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Transition Block > 14/04/18 > Flashcards

14/04/18 Flashcards

1
Q

What is this type of breathing?- high resp rate and shalow breathing?

A

Kussmaul breathing

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2
Q

What are the causes a metabolic acidosis with a high anion gap?

A

lactic acidosis; DKA; aspirin overdose; uraemic acidosis-renal failure

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3
Q

What are the triggers of DKA?

A

infection; surgery; MI; pancreatitis; chemotherapy; antipyschotics; wrong insulin dose/ non-compliance

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4
Q

What are required for a diagnosis of DKA?

A

acidaemia; hyperglycaemia/known DM; ketonaemia or ketonuria

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5
Q

What investigations should be done in DKA?

A

CXR; ECG; MSU; capillary and lab glucose; ketones; ph (venous unless decreased GCS/hypoxia); U&Es; bicarb; osmolality; FBC; blood cultures

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6
Q

What is the first thing to do with DKA?

A

fluid replacement: 1L 0/9% over 1h

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7
Q

What is the fluids in DKA if systolic <90?

A

500ml bolus over 15 mins

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8
Q

How much insulin should be given after fluids in DKa?

A

50 units to 50ml 0.9%

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9
Q

What is the aim for insulin in DKA?

A

fall in blood ketones of 0.5mmol/L/h or rise in bicarb of 3mmol/L/h with a fall of glucose of 3mmol/L/h

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10
Q

When should 10% glucose be started in DKA?

A

when glucose <14 mmol

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11
Q

How often should ketones and glucose be checked in DKA?

A

hourly

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12
Q

What should be suspected if glucose is normal but significant ketonuria?

A

alcohol

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13
Q

What are hte important secondary causes of immunodeficiency?

A

infections e.g HIV; malnutrition; malignancy; drugs; protein-losing states eg nephrotic syndrome; metabolic disease (DM; liver disease)

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14
Q

What are hte investigations for suspected immunodeficiency?

A

FBC; liver and renal function; UA; HIV; total serum proteins

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15
Q

What type of infection is common in CVID due to mucosal antibody deficiencies?

A

giardia

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16
Q

What are the potential complications of CVID?

A

increased AI disease; lung disease; granulomatous disease; cancenr

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17
Q

What causes CVID?

A

defect in ability of B cells to differentiate into antibody secreting plasma cells

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18
Q

What is normal anion gap?

A

10-18mmol

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19
Q

Why does renal tubular acidosis reuslt in nephrolithaisis?

A

acidosis causing increased citrate reabsoportion in the proximal tubule

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20
Q

What are the common causes of renal tubular acidosis?

A

autoimmune disease, sickle cells, drugs eg lithium

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21
Q

What does a normal anion gap mean?

A

hydrogen is being retained or that bicarb is being lost

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22
Q

How is AKI categoried?

A

pre-renal; renal and post-renal

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23
Q

What are hte causes of post-renal AKI?

A

bladder outflow obstruction; ureteric calculi; crystal nephropathy; urehtlial neoplasma

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24
Q

What are the biochemical abnormalities seen with tumour lysis sundrome?

A

increased urate; hyperkalaemia; hyperphosphataemia and hypocalcaemia

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25
Q

What are the symptoms of tumour lysis syndrome?

A

seizures; arrhytmia; death

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26
Q

Why are there increased uric acid in tumour lysis syndrome?

A

release of nucleic acids which are metabolised to uric acid

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27
Q

Why does renal failure occur with tumour lysis syndrome?

A

urate and phosphate may crystallise and cause intratubular obstruction

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28
Q

What is the treatment for hyperuricaemia?

A

rasburicase which converts uric acid to inacigve metabolits

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29
Q

Why is rasburicase preffered over allopurinol in acute hyperuricaemia?

A

breask down exisitng urate rather than just preventing further formation of urate which is the action of allopurinol

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30
Q

What are the 2 broad categories of ambiguous genitalia?

A

virilised XX female and undervirilised male

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31
Q

what are the causes of virilised females?

A

fetal androgens- CAH or maternal

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32
Q

What are the causes of undervirilised males?

