Wrong Answers Flashcards
1
Q
folate deficiency in dividing cells causes what
A
dna breaks and apoptosis due to imparied thymidine synthesis see page 79 FA SUPPLEMENT THYMIDINE
2
Q
what to supplement in folate deficient dividing cells
A
thymidine
3
Q
fibrillin 1 deficiency leads to
A
marfan synfrome. it acts as scaffold for elastin and abudant in zonular fibres of the lens periosteum and aortic media. cause of death mosly CVS like aortic rupture
4
Q
malignant tumors of parotid fland cause
A
ipsilateral facial droop by involving facial nerve. it exits stylomastoid foramen and inn muscles of expression.
5
Q
intracranial hemorrhage in new born due to
A
vit k deficiency clotting factOrs gamma carboxylation if vit k given im then maybe due to trauma or abuse.
6
Q
where does class switching of IG by B cells happens and how
A
germinal center of lymph nodes. initiall all igm later igg. cd40 b cell with cd40l of t cell. see page 195 and notes on B cell
7
Q
how do osteocytes connect to each other
A
long intracanalicular processes via GAP JUNCTION see note attached to pag 438
8
Q
which aortic arch does carotid artery come from
A
3rd see page 569
9
Q
how does strep pneumoniae become virulent
A
TRANSFORMATION. picks up Dna after cell lysis and acquires capsule to become encapsulated and virulent. same with shine bact
10
Q
K channels in pancreatic b cells inactivated by
A
Atp
11
Q
increasing maternal age resuLTS in which chr. abnormality
A
NONDISJUNCTION downs 21 edward 18 patau 13
12
Q
anti histone and anti nuclear antibodies seen in
A
Drug induced lupus due to SHIPP drugs. mostly hydralazine and procainamide. anti histone specific, anti dsdna with sle.
13
Q
rash on cheeks followed by lacy reticular rash on whole body. which blood cell is attacked
A
erythrocyte precursor cells of bone marrow. parvovirus b19. erythema infectiosum. attach to blood group P antigen called globoside.
14
Q
obesity, menstrual irregularities and hirsutism with infertility
A
PCOS diff from CS pg 591
15
Q
clinical features of acute salicylate intoxication
A
fever tinnitus tachypnea
16
Q
ABG in salicylate intox
A
mixed resp alkalosis met acidosis. PH n range as both processes opp. Paco2 is lower than expected compensation value d/t resp alk and hco3 is low d/t met alk
17
Q
neurokinin 1 receptor clinically useful how
A
present in area postrema 4th ventricle (CTZ) and NTS in medulla resp for vomiting. used when ondasetron 5ht3 and D2 antagonists like Metoclopramide are innefective. Drug is Aprepitant which blocks these NK1 receptors and prevents substance P release see notes
18
Q
rat poison toxicity rx
A
contains superwarfarin treat with FFP plus Vit K to reverse anticoagulant activity leading to GI bleed and ecchymoses
19
Q
Rash on leg tt with Antibiotics 3 weeks back followed by eDema proteinuria hematuria
A
PSGN with deposition of immune complxes on epithelial side on BM as humps. lumpy bumpy and starry sky app. conplexes are igg igm and c3.
20
Q
Hepatocytes With epinephrine metabolites
A
DUBIN JOHNSON syndrome due to defect in canalicular.transport leads to BLACK LIVER
21
Q
bee sting followed by central pallor and peripheral erythema
A
wheal abd flare type 1 HSN due to histamine protease and leukotrienes
22
Q
Hyperammonemia with elevated urinary orotic acid
A
Ornithine Trans Carbamoylase deficiency. diff from UMP synthase deficiency where there is no Hyperammonemia But megaloblastic anemia
23
Q
types of dissociative disordera
A
dissociative identity disorder, depersonalization derealization disorder and dissociative amnesia
24
Q
pulmonary embolism in pt taking warfarin
A
may be due to cyp450 inducers like pheny phenobarb and rifampin
25
bleeding in pt taking warfarin due to atrial fibrillation
may be due to amiodarone as its a cyp450 inhibitor which increases warfarin and causes bleeding. also cimetidine and tmp smx by same mech and aspirin and indomethacin as they are antiplatelet
26
renal blood flow calculation
Rpf is urine PAH x urine Flow rate / plasma PAH and RBF us RPF / 1 - HCT
27
abcense of sertoli cells in genetic male
male external genitalia and both female and male internal genitalia page 571. female parts develop frol.mullerian duct
28
right numbness paraesthesia leading to generalized tonic clonic siezure
left prinary somatosensory cortex aka left post central gyrus affected by stroke? leading to focal siezure which eventually spreads and becomes GTCS
29
recent bacteremia followed by back pain fever neurological signs
vertebral osteomyelitis do mri spine and blood culture. porbably staph aureus or CONS due to intravascular catheter etc.
