIMULATES increased lipoprotein production
Which HIV drug causes nephrotixicity?
Tenofovir(NRTIs)
Ascent of horseshoe kidney into the abdomen is failed due to which vessel?
IMA
Failed closure of lateral body folds at the umbilicus would result in?
Ventral wall defect allowing abdominal contents to herniate
Failure of hindgut descent along IMA?
Imperforate Anus
Failure of Neural crest Cell Migration into the bowel wall?
Hirshprung’s disease
Pertechetate scintigraphy demonstrates focal radiotracer accumulation in RLQ in which condition?
Meckel’s Diverticulam.
Why does Meckel’s Diverticulam take up pertechnetate?
Parietal cells of ectopic gastric mucosa present in Meckel’s diverticulum has an affinity for Pertechnetate.
What is seen in a patient as a response to pembrolizumab initiated in him?
Pembrolizumab blocks PD-1——-> Restrores Cytotoxic T cell response/Disinhibition/ CD8+ lymphocyte infilteration———-> causing tumour cell apoptosis!
Drug induced amenorrhea due to respiridone is because?
Dopamine antagonists cause hyperprolactinemia
Example of inhaled corticosteroid that can be used for treatment of asthma?
Fluticasone
What pathogen stains positive for Mucicarmine and which colour?
Bronchioalveolar lavage of Cryptococcus Neoformans stains postive for Mucicarmine.
Stains the thick polysaccaride capsule RED.
What are integrins?
Transmembrane protein receptors.
Inside the cell they attach to actin, keratin
Out the cell they attach to FIBRONECTIN.
Fibronectin they attaches itself to Collagen.
______________ is a GAG in the extracellular matrix that may play a tole in Type 1 Collagen Fibril organization in cornea
Keratan sulfate
How can neonatal tetanus be prevented?
Hygeine and cord care
Immunization of pregnant women.
(They’ll provide IgG antibodies to the fetus which decreases incidence of neonatal tetanus by 95%)
Tetanus causes spastic paralysis via EXOTOXIN (Exotoxins are polypeptides so can be presented to MHC, hence they are thymus antigen DEPENDANT. However, the ae fatal at very low doses so the person dies before generating an immune response—> vaccination.TIG is required, no life-long immunity.
A patient on IV dobutamine for Decompensated HF does not receive medication for 6 hours and experiences worsening of the condition with resulting hypotensive shock. Hospital committee to address this incident. What is the most appropriate step in addressing this problem?
ROOT CAUSE ANALYSIS- interview pharmacy, nursing, Medical Staff on the units where this occured.
Cause of gynecomastia in a person taking finastride?
Finastride which is a 5-alpha reductase inhibitor. So the INCREASED PERIPHERAL CONVERSION OF TESTOSTERONE TO ESTRONE causes gynecomastia.
What infection is it if a person back from peurto rico has SEVER polyarticular arthralgia, Fever and a rash?
Chikunguniya fever caused by mosquito bite
What peculiar about Chikunguniya fever?
Person has fever, polyarticular arthralgia. But on labs this person will have lymphopenia
Difference in deep tendon reflexes and Nerve stimulation studies in pts of Myesthenia Gravis vs Lambert Eaton Myasthenic Syndrome?
In MS, deep tendon reflexes are INTACT. Nerve Stimulation studies show DECREMENTAL response.
In LEMS, deep tendon reflexes are ABSENT. Nerve stimulation studies show INCREMENTAL RESPONSE
Root Value of Triceps reflex?
C7,C8
Reactivation of VZV causes ____________ inflammation of dorsal root ganglion and peripheral nerve
Hemorrhagic
In class 3 antiarrythmic drugs, __________ has very little risk of inducing polymorphic ventricular tachycardia.
Amiodarone, because it has more HOMOGENEOUS effect on ventricular repolarization as compared to other drugs.
Impaired language comprehension/ Wernicke’s aphasia results from lesions in which part of the brain?
Dominant superior temporal gyrus,
What is inability to recognize a familiar face called?
It may result from lesions in what part of brain?
Prosopagnosia
Damage to fusiform gyrus
Patients with lesions in _______ and ______________ have Gerstmann Syndrome.
Dominant angular and supramarginal gyri in parietal lobe
Gerstmann syndrome signs?
Finger agnosia
Right left disorientation
Agraphia
Acalculia
Name two cells which perform insulin mediated glucose uptake?
Muscle Cells, Adipocytes
Which anemia and retic count is seen in Anemia of chronic disease?
Normocytic anemia with low retic count
What is the cause low reticulocyte count in Anemia of Chronic Disease?
Increased sequestration of iron within macrophages and Reduced quantities of erthrocyte precursor cells (Normoblasts, Reticulocytes) in Bone Marrow.
In Anemia of Chronic disease:
Circulating iron levels are: High/low/Normal.
Bone Marrow Iron Levels: High/Low/Normal.
Circulating iron levels are LOW.
Bone Marrow Iron levels are HIGH.
First line treatment of PTSD?
Trauma-focused CBT
First line Drug of choice for Treatment of PTSD?
SSRIs.
__________________ is the most common arrythmia in those with inferior wall MI.
It occurs due to _____________ triggered by infarction of myocardial tissue
Sinus Bradycardia
Enhanced Vagal tone
What is the treatment for Sinus Bradycardia in a patient of Inferior Wall MI? Give the reason for your drug of choice.
Atropine.
Sinus Bradycardia occurs due to enhanced vagal tone, and IV atropine counteracts this by its anti-cholinergic effects
Avascular necrosis of the proximal pole of scaphoid bone is a risk in scaphoid fractures because ____________ artery proceeds in a retrograde manner to provide blood.
Dorsal scaphoid branch of radial artery
A thick, gelatinous exudate, most prominent in the basal portion of brain is highly suggestive of?
TB meningitis
Radiotherapy causes damage to cells via?
Generation of ROS
Aggressive hydration therapy can prevent nephrotoxicity due to which drug?
Acyclovir
Intrauterine cocaine exposure vs intrauterine alchohol exposure in neonates?
Intrauterine cocaine exposure cause HYPERTONIA and TREMORS in neonates. No facial anomalies.
Intrauterine alcohol exposure causes smooth philtrum, small palpebral fissures, thin vermilion border
Giant cell arteritis causes visual disturbance due to?
Ischemic Optic Neuropathy
How does COPD cause right-sided heart failure?
COPD causes pulmonary vasoconstriction due to hypoxia——-> This causes pulmonary HTN AKA Increased right ventricular afterload———> Right-side heart failure
Why does a selective dorsal rhizotomy result in reduced muscle spasticity?
(Qid 19893)
The afferent signals of the stretch reflex is dorsal nerve fibres.
Stretch reflex has 2 functions:
A) Deep Tendon Reflexes
B) Maintenance of Muscle tone
Left gonadal artery arises from?
Abdominal aorta,
However left gonadal vein drains into left renal vein
Cause of Stress Hyperglycemia?
Cortisol induced increased hepatic glycogenolysis and gluconeogenesis after surgery/trauma/hypoxia
Seperation anxiety disorder time criteria for children and adults?
For children- more than 4 weeks.
Adults- More than 6 months
What labs should be obtained before starting statin therapy?
Liver Transaminase Levels.
