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Clinical Sciences Flashcards

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1
Q

Risk factors of statin myopathy

A

Female
Old
Low BMI
Multisystem disease

An old think woman with lots wrong

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2
Q

Statin mechanism of action

A

Inhibits HMG-CoA reductase.

This is the rate limiting enzyme in cholesterol synthesis

Lipophilic statins - simvastatin and atorvastatin- more myopathy

Hydrophilic- rosuvastatin, pravastatin, fluvavastin - less myopathy

Erythromycin/clarithromycin - increase CK

Stop statin if after 3/12 trbsaminases rise by 3x

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3
Q

Innate immune response

A

Neutrophil - primary phagocytise in acute inflammation. Contains myeloperoxidase + lysozyme. Multilobed nuclei

Basophils - histamine I’m allergic response m. Expresses IgE - bilobed nuckeus

Mast cells - similar to basophils function Present in tissues.

Eosinophils- defence vs protozoan and helminthic infect - bilobed nuclei

Macrophage - phagocytosis of vellular debris + pathogen. APC. Nah source of IL-1 (fat laden = FOAM. CELL)

Dendritic cell - APC

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4
Q

Helminths

A

Seen in poorer countries with ooor sanitation and communities. Eggs in soil from poo in soil.

Get in body from eating eggs - veg or meat infected with eggs

Grow inside —> anaemia, WL, malnutrition.

Can lead to Bowel obstruction —> surgery

To bendazoles mainly

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5
Q

Adaptive immune response cells

A

Helper T - cell mediated respond CD4 - recog MHC class 2 - acute + chronic organ rejection

Cytotoxic T cells - MHC class 1 recognition - Expresses CD8. Acute in chronic rejection

B cells - hyperacute rejection - humoral immune response

Plasma cells - differentiate from B cells. Specific

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6
Q

Endothelin

A

Bunds to target tissues —> ETA & ETb to coulek to Gq protein —> formation of IP3 —> calcium release from SR

Causes: vasoconstriction and Positivr inotropic. Causes aldosterone secretion, decreases renal
BF & eGfFR and release ANP

Stimulated by- ADH, AT2, thrombin, Hypoxia, shearing force

Inhibited by: prostacyclin and ANP(neg feedback)

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7
Q

Hungry bone syndrome

A

Rare

Follows parathyroidectomy for hyperPTH and a rapid decrease in PTH

Normal
To get trainsient hypoPTH for few weeks —> hypocalcaemia, but I’m hungry bone you get a rapid absorption of Ca into bones which prolongs hypocalcaemia.

Suppressed PTH and low Ca, PO4- and Mg

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8
Q

T helper cells

A

TH1 (think gamma (1)-2-3)

  • cell mediated response in Type 4 hypersensitivity
  • Secretes: IFN-gamma, Il 2 and Il3

Th2:

  • humoral immunity
  • eg stimulating IgE in asthma
  • IL4,5,6,10,13

TH-17

  • driven by IL17
  • unknown
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9
Q

HLA classes

A

HLA-A3 - haemochromatosis

HLA-B51: Bechets

HLA-B27 - Ank spond, Reiter’s, acute ant uveitis

HLA-DQ2/8 - Coeliac disease

HLA- DR2 - narcolepsy + goodpasteures

HLA - DR3 - dermatitis heroetiformis, sjrogrens, PBC

HLA-DR4 - DB type 1/RA

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10
Q

Standard deviations and percentage values

A

1 SD - 68.3%
2 SD - 95.4%
3 SD -99.7%

68.3–> 95.4 —> 99.7

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11
Q

Clopidogrek mexhsnism of action

A

Inhibits ADP binding to platelet, therefore inhibits activation of platelets

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12
Q

Pulmonary surfactant

A

Released by type 2 pneumocystis.

Main component is dipalmitoyl phosphatidylcholine (DPPC)

1st detected at 28 weeks

Mechanism: as alveoli decrease in size it increases in conc, therefore making sure no collapse - by lowering elastic recoil

Reduces manic forces needed to expand lungs

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13
Q

Pellagra

A

Vitamin B3 deficiency - niacin

Get in alcoholism

3Ds

Dementia
Diarrhoea
Dermatitis

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14
Q

Likelihood ratios

A

LR+ = sensitivity/(1- specificity)

LR- = (1- sens)/spec

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15
Q

Common Tumour supressor genes.

