Deck 3

Question 1

what prophylaxis drug in preventing Pre-eclampsia and it’s complication ( post partum hemorrhage) in pregnancy?

Answer 1

Aspirin 150 mg nocte - start end of first trimester - 12th week

Question 2

In pre-eclampsia what is the pathogenesis?

Answer 2

sFLT (anti-angiogenic) is very high - VEGF/PIGF (platelet growth factor) is low = endothelial dysfunction

Can use PIGF test to check

Question 3

Nausea and vomiting of pregnancy (NVP) versus Hyperemesis gravidarum?

Answer 3

NVP - mild to moderate disease

HG = severe + electrolyte abnormalities + 5% weight loss

Question 4

Prophylaxis against clots in subsequent pregnancy if?

Antenatal and post-partum period?

Answer 4

Antenatal + post-partum

• Anti-Thrombin III deficiency
• Previous VTE - inc. ESTROGEN PROVOKED

otherwise after pregnancy

Question 5

Prednisolone in pregnancy if given before 8th week?

Answer 5

Cleft palate

Question 6

Peri-partum cardiomyopathy pathogenesis?

Answer 6

Oxidative stress by prolactin fragment ( cardiotoxic) - Cathepsin D cleaves prolactin

Question 7

Obstetric cholestasis versus intrahepatic cholestasis of pregnancy

Pathogenesis?

Answer 7

ICP - Bile acids > 40 = Delivery at 39/ 40 weeks

OC = Bile acids > 100 = Delivery at 35 weeks if not stillbirth!

Estrogen disrupts bile acid flow into hepatic canaliculi - Mom’s bile acid flows into fetus instead

Question 8

Swansea criteria to dx what?

Answer 8

Acute fatty liver of pregnancy

Question 9

Calcium intake to prevent Pre-eclampsia?

Answer 9

Only in low baseline dietary calcium intake

Question 10

Steroids can cause immunosuppression - how?

Answer 10

Inhibit cytokine transcription factors
Inhibit IL1, TNF-a = macrophage dysfunction
Inhibit IL2 and thus Th1 differentiation- no T cell
Inhibit IL5 - no eosinophils

Question 11

what medications induces hyperkalemia via

1. reduces/inhibit adrenal aldosterone synthesis?
2. Blocks Na channel
3. Inhibits NA/K/-ATPase

Answer 11

1. ACEI/ARB/CNI/Heparin
2. Trimethoprim/ Amiloride
3. Digoxin

Question 12

Lithium causes what clinical side effects?

Answer 12

Polyuria and polydipsia
Kidney not responsive to ADH = Nephrogenic DI

HyperCALCIUM, Hyper PTH

Question 13

New drugs for Hyperkalemia

Patiromer vs Na Zirconium Cyclosilicate difference?

Answer 13

Patiromer

• Bind K, exchange for Calcium
• Acts at Distal colon
• SE - hypoMg and GI side effects

Na Zirconium Cyclosilicate

• Binds K, exchange for sodium
• Acts everywere in GI tract
• SE : Oedema and GI side effects

Question 14

Trimethoprim causes elevated creatinine - why?

Answer 14

Blocks creatinine secretion from proximal tubule

Question 15

Tacrolimus target level

• few months after transplant?
• after 1st year?
• presence of malignancy/infection/BK viremia

Answer 15

• few months after transplant = 10 ng
• 1st year = 5 ng
• malignancy/infection/BK viremia = 3 ng

Question 16

Pre-eclampsia definition?

Answer 16

BP > 140/90 at 20th week of pregnancy
Proteinuria
Maternal - organ dysfunction ( neuro/liver/renal/heam complications)
Fetus dysfunction - fetal growth restriction, stillbirth

Question 17

Most defining feature of cell apoptosis?

Answer 17

Pyknosis - irreversible condensation of chromatin in cell’s nucleus

Other features

• cytoplasmic shrinks, Eosinophils increased
• apoptotic bodies
• mitochondrial can be swollen ( may be noT)

Question 18

What differentiates cell apoptosis and cell necrosis?

Answer 18

Cell apoptosis is programmed cell death - NO INFLAMMATION
-dead cells quickly phagocytosed

Cell necrosis is unintended cell death due to uncontrollable external factors- release cytokines and inflammation

Question 19

Circulating free DNA (cfDNA) released by?

Answer 19

Cell necrosis/apoptosis triggered by cancer
*Can be found in lower levels of healthy person

• double stranded fragments
• short half-life

Question 20

Muscles involved in rotator cuff syndrome?

Answer 20

Supraspinatus
Infraspinatus
Subscapularis
Teres minor

Question 21

Difference between GLUT and SGLT2 channel?

Answer 21

SGLT - active transporter

GLUT- passive transporter

Question 22

What is Bing-Neel syndrome?

Answer 22

Walderstron Macroglobulinemia that infiltrates optic nerve

• nil optic disc oedema and optic nerve enhancement
• Have OPTIC NEURITIS

Question 23

What yeast organism is resistant to Amphotericin?

Answer 23

Aspergillus Terreus

Scedosporium

Question 24

What yeast is resistant to Fluconazole?

Answer 24

Candida Kruzei

Question 25

What organism is resistant to all anti-fungals

Answer 25

Scedosporium prolificans

Question 26

Flucytosine is drug of choice for what fungal infection?

Answer 26

Cryptococcus

Question 27

Risk factors of systemic fungal infection?

Answer 27

Degree of neutropenia - < 0.1
Duration of neutropenia > 2 weeks
Central line access esp. for TPN

Question 28

Naloxone cause what complications?

Answer 28

Withdrawal effect

Non-cardiogenic pulmonary oedema

Question 29

Most common driver mutation of NSCLC and oncogenic?

Answer 29

KRAS

Question 30

what correlates with severity of COVID19?

Answer 30

IL6 levels

Question 31

what drugs causes false negative results for hyperaldosteronism?

Answer 31

ACE/ARB

K sparing diuretics - suppress Aldosterone

Question 32

what drugs causes false positive results for hyperaldosteronism?

Answer 32

B-blockers