What will muscle biopsy reveal in polymyositis vs dermatomyositis?
Endomysial mononuclear infilterare and patchy/scattered muscle fiber necrosis
In contrast, dermatomyositis causes PERIFASCICULAR inflammation in a SEGMENTAL pattern
Autoantibody against which antigen is commonly seen in polymyositis?
tRNA Synthetase
anti-Jo-1
Oropharyngeal carcinoma of squamous cell type is frequently associated with _____________ exposure, particularly in younger patients.
(Question said the tumour is an small area of ulceration in right tonsil)
HPV
Lung condition in which tactile fremitus is increased?
Consolidation
Cytochrome P450 inducers?
Queen Barb Steals Phen, refuses to eat greasy carbs continuously. Queen---> Quinidine Barb---> Barbiturates. Steals--> St. John Wort Refuses---> Rifampin greasy--> Griseofulvin Carbs--> Carbamazepine. Continuosly--> Chronic Alcohol Consumption.
Damage to infraorbital nerve in an orbital floor fracture results in?
Numbness/Parasthesia of upper lip and upper cheek, upper gingiva
Entrapment of inferior rectus muscle can impair vertical gaze——> It will be written that diplopia worsens when person looks upwards.
Hematomas over the mastoid process are a sign of ____________ skull fracture
Basilar skull fracture.
What are the signs of basilar skull fracture?
Battle signs (Post auricular eccymosis/ Hematomas over the mastoid process) Periorbital ecchymosis (sparing of tarsal plate/Raccoon eyes) Clear otorrhea
MOA of Cromolyn?
Inhibits mast cell degranulation
Where does botulinum toxin bind?
It prevents binding and fusion of Acetylcholine-containing synaptic vesicles with the plasma membrane through the destruction of SNARE proteins
Enveloped virus containing partially double stranded circular DNA?
Hep B virus
Non-allergic drug reaction of vancomycin is?
Red Man syndrome
It is not IgE mediated because it is not a true allergic reaction
What is Red Man Syndrome? How can it be avoided?
Flushing, erythema and pruritis when vancomycin is given too rapidly.
To avoid it, infuse vancomycin slowly.
In Cystinuria, which 4 amino acids cannot be absorped adequately?
COLA is the mnemonic.
C-Cysteine
O-Ornithine
L-Lysine
A-Arginine
Shape of renal calculi found in Cystinuria?
Flat, hexagonal
Which anti-hyperlipidemic drug should be avoided in a patient with gallstones?
Fibrates. eg. Gemfibrozil
_______________ is the most common underlying valvular disease predisposing to the development of infective endocarditis in DEVELOPED COUNTRIES.
Mitral Valve Prolapse.
Yeh ghalat kiya tha tumnay moti
2 important findings in midgut malrotation?
Cecum found in RUQ instead of RLQ.
Ladd’s bands from cecum and right colon connect to retroperitoneum and compressing the 2nd part of duodenum.
Which part of duodenum is compressed by Ladd’s bands in midgut marotation?
2nd
Midgut malrotation ki common complication kya hai baeta?
Midgut volvulus, when the mesentary twists around SMA.
Can cause bowel necrosis because of compromised blood supply.
Incomplete (Clockwise/Anti-clockwise) rotation will result in midgut rotation.
Incomplete ANTI-CLOCKWISE rotation will cause midgut malrotation
LAP levels in Leukamoid reaction vs in CML?
LAP in leukamoid is normal, or increased.
LAP in CML is LOW.
Blood Smear on leukamoid reaction typically shows mature neutrophils. What are the morphological characteristics of these mature neutrophils?
Dohle bodies- blue inclusions of RER
Toxic Granules- purple, large granules.
Cytoplasmic vacuoles
Crohn’s is characterized by ____________ inflammation which predisposes it to complications like strictures, fistulas and Abcesses
Transmural
A female patient has come to you with pain and constipation after severe dieting. Heme preparation is given to her IV, and it resolves her problems. The improvement in symptoms downregulates which enzymes?
ALA Synthase is inhibited by Heme, and Glucose
Port-wine colored urine is seen in which enzyme defect and what is the condition called?
Acute intermittent porphyria, due to the defect of porphobilinogen deaminase
What is the most common porphyria? What is it exacerbated by?
Porphyria cutanea tarda, in which uroporphyrinogen decarboxylase is defective.
Exacerbated by Alcohol consumption
A patient of ATN in its maintenance phase is at the highest risk of developing?
Volume Overload, Hyperphosphatemia, Anion Gap Metabolic Acidosis
A patient of ATN, has gotten better as he develops transient polyuria after being treated. This patient is at highest risk for which complication?
HYPOKALEMIA
What is the nephrotoxic effect of ethelyne glycol?
Cause Acute Tubular Necrosis.
Two metabolites produced upon Ethylene Glycol ingestion: Glycolic acid which is directly toxic to tubules, and oxalic acid which CRYATALIZES.
Aminoglycosides, Radiocontrast agents causing ATN basically cause _________ necrosis of ____________ cells.
Diffuse necrosis of Proximal tubular cells!
IMPORTANT
What kind of urine casts are seen in ATN?
Granular, muddy brown
What does the M2 ion channel do in influenza?
In sketchy- it is represented as octopus in a shell
M2 ion channel mediates fusion of influenza envelope with endosome membrane, which liberates nucleocapsid and enzymes into the cytoplasm of host cells
Sanitizers/alchohol based disinfectants kill enveloped virus because?
Alcohol dissolves the lipid bilayer envelope of these pathogens.
Hence, do not work on naked virus.
This cytokine contributes to scar formation after injury and plays a role in fibrosis seen with chronic inflammation?
TGF-beta,
That is why it is key cytokine in development of IDIOPATHIC PULMONARY FIBROSIS
TB cavities are basically ___________ necrosis of lung tissue due to ____________________________.
TB cavitation is due to liquefying necrosis of lung tissue due to lysosomal content release by neutrophils.
Which cytokine plays key role in TB, leading to development of mature phagolysosomes capable of destroying phagocytosed bacteria?
Interferon-gamma
Why does a person taking first generation anti-histamines experiences impaired visual accommodation?
First-generation antihistamines have ANTI-CHOLINERGIC S/E.
The ciliary muscle is under P-ANS. So inhibition of this pathway by anti-cholinergic agents will limit accomodation.
(Dilated pupils, flushed cheeks, confusion, urinary retention are other common S/E due to anti-cholinergic activity)
(Qid 173)
Abacavir is associated with?
ABBA-KA-VEER
Type 4 HSR, due to direct binding of the drug to a segment on the HLA-B57:01 molecule
Which laxative has the same MOA as Senna leaves?
BISACODYL
The most important during the pathogenesis of Shigella is?
A) Mucosal invasion
B) Proliferation in lymph nodes
(You were confused while doing this in uworld)
A) Mucosal invasion via M cells the overlie the Peyer’s patches of intestines.
Lymph Node proliferation is characteristic of Salmonella Typhi and Yersnia enterolitica. They both proliferate in mesenteric Lymph nodes. Yersinia for this reason causes enlargement of lymphoid tissue around appendix and it is called pseudo-appendicitis.
What are the Myesthenia Gravis Antibodies against?
