18/06 Flashcards
1
Q
cANCA
A
granulomatosis with polyangitis
2
Q
pANCA
A
eosinophilic granulomatosis
Ulcerative colitis (70%)
Primary sclerosing cholangitis (70%)
Anti-GBM disease (25%)
Crohn’s disease (20%)
3
Q
paradoxical rise in APTT and thrombocytopenia
A
APS
4
Q
APS primary prophylaxis
A
low dose aspirin
5
Q
APS secondary prophylaxis
A
initial venous thromboembolic events: lifelong warfarin with a target INR of 2-3
recurrent venous thromboembolic events: lifelong warfarin; if occurred whilst taking warfarin then consider adding low-dose aspirin, increase target INR to 3-4
6
Q
APS tx of arterial thrombosis
A
lifelong warfarin target INR 2-3
7
Q
azathioprine prior test
A
TPMT test
8
Q
azathioprine adverse effects
A
bone marrow suppression
n/v
pancreatitis
> risk of non-melanoma skin cancer
but safe in preg !!
9
Q
azathioprine drug interaction
A
allopurinol so lower doses needed
10
Q
oral ulcers, genital ulcers and anterior uveitis
A
behcets
11
Q
HLA B51
A
behcets
12
Q
behcets pathergy test
A
puncture site following needle prick becomes inflamed with small pustule forming
13
Q
bisphosphonates MOA
A
inhibit osteoclasts by reducing recruitment and promoting apoptosis
14
Q
bisphosphonates adverse effects
A
oesophageal reactions
osteonecrosis of the jaw
> risk atypical stress fractures
acute phase response
hypocalcaemia
15
Q
important check before starting bisphosphonates
A
Hypocalcemia/vitamin D deficiency should be corrected before
16
Q
benign ‘overgrowth’ of bone, most typically occuring on the skull
A
osteoma
17
Q
cartilage-capped bony projection on the external surface of a bone
A
osteochondroma
18
Q
X-ray shows a ‘double bubble’ or ‘soap bubble’ appearance
A
giant cell tumour
19
Q
occurs most frequently in the metaphyseal region of long bones prior to epiphyseal closure
codman triangle and sunburst appearance
Rb gene
A
osteosarcoma
20
Q
small round blue cell tumour
onion skin appearance
A
ewings sarcoma
21
Q
malignant tumour of cartilage
A
chondrosarcoma
22
Q
CFS mx
A
specialist service
energy mx
physical activity and exercise
CBT
23
Q
denosumab MOA
A
human monoclonal antibody that prevents the development of osteoclasts by inhibiting RANKL
24
Q
prevention of skeletal-related events (i.e. pathological fractures)
A
denosumab
25
drug induced lupus antibodies
ANA +ve, dsDNA -ve
anti-histone
anti-ro anti-smith
26
drug induced lupus
procainamide
hydralazine
27
consequence of ileaocaecal resection in crohns
b12 def
28
Normal/raised total gas transfer with raised transfer coefficient
asthma or pulmonary haemorrhage
29
when should dex not be given in meningitis
suspected menigococcal septicaemia
30
ehlers danlos syndrome
type III collagen
31
fibromyalgia diagnosis
American College of Rheumatology
classification criteria which lists 9 pairs of tender points on the body
If a patient is tender in at least 11 of these 18 points it makes a diagnosis of fibromyalgia more likely
32
fibromyalgia mx
explanation
aerobic exercise: has the strongest evidence base
cognitive behavioural therapy
medication: pregabalin, duloxetine, amitriptyline
33
gout precipitating drug
thiazides
34
HLA-DQ2/DQ8
coeliac disease
35
HLA-DR2
narcolepsy
good pastures
36
marfans syndrome
protein fibrillin 1
37
methotrexate adverse effects
mucositis
myelosuppression
pneumonitis
pulmonary fibrosis
liver fibrosis
38
methotrexate co-prescription
folic acid 5mg once weekly
39
methotrexate interactions
trimethoprim or co-trimoxazole
high dose aspirin
40
methotrexate toxicity
folinic acid
41
myopathies
symmetrical muscle weakness (proximal>distal)
42
DIP, PIP joints
OA
43
MCP, PIP joints
RA
44
osteomalacia invx
low vit D, calcium and phosphate
raised alkaline phosphatase
xray - translucent bands
45
what is z score adjusted for
age, gender and ethnic factors
46
bones affected pagets
skull, spine/pelvis, and long bones of the lower extremities
47
mx of pagets
bisphosphonate
48
polymyositis antibodies
anti-synthestase
anti-JO1
49
DIPs affected
OA or PSORIATIC
50
raynauds mx
CCB eg nifedipine
51
post STI form of reactive arthritia
chlamydia
52
what invx should be done in all pts with suspected rheumatoid
xrays of hands and feet
53
supraspinatus
aBDucts arm before deltoid
Most commonly injured
54
infraspinatus
Rotates arm laterally
55
teres minor
aDDucts & rotates arm laterally
