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Y4S2 Medicine > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

What is the function of protein S?

A

Cofactor of protein C

Inhibits factors Va and VIIIa

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2
Q

What is the function of protein C?

A

Inhibits factors Va and VIIIa

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3
Q

How is multiple myeloma diagnosed?

A

>10% clonal bone marrow plasma cells in biopsy

PLUS one of the CRAB features

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4
Q

What are the 5 most common inherited hypercoagulable states?

A
  1. Factor V Leiden mutation
  2. Prothrombin gene mutation G20210A
  3. Protein S deficiency
  4. Protein C deficiency
  5. Antithrombin deficiency
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5
Q

Are petechiae more characteristic of disorders of coagulation (clotting factor deficiencies) or purpuric disorders (platelets and blood vessels)?

A

Purpuric disorders

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6
Q

Are joint haemorrhages and soft tissue haematomas more characteristic of disorders of coagulation (clotting factor deficiencies) or purpuric disorders (platelets and blood vessels)?

A

Disorders of coagulation

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7
Q

Which diseases are associated with mutations in the janus kinase 2 (JAK2) gene?

A

Myeloproliferative neoplasms e.g. polycythemia vera, essential thrombocytopenia, myelofibrosis

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8
Q

Which type of cell is pathognomonic for Hodgkin’s lymphoma?

A

Reed-Sternberg cells (RSCs)

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9
Q

Which NOAC(s) have a reversal agent?

A

Dabigatran only (idarucizumab)

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10
Q

What is the reversal agent for dabigatran?

A

Idarucizumab

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11
Q

What are the four types of thalassemia major?

A

Silent carrier/minima (-a/aa)

Alpha thalassemia trait/minor (-a/-a or –/aa)

Haemoglobin H disease/alpha thalassemia major (–/-a)

Haemoglobin Bart disease (–/–)

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12
Q

Which three types of haemoglobin are typically found in adult blood?

A

HbA (ααββ) >95%

HbA2 (ααδδ) 2-3%

HbF (ααγγ) 1%

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13
Q

Levels of which types of haemoglobin are increased in people with beta thalassemia?

A

HbF (ααγγ)

HbA2 (ααδδ)

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14
Q

Levels of which types of haemoglobin are increased in people with alpha thalassemia?

A

HbH (ββββ)

Hb Bart (γγγγ)

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15
Q

Is adrenaline predominantly an inotrope and/or a vasopressor?

A

Inotrope (increases myocardial contractility)

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16
Q

Is noradrenaline predominantly an inotrope and/or a vasopressor?

A

Vasopressor (causes vasoconstriction, leading to increased systemic and/or pulmonary vascular resistance)

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17
Q

Which vasoactive agent is first-line for septic shock?

A

Noradrenaline

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18
Q

What is a rouleaux?

A

Stack of RBCs

Occur when the plasma protein concentration is high e.g. infections, MM

Can impair blood flow through capillaries

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19
Q

What is the most notable adverse effect of Tazocin (piperacillin with tazobactam)?

A

Transient increases in liver enzymes and bilirubin, cholestatic jaundice

20
Q

What is a Jarisch-Herxheimer reaction?

A

Acute, transient reaction to bacterial endotoxins and pyrogens released after initiation of antibiotic therapy in patients with syphilis

Flu-like symptoms, tachypnoea, hypotension, tachycardia, exanthem

21
Q

Why is clavulanic acid given with amoxicillin?

A

Clavulanic acid is a ß-lactamases inhibitor

ß-lactamases are secreted by some bacteria and they inhibit the effects of ß-lactam antibiotics (penicillins)

22
Q

On which receptors does noradrenaline act?

A

Alpha 1 (vasoconstriction)

Beta 1 (heart → increased CO)

Reflex bradycardia often occurs due to increased MAP

23
Q

On which receptors does adrenaline act?

A

Potent

Beta 1 (inotropic and chronotropic → increased CO)

Weak

Beta 2 (vasodilation offset by alpha 1 vasoconstriction)

Alpha 1 (vasoconstriction offset by beta 2 vasodilation)

At high doses, alpha 1 activity predominates, increasing systemic vascular resistance and therefore BP

24
Q

Which antibiotics are beta lactams?