Post-synaptic Acetylcholine receptors. And because yeh antibodies haath dho ker peechay parr jaati hein inn receptors kay——-> there’s endocytosis of receptors/ receptor internalization————> causing a DECREASE in number of post-synaptic Ach receptos.
Which treatment action prevents recurrence of Genital Herpes?
Continuous daily valacyclovir.
(you did it wrong, you selected weekly long course of acyclovir during the first episode——-> but acyclovir DOESN’T APPEAR TO ALTER RECURRENCE RATES)
How do you diagnose female sexual interest/arousal disorder?
Decreased interest and decreased arousal but adequate lubrication and orgasm
Runs out of breath quickly
Chest infection
Bones hurt
Sickle cell anemia due to valine substitution for glutamic acid
What is special about Tenofovir?
Tenofovir unlike other NRTIs is a Nucleotide instead of a nucleoside, hence doesn’t require phosphorylation to be activated.
Causes nephotoxicity
How does tenofovir affect the kidney?
Tenofovir is eleminated via proximal tubular cells of the kidney. On high concentrations, tenofovir interferes with Mitochondrial DNA synthesis. This causes giant mitochondria wilhich appear as large intracytoplasmic eosinophillic inclusions seen in proximal tubular cells
There is an increased number of _____________ in freckle.
Melanosomes
Which gene mutation predisposes to Atopic dermatitis/Eczema?
Fila-ggrin.
Not in FA, one question in uworld.
What is epidermolysis bullosa?
What is the defect?
What would skin biopsy show?
Epidermolysis bullosa means bulla or blisters because of friction.
(Babies have oral blisters because of friction due to bottle feeding)
Impaired keratin assembly
Skin biopsy shows INTRAEPIDERMAL CLEAVAGE.
Location of femoral hernia?
Bulge BELOW INGUINAL LIGAMENT; LATERAL TO PUBIC TUBERCLE
XLA story?
XLA means X-linked agammaglobulinemia and has lack of B-cells
B-cells would mean bra, and bras are used to cover round stuff. So in XLA the round structure in lymphoid are missing i.e. the primary follicles and the germinal centres that inhabit B-cells are absent in this disease.
Woman above 18 can easily wear Bras, so cells missing will be the ones with markers above 18—-> CD19, CD20, CD21
What is seen in the spleen of a patient of primary myelofibrosis?
Larger islands of hematopoietic progenitor cells.
Dry tap of Bone marrow is seen in? And due to which cytokine?
Seen in myelofibrosis, due to clonal megakaryocytes secreting Tranforming growth factor Beta.
________________________ are a hallmark of asbestos exposure.
Name possible occupational exposures of asbestos? (mnemonic is dineen’s cousin working on the wall)
Pleural plaques (as well as subdiaphragmatic plaques)
Drywall workers,
Insulation manufacturers,
Shipbuilding.
Person comes to for refill of pain medication? What are you supposed to say?
You’re still experiencing a lot of pain, and it has not been easy managing it; let’s discuss how you have been taking the medication?
DON’T SAY:
It doesn’t seem like the medication is effective anymore, your pain symptoms don’t seem to be improving——> These statements prematurely shut down the conversation.
Patient sweats over a benign tumour that has already been removed. What do you say to calm him down?
I realize it can very upsetting to be told something unexpected about your health. What is your understanding of the results?
Lowest osmolarity of urine occurs in which part of the nephron?
DCT
Barr body is made up of _____________, which consists of heavily (methylated/unmethylated) DNA and (acetylated/deacetylated) histones. And hence, has (high/low) level of transcription activity
Barr body is made up of heterochromatin which consists of heavily methylated DNA and deacetylated histones. And hence, has low level of transcription activity
Pulmonary function tests for pulmonary fibrosis?
FVC?
FEV1/FVC ratio?
Expiratory flow rates when corrected for lung volume?
FVC- DECREASED
FEV1/FVC ratio-DECREASED
Expiratory flow rates when corrected for lung volume- SUPERNORMAL
Interstitial lung diseases are associated with (decreased/increased) lung elastic recoil and that is due to?
Interstitial lung diseases are associated with increased lung elastic recoil and that is due to increased radial traction
Malassezia furfur is a cutaneous fungus which causes?
Hypopigmentated skin patches.
Diffrential with Tuberous Sclerosis
Malassezia furfur on KOH scraping shows?
Spaghetti and meatballs—-> shows both short hyphae and spores
KOH preparation of biopsy of the following will show what? Sporothrix schenki Coccidiodes immitis Histoplasma? Blastomyces Cryptococcus Neoformans
Cigar shapped budding yeasts
Thick walled spherules filled with endospores
Oval bodies in macrophages, (narrow based budding-not high yield)
Broad-based budding
Narrow-based budding and is also urease positive.
Metalloproteinases are essential for?
Proper tissue remodelling during wound healing.
They degrade extracelluar matrix like collagen
Elevated levels CAMP activate __________?
Protein Kinase A
Camp lagaaanay kay liyay muscles honay chahiyay bhaeeee!!!
The patients insulin therapy such that it mimics physiological pattern of insuline release?
Insulin glargine once, plus insulin lispro before each meal
What hemotological lab is prolonged in Antiphospholipid antibody Syndrome?
Prolonged APTT that is not corrected by giving platelet-free plasma.
Which rotator cuff muscle causes abduction?
SUPRASPINATUS.
Uthaanay kay liyay super hona parrta hai
Oligoclonal bands on CSF analysis mean?
Multiple Sclerosis——>oligoclonal bands in CSF mean intrathecal production of immunoglobulins
What is the mechanism of Oligodendrocyte depletion in MS?
CD8+ cells release cytotoxic granules to injure oligodendrocytes directly.
Then B cell recruitment produces antibodies to facilitate myelin breakdown
Struvite stone, urine will be acidic/alkaline
Alkaline because produced urea gets converted to ammonia and that alkanizes urine.
Ulcers found ____________ suggest ZES.
Beyond the duedonal bulb
Test for ZES?
Serum gastrin rises in response to Secretin.
that’s not case in other conditions of hypergastrinemias
Giant Cell arteritis, how can it be diagnosed?
Raised ESR, on temporal artery biopsy——-> intimal thickening, multinucleated giant cells.
The patient is prescribed a medication for asthma, that reduces the bronchoconstriction by inhibiting the interaction of inflammatory mediators with cell surface receptos?
Montelukast, Zafirlukast.
More ghrelin produced will cause more?
BHOOK.
Straw-colored discharge from umbilicus? What the embryological cause of this condition?
Persistence of allantois remnant.
patent urachus causes urine discharge from the umbulicus
Give one example of the following types of drug reactions?
Exxagerated drug senstivity
Idiosyncratic drug reaction
Immunologic drug reaction
Predictable drug reaction( Pharmacological and Secondary both)
Pseudoallergic drug reaction
Exxagerated drug sensitivity- Azathoprine sensitivity due to deficiency of TMPT
Idiosyncratic drug reaction- UNPREDICTABLE reactions due to genetic differences, such as tmp-sulfamethoxazole causing non-immune hemolytic anemia and cellular oxidative injury in G6PD deficiency.