A

reduced foetal androgen production e.g Leydig cells defects; 5 alpha reductase defieicny; deficiency of anti-mullerian hormone ; androgen insufficiency; testicular dysgenesis

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33
Q

What is the inheritance of CAH?

A

AR

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34
Q

What is the most common cause of CAH?

A

21 hydroxylase deficiency

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35
Q

What happens in 21 hydroxylase defiency?

A

needed for the synthesis of aldosterone and cortisol but not adrenal androgens

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36
Q

Why is there hyperplasia in CAH?

A

lack of cortisol stimulates increased ACTH– hyperplasia of the gland

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37
Q

What blood test is done for CAH?

A

increased 17-hydroxyprogesterone levels

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38
Q

What form of CAH may give boys ambiguous genitalia?

A

17-hydroxylase defiency results in decreased androgens

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39
Q

What forms the buffalo hump in Cushings disease?

A

supraclavicular and cervical fat deposits

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40
Q

What is the function of a high-dose dexamethasone suppression test?

A

suppresses cortisol levels in Cushing’s disease but not ectopic ACTH or adrenal tumour

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41
Q

What are the endocrine causes of hypertension?

A

primary aldosteronism; Cushing’s syndrone; phaeo; acromegaly; hypo/hyperthyroidism

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42
Q

What are the causes of transcellular movement of K causing hypolaemaia?

A

alkalosis; insulin treatment; beta-agonist; refeeding syndrome

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43
Q

What are the complications of hypokalaemia?

A

cardiac arrhythmia; constipation; ileus; rhabdomyolysys; respiratory muscle weakness-resp failure ; nephrogenic DI

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44
Q

What is the other term for primary hypogonadism?

A

hypergonadotrophic hypogonadism

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45
Q

What are the congenital causes of primary hypogonadism?

A

Klinefelters; testicular ageneis;s enzyme defects

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46
Q

What are hte acquired causes of priamry hypogonadism?

A

mumps orchiditis; bilateral testicualr injury/ torsion; irradiation or cytotoxic drugs

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47
Q

What common causes of secondary hypogonadism?

A

pituitary; hypothalamic; obesity; drugs

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48
Q

What is the tumour if there is hypogonadism; reduced libido and erectile dysfunction?

A

prolactinoma

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49
Q

Why should TFTs be done with suspected prolactinomas?

A

primary hypothyroidism is a common cause of hyperprolactinaemia

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50
Q

What is the definition of a microprolactinoma?

A

<10mm on MRI

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51
Q

what is first line treatment for prolactinomas?

A

bromocriptine or cabergoline

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52
Q

What happens as density of lipoproteins increases?

A

less Tgs with increasing cholesterol and protein

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53
Q

What are the causes of hyperlipidaemia?

A

primary or secondary- hypothyroidism; DM; obesity; nephrotic syndrome; renal and liver failure; drusg and alcohol

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54
Q

What drugs are implicated in hyperlipidaemia?

A

thiazides and antiretrovirals

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55
Q

What is the MOA of ezetimibe?

A

inhibits intestinal cholesterol absoprtion

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56
Q

What vessels do chylomicrons go into first?

A

lynphatics

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57
Q

What is cholesterol made from?

A

acetyl-CoA

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58
Q

What else is made from acetyl- CoA?

A

fatty acids

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59
Q

What makes lipoproteins?

A

golgi apparatus

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60
Q

What is found in lipoproteins?

A

apoprotein; TGs; phospholipids and cholesterol

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61
Q

What are the 2 types of lipoproteins the liver makes?

A

HDL and VLDL

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62
Q

How are fatty acids liberated in VLDL?

A

lipases in endothelial cells

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63
Q

What does VLDL become once some fatty acids are liberated?

A

IDL

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64
Q

What does IDL turn into?

A

LDL

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65
Q

What is the main function of LDL?

A

transportation of cholesterol

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66
Q

What is the function of VLDL?

A

transportation of fatty acids to tissues

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67
Q

what are the functions of cholesterol?

A

to make hormoens and stabilise cell membrane

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68
Q

What happens to excess cholesterol?

A

excreted in bile

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69
Q

What receptor is invovled in the uptake of HDL into hepatocytes?

