2nd year stuff Flashcards
what is the first line treatment for acne rosacea
topical metronidazole
what is the first line treatment for acne vulgarisms
benzyl peroxide or topical clindamycin
what is epidermolysis bullosa
inherited breakdown of anchoring between epidermis and dermis
red, flaky, crusty patches skin patches covered with silvery scales normally on elbows, knees, scalp and lower back k
psoriasis
treatment of psoriasis
corticosteroid or vitamin D3 analogue cream
coal tar/keratolytic
what causes a neurogenic pruritus
an effect on the CNS receptors, thyroid disease or malignancy
how are autoimmune blistering conditions confirmed
diagnostic biopsy with immunofluorescence
what is toxic epidermal necrolysis
severe, acute superficial desquamating eruption secondary to a drug
how does toxic epidermal necrolysis
fever
malaise
painful erosions
generalised erythema
what do meissner’s corpuscles detect
vibration
what do pacinian corpuscles detect
pressure
what are risk factors for skin cancer
childhood sunburn occupation related to high sun exposure sun beds type 1 skin pre-cancerous lesions Fix of skin cancer immunosuppressed exposure to radiation treatment
why are creams more likely to cause contact sensitisation than ointments
they contain preservatives
what condition is dermatitis herpetiformis associated with
coeliac
which type if insulin do you give once a day
basal (long acting)
which diabetic drug is weight neutral
DPP4 inhibitors (gliptins) and metformin
which diabetic drugs cause weight loss
GLP1 agonists
which diabetic drug causes glycosuria
SGLT2 inhibitor
‘strawberry milkshake coloured blood’
hyperlipidaemia
what are features of hyperparathyroidism
bone disease renal stones GI complications depression lethargy seizures weakness fatigue calcification of aortic and mitral valves
what are features of hypoparathyroidism
neuromuscular irritability Chvostek's sign Trousseau's sign emotional lability anxiety confusion psychosis basal ganglia calcification cataracts
which hormone peaks before ovulation
LH about 12 hours before
what hormone do you test to check for ovulation
progesterone
what is the pathophysiology of Paget’s disease of bone
increased abnormal osteoclastic reabsorption followed by increased osteoblastic activity
results in abnormal bone structure with reduced strength and increased fracture risk
presentation of Paget’s disease of bone
old man bone pain (pelvis, lumbar spine, femur) deformity deafness compression neuropathies
how is Paget’s disease treated
bisphosphonates
what do osteoclasts do
breakdown bone for maintenance, repair and remodelling
what do osteoclasts do
synthesise and lay down new bone
what causes osteomalacia
vitamin D deficiency (malabsorption, poor diet, lack of sunlight)
what is the pathophysiology of osteomalacia
abnormal softening of the bone due to deficient mineralisation of osteoid (immature) bone
what are symptoms of osteomalacia
bone pain
tenderness
fractures (femoral neck)
proximal myopathy
what is the treatment for osteomalacia
vitamin D therapy with Ca and phosphate supplements
how do you assess the risk of osteoporosis
DEXA scan
features of grave’s
gradual onset mild/moderate thyroid enlargement diffuse enlargement on palpation hyperdynamic tachycardia heat intolerant eye disease etc
TFTs in grave’s
raised T4 and fT3, suppressed TSH
features of Hashimoto’s
slow onset firm and well-defined lymph nodes bradycardia cold intolerance no tremor hoarseness dysphagia etc
TFTs in Hashimoto’s
low T4 and fT3
raised TSH
symptoms of De Quervain’s thyroiditis
acute, painful moderate swelling smooth, diffuse and tender bilateral swelling transiently hyper dynamic and tremor painful dysphagia
TFTs of De Quervian’s thyroiditis
raised T4 and fT3
suppressed TSH
what is the commonest thyroid cancer
papillary thyroid cancer
which thyroid cancer has a poor prognosis
medullary thyroid cancer
what is the purpose of thyroid remnant ablation
removes residual tissue to prevent recurrence
always combined with surgery
what conditions are present in MEN1
hyperparathyroidism
prolcatinoma
pancreatic tumour
what conditions are present in MEN2a
parathyroid hyperplasia
medullary thyroid carcinoma
phaeochromocytoma
what conditions are present in MEN2b
marfanoid body habitus
