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Akt Flashcards

0
Q

breast papilloma

A

Occurs in middle aged women and develops in the lactiferous ducts just below the nipple. Form a lumpy mass and associated with a bloody discharge.

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1
Q

Sumitriptan

A

5ht 1 agonist to regulate blood flow
Not for hemiplegic migraine or chd or uncontrolled htn
For aborting acute attacks

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2
Q

clonidine SE

A

Rebound hypertension following acute withdrawal.

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3
Q

verapamil + B-blocker

A

can precipitate complete heart block

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4
Q

hydralazine SE

A

A drug-induced systemic lupus erythematosus (SLE) is associated with hydralazine therapy and serology for the antinuclear factor (ANF) is negative

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5
Q

minoxidil SE

A

widespread hirsutism, which has been harnessed in the treatment of baldness (Regaine topical minoxidil solution).

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6
Q

alpha methyl-dopa SE

A

coombs positive haemolytic anaemia

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7
Q

necrotising fasciitis organism

A

group A strep

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8
Q

lymes org

A

Borrelia burgdorferi - erythema migrans

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9
Q

reactive arthritis orgs

A

Ureaplasma urealyticum and Mycoplasma genitalium

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10
Q

cat scratch disease rash and org

A

red papule and regional lymphadenopathy

bartonella henselae

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11
Q

mycoplasma pneumonia

A

autoimmune haemolytic anaemia

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12
Q

early diastolic murmur

A

pulmonary regurgitation

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13
Q

late systolic

A

mitral /tricuspid valve prolapse

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14
Q

mid diastolic

A

mitral stenosis

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15
Q

type 3 hyperlipidaemia

A

high total cholestrol and triglyceride
autosomal recessive
premature Cardiovascular disease and pancreatitis.

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16
Q

statin associated myopathy

A

exacerbated by the co-prescription of other drugs such as calcium channel blockers, macrolide antibiotics, fibrates, amiodarone and grapefruit juice.

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17
Q

occupational asthma causes

A

isocyanate ( foams and plastics)

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18
Q

coal workers disease

A

nodular interstitial lung disease

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19
Q

heart failure drug treatment

A

ACE inhibitor and bblocker therapy should be instituted in patients with heart failure due to left ventricular systolic dysfunction.

ACE inhibitor therapy should be initiated at the appropriate dose, and titrated upwards at short intervals (for example, every two weeks) until the optimal tolerated or target dose is achieved.

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20
Q

silica ( found in coal dust and paint sprays) leads to

A

causes pulmonary fibrosis/silicosis and contributes to pneumoconiosis

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21
Q

HRT for women who are 54 or older or any age and more than one year after the menopause.

A

continuous combined therapy

may get some bleeding but should settle in 6 months

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22
Q

acute severe asthma

A

inability to complete sentences
a tachycardia in excess of 110 bpm
a respiratory rate above 25/minute, and
a PEFR 33-50% of the predicted value

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23
Q

life threatening asthma

A

silent chest
bradycardia
hypotension, and
hypoxia.

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24
Q

laryngocoele

A

rare cause of neck lump in wind instruments players. High pressure in the larynx causes an out pouching of the laryngeal mucosa.

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25
Q

erythema multiforme

A

annular lesions, sometimes bullous and more common on the extrmeties. The commonest cause is infection with herpes simplex virus. Other infections that may cause it are vaccinia, infectious mononucleosis, hepatitis, mycoplasma and histoplasmosis.

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26
Q

(CA) 27.29

A

follow response to therapy in patients with metastatic breast cancer.

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27
Q

Combined AFP and b-hCG testing

A

?testicular ca

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28
Q

All patients who have had an acute MI should be offered treatment with

A

ACE inhibitor, beta-blocker, aspirin, statin.

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29
Q

coumarin metabolism inducers

A

rifampicin, carbamazepine. st johns wort also diminishes warfarin anticoag

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30
Q

slowing of warfarin metabolism

A

(so raising INR, miconazole)

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31
Q

heart murmurs louder on expiration

A

left heart side

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32
Q

serum urate level to aim for if gout treated by allopurinol

A

<0.3 (0.42 is upper limit of normal)

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33
Q

rheumatic fever

A

Flitting pains in the joints relieved by aspirin are typical. Carditis also occurs and a positive antistreptolysin is classical.

