QBank Fortnightly Newsletter

VOLUME 1, ISSUE 4

We are back with the fourth issue of our newsletter. This time we bring you a mixed-bag of Qbank updates.

Take a look at the various updates and the new and revised MCQs.

1. Fragile X-associated primary ovarian failure (MCQ id- MC2220)

CGG premutation in FMR 1 gene is seen in Fragile X-associated primary ovarian failure, as well as Fragile X-ataxia(progressive neurodegenerative syndrome).

Women affected with fragile X–associated primary ovarian failure have menstrual irregularities and decreased fertility. 

FSH levels are elevated, and antimüllerian hormone levels are decreased—both are markers of declining ovarian function. 

Reference- Robbins and Cotran Pathologic Basis of Disease, 10th edition, page no 177.

2. Ferroptosis (MCQ id- MD4614)

Ferroptosis is a new mechanism of cell death that has been introduced in the latest edition of Robbins. It is a distinct form of cell death that is triggered when excessive intracellular levels of iron or reactive oxygen species cause unchecked membrane lipid peroxidation. The process can be prevented by reducing iron levels.

Ferroptosis has been linked to cell death in a variety of human pathologies, including cancer, neurodegenerative diseases, and stroke.

Reference- Robbins and Cotran Pathologic Basis of Disease 10th edition, page no 47

3. Osteomalacia and paraneoplastic syndrome (MCQ id: MD4606)

As per the recent edition of Robbins, Osteomalacia occurs as a paraneoplastic syndrome due to phosphaturic mesenchymal tumour. The gene mutation responsible for the disease is FGF-23 gene.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th edition, page no 329.

4. Antibiotics as the most common anaphylactic agent (MCQ id:MA6987)

As per the recent edition of Miller’s, the most common anaphylactic agent during anesthesia is antibiotics followed by neuromuscular blocking agents. 

Among the antibiotics, penicillins and cephalosporins are most commonly implicated in deaths due to anaphylaxis.

Ref: Miller’s Anesthesiology, 9th edition, pane no. 980

5. Routine antenatal anti-D prophylaxis (RAADP) (MCQ id: MB1404, MC9526, MB9714)

NICE now recommends a single dose of 1500 IU (300 mcg) of anti-D at 28 – 30 weeks as the Routine Antenatal Anti-D Prophylaxis (RAADP). As per the earlier guidelines, 2 doses (at least 500 units each) at 28 and 34 weeks of gestation were recommended. Now only a single dose is required as prophylaxis.

Also, 1500 IU is the minimum dose of Anti D which is used for alloimmunization as per the recent NICE guidelines.

Reference: https://www.nice.org.uk/guidance/dg25/resources/clinical-guideline-rhesus-rhd-negative-antenatal-management-bristol-university-hospital-pdf-4368966308  https://www.nice.org.uk/guidance/dg25/resources/guidelines-for-the-use-of-antid-taunton-and-somerset-nhs-ft-pdf-4368966307, page 6.

6. Medical management of induced abortion (latest WHO guideline) (MCQ ID: MB9780)

This recommendation has been updated from the WHO 2012 safe abortion guidance and presents recommendations related to medical management of induced abortion at < 12 weeks and at ≥ 12 weeks. 

Recommendation for induced abortion for < 12 weeks of gestation:

• Combined Regimen (Recommended): 200 mg of oral Mifepristone followed 1-2 days later by 800 mcg of buccal, vaginal or sublingual Misoprostol
• Misoprostol only regimen (Alternative): 800 mcg misoprostol administered vaginal, sublingual, or buccal routes.

This updated recommendation applies to pregnancies up to 12 weeks of gestation, whereas, in the previous guidelines, different regimens were recommended for pregnancies up to 7 weeks, 9 weeks, and 12 weeks. 

For the recommended misoprostol-only regimen, the buccal route of administration has been added and the maximum number of doses has been removed. 

Recommendation for induced abortion for >12 weeks of gestation:

• Recommended Combined Regimen: 200 mg of oral Mifepristone followed 1-2 days later by 400 mcg of buccal, vaginal, or sublingual Misoprostol, every 3 hours.
• Misoprostol only regimen (Alternative): 400 mcg misoprostol administered vaginally, sublingually or buccally, every 3 hours.

In pregnancies, more than 12 weeks of gestation the combined regimen (mifepristone and misoprostol) does not have the loading dose of 800 mcg misoprostol as in the prior guidance. 

For both the combination regimen and the misoprostol-only regimen, the buccal route has been added as an option. The maximum number of doses has been removed and the time period between mifepristone and misoprostol dosing is given in days.

Ref: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1

7. C3 convertase controversy (re-solved) (MCQ ID: MC2954)

Clearing the confusion, in accordance with the latest update, C3 convertase in the classical complement pathway and lectin complement pathway is C4b2a.

C3 convertase in the alternate complement pathway is C3bBb.

Ref: Kuby’s Immunology – 8th edition, Page no. 364.