A

APC - colorectal Ca

p53 - multipla Ca. Li Fraumeni

BRCA1 - Breast + Ovarian Ca

BRCA2 - Breast Ca

RB - Retinoblastoma

NF1 - Neurofibromatosis

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16
Q

Cell Cycle:

A

G0 - resting phase

G1 - Gap 1 - Cell increase in size - determines length of cell cycle (p53)

S - Synthesis phase - RNA + DNA + Histones form

G2 - Gap 2 - cell increase in Size

M - Mitosis = shortest phase

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17
Q

IFN

A

IFN - alpha:

  • think a for A - best antiviral acttion
  • Vs Hep B + C, Karposi sarcome, metestatic RCC

IFN - B:

  • antiviral
  • shown to decrease freq of exac. in R-R M.S.

IFN - G:

  • Immunomodulation
  • Chronic granulamtous dx & Osteopetrosis

IFN a + B = bind to type 1 receptor

IFN–gamma - binds type 2

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18
Q

Haldane vs Bohr Effect

A

Haldane:

O2 causes Hb to have a decreased affinity for CO2

Bohr:

CO2 + pH (acid) causes Hb to have a decreased affinity for O2

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19
Q

Organelles and their fn:

1) Endoplasmic reticulum
2) Golgi apparatus
3) Mitochondrion
4) Nucleus
5) Nucelous
6) Ribosome
7) Lysosome
8) Peroxisome
9) Proteasome

A

1) Rough ER - Translation and folding of proteins. Manafacturesn lysosomal enzymes
N-linked glycosylation
1) Smooth ER - steroid + lipid syntesis

2) Packaging of above for those that are destined to be secreted by cell. O-linked glycosylation
3) Aerobic resp. Contains mitochondrial circular DNA
4) DNA –>RNA
5) Produces ribosome
6) RNA –> protewin
7) B.D>. of proteins + polysaccharides
8) B.D. of long chain fatty acids –> forms hydrogen peroxide
9) B.D> of proteins

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20
Q

Common CDs

A

CD1 - MHC molecule that presents lipid molecules
CD2 - Found on thymocytes, T cells, and some natural killer cells
CD3 - The signalling component of the T cell receptor (TCR) complex
CD4 - Found on helper T cells.
Co-receptor for MHC class II
Used by HIV to enter T cells
CD5 Found in the majority of mantle cell lymphomas
CD8 Found on cytotoxic T cells.
Co-receptor for MHC class I
Found on a subset of myeloid dendritic cells
CD14 Cell surface marker for macrophages
CD15 Expressed on Reed-Sternberg cells (along with CD30)
CD16 Bind to the Fc portion of IgG antibodies
CD21 Receptor for Epstein-Barr virus
CD28 Interacts with B7 on antigen presenting cell as costimulation signal
CD45 Protein tyrosine phosphatase present on all leucocytes
CD56 Unique marker for natural killer cells
CD95 Acts as the FAS receptor, involved in apoptosis

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21
Q

Compliment deficiencies

A
  • C1 inhibitor – hereditary angioedema (remember 1 = A 1st letter alphabet)
  • C1q, C1rs, C2, C4 –> immune complex dx – HSP/SLE
  • C3 – Bacterial infections – 3 looks like a B
  • C5 – leinier disease – recurrent diarrhoea, wasting and seberrhoeic dermatitis.
  • C5-9 – MAC complex disorder – Neisseria meningitides
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22
Q

Chicken pox

A

Highly infectious:

  • Spread via reps route.
  • Infectivity – 4days before rash, until 5 days after
  • Incubation = 10-21 days

Mx symptoms– lotion + trim nails

Immunocompromised, newborns with periparrtum exposure –> VZIG

If chicken pox develop –> IV Aciclovir

Complications:

Pneumonia –> Giv IV Acicllovir – fine crackles bilaterally. Multiple itny opacities

Encephalitis

Arthritis

nephritis

pancreatits

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23
Q

GI Hormones

A

Gastrin

  • secreted by G cells of antrum
  • stimulus: vagus nerve activity vi distension. Luminal peptides + AA. Low Ph
  • secretes acid + digestive enzymes, increase motility

Somatostatin:

  • D cells of stomach + SI
  • stimulated by digestive prod - fat, bile salts + glucose
  • essentially opp of above: decrease acid + motility + digestive enzymes

CCK:

  • I cells of SI
  • stim: partially digested protein + TG
  • increases secretion of pancreas, contract GB relax sphincter of oddi. Decrease gastric emptying. Induces satiety

Secretin:

  • S cells of SI
  • acidic chyme + FA
  • increase BICARBONATE secretion + decrease acid

VIP:

  • secreted by cells SI
  • Naural
  • secretion if pancreas’s + intestine
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24
Q

Sigmificance tests and statistical

Errors:

A

Null
Hypothesis - two to see equally effective

Alternative hypotheses- is the opp null hypothesis

Type 1 statistical error: null hypothesis rejected when it’s true.

