MBBS revision

vegejewu's version from 2016-05-19 02:10

Section 1

Question Answer
What are sulbactam and tazobactum?B-lactamase inhibitors
What antibiotic is used for serious sepsis?Gentamycin (aminoglycoside)
How do aminoglycoside antibiotics work?Interfere with ribosomal reading, inhibit protein synthesis
What is ciprofloxacin?A quinolone
What causes common cold?Rhinovirus (30%), coronavirus, parainfluenza, RS influenza virus adenovirus
What viruses cause a sore throat?70% viral, common cold, influenza enterovirus, adenovirus, HSV, coxsackie,
What other than viruses cause a sore throat?Bacterial (30%), strep pyogenes (GAS), corynebacterium diphtheria (bull neck) ludwig's angina, vincent's angina Lemierre's disease
What causes whooping cough?Bordetella pertussis
What causes bronchiolitis?RSV
What are the common community acquired causes for pneumonia?Strep pneumonia, haemophilus influennza, legionella, TB
What are the common hospital acquired causes for pneumonia?pseudomonas aeruginosa, MRSA inc. staph aureus
What are the common opportunisic causes for pneumonia?pneumocystis pneumoniae
What is trimethoprim used for?UTIs, Gram - bacteria
What is metronidzole active against?All anaerobes,amoebae, trichmonas vaginalis
What are oxytetracycline and doxycycline?Tetracyclins
When are macrolides and erythromycin used?in penicillin-allergic patients against staphylococci and streptococci
Mechanisms of resistance: what is it called when "bacterial DNA is spread by bacteriophages"?Transduction
Mechanisms of resistance: what is conjugation?plasmids spread by bacteria forming a sex pilus
Mechanisms of resistance: what is transformation?bacterium takes up DNA from environment
What does the H antigen do?binds to sialic acid residues on cell surface
What does N antigen do?catalyses cleavage of glycosidic linkages to break free from cell on release

Section 2

Question Answer
What is a transudate pleural effusion?high capillary pressure forces fluid into interstitium, low plasma oncotic pressure due to loss of protein
What is an exudative pleural effusion?plasma proteins cross to interstitium through leaky capillaries
How much pleural fluid made per day?15ml
What caused exudative PEs?diseases that damage pulmonary capillary endothelium: pneumonia, malignancy, TB
What are the source of the pulmonary plexus?Sympathetics from: T1-5, parasympathetics from: vagus
Where are the source of the cardiac plexus?Sympathetics from: T1-4, parasympathetics from: vagus
Where are the source of the oesophageal plexus?Sympathetics from: T2-6, parasympathetics from: vagus
How much does pressure in the feet go up by on standing?90mmhg
Where are the baroreceptors?most important in carotid sinus
How much can the baroreceptor reflex limit the fall in cardiac output to?20%
What are the signs of shock?pale or cyanotic clammy skin, rapid shallow breathing, rapid weak pulse, thirst, low urine, nausea, anxiety, acidosis decreased coagulation
What happens when blood pressure falls below 50mmHg in shock?CNS ischaemic respnse: powerful peripheral vasoconstriction, gut and kidney cut off
What is reverse stress compensation?veins shrink around reduced blood to maintain pressure