mucosal neuroma
medullary thyroid carcinoma
phaeochromocytoma
what is the function of oxytocin
breastfeeding let down reflex
induction of labour
how are ketone bodies generated in DKA
lipolysis
which drug classes are associated with reactivation of latent TB
TNF alpha inhibitor (etanercept, infliximab)
what causes cubital tunnel syndrome
compression of ulnar nerve n cubital fossa
presentation of cubital tunnel syndrome
tingling in ring and pinky finger
how do you treat necrotising fasciitis
debridement + penicillin + clindamycin
which DMARD causes interstitial pneumonitis
methotrexate
which drug used in the management of rheumatoid conditions can cause black tarry stool
NSAIDs
gastric ulcer
which rheumatoid drugs are nephrotoxic
gold
penicillamine
which DMARD causes bone symptoms
prednisolone
what type of hypersensitivity is RhA
type IV
what is the pathophysiology of RhA
synovial fills with macrophages, fibroblasts and giant cells
the membrane expands and erodes bone and cartilage
what are signs of poor prognosis in RhA
pre-menopausal status smoker young onset high inflammatory markers at onset positive RF
what are X-ray signs of OA
loss of joint space
osteophyte formation
subchondral sclerosis/cysts
where are hederden’s and Bouchard’s nodes found
DIP and PIP respectively
20-55 years old well patient back/buttock/thigh pain normally neurology pain changes with position of movement
simple backache
mechanical
unilateral leg pain paraesthesia in same distribution leg>back pain abnormal neurology weakness reflex/sensory changes nerve stretch pain
nerve root pain
osteoporosis/long term steroid use premature menopause cancer Hx weight loss unremitting pain sleep loss under 20 or over 55
serious spinal pathology
saddle anaesthesia
altered bladder control
bowel incontinence
gait disturbance
cauda equina syndrome
treatment of carpal tunnel
corticosteroid injection, splint, workplace task modification, standard open carpal tunnel release, arthroscopic
cubital tunnel treatment
splint
neurolysis
anterior transposition
dupuytren treatment
radiation therapy
needle aponeurotomy
collagenase injection
trigger finger treatment
corticosteroid injection
surgery
which nerve is most likely to be damaged in humeral shaft fractures
radial nerve
which nerve is most likely to be damaged in a supracondylar fracture of distal humerus
median nerve damage
how does dupuytren’s contracture develop
nodule develop
during active contractile phase, contraction forms because of contractile myofibroblasts within the lesion
why is hydroxyquinolone used as a last-line treatment in RhA
rarely causes retinopathy
Charcot foot is often associated with which condition
diabetes
how does Charcot arthropathy present
unilateral ankle swelling with no pain
slight erythema
paraesthesia of the foot ankle instability
what are typical features of seronegative arthritis
sacra-iliac joint erosions
soft tissue swelling
irregular peri-articular new bone formation
pencil-in-cup deformity
spinal ligament ossification (syndesmophyte)
how does RhA present
symmetrical polyarthritis usually affecting small peripheral joints with red hot swelling and raised inflammatory markers
which antibody is associated with RhA
anti-CCP
which antibody is associated with APS
anti-cardiolipin
which conditions is investigated by anti-centromere antibodies
systemic sclerosis
features of ankylosing spondylitis
acute pain and stiffness of cervical spine
bilateral foot pain
trouble breathing
signs of prolapsed disc
pain and numbness in spinal nerve distribution with foot drop
signs of burst fracture
severe lumbar pain following a fall from height or severe axial loading
what causes a colles fracture
FOOSH
what are features of a colles fracture
extra-articular fracture of distal radius
dorsal angulation
dorsal displacement
what are complications of colles fracture
median nerve compression
EPL rupture
CRPS
loss of grip strength
what are features of bone mets
high calcium
osteoclast proliferation
bone pain
what causes inflammation and degeneration of skeletal muscle throughout the body
polymyositis
features of polymyalgia rheumatica
pain or stiffness, usually in the neck, shoulder, upper arms and hips
signs of systemic sclerosis
Calcinosis Raynaud's Esophageal dysmotility Sclerodactyly Telangiectasia