30
hormone which is mahorly activated by gastric acid and only serves to neutralize it and decrease it
Secretin released by S cells of SI releases HCO3 rich fuild from pancreas and decreases gastric H+ . No effect on acinar cells which are under CCK even that increases pancreatic enzymes and hco3
31
Dapsone use and adverse effect
Used for.leprosy and pneumocystis prophylaxis in HIV when Cd4 below 200 and pt allergic to TMP SMX. Adverse effect is G6PD def. so pt should be screened prior to starting.
32
bug causing meningitis and Cephalosporin reistant
Listeria. Others are atypicals like chlamydia and Mycoplasma, MRSA and enterobacter. Causes Neonatal Meningtis as can spread through placenta and vagina. use ampicillin to treat
33
Fluid retention wt gain edema CHF due to which antidiabetic drug
GLITAZONES. PPAR intracellular nuckear receptor binders which influence transcription to increase insulin sensitivity and adiponectin which inceeases fatty acid oxidation
34
if mother comes from population where carrier freq is x and father is 4m pop where its y what are chances that son will suffer from AR dis
1/4 xy
35
wc antifungal binds to squalene epoxidase
terbinafine used for dermatophytoses esp onchomycoses. prevents lanosterol synthesis
36
umbillical hernia with clear fluid from umbilicus and erythema around it
patent urachus which is remnant of allantois which connects fetal bladder to umbillicus. urachus obliterates at birth.
37
Turner Syndrome Ovaries
OVarian dysgenesis. streak ovaries. primary amenorrhea.
38
serum sickness caused by which drugs
protein drugs like MAB infliximba rituximab and antitoxins or non protein drugs like penicillin cefaclor tmp smx
39
Type 3 HSN Serum sickness M/E
small vessel vasculitis with fibrinoid necrosis due to immune complex deposition and neutrophil deposition
40
Type 3 HSN serum sickness blood picture
hypocomplementemia decreased c3 and neutropenia
41
branch of external illiac which goes upwards
inf epigastric artery which supplies lower abd wall along with deep.circumflex artery. this is before inguinal ligament as after inguinal ligament ext iliac continues as femoral artery. also inf epigastric forms border of hasselbach triangle.
42
Anemia caused by Isoniazid
Sideroblastic anemia also due to b6 def alcohol copper def inherited lead poisoning. see ring sideroblasts which stain with Prussian blue on pbf. inhibition of ala synthase.
43
tt of panic disorder
immediate By bzd long term by SSRI SNRI. avoid bzd in pt with history of substance use.
44
fetal hypoglycemia of diabetic mother due to
B cell hyperplasia in fetal pancreas in response to high glucose from mothers blood which leads to high fetal insulin causing hypoglycemia macrosomia and hypertrophic cardiomyopathy
45
Metformin side effect
lactic acidosis wirh increased risk in renal ds old pt CHF pt and Alcoholics. metformin inhibits ETC comPlex 1 to Decrease glyconeogenesis and increase glucose uptake for glycolysis which leads to increased lactic acid.
46
Aspergillus appearance on M/E
thick septa and branch at acute angles forming V shaped Hyphae
47
Waterhouse Freidrichson Syndrome due to
N. Meningitidis causing meningococcimea sepsis presents as bilateral adrenal hemorrhage and insufficiency fever DIC and shock
48
Pacemaker cells diff from myocytes
funnt current due to sodium influx in phase 4 which lead to rapid calcium influx in phase 0 and potassium efflux in phase 3
49
Bleeding in Patient of Crohns disease
Due to malabsorption of bile acids which are reabsorbed from terminal ileum. leads to deficiency of fat soluble vitamins like vitamin k which can cause hemarthrosis ecchymoses and bleeding disorder
50
Elastase in Lungs secreted by
Macrophage lysosomes and Neutrophil azurophilic granules. Macrophage Elastase inhibited by TIMPs tissue inhibitor of metalloproteinases and Neutrophil Elastase inhibition by serum a1 at
51
what is the best parameter for answering the question "given my risk factors and negative test what are the chances that i really dont have this disease"
negative predictive value as it varies inversely with pre test probability.