Section 3

Question Answer
What are the signs of undernourishment?- BMI <18, -weight loss exceeding 10%, -reduced anthropometry -electrolyte, mineral or vitamin deficiency, -poor bio-impedence testing
John is 75% of expected weight and shows signs of oedema; what is the likely diagnosis?kwashiorkor
Mohammed is 85% of expected weight and shows no signs of oedema; what is the likely diagnosis?underweight
Abdullah is 55% of expected weight and shows signs of oedema; what is the likely diagnosis?marasmic kwashiorkor
Anne is 60% of expected weight and shows no signs of oedema; what is the likely diagnosis?borderline marasmic
Andy has a BMI of 38; what is the likely diagnosis?obese (borderline superobese)
Pauline is 70% of expected weight and shows no signs of oedema; what is the likely diagnosis?underweight
High levels of insulin inhibit what?hunger, and obviously gluconeogenesis etc
How does insulin inhibit hunger?stimulates POMC neurons to release hunger inhibiting peptides
How does leptin concentration relate to hunger?High amounts inhibit AgRP neurons which stimulate hunger
How does grehlin concentration relate to hunger?Makes you hungry yo
Which vitamins are fat soluble?A D, E, K
Which vitamins are water soluble?B, C
Which vitamins are toxic in excess?A, D
Which vitamin is a co-enzyme for pyruvate reaction?Thiamin
Deficiency in which vitamin causes blindness?A
What is B3?Niacin: for NAD and NADH, deficiency is pelllegra (dermatitis dementia diarrhoea)
What is B1?Thiamin: anti beri-beri factor, deficiency causes Korsakoff's psychosis. Deficient in polished rice fat, processed foods
What is B2?Riboflavin: mainly in milk, needed for FAD and FMN in redox reactions
What is B12?Folate/cobalamin: amino acid synthesis, purine and pyramidine synthesis. Folate: carrier of 1-C groups. B12: carries methyl group
What is B6?Pyridoxine: protein/amino acid synthesis
What is B7?Biotin
Deficiency in which vitamin causes diarrhoea, dementia and dermatitis?Niacin (B3)
Deficiency in which vitamin causes impaired wound healing, haemorrage and anaemia?Vit C (also K has similar effect)
Deficiency in which vitamin causes osteomalacia?D
Deficiency in which vitamin can be caused by long term antibiotics?K
What is folate converted to?DHF (dihydrofolate)

Section 4

Question Answer
_____ broken down by salivary _____, pancreatic _____, into ____________ and free fatty acids. Pancreatic amylase complexes with _______, preventing bile salts displacing _____ from the fat droplets. Bile salts are absorbed in the ______. Lipid absorption usually complete by the _________. (1) triglycerides, (2, 3) amylase, (4) monoglycerides, (5) colipase, (6) lipase, (7) ileum, (8) middle of the jejunum,
Triglycerides are resynthesised in the enterocyte by the _______________________ pathway (major) and the ______________________ pathway (minor)(1) monoglyceride acylation, (2) phosphatidic acid
Triacylglycerol, cholesterol and cholesterol esters are bound by what apoprotein in the enterocyte?B48
Primary chylomicron picks up ___ and ____ from ______.(1) C2, (2), E, (3) HDL
C2 activates ___, causing what?(1) LPL causing hydrolysis of chylomicrons to fatty acids (which are transported into adipocytes), glycerol and chylomicron remnants.
When does the adipocyte use glycolysis?To form glycerol phosphate for re-esterification of FA to TAG
Chylomicron remnants bind to what receptor on the liver?E2R
VLDL picks up what protein in the liver?B100
Deficiency in what protein can cause hypercholesterolaemia?B100 LDL receptor
What do statins do?inhibit HMG CoA
What's th rate-limitng step in cholesterol synthesis?HMG-CoA
Tell me about HDL yoApo A1, has phosphatidyl choline on surface of HDL to esterify cholesterol and sequester it away inside
Why are Cu and Fe metalloproteins important?Oxygen carriage, oxidases
What are the signs of zinc deficiency?Impaired would healing, hypogonadism, growth retardation
What condition is associated with a mutation in HFE and what are the effects?Haemochromatosis: absorb excessive dietary iron causes liver failure, diabetes, cardiac failure. Test for serum ferritin and transerrin saturation
FASTING STATE 1) Glucose is low, insulin is low, glucagon is high 2) Glucagon binds to _____________ in the liver, which leads to elevation of _________________ 3) Glycogen phosphorylase converts glycogen to ___________, which in turn is converted to ________________ 4) Glucose-6-P is converted to glucose by glucose-6-phosphatase, and glucose is released into the circulation. Liver glycogen depletes quickly, and within a short time it can no longer release glucose. 5) In muscle, glycogen is used internally, converted to G-1-P to G-6-P and then into glycolysis. It lacks G6Pase and so cannot produce glucose to be released into the circulation 6) Blood glucose is taken up by the brain and RBCs; the RBCs release _______ 7) Lactate is transported back to the liver where it is converted to _________ by the Cori cycle. Pyruvate is then converted to glucose by gluconeogenesis 8) With no dietary glucose coming in and depleted liver glycogen stores, glucagon binds to adipocyte receptors and ____________ is released in fat stores 9) ____ is hydrolysed and free fatty acid (non-esterified fatty acids bound to _______) is released into the circulation along with ______ 10) Muscle and the liver will take up fatty acids and oxidise to ____________; glycerol contributes to liver gluconeogenesis 11) The liver will convert acetyl CoA (which in the fed state is converted to fatty acids by insulin) to ketone bodies and release them into the circulation; these KBs, acetoacetate and b-hydroxybutyrate, are taken up by the brain and used as a source of energy 12) In continued absence of blood glucose, the muscle catabolises _______ to ____________ which are transported to the liver for gluconeogenesis; this leads to an increase in ________ production1) adenylate-cyclase-coupled glucagon receptors; 2) cAMP levels and PKA, 3) glucose-1-P, 4) glucose-6-P , 5) lactate, 6) pyruvate, 7) hormone sensitive lipase, 8) TAG, 9) albumin, 10) glycerol, 11) acetyl coa, 12) protein, 13) amino acids, 14) urea
Biguanides increase.....? glut 4 transporters
What do sulphonylureas do?act on beta cells to improve insulin secretion