56
subscapularis
aDDuct & rotates arm medially
57
malignancy from sjogrens
lymphoid
58
stills disease diagnosis
Yamaguchi criteria
59
cautions sulfasalazine
G6PD deficiency
allergy to aspirin or sulphonamides (cross-sensitivity)
60
adverse effects sulfasalazine
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses
61
SLE
type 3 hypersensitivity reaction
62
what does raised CRP in sle indicate
infection as levels are usually normal during flares
63
sle complement c3 c4 levels
usually low during active disease
64
limited cutaneous systemic sclerosis
face and distal limbs predominately
anti-centromere antibodies
65
diffuse cutaneous systemic sclerosis
trunk and proximal limbs
anti-scl70
66
evolving visual loss temporal arteritis tx
IV methylprednisolone
67
SAMA
ipratropium
68
what meds can trigger haemolysis in G6PD def
sulph- drugs: sulphonamides, sulphasalazine and sulfonylureas
69
UC most commonly affected area
rectum
70
bradycardia mx
atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion
71
post heel pain
achilles tendon disorder
72
achilles tendon disorder RF
quinolone eg ciprofloxacin use
hypercholesterolaemia
73
adhesive capsulitis assoc
diabetes
74
otawa rules for ankle xray
pain in the malleolar zone and any one of the following findings:
bony tenderness at the lateral malleolar zone
bony tenderness at the medial malleolar zone
inability to walk four weight bearing steps immediately after the injury and in the emergency department
75
weber type A fracture
below the syndesmosis
76
weber type B fracture
start at the level of the tibial plafond and may extend proximally to involve the syndesmosis
77
weber type c fracture
above the syndesmosis which may itself be damaged
78
Maisonneuve fracture
spiral fibular fracture that leads to disruption of the syndesmosis with widening of the ankle joint, surgery is required
79
AVN of the hip causes
long-term steroid use
chemotherapy
alcohol excess
trauma
80
avn hip invx of choice
mri
81
most freq loc of biceps rupture
proximal
long tendon which attaches to the glenoid
82
biceps rupture invx
USS
83
wasting in carpal tunnel
thenar eminence
84
carpal tunnel EPS findings
motor + sensory: prolongation of the action potential
85
carpal tunnel mx
6 wk trial of conservative mx if mild-mod
steroid inj + wrist splints at night
if severe or trial failed
surgical decompression (flexor retinaculum division)
86
tinels sign
tapping causes paraesthesia
87
phalens sign
flexion of wrist causes symptoms
88
colles fracture
Dorsally Displaced Distal radius → Dinner fork Deformity
89
complication colles fracture
median nerve injury: acute carpal tunnel syndrome presenting with weakness or loss of thumb or index finger flexion
90
De Quervain's tenosynovitis
pain on radial side of wrist
finklesteins test
91
duputryens contracture affected fingers
ring and pinkie
92
duputryens contracture causes
+ve FH
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
93
smiths fracture
reverse colles fracture caused by falling backwards
Volar angulation of distal radius fragment (Garden spade deformity)
94
bennets fracture
Intra-articular fracture of the first carpometacarpal joint
95
bartons fracture
Distal radius fracture (Colles'/Smith's) with associated radiocarpal dislocation
96
fat embolism invx
CTPA
97
greater trochanter pain syndrome/trochanteric bursitis
pain over the lateral side of hip/thigh
tenderness on palpation of the greater trochanter
98
T1DM UGI symptoms and erratic blood glucose
gastroparesis -> metoclopramide
99
hip disclocation
POSTERIOR - shortened, adducted and internally rotated leg
100
hip fracture
shortened and externally rotated leg
101
classification of hip fracture
garden system
102
undisplaced intracapsular hip fracture
internal fixation, or hemiarthroplasty if unfit
103
displaced intracapsular hip fracture
arthroplasty (total hip replacement or hemiarthroplasty)
THR if prev fit and well well
104
extracapsular fracture - stable intertorchanteric
dynamic hip screw
105
extracapsular fracture - reverse oblique, transverse or subtrochanteric
intramedullary device
106
iliopsoas abscess invx
CT abdo
107
iopsoas abscess mx
IV abx
percutaneous drainage
if this fails -> surgery
108
lateral knee pain in runner
iliotibial band syndrome
109
