100 common qs Flashcards
What medications can cause drug induced pneumonitis?
Sulfasalazine
Leflunomide
Amiodarone
Methotrexate
Who is idiopathic intracranial hypertension classically seen in? What are risk factors for it?
Young, overweight females
RF) Obesity, female sex, pregnancy and certain drugs
Idiopathic intracranial hypertension: what are the features? What is the management?
Features - headache, blurred vision, papilloedema, enlarged blind spot, 6th nerve palsy
Weight loss, diuretics (acetazolamide), topiramate, repeated LP, surgery
Acetazolamide: MOA?
MOA: Carbonic anhydrase inhibitor.. Diuretic action is in the PCT, where carbonic anhydrase causes reabsorption of bicarbonate, sodium, and chloride. With reabsorption blocked these components hold water with them, causing increased urination.
Acetazolamide: Uses?
IIH
Prevention of acute mountain sickness and treatment of high altitude pulmonary oedema
Acute closed angle glaucoma - (IV)
Where in the brain does herpes simplex encephalitis commonly effect?
How does it commonly present?
Temporal and inferior frontal lobes
Fever, headache, psych problems, seizures, vomitting, aphasia
HERPES SIMPLEX ENCEPHALITIS:
What is the pathophysiology?
What will you see on investigation?
What is the managment?
HSV-1 is responsible in 95% of cases in adults CSF: Lymphocytosis, increased protein PCR - HSV CT/MRI: Petechial haemorrhages Management: IV aciclovir
ADDISON’S DISEASE: Investigation of choice? How does it work?
ACTH stimulation test (AKA short synacthen test)
Plasma cortisol is measures before and 30 minutes after giving synacthen 250 micrograms IM.
ADDISON’S DISEASE: What is it?
Autoimmune destruction of the adrenal glands
DERMATITIS HERPETIFORMIS: What is it? When do you see it? Pathophysiology? Where on the body do you see it?
An autoimmune blistering disorder
Associated with coeliac’s disease
IgA deposition in the dermis
Elbows, knees and buttocks
CUSHINGS: What test is used to confirm?
Overnight dexamethasone suppression test (most sensitive)
OR
24 hour urinary free cortisol
What anticoagulants should patients with AF be started on post stroke?
After 2 weeks high dose aspirin:
Warfarin on a factor Xa inhibitor (apoxaban, rivaroxaban, dabigatran, edoxaban)
ACROMEGALY
Investigation?
What Ix results would you expect with acromegaly?
Serum IGF-1 levels
If serum IGF-1 levels are uncertain or raised do OGTT (in acromegaly you commonly see raised IGF-1)
OGTT: In normal patients GH is suppressed to <2 with hyperglycaemia (which is induced in this test)
In acromegaly there is no suppression of GH
Chest discomfort and dysphagia with liquids and solids - what should you think of?
Achalasia
What is achalasia?
Failure of oesophageal peristalsis and of relaxation of the lower oesophageal sphincter (LOS) due to degenerative loss of ganglia from Auerbach’s plexus
Foreign travel, maculopapular rash, flu like illness - what should you think of?
Acute HIV (seroconversion)
What should you think of if you see: photosensitive rash with blistering and skin fragility (i.e may me torn) on the face and dorsal aspect of hands. This can occur after minor trauma ??
Porphyria cutanea tarda
When should vaccination for a splenectomy be carried out?
If elective 2 weeks before operation
What vaccinations are required for a splenectomy? Why?
Hib, meningitis A & C, Annual influenza vaccination,
pneumococcal vaccine every 5 years
Also
Prophylactic penicillin V
In primary hyperthyroidism what do you expect the levels of:
Calcium
PO4
PTH to be?
Calcium: High
PO4: Low
PTH: High or normal
Young/middle aged man with knee arthritis what should you think of?
Gonococcal sepsis
What should you think if:
sarcoidosis - bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia
Lofgren’s syndrome
What is titubation?
Head tremor
What should you think if a tremor is: Postural Slow progression Titubation Improved with alcohol?
Benign essential tremor
In what fashion is benign essential tremor inherited?
Autosomal dominant
What are the focal features of a temporal lobe encephalitis?
Aphasia