Section 5

Question Answer
What immunoglobulin is released in the saliva?IgA
Are salivary glands merocrine, apocrine or holocrine?Merocrine
What are sodium glycocholate and deoxycholate?Bile salts
Where are Kupffer cells found and what are they?Phagocytes in liver
What fibres are found in the space of Disse?reticulin
Which cells produce cirrhosis-associated collagen?Stellate cells
What is a unit of alcohol?10ml or 8g
Are polymorphisms in ADH2 and ADH3 related to differences in alcohol metabolism?No
What is disulfram?ALDH inhibitor
Which has a lower Km - ALDH1 or ALDH2?ALDH2
Which lobes of the liver are supplied by the left hepatic artery?Caudate, quadrate
Why does hypoglycaemia occur in liver failure?1) failure to break down insulin - hyperinsulinaemia, 2) decreased breakdown of glycogen, 3) decreased gluconeogenesis
Which amino acids are reduced in liver failure?leucine, isoleucine, valine
Which amino acids are increased in liver failure?phenylalanine, tryptophan, tyrosine, methionine
Why does hypermetabolism occur in liver failure?no breakdown of adrenaline/noradrenaline, increased levels of pro- and anti-inflammatory markers fighting it oot
Why does increased susceptibility to infection occur in liver failure?loss of kuppfer cells, infected ascites, gut bacteria not cleared
how much bile can the galbladder store?50ml
What is the UK legal alcohol driving limit?0.08g/100ml (35ug/100ml on breathaliser)
What antioxidant gets rapidly depleted in a paracetamol overdose?Glutathione
What is the median survival of a grade A child-pugh rating?5yr
What is the median survival of a grade B child-pugh rating?3-5yr
What is the median survival of a grade C child-pugh rating?2 yr
What serology result indicates acute viral hepatitis?IgM
What serology result indicates past viral hepatitis?IgG
Which hepatitis viruses do not cause chronic infection?A, E
What is the nucleic acid form found in Hep A?ss RNA (virus is unenveloped)
What is the nucleic acid form found in Hep B?partially ds RNA
What is the nucleic acid form found in Hep C?ss RNA (virus is enveloped)
What is the nucleic acid form found in Hep D?ss RNA (virus enveloped by HBsAg)
Which hep virus has retroviral activity?B
Hep B immunization is cross protective for which strain?D