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34
Q

gliptin

A

dpp-4, eg sitagliptin, vildagliptin. consider instead of sulphonureas if risk of hypos / consequences

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35
Q

type 2 diabetes oral hypoglycaemic introductions

A

48mmol or 6.5%, add in dual if still not good, consider triple 58mmol/l or 7.5%

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36
Q

campylobacter

A

getting resistent to quinolones so erythromycin better

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37
Q

c.diff anitbiotic choice

A

vancomycin or metronidazole

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38
Q

addisons biochem

A

low sodium, hyperkalaemic acidosis

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39
Q

cushings biochem

A

Hypokalaemic alkalosis

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41
Q

conns

A

high BP and low potassium.. adrenal adenoma

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42
Q

FP10MDA

A

addiction prescribing

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43
Q

fw8

A

application for maternity exemption from prescription charges.

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44
Q

fp92a

A

application for medical exemption from prescription charges.

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45
Q

d4

A

application and medical report for group 2 driving licence.

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46
Q

gos18

A

A request for an ophthalmology opinion from an optician to the GP

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47
Q

hsa1

A

termination of pregnancy form

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48
Q

doxazosin risk

A

congestive cardiac failure

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49
Q

atenolol risk

A

increased incidence diabetes when using for HTN treatment

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50
Q

mitral stenosis

A

tapping apex, loud first heart sound, apical rumbling mid-diastolic murmur

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51
Q

mitralvalve prolapse

A

soft first heart sound, a mid-systolic click and an apical blowing late systolic murmur radiating to the axilla.

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52
Q

confidence interval

A

statistical range with a specified probability that a given parameter lies within the range.

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53
Q

relative risk

A

measure of how much a particular risk factor (for example, cigarette smoking) influences the risk of a specified outcome such as lung cancer, relative to the risk in the population as a whole.

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54
Q

glitazone

A

only one in UK poiglitazone
peroxisome proliferator activated receptor (PPAR)-gamma receptor agonist producing a therapeutic effect by improving insulin sensitivity. Peripheral oedema and fluid retention are reported side effects, which may exacerbate pre-existing heart failure, consequently this group of drugs are contraindicated in the presence of heart failure.Bladder cancer is a known side effect.
can cause weight gain but good for glycaemic control

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55
Q

exenatide

A

GLP-1 mimetic that may cause pancreatitis.

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56
Q

Z score

A

Standard deviation with age matched population

Normal distrib 34% over and under mean

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57
Q

sulphonureas

A

work by increasing beta cell sensitivity to glucose thus increasing insulin release at a given plasma glucose concentration. This leads directly to a reduction in hepatic glucose production and indirectly, via a lowering of plasma glucose concentration, to decreased peripheral insulin resistance
can cause weight gain and hypoglycaemia

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58
Q

biguanides e.g. metformin

A

main mechanism is reducign hepatic glucose production

GI disturbance common, also lactic acidosis serious SE.

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59
Q

alpha-glucosidase inhibitors e.g. acarbose

A

reversibly antagonise and slow the action of sucrase, glucoamylase, dextrinase, maltase and isomaltase enzymes within the intestinal tract. This hinders the production of absorbable monosaccharidases and so reduces the postprandial blood glucose concentration

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60
Q

meglitinides e.g repaglinide, nateglinide

A

lower blood glucose by stimulation of insulin release from the pancreas

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61
Q

gliptins e.g. sitagliptin

A

work via slowing degradation incretin hormones*
* incretin hormones - for example glucagon-dependent insulinotropic peptide (GIP) and glucagon-like peptide-1 (GLP-1) - these hormones are secreted by specialised enteroendocrine cells in response to a meal. The incretin hormones promote insulin secretion and inhibit glucagon secretion when blood glucose is high; when blood glucose is low then insulin secretion is inhibited and glucagon secretion is promoted

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62
Q

dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor

A

dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor

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63
Q

haemochromatosis

A

pituitary and pancreatic deposition of excess iron causing both type 2 diabetes and hypogonadotrophic hypogonadism.