52
calcified aortic valve is what calcification
dystrophic calcification. occurs in clearly due chronic hemodynamic stress and atherosclerosis which both lead to cell damage and necrosis leading to dystrophic calcification
53
Hypocretin 1 levels of CSF associated with
Narcolepsy. Other features are sleep paralysis daytime sleepiness. Cataplexy. REM latency less that 15 minutes. Treat with amphetamines and modafenil
54
Coiled glans with tortuous arteries. cells with vacuoles secreting glycogen mucous. edematous stroma with gland stroma ratio 1:1 seen in which phase of menstrual cycle
Secretory phase from 15 to 28 days under effect of progesterone
55
Pharmacotherapy for generalized anxiety disorder
SSRI SNRI fiRST line. second line buspirone and TCAs. Avoid BZD except acute anxiety
56
Fungal Infections in febrile neutropenia.
Febrile neutropenis fever plus less than 500 neutrophils due to Chemotherapy, Radiotherapy , aplastic anemia, SLE. Most common infection with gram positive but may if PROLONGED then viral and fungal esp aspergillus causing lung infection
57
Downs syndrome CNS complication
Early Onset Alzheimer due to Amyloid Precursor protein coded in chromosome 21. So there are 3 copies of this protein therefore leading to early onset Alzheimer. Amyloid precursor protein forms amyloid beta plaques and tau protein forms neurofibrillary tangles.
58
Depressive patient having sexual side effect with Ssri what to give next
BUPROPION which is now first line for depression and smoking cessation. It inhibits reuptake of NE and DA and can act as stimulant so use in Pt with low energy and hypersomnia.
59
Most common enteric parasite
GIardia with multinucleate cysts and trophozite can cause diarrhoea flatulence malabsorption of fat with steatorrhea and normla diarrhoea in campers and hikers. Treat with metronidazole.
60
Spleen derived from
MESODERM : Mesenchymal cells of dorsal mesentry. rest git from endoderm
61
Irregular uterine enlargement with constipation
UTERINE FIBROID mostly subserosal. Pelvic pressure and pressure on colon due to posterior location which may be relieved by manual deflection called splinting
62
MIFEPRESTONE USE AND WHY
termination of pregnancy as it is anti progesterone and binds to receptors with greater affinity cancelling the hormones action leading to apoptosis necrosis and shedding of uterine decidua. Used with miso as it is a pge1 analog which contracts uterus and expels conceptus.
63
MIFEPRESTONE USE AND WHY
termination of pregnancy as it is anti progesterone and binds to receptors with greater affinity cancelling the hormones action leading to apoptosis necrosis and shedding of uterine decidua. Used with miso as it is a pge1 analog which contracts uterus and expels conceptus.
64
Painful genital ulcer with great exudate inguinal lymphadenopathy ragged borders
Chancroid caused by hemophillus ducreyi. It is so. Painful do u cry
65
NITRATE THERAPY ADVERSE EFFECTS
Hypotension Flushing headache reflex tachycardia
66
Blowing holosystolic murmur seen in
Mitral regurgitation which us early valve disease in RHD and presents in first few decades. In middle age it becomes mitral stenosis and older Pt presents with mixed mitral disease with both stenosis and regurg
67
Cavitary lesion with air fluid level in right Lower lobe in alcoholic. Cough with greenish sputum foul smelling.
Lung abscess due to aspiration pneumonia by aspiration of anaerobic bacteria from. Gingivostomal Sulcus like bacteroides fusobacterium peptostreptococcus.
68
Infant with hepatosplenomegaly neurological regression of developement and cherry red spot on macula
NIEMANN PICK DS. due to deficiency of sphingomyelinase leading to accumulation of sphingomyelin with foam cell lipid laden macrophages.
69
Diabetes insipidus following trauma. Which structure injured.
Head trauma may lead to injury to hypothalamus and pituitary. If only pituitary then axons will regenerate and after a while adh levels will be normal. Hypothalamus injury leads to permanent di.
70
Hyoid and stapes from which arches
Greater horn of hyoid from 3rd lesser horn from 2nd. Stapes : from 2nd vs malleus and incus from 1st
71
Primary amenorrhea with normal secondary sexual characteristics. Cyclical pain without menses and bulge from vagina and mass anterior to rectum.
HEMATOCOLPOS due to imperforate hymen which may be due to release of mucus as a child under influence of maternal estrogen
72
Stimulus control methods for treatment of insomnia
Use bed only for sleeping and sex. Go to bed only when sleepy and if can't sleep for 20 minutes leave and go to diff room. Have fixed wakeup time even on weekends.