A

scavenger receptors

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70
Q

What is the typical rash seen with graft vs host disease?

A

erythematous rash taht develops on the palms or soles of the feet

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71
Q

What is the chemo regime for hogdkins ?

A

ABVD

72
Q

How can graft vs host disease occur in autologous grafts?

A

chemotherapy exposes self-antigens

73
Q

What are the manifestations of GVHD?

A

maculo-papular rash; jaundice and hepatosplenomeglay and ultimately organ fibrosis

74
Q

What are the common complications of a bone marrow transplant?

A

infection; bleeding and GVHD

75
Q

What type of hypersensitivity reaction is GVHD?

A

type 4- T cell mediated

76
Q

What are the 3 types of fragility #?

A

Colles; neck of femur and vertebral body

77
Q

What tests should be done to look for secondary causes of osteoporosis?

A

FBC; ESR; bone profile; liver and renal function; thyroid function; screen for myeloma

78
Q

What are the initial signs of allograft transplant rejection?

A

increased serum bilirubin and deranged LFTs

79
Q

What type of hypersensitivty reaction is hyperacute organ rejection?

A

type II

80
Q

When does acute organ rejection take place?

A

a number of weeks after the transplant

81
Q

when does hyperacute organ rejection take palce?

A

within minutes of graft perfusion in theatre

82
Q

What type of hypersensitivty reaction is acute organ rejection?

A

type 4

83
Q

What are the calcineurin inhibitiors?

A

cyclosproin and tacrolimus

84
Q

what is the fucntion of calcineurin inhibitiors?

A

inihibit calcineurin and production of IL2 by T cells

85
Q

What is hyperacute rejection a result of ?

A

ABO incompatibility

86
Q

What are the common causes of CKD?

A

DM; HT; GN; renovascular disease; chronic obstruction; hereditry

87
Q

What occurs in renal osteodystrophy?

A

kidney failure- phosphate retenion and hypocalcaemia with reduced vitamin D–osteomalacia and hyperaprathyroidism; and in acidosis excess hydrogen ions are buffered by bone- further demineralisation

88
Q

What is adrenoleukodystrophy?

A

x-linked disorder with accumulation of ver long chain fatty acids in several organs including the adrenal gladn

89
Q

what is the treatment for Marfans?

A

regular screening with echo; beta blockers; surgery

90
Q

Why are patients with marfans at increased risk of aortic aneurysm and dissection?

A

aortic root dilatation

91
Q

What are the mx options for women with the BRCA mutations?

A

primary prevention- prophylactic mastectomy and/or oopherectomy; chemoprevention with tamoxifen or surveillance- self-examination with annual mammography and breast MRI

92
Q

What is the risk of breast cancer with BRCA1?

A

80% lifetime

93
Q

What is the risk of breast cancer with BRCA2?

A

40%

94
Q

What is the risk of ovarian cancer in BRCA1 compared to BRCA2?

A

40% with BRCA1 and 10% with BRCA2

95
Q

What are the most common causes of neonatal seizure?

A

hypoxic-ischaemic encephalopathy; intracranial haemorrhage; CNS infections; metabolic disorders

96
Q

What is the most common cause of hypocalcaemia?

A

hypoalbuminaemia

97
Q

What are the features of tetralogy of fallot?

A

ventricular septal defect; pulmonary stenosis; over-riding aorta; RV hypertrophy

98
Q

What is the function of the 3rd branchial pouch?

A

development of hte inferior parathyroid glands and thymus

99
Q

What is the function of the 4th branchial pouch?

A

superior parathyroid glands

100
Q

What happens in DiGeorge syndrome?

A

defect in neural crest cell migration and defects in 3rd and 4th branchial pouch

101
Q

What does a defect in neural crest migration result in?

A

defects in development of the heart, ascending aorta and pulmonary trunk

102
Q

What is the second most common casue of congenital cardiac anomalies ?

A

DiGeorge (second to Down’s)

103
Q

What is the usual inheritnace of DiGeorge syndrome?

A

usually denovo but can be AD

104
Q

What are the features of DiGeorge syndrome?