Type 2 statistical error: null hypothesis accepted when it’s fals

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25
Respiratory physiology: control
Control of resp: Central reg centres - medullary resp centre - apneustic centre- lowerpons - pneumotaxic Centre- upped pons Central + peripheral chemoreceptors - central: raised (H+) ECF - perioheral; carotid + aortic bodies - respond to raised pCO2/(H+, lesser extent low pO2 Pulm receptors - stretch receptors. Distension —> slower RR (hering-bruer reflex) - irritant receptor —> bronchoconstriction - juxtacapillary - stretching of micro add
26
Clinical trial: phases
Phase 1 - determines pharmokinetics, pharmodynamocd and side effects - healthy volunteers Phase2: - 2a - optimal dosing - 2b - assessed efficacy - small number of dx patients Phase 3: - assess effectiveness. - RCT Phase 4: - post marketing surveillance - Lt effectiveness and side-effects
27
Immunoglobulins
IgG - most common - phagocytosis. Complement. Passes to foetal circulation IgA - breast milk. Secreted by resp/digestive/urogenitak. Localised protection to mucous membrane IgM - 1st secreted in response to infection. Complement. Doesn’t pass into foetal circ. BLOOD GROUPS. IgD - activation of B cells IgE - LEAST COMMON - type 1 hypersensitivity.
28
Hypersensitivity reactions A B.C D E
Type 1 = A - - Allergic, Anaphylactic,Atopy. - IgE - Caused by cross linking of multiple IgE on mast cell/Basophils. —> mast cell granules —> histamine release. (Can be presensitised - happens V quick) Type 2 - B - anti-B-ody, = IgG and IgM - antibody dependedant cytotoxicity. Same as humours immunity but targeted at own body cells. - examples include goodpasteures , haemolytic dx of newborns - GRAVES DISEASE Type 3 - C - immune-C-omplex - increase Ag Ab ratio in body. - clumping —> inflammation by aCompement + attracting neutrophils. - SLE, rheumatoid, golmerulonephritis - hypoclompementaemia Type 4 - D - D-elayed hypersensitivy - Th 1 attract and activate macrophages - cell mediated and antibody independent - GvH dx And BCG - contact dermatitis/ PPD - TB skin test/ MS Type 5 - E - Ab that recognise cell surface or E-xternal receptors - graVEs or MG
29
Staph epididermis
Most common organism for central line infection
30
Standard error of the mean
Standard deviation/square root of number of patients
31
Acute phase proteins
``` CRP Ferritin Complement Alpha - 1 antitrypsin Procalcitonin Serum amyloid A & P Caeruloplasmkn Haptoglobin ```
32
Alkaptonuria
Lack of enzyme homogentisic dioxygenase. Get build up of homogentisic acid in urine Blue sclera and black urine Intervertebral disc calc —> back pain Renal stones Tx: - high dose vitamin C - diet: restrict phenylalanine and tyrosine
33
HIV immunology
Progressive HIV you se: - reduced CD4 - reduced IL2 - increase B2-microglobulin - polyclonal activation of B cells - decrease Nkcells - reduced delayed hypersensitivity rxn
34
Proto-oncogenes
Gain of function via: - mutation - translocation - increased protein expressions ABL - CML c-MYC - burkitts lymphoma n-MYC - neuroblastoma BCL-2 - follicular lymphoma RET - MEN 1 & 2 RAS - many cancers Erb- B2 (HER2) - Brest and ovarian ca
35
Innate | Immune response
PRRs on phagocytic cells recognise PAMPs —> complement/chemokines/ cytokines —> phagocytosis —> release pathogenic peptides —> APCs
36
Complement pathway triggers
Classic - Anyibody activated Alternative and leptin - polysaccharide component of cell wall.
37
Hereditary A-ngioedema
Think C-1 and letter -A- Increase in classic pathway and kallikerin Kallikerin —> bradykinin driven angioedena Distinguish from anaphylaxis as - NO URTICARIA - NO HYPOTENSION
38
Cytokines