73
Most common cause of community acquired pneumonia in adults
STREP PNEUMONIA in all immunocompetent patients who's CD 4 is more than 400 even if hiv positive. Mycoplasma most common in young adults like school college students and military recruits but it causes atypical pneumonia.
74
Bicuspid aortic valve with
Turners syndrome may be associated with coarctation and may lead to stenosis or regurgitation later. Non stenosis valve presents with systolic click over 2nd right intercostal space.
75
Resting membrane potential due to
High k conductance and some Na conductance
76
Pituitary adenoma hormone level changes
If Prolactinoma : Low Gnrh with low FH LSH and therefore low products like testosterone. Also presents with bitemporal hemianopia
77
Different durations of action of human recombinant insulins
Ultra short 4 hours due to no hexamers used for post Prandial. Short acting regular 8 hours used for DKA. INTERMEDIATE NPH combined with Zinc and Protamine 16 hours. Glargine 24 hours as has fatty acid chain which binds to albumin. Detemir more than 24 hours due to low ph and microppt formation
78
Attributable risk and AR percentage
AR is probability in exposed minus probability in unexposed. Divide by probability in exposed and multiply by 100 to get AR percent
79
Role of propranolol in thyrotoxicosis
Inhibits peripheral conversion to t3 and blocks sympathetic over activity
80
Brown fat location and function
Around scapula clavicle kidneys etc. Has increased mitochondria and increased fat with thermogenin protein to uncouple oxidative phosphorylation leading to heat production
81
Test which uses antibodies to detect a target protein
Western blot used for detection of hiv after Elisa
82
Inner zone of kidney is
Medulla with chromaffin cells which are modified postganglionic cells stimulated by Ach through preganglioni fibres.
83
Frameshift mutations affect
Both mRNA and Protein whereas single base mutations like silent, missense, nonsence only affect Protein but wont show as base differences in mRNA
84
Frameshift mutations are what
Deletion or addition of a number of bases that is not divisible by 3 : NON FUNCTIONAL PROTEIN eg : Duchenne Muscular Dystrophy / Cystic Fibrosis (CFTR)
85
Doxorubicin most imp side effect
Dilated Cardiomyopathy due to formation of FREE radicals which presents as L/R HF
86
How will intestinal malrotation present in a baby
Intestinal malrotation results when the midgut undergoes incomplete embryological counterclockwise rotation (usually 270) . It can present as intestinal obstruction leading to bilous vomiting in first few days of life (due to compression by the adhesive bands called Ladds bands which are between CAECUM which is now in RUQ and its original position in the RLQ retroperitonuem) and midgut volvulus (intestinal ischemia due to twisting around the blood vessels).
87
Dobutamine acts via which signalling pathway
activates B1 leading to Gs activation and incr. cAMP and incr. Calcium leading to contractility
88
Left shift of Hb O2 dissociation curve?
A left shift of the hemoglobin oxygen dissociation curve indicates increased hemoglobin O2 affinity and can be caused by increased pH, decreased 2,3-bisphosphoglycerate, and decreased temperature. A leftward shift of the oxygen-dissociation curve means that O2 is relatively less available to tissues.
89
Difference between Acute Stress Disorder and PTSD
Same symptoms like nightmare, flashbacks and hypervigilance but PTSD has to last for more than a month whereas Acute Stress is less
90
Statins effect on hepatocytes
Increase LDL receptor density to increase uptake of LDL by liver
91
Blood loss in menstruation protects against
Hemochromatosis. Happens later in women due to iron loss through pregnancy and menstruation
92
DIff between minute ventilation and alveolar ventilation
Minute ventilation is equal to the product of tidal volume and respiratory rate and includes dead space ventilation. Alveolar ventilation is equal to the product of respiratory rate and the difference between tidal volume and dead space volume.
93
Ant Cerebral Artery infarct causes
The anterior cerebral arteries supply the medial portions of the 2 hemispheres (frontal and parietal lobes). Occlusion can cause contralateral motor and sensory deficits of the lower extremities, behavioral changes, and urinary incontinence.
94
When duodenal ulcers bleed which artery is affected
The gastroduodenal artery lies along the posterior wall of the duodenal bulb and is likely to be eroded by posterior duodenal ulcers. Ulceration into the gastroduodenal artery can be a source of life-threatening hemorrhage.