A 
Cardiac defects
Abnormal facies
Thymus hypoplasia
Cleft palate
Hypocalcaemia (parathyroid hypoplasia)
105
Q

How long does the serological response to HIV take ?

A

4-8 weeks

106
Q

What is AIDS?

A

dramatic increase in viral load with breakdown of host defences and appearance of serious opportunistic infections, secondary neoplasma and neurologica disease

107
Q

What are the specific anti-retroviral investigations for newly diagnosed HIV?

A

CD4 coutn; HIV viral load; serological tests for toxoplasma; CMV; tuberculin skin test; ECG; CXR

108
Q

When should prophylactic co-trimoxazole be started?

A

CD4 count <200

109
Q

When should mycoplasma prophylaxis with azitrhomycin be used?

A

CD4 <50

110
Q

What vaccines should all HIV patietns recieve?

A

strep; influenza and hepB

111
Q

What type of hypersensitivity with Rheumatic fever?

A

type II

112
Q

Why is there a delay in presentation of cardiac symptoms following rheumatic fever?

A

continued immunologic damage and fibrosis progresses over years to cause deformity of the heart valves

113
Q

What are the pathognomic histologic features of Rheumatic fever?

A

Aschoff bodies - granulomas with giant cells (macrophages)– which can become activated = Anitschkows cells

114
Q

what are the complications of rheumatic heart disease?

A

cardiac failure; AF and VTE; infective endocarditis

115
Q

What is the common mechanism of death in SCD?

A

lethal arrhythmia triggered by irritability of the myocardium

116
Q

What is sudden cardiac death defiend as?

A

death within 1 hour of onset of cardiac sypmtosm

117
Q

What is Dresslers syndrome?

A

recurrent pericarditis; pleural effusions; fever; anaemia; and increased ESR 1-3 weeks psot MI

118
Q

What is hte treatment for pericarditis?

A

NSAIDs

119
Q

What is Kussmauls sign?

A

JVP rises during inspiration

120
Q

What are the causes of mitral regurgitation following an MI?

A

papillary muscle dysfunction or papillary/choradal muscle rupture secondary to ischaemia

121
Q

How does VSD present?

A

pansystolic murmur, increase JVP; cardiac failure

122
Q

What would persisten ST elevation signify 4-6 weeks post-MI?

A

left ventricular aneurysm

123
Q

What is the definition of an aneurysm?

A

abnormal permanent focal dilatation of all layers of a blood vessel

124
Q

What conditions are associated with thoracic aneurysms?

A

Marfans; late stage syphilis

125
Q

What condition is assocaited with coronary artery aneurysms?

A

Kawasaki’s

126
Q

What is a false aneurysm?

A

contained collections of blood immediately outside a vessel but where there is still direct comunication thorugh a defect in the vessel wall

127
Q

What condition is assocaited with panacinar distribution emphysema?

A

alpha-1 antitrypsin deficiency

128
Q

What is cor pulmonale?

A

pure right sided heart failure

129
Q

What are the complications of COPD which can result in sudden death?

A

respiratory failure; cor pulmonale; pneumothorax

130
Q

What do red cell casts mean?

A

GN or vasculitis

131
Q

what do white cell casts mean?

A

acute interstitial nephritis

132
Q

What do fatty casts mean?

A

nephrotic syndrome; minimal change disease

133
Q

What do muddy casts mean?

A

acute tubular necrosis

134
Q

What do renal tubular epithelial cell casts mean?

A

damage to the tubules- eg renal tubular necoriss

135
Q

What is the penumbra?

A

area at the periphery of an infarct

136
Q

What are the main macroscopic abnormalities in Alzhemiers?

A

widening of gyris; atrophy of sulci neurofibrillary tangles; senile plaques and amyoid angiopathy

137
Q

What is a pancreatic gastrinoma associatedi wth peptic ulceration known as ?

A

Zollinger-Ellison syndrome

138
Q

How does H.pylori survive the acidic stomach environment?

A

produces urease- which splits urea into CO2 and ammonia which neutralises smtomach acid

139
Q

Why are U&Es done in a upper GI bleed?

A

increase urea out of proportion to creatinine suggests large blood meal

140
Q

What type of ulcer is at highest risk of rebleeding?