A
  1. Penicillins
  2. Cephalosporins
  3. Monobactams (aztreonam)
  4. Carbapenems “-penem”
25
Q

What is an ECOG score?

A

A measure of how a disease impacts a person’s daily living. Initially made for oncological purposes

26
Q

How do you calculate an anion gap?

A

[Na+ + K+] - [Cl- + HCO3-]

Normal: 10-16 mmol/L

27
Q

What can cause a high anion gap acidosis?

A
  • Increased organic acids - no compensatory increase in Cl-*
  • TLKR (total left knee replacement)* mneumonic

L - lactate

T - toxins (paracetamol, isoniazid, metformin, methanol, ethanol)

K - ketones (diabetic and alcoholic)

R - renal failure

28
Q

How are autoimmune haemolytic anaemias distinguished from non-autoimmune?

A

Coombs test

29
Q

What are 4 causes of corpuscular haemolytic anaemia?

A
  • Membrane defect*
    1. Hereditary spherocytosis
    2. Paroxysmal nocturnal haemoglobinuria
  • Enzyme defect*
    3. G6PD deficiency
    4. Pyruvate kinase deficiency
  • Haemoglobinopathy*
    5. Sickle cell disease
    6. Thalassemia
    7. Haemoglobin C disease
30
Q

What are 4 causes of extracorpuscular haemolytic anaemia?

A
  • Isoimmune*
    1. AB0 incompatibility
    2. Rhesus incompatibility
  • Autoimmune*
    3. Cold/warm agglutinin disease
  • Microangiopathic*
    4. HUS
    5. TTP
    6. SLE
  • Macroangiopathic*
    7. Aortic stenosis, valve replacement, dialysis
    8. Exertional e.g. running, walking on hard surfaces
31
Q

What are haptoglobin levels used for?

A

Distinguishing intra- and extravascular haemolysis

Haemoglobin released from broken down RBCs binds to haptoglobin, decreasing free circulating haptoglobin

Occurs mostly in intravascular haemolysis (i.e. not spleen or liver)

32
Q

What generation cephalosporin is ceftriaxone?

A

3rd

(strong Gram - cover and some +)

33
Q

What generation cephalosporin is cefazolin?

A

1st

(used for Gram +)

34
Q

Which antibiotic is used for MRSA?

A

Vancomycin

35
Q

What are the major adverse effects of aminoglycosides?

A

Nephrotoxicity

Ototoxicity

Gentamycin

36
Q

Why do people with lymphoma get autoimmune haemolytic anaemia?

A

Dysfunctional T cells → failed negative selection → self-reactive B cells against RBCs

37
Q

Why do people with lymphoma have hypogammaglobulinaemia?

A

Dysfunctional T cells → decreased B cell activation (IL-4)

OR

Dysfunctional B cells → impaired stimulation of immunoglobulin production

38
Q

Which immunoglobulins are involved in the primary and secondary immune responses?

A

Primary: IgM (first encounter)

Secondary: IgG (subsequent encounters)

39
Q

What is a pannus?

A

Abnormal layer of fibrovascular/granulation tissue

40
Q

How can a PE lead to a metabolic acidosis?

A

Hypoxia → lactic acidosis

41
Q

What is an antalgic gait?

A

A limb that develops to avoid weight-bearing on a leg

e.g., sprained ankle

42
Q

What are the indications for hypertonic saline in the treatment of hyponatremia?

A

Seizures

Obtundation (altered level of consciousness)

Coma

Respiratory distress

43
Q

What causes hypermagnesemia?

A

Renal failure

Rhabdomyolysis (release of Mg from muscles)

Magnesium administration e.g., pre-eclampsia

44
Q

What is the function of magnesium?

A

A calcium antagonist

Prevents the intra-cellular movement of calcium

Low Mg → low serum Ca

45
Q

Which hormone is primarily responsible for phosphate regulation?

A

PTH

Causes phosphate excretion

Y4S2 Medicine (18 decks)

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