IL-1 - proinflamm of innate - seen in autoinflamm dx - periodic fever syndrome Il-2 - T cell driven response - inhibition useful In Transplant rejection - calcineurin inhib, ciclosporin, tacrolimus - s.e. HIV LIKE Il-6 - proinflamm - ACUTE PHASE RESPONSE CRP - inhibition used in RA - therefore falsely reassuring low CRP Il-10 - decreases cytokines and inhib HLA —> ANTINFLAMM Il-17 —> TH17 TNF - pro inflamm —> Tcell recruitment. - prod by Mac - s.e of TNF-I —> granuloma reactivation IFN: - proinflamm - seen in VIRAL infection - used to tx chronic viral Infection - SE —> FLU LIKE SX
39
Adaptive immunity —> cellular and humoral response
Humoral: - circulating B cells recognise circulating antibodies - Initial IgM response —> memory cells which produce IgG - re-exposure —> rapid specific IgG response Cellular: - some pathogens hide in cells - therefore cells present intracellular material using HLA system (APCs) - interact with Tcells - this system recognised self vs non-self
40
Cryoglobulin
Ig that precipitate out at low temp 3 types: Type1 - monoclonal IgM - Walldenstroms macroglobuniaemia —> hypervsicosity Type 2 - mixed - chronic infection - Hep C Type 3 - polyclonal - mixed CT dx
41
Cold agglutin
Different from Cryoglobulin A form of haemolytic anaemia Seen in lymphoproliferative dx and mycoplasma pneumonia
42
Rituximab
Causes complement mediated lysis of CD20 express cells - B CELLS
43
Transplantation
Hyperacute: - humoral - Min’s —> hrs - pre-existing ab bs donor HLA1 Acute: - <6/12 - mismatched HLA / CMV - reversible with IS Chronic: - >6/12 - ab & cell mediated —> fibrosis
44
Neutrophil deficiency
Recurrent bacterial or fungal Skin infection Causes: - primary - chronic granulmatous dx - secondary -DB
45
B cell deficiency
Get spinopulmonary infection/bronchiectasis Primary: - common variable immunodeficiency - IgA deficiency - bruttons agammaglobulinaemia - Wishkott Aldrich - eczema + Thrombocytopaenia Secondary: - CLL - Rituximab - Gold - Phenytoin
46
T cell deficiency
results in HIV like syndromes —> PCP CMV SALMONELLA MYCOBACTER Causes Primary: - di George - SCID - Ataxia telangectasia SEcondary: - HIV - Ciclosporin / calcineurin inhib / Tacrolimus
47
IL-1
Secreted by macrophages/monocytes Causes T and B cell prolif
48
Layers of the epidermis Come Lets Get Some Beers
``` Corneum Lucidum Granukosum Spinosum - swuamous cells Germinatavum - deepest - columnar cells. Produce keratinocytes and has melanocytes ```
49
Molecular biology techniquss SNoW DRoP
S-outhern - detects D-NA - N-othern - detexts - R-NA - W- est - detects - P-rotein
50
Carcinomas and their cancers
Aflatoxin - liver - hepatocellular carcinoma Aniline dyes - bladder - transitional cell carcinoma Asbestos - mesothelioma and bronchial carcinona Nitrosamines - oesophageal and gastric ca Vinyl chloride - hepatic angiocarcinoma
51
Positive vs NFlegative skewed data
Positively skewed data = Nailed down and pullled to the right --> so the right had is longed out and lower NEgatively = opposite in normal distribution median and mean = the same. In skewed data - Median still the same as this its the apex, but the mean is pulled into the tail. - Neg skew - MEan Med
52
Muscle relaxants
Suxamethonium: - Depolarising musc relaxant - Inhibits Ach at NMJ - Fastest onset and shortest duration of all musc relax - RSI - PRod gen contraction --> Relaxation - s.e.: HyperK+ / MAlignant hyperthermia and AcH lack. Atracurium: - Non-depolarising - Duration 30-45 mins - Histamine release --> Flushing, tachy, hypotensive - Not BD by kidneys/liver (hydrolysis) - Reversed by NEostigmine VEcuronium: - Non depolarision - duration = 30-40 mins - B.D> by kidney/liver --> therefore dysfn --> acccumulatuin - Reversed by neostigmine Pancuronium: - Non-depolarising - long duration 2 hours - effects partially revered by nestigmine
53
pre and post test odds