A

psoterior duodenal ulcer as nearest to gastroduodenal artery

141
Q

What are the alarm symptoms associated with dyspepsia?

A

anaemia; loss of weight; anorex;a recent onset/progressive; malaena/haematemesis; swallowing difficulty

142
Q

What are typical tirgger foods with peptic ulceration?

A

coffee; chocolate; tomatoes; fatty or spicy foods

143
Q

What is the treatment for H.pylori infection?

A

PPI and 7 days of amoxicillin and clarithromycin /metronidazole

144
Q

What is the treatment for H.pylori infection is penicillin allergic?

A

PPI and 7 days of clarithromycin and metronidazole

145
Q

What conditions are associated with gallstones?

A

haemolytic disorders; pregnancy; parenteral nutrition; rapid weight loss; loss of bile salts due to terminal ileal resection

146
Q

What is Murphy’s sign?

A

sudden cessation of inspiration while hand is placed on right subcostal area

147
Q

What is a gallstone ileus?

A

gallstoen erosed through the GB into the duodenum. which obstructs the terminal ileum

148
Q

What is Mirrizi’s syndrome?

A

obstructive jaundice from common bile duct compression by a gallsteon impacted in the cystic duct

149
Q

What HLA is assocaited with coeliac disease?

A

HLA DQ2 and DQ8

150
Q

What is seen on biopsy with coeliac disease?

A

subtotal villous atrophy; increased intra-epithelial WBCs and crypt hyperplasia

151
Q

What are the complications of coeliac disease?

A

anaemia; dermatitis herpetiformis; osetoporosis; hyposplenism; GI T-cell lymphoma; increased malignany- lymphoma; gastric; oesophageal; colorectal and neuropathies

152
Q

What is the function of apo-B100?

A

binds to LDL receptors allowing uptake of VLDLs; IDLs and LDLs

153
Q

Why would thiazides be given to a patient with oseoporosis instead of CCBs??

A

increase calcium reabsorption

154
Q

Why is ability to abduct the thumb preserved in carpal tunnel syndrome?

A

action of abductor pollicis longus (radial nerve)- although it is weakened

155
Q

What is seen in central cord syndrome?

A

bilateral weakness- upper more than lower and proximal more than distal

156
Q

What is seen classically with cervical central cord syndrome?

A

cape distribtuion

157
Q

When does papillary thyroid cancer present?

A

3rd and 4th decades in women

158
Q

What is the CD4 count aim?

A

> 350

159
Q

Why is there an increased ferritin in anaemia of chornic disease?

A

ferritin is a serum reactant protein

160
Q

What type of zoster is considered AIDS defining?

A

multidermatomal

161
Q

Is Felty’s syndrome assocaited with leukaemia?

A

No

162
Q

What is HTLV-1 virus associated with?

A

adult T-cell leukaemia

163
Q

What malignancy is assocaited wiht polycythaemia vera?

A

AML

164
Q

What is benzene exposure associated with?

A

AML

165
Q

Which type of leukaemia is assocaited with PAS positive blast cells?

A

ALL

166
Q

What does cytoplasmic grnaulation in blasts indicate?

A

degree of myeloid differentiation-AML

167
Q

What type of leukaemia is associated with DIC?

A

AML

168
Q

What is the most common type of ALL?

A

pre-B phenotype

169
Q

What is a saddle PE?

A

at the bifurcation of the pulmonary veins

170
Q

What is the appearnce of glioblastoma multiforme on CT and why?

A

butterfuly-crosses over the corpus callosum

171
Q

What other name is glioblastoma multiforme give?

A

type 4 astrocytoma

172
Q

Waht is the appearnce of hte meningioma?

A

grows from teh periphery of the brain

173
Q

What conditions are associated with meningiomas?

A

NFII;

174
Q

What condition is situs inversus assocaited with?

A

kartageners syndrome- pulmonary infection;s difficulty conceiving

175
Q

What is horseshoe kidney assocaited with?

A

45XO

176
Q

If there is white out and shift of structures toward the side of opacification what does this mean?

A

atelectasis

177
Q

What is a jones #?

A

fracutre of the base of the 5th metatarsal

Transition Block (35 decks)

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