why should tetracycline not be prescribed to children under 12 years
causes permanent tooth discolouration and occasional dental hypoplasia
what are features of Aspergers
impaired social interaction without delays in cognition or language development
2-day-old infant with non-projectile bilious vomiting
volvulus
4-day-old infant with projectile vomiting and associated constipation, eager to feed
pyloric stenosis
week old infant vomiting small amount after every feed, child well and gaining weight
gastro-oesophageal reflux
placental artery carries oxygenated/deoxygenated blood
deoxygenated blood
placental vein carries oxygenated/deoxygenated blood
oxygenated blood
how long do episodes of BPPV last
seconds to minutes
how is BPPV diagnosed
hallpike
treatment of BPPV
epley manoeuvre
compression of CN VII in facial canal
Bell’s palsy
what causes Ramsay Hunt Syndrome
reactivation of VZV n geniculate ganglion of CN VII
what are features of Ramsay hunt syndrome
auricular pain
facial nerve palsy
vesicular rash around ear, vertigo and tinnitus
management of Ramsay hunt syndrome
oral acyclovir and corticosteroids
which condition causes aural fullness
meniere’s disease
symptoms of labyrinthitis
dizziness
hearing loss
vertigo
signs of vestibular schwannoma
loss of corneal reflex
sensorineural hearing loss
vertigo
tinnitus
bilateral vestibular schwannoma is a feature of…
neurofibromatosis II
which nerve supplies sensory innervation of the cornea
ophthalmic division of the trigeminal nerve
what is central scotoma
absence of central vision
what type of visual loss is associated with dry ARMD
central scotoma
signs of CN III palsy
eye looking down and out
fixed dilated pupil
proptosis
ptosis
signs of CN IV palsy
eyes look upwards
vertical diplopia
cannot look down and in
head held tilted
signs of CN VI
horizontal diplopia
eyes medially deviated
cannot move laterally from midline
convergent squint
what causes cataracts
denaturation of the lens protein as part of ageing
gradual painless loss of vision, reduced visual acuity, diminished red reflex
cataracts
sudden painless profound loss of central vision in one eye following few days distorted vision
ARMD
what causes wet ARMD
neovascularisation leads to large solitary haemorrhage at the macula leading to scarring
what are characteristics of primary open angle glaucoma
raised IOP
disc cupping
field defects
red irritable sticky eyes with normal visual acuity
bacterial conjuncitivitis
red irritable itchy eyes with normal visual acuity
allergic conjunctivitis
sudden onset unilateral visual loss associated with poorly controlled diabetes
retinal haemorrhage
what is the first line treatment for BPH
alpha blocker (tamsulosin)
what is second line treatment for BPH
5 alpha reductase (finestride)
what is the biggest cause of kidney disease
diabetes
what is the first line investigation for a hydrocele
doppler ultrasound with colour
non-transilluminable scrotal swelling
testicular tumour
torsion
hard lump scrotal swelling
testicular tumour
torsion
scrotal swelling associated with absence of cremasteric reflex
torsion
scrotal swelling associated with a ‘blue dot’ sign
torsion of appendix
CKD stage 1
GFR >90
evidence of kidney damage (proteinuria, haematuria or abnormal imaging)
CKD stage 2
GFR 60-90
with evidence of kidney damage (proteinuria, haematuria or abnormal imaging)
CKD stage 3
GFR 30-60
dependent on GFR alone
CKD stage 4
GFR 15-30
dependent on GFR alone
CKD stage 5
GFR <15 or on renal replacement therapy
what do you give in proteinuria and HTN
ACEI
what is the commonest cause of glomerulonephritis
IgA nephropathy
HSP is associated with which type of glomerulonephritis
IgA nephropathy
IgA nephropathy pathology
mesangial cell proliferation and expansion on light microscopy with IgA deposits in mesangium
minimal change glomerulonephritis is common in which age group
children
how is minimal change glomerulonephritis managed
oral steroids
what is seen on EM in minimal change glomerulonephritis
foot process fusion
what antibody is associated with Churg-Strauss (eGPA)
p-ANCA
which antibody is associated with GPA (Wegner’s)
c-ANCA
rhinitis, epistaxis, saddle nose deformity, conductive hearing loss
GPA
investigations for suspected renal colic caused by obstruction