pre-test probability = prevelance Post-test probability = post test odds/ 1+post test odds Pre test odds = pretest probability / 1 - pretest prob Post test odds = pre-test odds x likelihood ratio
54
Most common gene disorder in down syndrome ?
NON-DYSJUNCTION
55
Significance tests
Parametric data (measureable and normally distrivuted) - Students - paired or unpaired - Pearsons - CORRELATION ``` non=paramterict - Chi-squared - PROPORTIONS AND PERCENTAGES or Fisheres exact (small sample size) ]- Mann -whitney - unpaired - Spearman-kendal rank - CORRELATION - Wilcoxon signed ``` ``` PAired = data from single group unpaired = data from 2 diff groups ```
56
Adrenoreceptors
alpa-1 - activates phopholipase C --> IP3 --> DAG - VC - Relax Gastic SM - salivary secretion alpha - 2 : - Inhibits pre-synaptic NT - Inhibits adenyl cyclase - Inhibit insulin secretion - Platelet aggregation Beta 1 = - Stim Adenyl cyclase - Heart --> +chronotrope +ionotrope Beta 2 - Stim AC - Bronchodilation - vasodilation - Relax gastric SM Beta 3 - Stim AC - Lipolysis
57
What is gthe power of a study
1 - probablity of a type 2 error
58
Types of error
Type 1: - null hypothesis is rejected when its true (Type 1, what people doing study want) Type 2 - accepting null hypothesis when it is false.
59
Post-test odds =
Pre test odds x +ve likelihood ration | positive likelihood ratio = sensitivity/(1 - spec)
60
Which cytokines involved in acute phase response
Tbf - alpha (a in acute phase) Il-1 (1 for first phase) Ik-6 (6 looks like upside down p)
61
How does variance relate to standard deviation
Standard deviation is the square root of the variance Remember 95% of normally distributed data will. Like between 2 SD bellow and above the mean
62
Shock
Grade 1: - losss of 15% of blood vol - 750 ml - Not low BP - MAY nbe tach GRade 2: - 15-30% - BP normal - Tachy ~GRade 3: - 30-40 - Decreased UO GRade 4: - >40% - Anuria
63
What is degranulation - in respect to eosinophils?
degranulation is where mast cells/eosinophils/basophils, release their lysosomes. intracellular lysosomes fuse with plasma membrane and release their contents --> extracelllular This maks them useful vs larger organisms such as helminths and protozoa
64
Process of phagocytosis
chemotaxis --> ingestion --> intracellular enzymatic degradation --> exocytosis
65
What is the product of a codon?
Codon is 3 adjacent nucletodies --> code for Amino acid
66
Linear vs logistic regression
measures teh strength of a relationship between two variables. y= a +b.X X = input Y = ouput if Y = continuus - linear (i.e. dose) If Y = 2 x categories = logistic.
67
Fisher exact test and chi2 test
Both sinificance tests Essentially the same, but Fishers is Exact P-value and Chi2 is approximate P value therefore fishers is better if SMALL SAMPLES Chi2 is ok in BIG SAMPLES
68
Number needed to treat
1/absolute risk reduction
69
DNA - investigations - FISH:
FISH: - Microdeletion conditions - DiGEorge, Kallman, Williams - DNA denatured, Fluorescent probe added which is complimentary to DNA sequence you want to identify. - If that DNA is present --> binds and you detect signal Metaphase FISH: - Like above but cells need to be in GROWTH PHASE. Interphase FISH: - Cells dont need to be in growth phase - USed in anueploid cells.
70
Incidence vs prevelance
Incidence - number of NEW cases Prevelance - number of ALL Cases
71
Relative Risk
PRobability of event occuring in exposed / prob of event occuring in unexposed.
72
Types of Analysis
Intention to treat}: - similar to clinical situation - Includes ALL participants , incl. those who drop out - good for compliance Completer Analysis: - Only those that complete trial - Smaller smaple size and BIAS Pre-protocol analysis : - Even stricter than completer analysis Severity analysis: - look at how robust an assesment is by seeing if changing method --> Changes results.
73
Absolute risk reduction