Immunologic drug reaction- Also unpredictable, but more of IgE mediated. Drug allergies——->includes drug induced lupus, SJS, TEN, Anaphylaxis
Predictable drug reaction-pharmacological are gastritis with COX inhibitors, bradycardia with B-blockre. Secondary are oral thrush with antibiotics.
Pseudoallergic drug reaction- Red Man syndrome with vancomycin (Non IgE mediated mast cell degranulation)
Tell 4 drug adverse affects that are of predictable pharmacological type?
Orthostatic hypotension with alpha-blocker.
Bradycardia with Beta-blocker.
Gastritis with COX inhibition.
Nausea with many drugs
Tell 2 drug adverse effects that are of predictable indirect type?
Oral thrush, or clostridium colitis after antibiotics
Phototoxicity with doxycycline
3 immunology related events happening in the germinal centres of lymph nodes?
- Isotype switching (from IgM to other types of immunoglobulins)
- Somatic Hypermutation
- Memory B and Plasma cells
Heavy chain constant regions of immunoglobulins are __________ specific, while the variables regions are ___________ specific.
Heavy chain constant regions of immunoglobulins are isotype specific,(i.e. kaunsi antibody honi chahiyay? IgG, IgA? Kaunsi waali) while the variables regions are antigen specific.
What is negative selection? And where does it occur?
Negative selection is a process that ensures that T-cells don’t bind too tightly to MHC because that would mean that the T-cell is self-reactive.
It occurs in the fetal thymus
Problems with negative selection of T-cells result in what kind of diseases?
Auto-immune diseases
What is the concept of tolerance in immunology? And where does it occur?
Tolerance is the immunologic unresponsiveness to T-cells.
It is divided into two stages.
The central stage is when negative selection occurs in fetal thymus.
Peripheral tolerance stage is by means of T-cell anergy.
VDJ recombination and VJ recombination occurs for the rearrangement of which parts of the immunoglobulins? Which rearrangement occurs first?
VDJ rearrangements occur for heavy chains.
VJ rearrangements occur for light chains.
Heavy chain rearrangements occurs always before that of light chains
Isotype switching occurs in _________________ and requires interaction of ____________ with ______________.
Isotype switching occurs in germinal centres of lymph nodes and requires interaction of CD40 receptor on B-cells, with CD40 ligand (CD154) receptor on activated T-cells
Abnormal ristocetin co-factor assay is seen in which two diseases?
How can these diseases be diffrentiated then?
Bernard Soulier and vWF deficiency.
By adding normal plasma to the solution of patient’s platelets,
If agglutination occurs- then it is vWF deficiency because PLASMA ADDED DOES HAVE vWF.
If agglutination doesn’t occur- Gp1b ka masla hai, patient kay platelets ka hee masla hai.
Which reaction is takes places by the enzyme G6PD?
Glucose-6-phosphate is converted to 6-phosphogluconate by G6PD.
(you did this wrong 3 times in uworld-sharam kerlo)
Delirium is acute onset fluctuating level of consciousness(kabhi larayi maar kutaayi, kabhi behosh) and global memory impairment can be due to?
Underlying Infection
What are the similarities between SVC syndrome and brachiocephalic obstruction?
What is the difference?
The blockage of these veins causes swelling of arm and face BOTH.
SVC however causes B/L swelling, brachiocephalic causes U/L
Obstruction of ___________________ would cause u/L arm swelling WITHOUT associated facial swelling.
Obstruction of would cause U/L facial swelling without arm swelling.
Subclavian vein/axillary vein( subclavian vein is the continuation of axillary vein)
Internal jugular vein
External jugular vein drains ___________.
Internal Jugular vein drains ____________.
External jugular vein drains U/L scalp, face.
Internal jugular vein drains U/L brain, superficial face and neck
Which of the 2 teratogenic drugs cause Neural tube defects?
One out of the two causes more? What are those teratogenic effects?
(Table in Qid507)
Valproate and Phenytoin
Phenytoin also causes orocranial cleft, nail or digit hypoplasia
Where is an atrial myxoma located?
Left atrium.
Mechanism of digoxin in heart rate lowering effects?
Digoxin slows ventricular rate by increased parasympathetic tone which leads to inhibition of AV nodal conduction.
What is seen on ECG in digoxin toxicity?
Delayed after-repolarizations via its mechanism of increasing intracellular calcium leading to ventricular tachycardia and death
What is the causative organism for osteomyelitis in a 10 year boy located 3 cm above kneecap?
Staph aureus.
There’s a uworld table, amazing
In organophosphate poisoning, which symptom will persist even after IV atropine is given?
Muscle weakness will persist unless pralidoxime is given.
Because Atropine has no effects on nicotinic receptors, hence a patient who hasn’t been given pralidoxime but only atropine will be still at risk of muscle paralysis.
Why is pneumothorax a common occurence in patients of CF?
Chronic lung damage, combined with MUCUS PLUGGING and LARGE ALVEOLAR PRESSURE SURGES(e.g. coughing) predisposes to SPONTANEOUS ALVEOLAR RUPTURE.
What is the clinical presentation of pneumothorax?
Shortness of breath,
DECREASED breath sounds unilaterally,
Hypotension and Tachycardia(YOU FORGOT THIS MOTII AND DID THE QUESTION WRONG)
Subcutaneous crepitus.
Where can a radial nerve be damaged?
(Tell 2 locations)
What will happen in case of radial nerve damage?
Stab injury at humeral midshaft,
Superficial course within the axilla.
Will cause wrist drop/extension of the wrist will be weak.
Tail is mean and is towards the direction.
What does it mean?
That a distribution curve is positively skewed when the tail is towards positive, it is negatively skewed it the tail is towards negative.
Mean is the closest to tail.
Genetic associations with Early-Onset Alzheimer’s and Late-Onset Alzheimer’s?
Early onset: APP on 21, presenilin1 on Cr 14, Presenilin 2 on Cr 1.
Late Onset Alzheimer’s is associated with Apolipoprotein E4
What happens if a transplanted liver undergoes hepatic artery thrombosis?
Liver develops a biliary tree infarction and organ failure
Stool continenxe largely maintained by internal and external anal sphincters and the ____________ muscle.
PUBORECTALIS
Person with STD, when asked about sexual partners says “Why does it matter?
What will you say as a doctor?
“I routinely ask my parents about sexual partners because it helps me fully understand what their health needs are”
(don’t say to her that it is a difficult topic to discuss because NORMALIZING SEXUAL HISTORY IS IMPORTANT)
What are the watershed areas of colon?
Splenic flexure, rectosigmoid junction.
True Diverticula and Pseuodiveriticulam examples?
2 each
True: Meckels, Normal appendix
False: Zenker Esophygeal diverticulam, diverticulosis.
What is Light-near dissociation? And occurs in which brain tumour?
It is when pupils react to accommodation but not to light.
Occurs in pinealoma causing parinaud syndrome
Pinealoma is of _________________ origin hence produces __________ causing precocious puberty in young boys.
Embryonic germ cell origin, hCG
Perinaud Syndrome is due to the compression of which part of brain?
DORSAL MIDBRAIN
Patient has acid fast bacilli in sputum, but TST is negative. Why?
Because of T-cell ANERGY, in these individuals there is impaired lymphocyte response.
And this increases the risk of disseminated TB.