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64
Q

scc

A

ulcerated with everted edgepredisposing factors include:

radiation exposure
pre-malignant conditions - Bowen’s, senile keratosis, lupus vulgaris, Paget’s disease
inherited - xeroderma pigmentosum, albinism
chronic irritation - Marjolin’s ulcer, leukoplakia, varicose veins, osteomyelitis sinus
infection - HPV 5 & 8.

65
Q

von Recklinghausen’s disease or neurofibromatosis type I

A

fleshy lumps which are neurofibromas and café-au-lait spotsMay be associated with: multiple endocrine neoplasia IIb (medullary carcinoma of thyroid and phaeochromocytoma), glioma, and meningioma. It is autosomally dominantly inherited. Symptomatic lesions can be excised. There is a 10% risk of malignant change.

66
Q

de Quervain’s thyroiditis

A

weight loss and painful goitre,The ESR is typically grossly elevated, mild hyperthyroidism may be associated. The condition is typically self limiting and responds to NSAIDs and steroids.

67
Q

chalazion

A

inflammation of the meibomian glands. Treatment includes the use of antibiotic ointments but if persistent then surgery may be indicated.

68
Q

pinguecula

A

soft, yellowish patches over the sclera at 3 and 9 o’clock positions. The patient is asymptomatic.

69
Q

pterygium

A

vascularisation nasal aspect of cornea
related to excessive sun exposure. It is benign but may be removed for cosmesis or if it threatens vision by extending centrally.

70
Q

acute angle closure glaucoma

A

pain, circum corneal erythema, fixed, ovoid pupil, Miotic agents such as pilocarpine eye drops open the closed angle of Schlemm and improve drainage. Carbonic anhydrase inhibitors are also indicated, and topical beta blockers are also used.

71
Q

feltys syndrome

A

pancytopenia and hypersplenism

72
Q

haemolytic anaemia

A

raised reticulocyte count

73
Q

seborrhaic dermatitis

A

which is caused by a yeast infection (Malassezia furfur), and is common in immunosuppressed patients such as this lady who contracted HIV through IV drug abuse. red, scaly, crusty, itchy eruption on her scalp line and around her nose.

74
Q

HRT systemic oestrogens

A

for flushing and clonidine possible

75
Q

tibolone

A

improve sex drive in meopause (due to loss of circulating androgens)

76
Q

Graves’ disease that distinguish it from other causes of thyrotoxicosis include:

A

exophthalmos
pre-tibial myxoedema, and
a thyroid bruit.

77
Q

DeQuervain’s thyroiditis

A

nflammatory condition of the thyroid associated with marked systemic features including weight loss, fever and a high erythrocyte sedimentation rate. The iodine uptake scan shows markedly reduced iodine uptake.

78
Q

Increased blind spot

A

papilloedema, which may lead to optic atrophy.

79
Q

Tunnel vision occurs in:

A

Glaucoma
Retinitis pigmentosa, and
Retinal panphotocoagulation.

80
Q

systemic sclerosis

A 
Facial telangiectasia
Sclerodactyly
Atrophic nails
Raynaud's phenomenon.
calcinosis finger tips
81
Q

Thibierge-Weissenbach syndrome

A

diffuse skin calcification and atherosclerosis.

82
Q

diabetic amyotrophy

A

associated with a painful asymmetrical myopathy affecting the quadriceps. Investigations are usually normal except for plasma glucose. Generally, symptoms improve with insulin possibly due to the anabolic effects of the latter.

83
Q

pagets disease of the bone

A

Paget’s disease the continual repair process of bone is disturbed and ends at the stage of vascular osteoid bone. Bones are very weak.

Osteogenic sarcoma complicates 5% of cases.