ARR = Relative Risk x Placebo event rate. relative risk = experemential event rate/control event rate
74
DNA investigations - Microarray analysis
Microarray analysis: - Looks at transcription activity by converting RNA --> DNA: - Compafres RNA
75
DNA investiations - PRotein Aanlysis
Protein analysis: - Measures all protein in cell by Mass Spectometr. - compare healthy and disease tissues.
76
DNA investigations - PCR
1) Primer + DNA Template + DNA polymerase 2) heat --> Single strand DNA 3) Coooled --> primers bind to template 4) HEat --> activated DNA polymerase --> amplification Uses of PCR : - Mutation detection - detect bacteria/virus in tissues - Single cell genetic test of in-vitro fertilised embyos Reverse transcription PCR: - ooks at only transcribed genes 1) Reverse transcriptase used 1st 2) mRNA --> DNA --> analysis as above
77
Monoclonal Antibodies
Grown by injecting rat spleen with Antigen --> collect and combine with myeloma --> incrase antibody Humanisation of Mab: - chimeric Antiboody = mouse variable region and Fc = human - decreased chane of recognised as foreign, btu still small chance
78
Ligand gated ion channels
5 subunits 0 alpha-2/beta-2/gamma binding to alpha --> conformational change e. g: - ACH-R/GABA/GLutamte/G;ycerione
79
Tyrosine Kinase
Susbtrated --> binds receptor --> activates TK--> dimerisation --> autophosphorhylation Insuline/IGF-1/PDGF
80
GPCR
Couling of extracellular signal --> Second messenger. 3 subunits alpha/beta/gamma in inactive state GDP is bound to alpha Ligand binds --> GDP --> GTP --> alpha dissociates --> alpha-GTP or gamma --> activates 2nd messengers (Gi or Gs) inactivation of alpha-GTP --> GTP --> GDP ( alpha-GTPase) exampleS: - MUSCARINIC Achr - alpha + beta adrenergic-receptors - Rhodopsin Dx assoc: - Cholera - pit adenoma - Mcune Albrights - Aldbrights hereditary osteroedystrophhy
81
What fruit is associated with LAtex allergy
KIWI
82
Calculating Clearance
(U x V)/P ``` U = Urine concentration of drg (mg/ml) V = volume of urine in (ml/Min) P = plasma concentration (mg/Ml) ```
83
Cholera mechanism of action
GM-1 Agonism
84
Study design and levels of evidence
``` 1a = meta-anaylsis of RCTs 1b = at least 1 RCT 2a = well designed controlled trial but not an RCT 2b = one well designed experiental trial 3 = case/comparative/correlation studies 4= panel of experts ```
85
Standard deviation and variance
Standard deviation = Square of the variance Standard error = SD / square root of number in study
86
What are seen in biopsies of sarcoid granulomas
Asteroid bodies
87
Which HLA is seen in hyperacute rejection?
HLA-C
88
Interleukina
IL-1 - prod by MAc - acute inflamm + fever Il-2 - TH1 --> Growth + Tcell differentiation IL-3 - TH1 --> myeloif progenitor cells IL-4 - TH2 --> B cells IL-5 = TH2 --> Eosinphils IL-6 - TH2 + Mac --> B cells + fever IL8 - MAc --> Neutrophil chemotaxos IL-10 + TH2 - inhibits TH1 IL-12 - dendritic/MAc/Bcells --> activates NK and TH1 prod IFN-gamma - TH1 --> aMAcrophage TNFa - MAc --> Feveer + neutrophil chemotaxis
89
Homocystinuria
Deficiency in cystathionine beta snthase marfanoid lens dislocation - downward LEarning difficulty Cyanide-nitroprusside test Tx = pyridoxine
90
raised anion gap metabolic acidosis
C - CO/Cyanide/ CHFx A =- Aminoglyclosides T - Toluene/Tehoophylline ``` M- MEthanol U - Uraemia D- DKA/Starvation Keto/ Alcoholic ketoacidosis P - Paraceetamol/ I - Inborn error/ Iron/ Isoniazid L- lactic acidosis E- Ethanol/ Ethylene glycol S - Salicylates/ASA/Aspirin ```
91
Acute intermittent porphyria - drugs the precipitate attack
``` BArbituates alothane BZD EtOH OCP Suphonamides ```
92
Variance and 95% confidence interval
S.D. - Square root of variance Stander error = SD / sq root of.n 95% CI limit is mean +/- 2x SE

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