Methadone is a full/partial mu-opioid receptor Agonist.
Which property of methadone allows it to effectively suppress cravings and withdrawal symptoms?
Methadone’s property of maintaining high tolerance levels had what effect on the body?
It is a FULL mu agonist.
It has a LONG HALF-LIFE, which allows it to effectively suppress cravings and withdrawal symptoms.
It blocks euphoric effects of other opioids by maintaining high tolerance levels.
Spherocytes in peripheral
Blood Smear are seen in which condition other than heriditary spherocytosis?
(you did this wrong motiii, tumhein yaad hee nahyin aa raha tha?)
Autoimmune hemolytic anemia.
Extravascular, Macrophages in spleen bite off cell membrane of RBC and it becomes spherical
Patient has feelings of intense despair and emptiness for the past week following the break-up of her month long relationship.
Since the break up she’s been engaging in unsafe sex, drinking excessively. Past history is of 2 suicide attempts. What is the most likely diagnosis?
(Seerat)
Borderline personality disorder.
(Unstable self-image, unstable relationships)
Abandonment fears and feelings of emptiness.
Inappropriate anger.
Impulsive
Self injury.
Edward’s syndrome ka sab sey strange sign?
Clenched hands with overlapping fingers, rocker-bottom feet.
Muscle biopsy shows a very low carnitine content. This patient most likely has deficient synthesis of which of the following substance?
A)Acetoacetate
B)Lactate
The answer is acetoacetate.
You were confused between the two.
But these people produce lactate normally, even more than usual during times of stress due to inability to utilize fatty acids for energy production.
Postmortem studies done in patients of ALS typically demonstrate __________________.
diaphragmatic atrophy.
Surgeon operates on the wrong side. How can this be avoided?
Have the nurse and surgeon verify the surgical site independently.
What is peculiar about Meta-analysis?
A p-value much lower, is considered.
E.g. instead of 0.05 it’ll be 5* 10^-8
Which organism causes disease in people who handle wools and hides?
Bacillus anthrax
Which pathogen cause black eschar?
Bacillus anthrax.
Bacillus produces a toxin. Which other pathogen produces the same toxin?
Pertussis.
Both produce edema factor which calmodulin-dependent adenylate cyclase——> causes increased CAMP——-> edema, suppression of neutrophils and macrophage function.
Typical filtration fraction of healthy individual?
20%
Why does cancer cause muscle loss? Mechanism of Cachexia?
TNF-alpha, IL-6 stimulate ubiquitin-proteosome pathway to degrade skeletal muscle proteins actin, myosin.
_____________ attachement of ubiquitin to muscle protein causes cancer related cachexia.
Covelant.
In which two conditions do RBCs stop producing ATP during glycolysis and why?
In Hypoxia and Chronic Anemia, for the production of 2,3 BPG. In this step, 1,3 BPG gets converted to 2,3 BPG and then to 3 phosphoglycerate, and this produces NO ATP.
Which enzyme is bypassed in RBCs in conditions of hypoxia?
Phosphoglycerate Kinase
For GFR measurement, we can use __________ or ___________ clearance. But _________ clearance (overestimates/underestimates GFR)
For RPF measurement, we can use ________ clearance. But it (overestimates/underestimates) RPF
Inulin, Creatinine.
Creatinine clearance overestimates GFR.
(Creating means making something—> Adding–> Creatinine clearance OVER-ESTIMATES GFR)
PAH, it underestimates RPF (Both RPF and PAH have P in it.)
Both PAH and Creatinine are Excreted» Filtered.
Another high-yield concept about PAH is—-> Increasing PAH excretion occurs in kidney, but its extraction ratio decreases overtime, as it is freely filtered but secretion into the tubule can be saturated because it happens via a carrier-enzyme.
Which property of a substance can be utilized to measure RPF of a kidney?
A) Excreted=Filtered
B) Excreted» Filtered
C) Excreted«_space;Filtered.
B) Excreted» Filtered,
Like PAH.
What is seen on the peripheral smear of patients with asplenia (Functional or anatomical)
Howel-Jolly bodies in RBC, the purple dot is remnant of RBC Nucleus. It is not removed in patients whose Spleen is absent or doesn’t work properly.
(Functional asplenia–> Sickle Cell disease)
A patients echocardiography reveals a REDUCED ejection fraction in the absence of heart failure symptoms. This condition is called asymptomatic Left Ventricular systolic dysfunction.
What will be the levels of Angiotensin 2, ANP and NE in this phase of heart failure?
Because the body is trying to compensate by causing vasoconstriction and, Na and water retention to maintain adequate organ perfusion despite inadequate pumping of blood.
So NE, Angiotensin 2 and ANP are INCREASED.
An early asymptomatic period is common in the progression of heart failure; ultimately it leads to cardiac remodelling leading to decompensated heart failure because of compensatory (concentric/eccentric) hypertrophy in response to ________________.
(Q id 15528)
Eccentric hypertrophy in response to LV Volume Overload
Pityriasis Versicolor/Tinea Versicolor is caused by Malassezia Yeasts, and the infection is confined to the stratum _______ of the skin.
Stratum corneum.
What is the type of opiate receptors? Eg. Mu, delta, kappa.
They are transmembrane receptors that are coupled with Inhibitory G proteins
How does Morphine cause analgesia? Mechanism?
In spine, morphine goes and attaches to Mu-receptors.
These Mu-receptors on pre-synaptic membrane, upon opiate binding cause REDUCED CALCIUM INFLUX.
These Mu-receptos on post-synaptic membrane upon opiate binding cause INCREASED POTASSIUM EFFLUX (i.e causes hyperpolarization)
Local Anesthetics (eg. Lidocaine) reduces pain transmission by ______________________, which decreases Action Potential propagation.
Blocking voltage dependant Sodium channels, which decreases Sodium Influx and hence, action potential propagation.
What is the mechanism of formaldehyde and glutaraldehyde? And where are they used?
They function by alkylating and cross-linking DNA and proteins.
They are used for sterilization of instruments that cannot withstand autoclave temperatures.
Which one out of the following is the best for antisepsis in surgical and percutaneous procedures?
Chlorhexidine-Alcohol, Iodine
And what is the paradox in it?
(It bothered you pehlay, that is why I want you to be clear about it.)
Chlorhexidene-alcohol is more effective than iodine, because Iodine causes more skin irritation and toxicity.
(However, Iodine is sporicidal but Chlorhexidene-Alcohol is not. So you might think that Iodine is better but it is not)
SuccinylCholine is given to a patient and he dies instantly goes into cardiac arrest. Cardiac Monitoring shows Ventricular Fibrillation. What is the cause?
Succinylcholine causes Severe HYPERKALEMIA.
And hence, cardiac arrythmia leading to death.
You get confused between wilsons and hemochromatosis because both cause liver cirrhosis.
What is the story to differentiate wilsons and hemochromatosis defects?
Wilson is a cop appointed for biliary excretion.
Hemochromatosis is related to iron, and increased iron intestinal absorption.
17 year old boy went to a field trip to study bats in a cave. He comes in with dysphagia, headaches and periodic agitation. But dies after developing painful spasm, progressive paralysis and coma.
What would have prevented the most likely illness?
A)Inactivated vaccine
B) Toxoid Vaccine.