95
Metabolic picture at high altitude
High altitude exposure results in hypoxemia with respiratory alkalosis. Over a course of a few days, chronic respiratory alkalosis sets in, with a corresponding decrease in the serum bicarbonate level reflecting renal compensation.
96
Organisms causing esophagitis in HIV Pt
CMV (linear ulcers), HSV (eosinophilic inclusions), Candida (white adherent membrane with yeast cells, pseudohyphae)
97
Calculation of Number needed to treat
1/Absolute Risk Reduction
98
Fulminant Hepatitis in Pregnant Women
Hep E
99
Arrhythmias post MI and t/t
ventricular premature beats, ventricular tachycardia, ventricular fibrillation . Premature beats do not require any specific therapy. Intravenous amiodarone is generally considered the drug of choice in such a setting, with intravenous lidocaine as a second-line agent
100
Best indicator of severity of MR
Presence of s3 gallop
101
Role of KINESIN molecule
Kinesin is a microtubule-associated, ATP-powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals.
102
MATCHING in studies eliminates which bias or error
CONFOUNDING
103
Holoprosencephaly defect and reason
ocular hypotelorism, cleft lip/palate, single midline eye, primitive nasal structure or proboscis, mid facial clefts
trisomy 13, sonic hedgehog gene mutations and environmental (eg, maternal alcohol use) factors.
104
Absent thymic shadow in
Both DIgeorge and SCID. Severe combined immune deficiency is characterized by combined T and B cell dysfunction. It is a life-threatening condition that presents in infancy with mucocutaneous candidiasis; persistent diarrhea; and failure to thrive. Laboratory findings include absent T cells and hypogammaglobulinemia. The thymic shadow is not usually present due to severe T cell deficiency.
105
What happens in pulmonary vessels when there is hypoxia
The pulmonary vascular bed is relatively unique in that tissue hypoxia results in a vasoconstrictive response (other organs there is vasodilations). It is to divert blood flow away from underventilated regions of the lung toward better-ventilated areas.
106
Which other enzyme deficiency will be exactly like G6PD
Glutathione reductase deficiency as its absence results in an inability to utilize NADPH to reduce glutathione.
107
Pulmonary Capillary Wedge Pressure is an indicator of
LA pressure and Left Ventricle End Diastolic Pressure
108
When is PCWP increased
Mitral Stenosis as it leads to increased LA pressure and pressure diff between LA and LV during diastole
109
Difference between Mood disorder with Psychosis and Schizoaffective disorder
Two weeks of schizophrenic symptoms WITHOUT mood symtpoms
110
Duchenne Muscular Dystrophy is what type of gene defect
frameshift or nonsense mutation resulting in defective dystrophin gene
111
Methoterexate S/E
Methotrexate preferentially inhibits growth of rapidly dividing cells which also causes toxicity to tissues with rapid cellular turnover, such as oral and gastrointestinal mucosa (ulcerations), hair follicles (alopecia), and bone marrow (pancytopenia). Methotrexate can also cause hepatotoxicity (hepatitis, fibrosis, cirrhosis) and pulmonary fibrosis.
112
Which virus contains an RNA and DNA dependant DNA polymerase
Hep B which uses it to complete the dsDNA after entering the cell and then synthesising fresh dsDNA from mrna synthesised in the cell
113
Somatostatinoma pt have Biliary stones why
Due to inhibition of CCK. Other features are hyper hypoglycemia and steatorrhea
114
Angiotensin 2 is synthesised where
in small vessels of the lungs therefore its levels are high in pulmonary vein vs pulm artery
115
S/E of inhalation anaesthetics
Almost all volatile anesthetics increase cerebral blood flow. It is an undesirable effect as it results in increased ICP. Other important effects of inhalation anesthetics are myocardial depression, hypotension, respiratory depression and decreased renal function.
116
Stenosis of subclavian artery before it gives off verterbral artery leads to
Sublaclavian steal phenomenon as contralateral verterbral artery starts giving blood away from bransteam to the ipsilateral (stenotic side) verterbral artery leading to dizziness or syncope along with arm pain fatigue parasthesia. precipitated by arm exercise.
117
Carbidopa addition to Levodopa increases which side effect
Central side effects of dopamine like anxiety agitation etc. but it reduces other side effects like postural hypotension, arrhythmia and most common nausea and vomiting.
118
Meiotic non disjunction usually happens in which parent and in which stage
Maternal, during MEIOSIS 1 so that child gets total 3 copies, one from father and 2 from mother and those 2 copies are DIFFERENT vs. MEIOSIS 2 (less common) in which both maternal copies will be SAME