unhappy knee triad following lateral blow to knee damage
anterior cruciate ligament
medial collateral ligament
meniscus
110
twisting injuries
ACL or menisci
111
dashboard injuries
PCL
112
skiiing/valgus stress
MCL
113
chondromallacia patellae
Teenage girls, following an injury to knee e.g. Dislocation patella
Typical history of pain on going downstairs or at rest
114
tibial plateau fractures
Schatzker Classification
115
buttock claudication and impotence
leriche syndrome
116
spina stenosis diagnosis
MRI
117
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L3
118
sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
L4
119
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
L5
120
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
S1
121
Injury results in a positive Trendelenburg sign
superior gluteal nerve
122
lumbar spinal stenosis
central canal is narrowed by tumour, disk prolapse or other similar degenerative changes
123
lumbar spinal stenosis tx
laminectomy
124
pain is aggravated by wrist flexion and pronation
medial epicondylitis
125
froments sign
ulnar nerve palsy
126
osteomyelitis in sickle cell pts
salmonella
127
?osteoporotic vertebral fracture invx
xray
128
salter harris I
Fracture through the physis only (x-ray often normal)
129
salter harris II
Fracture through the physis and metaphysis (up the way)
130
salter harris III
Fracture through the physis and epiphysis to include the joint (down the way)
131
salter harris IV
Fracture involving the physis, metaphysis and epiphysis
132
salter harris V
Crush injury involving the physis (x-ray may resemble type I, and appear normal)
133
heel pain in adults
plantar fasciitis
134
rib fracture invx
ct chest
135
proximal scaphoid pole fractures
surgical fixation
136
shoulder dislocation
ANTERIOR
137
Painful arc of abduction between 60 and 120 degrees
Tenderness over anterior acromion
supraspinatus tendonitis
138
humeral neck fracture/dislocation
axillary nerve
139
humeral midshaft fracture
radial nerve
140
medial epicondyle fracture
ulnar nerve
141
thumb, middle, or ring finger
trigger finger
142
talipes equinovarus tx
ponseti method
143
pulled elbow tx
passively supination of the elbow joint whilst the elbow is flexed to 90 degrees
144
AACG
hypermetropia
145
OAG
myopia
146
osteomyelitis kids
metaphysis
147
osteomyelitis adults
epiphysis
148
adrenaline dose anaphylaxis
0.5ml 1:1,000 IM
149
adrenaline dose cardiac arrest
10ml 1:10,000 IV or 1ml of 1:1000 IV
150
mx of accidental adrenaline injection
local infiltration of phentolamine
151
disulfram
promotes abstinence
152
acamprosate
reduces craving
153
main SE of alpha blockers
postural hypotension
154
slate gray appearance
amiodarone
155
beta blocker overdose
atropine
in resistant cases glucagon may be used
156
cocaine toxicity
benzos
157
when should digoxin levels be measured if suspected toxicity
within 8 to 12 hours of the last dose
158
statins
LFTs
159
ACEi
U+Es
160
amiodarone
TFT, LFT
161
methorexate
FBC, LFT, U&E
162
azathioprine
FBC, LFT
163
lithium
Lithium level, TFT, U&E
164
valproate
LFT
165
glitazones
LFT
166
invasive diarrhoea
cipro
167
CK in PMR
normal
168
allergic contact dermatitis
type IV hypersensitivity
169
Otitis externa in diabetics
treat with cipro to cover pseudomonas
170
haemophilia
APTT increased
PT normal
bleeding time normal
171
von willebrands
APTT increased
PT normal
bleeding time increased
172
vit K def
APTT increased
PT increased
bleeding time normal
173
acute intermittent porphyria enzyme defect
porphobilinogen deaminase
174
abdominal, neuro and neuropsychiatric symptoms in 20-40 year olds
urine turns deep red on standing
acute intermittent porphyria
175
acute intermittent porphyria tx
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available
176
assoc with t(15;17)
fusion of PML and RAR-alpha genes
presents younger than other types of AML (average = 25 years old)
Auer rods (seen with myeloperoxidase stain)
DIC or thrombocytopenia often at presentation
good prognosis
Acute promyelocytic leukaemia M3
177
APS pregnancy mx
low-dose aspirin once the pregnancy is confirmed on urine testing
low molecular weight heparin once a fetal heart is seen on ultrasound. This is usually discontinued at 34 weeks gestation
178
blood film: spherocytes and reticulocytes
positive direct antiglobulin test (Coombs' test).