The correct answer is inactivated vaccine but you did toxoid vaccine thinking of it as tetanus due to painful spasms.
(Tetanus has SPASTIC paralysis, and Rabies gives Ascending Flaccid Paralysis, however in this question bats was the only clue)
What should be done post-exposure rabies?
Rabies immunoglobulins and Rabies Vaccination Series.
Person comes with complains of dry cough, sore throat at night and epigastric pain. On esophageal biopsy, barrette’s esophagus is seen. This pt is highest risk of which of the following?
A) Adenocarcinoma
B) Squamous Cell Carcinoma
(you were confused between the two, let’s see how well you managed to remember this)
ADENOCARCINOMA.
Barret’s lead to adenocarcinoma.
And increased risk for squamous cell carcinoma is in pts who SMOKE, DRINK ALCOHOL, or have ACHALASIA.
Absolute risk reduction kay liyay kya kertay hein?
RISKS KO MINUS.
Diagnostic test for clostridium difficile?
It is known as NAAT, it is a PCR FOR BACTERIAL GENE ENCODING A TOXIN.
Which histone is outside the nucleosome core and not a part of it inside?
H1—> Number one tab hee hotay ho jabb baahar nikaltay ho toxic environment sey.
Muscles that are myoglobin rich, glycogen poor with many mitochondria?
Paraspinal and soleus.
ST Elevations in lead I and aVL, due to occlusion of which artery?
LCX
Lead I and aVL mean lateral infarction, specifically lateral aspect of left ventricle.
A nerve that passes through obturator canal has been damaged. What movement will be affected?
Adduction of thigh!
Rash that starts on face and spreads to the trunk and extremities?
Measles(Rubeola) and German Measles(Rubella).
Plasminogen activator is released as a toxin by which bacteria?
Strep pyogenes.
What is the mechanism of infectious diarrhea caused by Clostridium difficile Cytotoxin B?
Actin depolymerisation.
Major differences between IDA and Anemia of Chronic disease?
In Anemia of Chronic Disease, Hepcidin is going to be INCREASED. The anemia usually normochromic and normocytic.
In IDA, the anemia is HYPOCHROMIC and hepcidin is decreased.
A person with Pulmonary HTN will show increased or decreased levels of the following? Prostacyclin Endothelin Thromboxane NO
Endothelin and Thromboxane will be increased because they are vasoconstrictors.
Prostacyclin and NO will be decreased because they are vasodilators.
4 year old child is brought to by his parents due to asthma exacerbation. You ask about a burn mark on boy’s thigh and he says: This happens everytime I’m bad.
What do you do?
A) Contact the child protection services
B) Seek permission from the parents to interview the patients alone.
A) Contact the child protection services!!!!
Once the abuse has been disclosed, there’s no need to seek permission from parents to talk to the child alone. YOU JUST CALL UP THE CHILD PROTECTION SERVICES RIGHT AWAY.
IDA mein everything’s decreased except for 2 things?
Transferrin (TIBC) and Epo are INCREASED only.
What happens in glucagonoma?
Necrolytic migratory erythema- Lesions enlarge and coalesce, leaving a central indurated area with peripheral blistering and scaling.
And Overt Diabetes Mellitus.
Patient after waiting for two hours in the waiting room, comes to the examination room and says: I am missing work to be here.
KEEP PATIENT’S FOCUS TO THE PROBLEM THAT BOUGHT HIM HERE.
Thank you for waiting. I apologize for the delay; let’s talk about the symptoms that you have been experiencing.
Ataxia telengectasia, why is there an increased risk of sinopulmonary infections?
Immunodeficiency is primarily IgA so mucosal infections are common.
What is impaired in a patient of ataxia-telengectasia?
A patient of ataxia telengectasia is hypersensitive to _________.
Non-Homologous End joining is defective.
X-ray!
What are the important sequelae of OSA?
Systemic HTN
Pulmonary HTN and ride-sided HF.
Obesity, tonsillar Hypertrophy and ________________ are additional contributing factors for OSA.
Hypothyroidism.
Hartnup disease, 2 very peculiar symptoms?
Development of rough rash after sun-exposure.
Cerebellar ataxia that gets better with increasing age.
Patient comes to you with an acute gouty arthritis attack.
But NSAIDS are contraindicated in him due to peptic ulcer disease. What will you give him now? What is the mechanism of that drug?
Colchicine- It inhibits microtubule formation.
Schizophrenia is caused by (lack of dopamine/Excess of dopamine) in the (Mesolimbic/ Nigrostriatal/ Tubuloinfundibular) pathway.
Excess of dopamine in Mesolimbic pathway.
What will happen if there’s
1—> INCREASE in dopamine in the nigrostriatal pathway.
2———> DECREASE in dopamine in the nigrostriatal pathway.
Movement disorders such as chorea, tics.
Decreased dopamine in nigrostriatal pathway causes EPS of antipsychotics, akathisia, acute dystonia, drug induced parkinsonism.
In liver cirrhosis causing ascited, the following will be increased or decreased?
ADH Urine Na Total Body Volume Intravascular Volume Systemic Pressure Lymph formation
ADH- Increased because intravascular volume depletion due to hypoalbuminemia
Urine Na- Decreased because ADH keeps on reabsorbing that Na.
Total Body Volume- INCREASE bhae ascites hai.
Intravascular Volume- Depleted
Systemic Pressure- Decreased due to vasodilators being released.
Lymph formation- Increased.
2 substances important for coronary autoregulation?
Adenosine and NO.
What changes occur in left ventricular CO, SVR and Left atrial filling in a patient of PDA/left to right shunt?
Lef to right shunt LOWERS svr. The blood being poured from aorta into pulmonary artery causes INCREASED venous return to LA and LV. This causes increased left ventricular CO because preload bhee ziaada hai aur afterload bhee kam hai.
Aur obviously Left atrial filling pressure tou ziaada hai hee.
What happens if the nerve root in between L5 and S1 vetebra is compressed?
L5 will be compressed it will caues weakness of foot dorsiflexion.
Knee reflex and hip flexion caused by same root values?
L2 and L4
Hip flexion because innervates iliopsoas.
Superficial inguinal ring is a physiological opening jn __________________.
External oblique aponeurosis.
During orchiopexy, the malpositioned testis will most likely be pulled through with opening?
Superficial inguinal ring.
Ligation of which arteries in postpartum hemorrhage can save the person’s uterus?
Internal Iliac arteries because uterine arteries come from here.
Hyperlaxity of joints but it is not ehlor-danlos.
Big testis, what is the disease?
Fragile X
You have done this wrong so many timesss.
Ceftriaxone’s MOA is:
A) Binds to cell wall glycoproteins
B) Binds transpeptidases.
Binds to transpeptidases——> leads to cell wall instability and bacteriolysis..
Resistance to ceftriaxone, what happened?
Action of beta-lactamases
Change in protein structure.
Change in protein structure.
Qid 2111
Strep Gallolyticus causing endocarditis association?
Colonic neoplasia
Release of which neurotransmitters are impaired in a patient of tetanus?
Ach Dopamina Glutamate Glycine Serotonine.
Glycine and GABA
What should be given in PCOS to enhance fertility?
Estrogen receptor modulator CLOMIPHENE.