KUB X-ray
CT non-contrast or MRI
investigation of macroscopic haematuria in over 50
CT urography
cystoscopy
investigation of macroscopic haematuria in under 50
US
cystoscopy
CTU when other two fail
when might CTU be contraindicated
contrast allergy
renal impairment
pregnancy
investigation for renal mass
CT
US for simple cyst
MRI with contrast instead of CT if young/pregnant
how to assess AKI
USS U&E coat screen urinalysis immunology protein electrophoresis
what is reabsorbed in the proximal convoluted tubule
all glucose all amino acids sodium Cl- water phosphate sulphate lactate
what is secreted in the proximal convoluted tubule
H+ hippurates bile pigments uric acids drugs toxins
the descending limb is permeable to
water
the descending limb is impermeable to
NaCl
what is reabsorbed in the ascending limb
Na+ and Cl-
which diuretics work on the PCT
carbonic anhydrase inhibitors
which diuretics work on the thick ascending limb of the loop of henle
loop diuretics
which diuretic work on the DCT
thiazides
which diuretics work on the collecting tubule
potassium-sparing diuretics
signs of kyperkalaemia on ECG
peaked T waves
widened QRS
small or absent P waves
how to treat hyperkalaemia
calcium glutinate (stabilise myocardium) insulin glucose IV infusion (insulin drives K+ into cells, glucose maintains blood glucose) NEB salbutamol (drives K+ into cells) calcium resonium (bind K+ in the large intestine to be excreted)
which Ig is found in mucosa
IgA
what bacteria produces endotoxin
gram negative
what is a side effect of ACEI
dry cough
ACEI are contraindicated in
renal stenosis
inferior MI shows up on which ECG leads
2, 3, avF
which artery is blocked in inferior MI
right coronary
lateral MI affects which leads
1 and avL, V5, V6
sharp stabbing chest pain which worsens on breathing in
sudden breathlessness
dry cough (maybe blood)
PE
risk factors for PE
OCP
long haul flight
investigation of PE
CXR
CTPA
ventilation-perfusion scan
management of PE
LMWH
warfarin
sudden severe ripping/tearing chest pain that radiates down back LOC
SOB
Hx of HTN
aortic dissection
management of campylobacter
clarithromycin/azithromycin
management of salmonella
ciprofloxacin
management of E coli
supportive
management of C diff
oral metronidazole
what are the 4Cs
cephalosporin
clindamycin
ciprofloxacin
clarithromycin
bird pneumonia
chlamydiophilia psittaci
sheep/farmer pneumonia
coxiella burnetti
water foreign holiday air conditioner pneumonia
legionella
what is the incidence
the number of NEW cases within a specified time period divided by the size of the population initially artist
what is the prevalence
the number of people found to have the condition with the total number of people studied
how is carpal tunnel syndrome caused
the median nerve passes through the carpal tunnel at the level of the wrist
if the contents of the tunnel swells, the space is too small and the nerve is compressed
which fingers are affected by carpal tunnel
thumb
index
middle
lateral side of ring
what imagining is required for a scaphoid fracture
two obliques
AP
lateral
(4 in total)
Paget’s disease predisposes to which malignancy
osteosarcoma
side effects of methotrexate
myelosuppresssion
liver cirrhosis
pneumonitis
side effects of sulfasalazine
rashes
oligospermia
Heinz Body anaemia
side effects of leflunomide
liver impairment
ILD
HTN
side effects of hydroxychloroquine
retinopathy
corneal deposits
side effects of prednisolone
cushingoeid features osteoporosis impaired glucose tolerance HTN cataracts
side effects of gold
proteinuria
side effects of penicillamine
proteinuria
exacerbation of myasthenia graves
side effects of etanercept
demyelination
reactivation of TB
side effects of mabs
reactivation of TB
what causes sjorgens
lymphocytes invading glands
what do people with systemic sclerosis die of
pulmonary hypertension
dermatitis herpeticum looks like
monomorphic punched out lesions
dermatitis herpeticum is caused by
secondary infection of eczema by HSV
what are gout crystals made of
monosodium urate
gout crystal birefringence
negatively birefringent needle shaped crystals
pseudo gout crystals are made of
calcium pyrophosphate dehydrate
pseudo gout crystal birefringence
positively birefringent rhomboid-shaped crystals