AI haemolytic anaemia
179
antibody in warm AIHA
IgG
180
antibody cold AIHA
IgM
181
warm AIHA tx
steroids (+/- rituximab)
182
absence of beta globulin chains
HbA2 & HbF raised
beta thalassaemia major
183
beta thalassaemia major tx
repeated transfusion + iron chelation therapy
184
microcytosis disproportionate to anaemia
beta thalassaemia trait
185
target cells
Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease
186
'Tear-drop' poikilocytes
myelofibrosis
187
spherocytes
Hereditary spherocytosis
Autoimmune hemolytic anaemia
188
basophillic stippling
Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia
189
howell jolly bodys
hyposplenism
190
heinz bodies
G6PD def
alpha thalassaemia
191
schistocytes/helmet cells
Intravascular haemolysis
Mechanical heart valve
Disseminated intravascular coagulation
192
'Pencil' poikilocytes
iron deficiency anaemia
193
hypersegmented neutrophils
megaloblastic anaemia
194
blood transfusion anaphylaxis cause
Can be caused by patients with IgA deficiency who have anti-IgA antibodies
195
RBC transfusion threshold in pts without ACS
70
196
RBC transfusion threshold in pts with ACS
80
197
burkitts lymphoma genetics
c-myc gene translocation, usually t(8:14)
198
starry sky appearance
burkitts lymphoma
199
CLL richters transformation
-> high grade lymphoma
200
smudge cells/smear cells
CLL
201
CLL invx
immunophenotyping: most cases can be identified using a panel of antibodies specific for CD5, CD19, CD20 and CD23
202
CML genetics
translocation between the long arm of chromosome 9 and 22 - t(9:22)(q34; q11) -> BCR-ABL gene -> tyrosine kinase activity in excess of normal
203
CML transformation
blast transformation -> AML, ALL
204
CML tx
imatinib
205
dabigatran MOA
direct thrombin inhibitor
206
rivaroxaban, apixaban and edoxaban MOA
direct XA inhibitors
207
apixaban and rivaroxaban reversal
Andexanet alfa
208
dabigatran reversal
Idarucizumab
209
DIC picture
↓ platelets
↓ fibrinogen
↑ PT & APTT
↑ fibrinogen degradation products
schistocytes due to microangiopathic haemolytic anaemia
210
most common inherited thrombophilia
factor V leiden/activated protein C resistance
211
heinz bodies, bite and blister cells
G6PD
212
G6PD diagnosis
G6PD enzyme assay 3 months after an acute episode of haemolysis
213
drugs causing haemolysis in G6PD
anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas
214
acute GVHD
within 100 days of transplantation
215
chronic GVHD
after 100 days following transplantation
216
t(9;22) - Philadelphia chromosome
CML
217
t(15;17)
acute promyelocytic leukaemia (M3)
218
t(8;14)
burkitts lyphoma
219
t(11;14)
mantle cell lymphoma
220
t(14;18)
follicular lymphoma
221
hereditary spherocytosis long term tx
folate replacement
splenectomy
222
reed sternberg cell
hodgkins lymphoma
223
hodgkins lymphoma tx
chemo - ABVD or BEACOPP