You selected progesteron-only pills- but they only reduce endometrial hyperplasia.
OCPS are given to those who do not wish from pregnancy—-> will reduce emdometrial proliferation and reduce androgenic symptoms
(progesterone only pills don’t reduce androgenic symptoms)
Friedrich’s ataxia patient dies from?
Hypertrophic cardiomyopathy.
HIV-aasociated esophagitis is caused by which 3 pathogens most commonly?
Candida Albicans, HSV1 and CMV.
Endoscopic and Microscopic findings of candida albicans causing HIV-associated esophagitis?
Endoscopic: Gray/White Pseudomembranes on erythamatous mucosa.
Microscopic: Yeast cells and pseudohyphae invading mucosal cells.
HIV-associated esophagitis caused by HSV is seen endoscopically and microscopically as?
HSV-1 causing eosinphilic intranuclear inclusions (Cowdry Type A) in multinuclear squamous cells at ulcer margins.
Endoscopically it shows——-> smalls vesicles turning into PUNCHED OUT ulcers
(hercules in Sketchy HSV is punching in the air)
3 lab tests that are useful to know the extent of liver function?
( Liver disease ho gayi hai, per hum jaana chaahtay hein kay liver abhi kitna kaam ker raha hai, jitnay yeh tests buray hongey liver function utna hee decreased hoga)
Impaired biosynthetic capacity of liver—-> Elevated PT, hypoalbuminemia.
Impaired transport and metabolic activity—-> Increased Bilrubin
Lab marks of liver injury vs lab markers of hepatobiliary injury?
Liver injury: Elevated transaminases.
Hepatobiliary injury: Elevated Alk phosphate, elevated gamma glutamyl transpeptidase.
What is the cause of thrombocytopenia is alcoholic liver disease?
Splenic sequestration of platelets causes thrombocytopenia.
Neonate comes with bilious emesis and andominal distension. No double bubble sign is visible on x-ray. What is the most likely location of the intestinal atresia?
The more distal the atresia, the more likely it is to present with abdominal distension rather than bilious emesis.
Jejenal or ileal atresia occur due to VASCULAR INJURY and is associated with Gastroschisis.
Jejenal or ileal atresia occur due to _________________ and is associated with __________________.
(Qid 319)
Jejenal or ileal atresia occur due to VASCULAR INJURY and is associated with Gastroschisis.
Skin tissue necrosis after Warfarin is due to?
Protein C depletion before factors 2 and 10 deplete, so hypercoagulobility causes SMALL VESSEL MICROTHROMBOSIS.
Immediate reversal of warfarin overdose can be done by?
Fresh Frozen plasma or PCC
Which test is done to keep a check on warfarin dosing?
INR which is a fraction of patient PT to standardized PT.
What kind of rash can you expect after Group A strep pharyngitis?
Scarlet Fever Rash.
It begins on the neck, armpit and groin. It begins as SCARLET SPOTS OR BLOTCHES GIVING A BOILED LOBSTER APPEARANCE.
Then it progresses to rest of the body and starts looking like sunburn with goosepimpls/sand paper like rash.
Area around mouth is spared- called circumoral pallor.
Bright red tongue- STRAWBERRY TONGUE.
Possible complication of scarlet fever?
Rheumatic fever and PSGN.
Strawberry tongue is seen in which 2 diseases?
In uworld, strawberry tongue has been written as BRIGHT RED TONGUE.
Kawasaki and Scarlet fever.
Kawasaki and Scarlet fever both have polymorphous—-> desquamting rash. And both have strawberry tongue. Both present with fever.
But what is another dermatological manifestation of Kawasaki that is absent in Scarlet fever?
Bilateral conjuctival injection in Kawasaki disease.
What is the most dreaded complication of Kawasaki disease?
Coronary artery aneurysm
Rash appears once fever subsides?
Roseala infantum caused by HHV6
and Parvo Virus B19.
How does pulmonary malignancy cause abnormal new bone formation?
(Qid 19443)
This is called hypertrophic osteoarthropathy.
Normally, megakaryocytes released from BM go to pulmonary circulation, where fragmentation releases platelets into the bloodstream.
In Pulmonary adenocarcinoma, the AV shunting allows megakaryocytes to bypass the lungs and enter bloodstream without fragmentation. Upom lodging in the peripheral tissues, they release PDGF and VEGF leading to fibrobascular hyperplasia and bone formation.
An increase in which of the following os expected at the peak of exercise exertion?
A) Arterial Blood Mean CO2 content B) Arterial Blood Mean O2 content C) Physiological Dead space D) Venous Blood Mean CO2 content E) Venous Blood mean O2 content.
The correct answer is that there will be an INCREASE IN VENOUS BLOOD MEAN CO2 CONTENT.
Arterial O2 and CO2 contents remain constant even during intense exercise.
HLA class 1 protein associated with with disease?
HLA-B27 associated with seronegative spondyloarthropathies.
What are class 2 HLA proteins? What are the diseases associated with it?
HLA class 2 proteins are D alleles. They are expressed by APC (Class 1 HLA are expressed by all nucleated cells). HLA class 2 present foreign antigens to CD4+ helper T cells, whereas class 1 present foreign antigens to CD8+ cells.
Diseases that class 2 HLA proteins are associated with are RA, Type 1 DM and celiac disease, hashimoto thyroiditis.
Pulmonary Embolism, High altitude hypoxemia, early salicylate overdose causes respiratory (acidosis/alkalosis)
RESPIRATORY ALKALOSIS.
Musculocutaneous nerve damaged, which area of the arm will lose sensation?
Lateral forearm.
Decompensated Heart failure——> pitting edema, decreased cardiac output, apical impulse is palpated in the 6th intercostal space.
What will be increased in this patient?
Arteriolar resistance
Stroke volume
Mixed Venous O2 content.
Arteriolar resistance—-> In HF, body tries to compensate reduced cardiac output by vasoconstriction.
Person with sickle cell anemia gets black stones in Gall bladder, what is the cause?
Increased efflux of bilirubin into bile causes supersaturation bile—-> Black pigment stones formed.
Happens due to chronic hemolysis in Sickle cell anemia and Spherocytosis.
In a patient of VSD, the oxygen saturation will be increased/decreased or normal in the following, as compared to a normal person.
RA RV LA LV Systemic circulation.
The O2 saturation will only increase in RV, in all of the other places it will be normal/same as other people without VSD.
5 year old boy plays with dolls. Father wants to know is it normal?
What will you say?
I hear your concern; let me reassure you that many boys play with dolls as a normal part of exploring the world
Or
I understand your concern, but at his age jt is best to allow him to play freely.
I hear your concern; let me reassure you that many boys play with dolls as a normal part of exploring the world.
Not the other one, because that doesn’t satisfy father’s distress.
Urine dipstick for a 28 year old pregnant woman reveals no blood or leukocyte esterase but is positive for protein. What is the cause?
Increased GFR is one of the many renal adaptations in Pregnancy.
Increased GFR allows increased leakage of protein into the tubular lumen.
Pregnancy, trace proteinuria is normal. What should be the limit?
Less than 300 mg/ 24 hours.
Renal Adaptations in Pregnancy?
INCREASED GFR, RPF, CREATININE CLEARANCE, capilary hydrostatic pressue.
Decreased Serum Albumin (Because of trace proteinuria), capillary oncotic pressure.
Arteriolar Dilatation.
PCWP is only raised in two conditions?
Cardiogenic Shock and Cardiac Temponade.
Cardiac Index is INCREASED in only one type of Shock?
Sepsis/Anaphylactic shock of Distributive Shock.
Upward Gaze Palsy can be caused due to Hydrocephalus causing dilation of the 3rd Ventricle with compression of __________ midbran (eg ___________, _______________)
Dorsal Midbrain (Superior Colliculus, Pretectal Area)
Drug given for the reversal of Atropine Overdose?
Physostigmine.
you did Neostigmine, which is wrong because it doesn’t cross BBB
Neisseri Gonorrhea can be cultures on Thayer- Martin VCN (Enriched/Selective) Medium.
Selective.
Example of Enriched Media is when Factor 5 and 10 are added to a medium for Hemophilus Influenza.
Biofilm’s other name is?
Extracellular polysaccaride Matrix.
Ankylosinh Spondylitis pain is worse when?
Worse with rest (Overnight and in the morning)
Elastin property of stretching can be attributed to?
Interchain cross links involving Lysine.
SVR and CVP in anaphylaxis are?
SVR is DECREASED.
CVP is DECREASED
Inhaled anesthetic hepatotoxicity will affect which lab value of a patient?
PT
not serum albumin because this damage is acute and Half life of Albumin is 20 days
What is the affect of metformin on the following?
Increased/Decreased/Unchanged
Hepatic Gluconeogenesis
Muscle Glucose Uptake
Endogenous Insulin Production
Hepatic Gluconeogenesis- Decreased
Muscle Glucose Uptake- Increased.
Endogenous Insulin Production- Unchanged.
Right-Sided Colon/Ascending Colom cancers manifest as?
Irom Deficiency Anemia.
Left side Colon Cancer manifest as?
Vs Irratable Bowel Syndrome’s manifestation?
Abdominal distension, nausea and constipation.
Constipation alternating with Diarrhea.
Hematochezia caused by cancer in intestine. What is the specific location of the tumour?
Rectosigmoid Cancer
Colon Adenomas occur due to which mutation?
K-ras
The change from normal colon to hyperproliferative epithelium occur due to which mutations?
APC inactivation, B-catenin accumulation.
Cells responsible for synthesising fibrous cap of an artheroma?
Smooth Muscle cells.
Neurophysins are?
Chaperone molecules for ADH and oxytocin. Move them from nuclei to posterior pituatary.
Congenital Hypothyroidism kay signs/Symptoms?
Barra bacha—-> Umbilical hernia, protruding tongue, enlarged fontanelle, pot-bellied
Slow kid—-> cries less, HYPOTONIC.
Constipation.
VSD vs ASD murmur?
VSD causes holosystolic murmur best heart at LLSB.
ASD causes systolic ejection murmur at LUSB (Pulmonic Flow Murmur)
Which nephrotic syndrome is characteristic of antibodies to Phosholipase A2 receptor?
Membranous Nephropathy.
T-Cell dysfunction after an event leads to an INCREASE in Interleukin-13, results kn which nephrotic syndrome?
Minimal Change disease secondary to lymphome (Cytokine mediated damage results in effacement of Podocytes)
Renal Cell Carcinoma orginates from which cells?
PCT cells
What is protective against Ovarian cancer?
OCPS, Breastfeeding, Multiparity
Polyarteritis Nodosa causes what kind of pathology in arteries.
(you hint is in the name)
Transmural inflammation of the arterial wall with fibrinoid necrosis,
In uworld it was written as Fibrinoid degeneration of the vessel wall with luminal narrowing.
Medium vessel vasculitis
Angiolipomas are associated with which disease?
Tuberous sclerosis.
Which is also associated with subependymal hamartomas
Sturge-Weber syndrome is a rare congenital vascular disorder characterized by ___________ and __________ malformation.
Sturge-Weber syndrome is a rare congenital vascular disorder characterized by a facial port-wine stain and leptomeningeal capillary-venous malformation.
(Anamoly of neural crest derivatives)
Neural Crest Cells
> Stain positive for S-100 (Schwannoma, Melanoma, Langerhan Cell histiocytes)
Articopulmonary septum and part of endocardial cushion are formed when neural crest cells migrate here.
Adrenal Medulla, Chromaffin Cells, Pheochromocytoma.
Neuroblastoma (N-myc gene amplification)
Hirschsprung disease (Due to failure of neural crest
cell migration. Associated with loss of function
mutations in RET)
PNS, Schwann Cells, Melanocytes (Schwann’s penis is dark)
Leptomeninges—–> Arachnoid and Pia Matter, that is affected in Sturge Webber Syndrome which is a disease of anomalous neural crest derivatives.
Treacher-Collins Syndrome. (Neural Crest cells make skull bones)
Sensory nerves are derived from neural crest cells.
Mitral Stenosis mnemonic?
MS—> Medical school kay MS are always angry and RUMBLING (Diastolic rumbling murmur), and they SNAP. (S2 to opening snap time tells the severity of the disease)
Snap preceeds the murmur (Snap is heard when Mitral valve opens)
Aortic Regurgitation mnemonic story?
Aortic Regurgitation is a lesbian (Murmur heard at LSB), who is blowing a dick (Blowing Decrescendo Murmur), widened pulse pressure because SV is increased (Wide mouth), head bobbing, rapid carotid distension and collapse, rapid rise and fall.
Associated with Marfans Syndrome and Ascending aortic aneurysm (ascends while blowing)
Aortic stenosis story?
AS is an ASS because he comes late (late peaking murmur means severe disease), rejects you ( systolic ejection murmur—> it is also seen in ASD, pulmonic stenosis, HCM).
Crescendo-decrescendo murmur (changes behaviour/attitude).
Goes to neck (Radiates to carotids)
P.Vivax and P.Ovale blood smear findings and treatment?
Schizonts seen in the liver. Schizonts are just cells full of merozoites. For Schizonts, mefloquine should be given for 8-30 days even after coming back from the trip.
Schuffner’s stippling/Schuffner’s dots/Schuffner’s granules—> Trophozoite containing RBCS, Schizonts–> RBC cytoplasmic inclusions.
These parasites also have HYPNOZOITES—-> For that, give Primaquine.
Oral Budesonide’s MOA?
Qid 18802
Inhaled budesonide is the same as fluticasone—> Inhaled corticosteroids are the first-line agents in CHRONIC ASTHMA.
But what about Oral Budesonide?
It is a glucocorticoid ( like prednisone, but doesn’t have high first pass metabolism like other glucocorticoids because it has a high topical potency.)
MOA of glucocorticoids is—-> Attach to a CYTOSOLIC receptor rather than a cell surface receptor. The glucocorticoid-receptor complex can then translocate into the nucleus, bind to the relevant DNA regions, and cause a tissue-specificalteration in transcription. In immune cells, the effects of glucocorticoids include inhibition of proinflammatory transcription factors such as nuclear factor-kappa-B (NF-κB), which results in reduced expression of cytokines and inflammatory mediators (eg, TNF-alpha) along with decreased immune cell survival and propagation.