84
Q

asthma guidelines children 5-12 yrs

A

Step 1 - Inhaled short acting b2 agonist as required.
Step 2 - Add inhaled steroid 200-400 mcg/day.
Step 3 - Add long acting b2 agonist (LABA) then assess control. If good response to LABA, continue. If benefit from LABA but control still inadequate, continue LABA and increase steroid up to 400 mcg/day, if not already on this dose. If no response to LABA, stop and try other therapies, for example, leukotriene receptor antagonist or SR theophylline.
Step 4 - Persistent poor control: increase steroid up to 800 mcg/day.
Step 5 - Daily oral steroid.

85
Q

children under 5 asthma guidelines

A

Step 1 - Beta-2 agonist.
Step 2 - Inhaled steroid 200-400 mcg/day.
Step 3 - In children age 2-5, try leukotriene receptor antagonist, in children under 2, go to step 4.
Step 4 - Refer to respiratory paediatrician.

86
Q

osteoporosis

A

bone density >-2.5SD (T-score). can treat with calcium and vit D

87
Q

teriparatide

A

recombinant human parathyroid hormone is a licensed anabolic treatment given by daily subcutaneous injection. It is appropriate in cases where other therapies for osteoporosis have failed.

88
Q

standard deviation percentages

A

one is 68%, 2 is 95% 3 is 99.7%

89
Q

non-live vaccines

A

Tetanus toxoid, hepatitis B and hepatitis A

90
Q

hydradenitis suppurativa

A

condition affecting apocrine glands as opposed to eccrine glands. dopamine agonists and antibiotics can help

91
Q

rett syndrome

A

developmental disorder, hand wringing, males die in utero

92
Q

citalopram

A

ssri better for multi drugs ( less interactions)

93
Q

alcohol abuse while pregnant

A

saddle-shaped nose, hypertelorism, a thin upper lip and absent philtrum.
growth restriction, cardiac abnormalities and developmental problems.

94
Q

Gorlin’s sign

A

Gorlin’s sign is the ability to touch the tip of the nose with the tongue seen in Ehlers-Danlos syndrome and some in the general population

95
Q

Carpet tack sign

A

In discoid lupus erythematosus the removal of scale reveals multiple horny plugs on the under surface of the scale giving the appearance of carpet tacks.

96
Q

Auspitz’ sign:

A

in psoriasis where upon scraping with a glass slide the lesion reveals pin-point bleeding on account of supra-papillary thinning of the epidermis.

97
Q

Favus

A

a form of tinea capitis, presents with lesions characterised by yellow cup-shaped crusts termed scutula, which surround the infected hair follicles.

98
Q

Kerion

A

fungal abscess

99
Q

liver enzyme inhibitors

A 
kissace
ketaconazole
isoniazid
sulphonureas
sodium valproate
allopurinol
cimetinide
erythromycin
100
Q

liver enzyme inducers

A 
crpb
carbamazapine
rifampicin
phenytoin
barbiturates
101
Q

number needed to treat

A

1/absolute risk reduction

102
Q

absolute risk reduction

A

1/NNT. calculation= (number harmed / total - intervention number harmed over total)

103
Q

odd ratio

A

ratio of the odds of outcome(AD/BC)

104
Q

confidence interval

A

large number = low confidence in the OR precision

105
Q

normal sperm

A

> 2mls
50%motile
15% normal morphology
2 millions sperm / ml

106
Q

UKPDS study

A

metformin reducing cardiovascular risk and insulin resitance if glucose reduced to 48mmol.

107
Q

stye

A

minor infection base of eyelash

108
Q

blepharitis

A

gritty oily tears. inflammed lid edge

109
Q

diabetes diagnosis

A

symptoms + >11.1 random
>7.0 fasting
OGGT 11.1, 2 hrs after 75g glucose

110
Q

impaired glucose tolerance

A

2 hr OGTT: 7.8-11.1

111
Q

targets for gestational diabetes

A

tighter:

3.5-5.9. or < 7.8 one hr after eating.

112
Q

MODY

A

maturity onset diabetes of young. monogenic diabetes parent with diabetes as AD inheritance. insulin might not work.

113
Q

wolfram syndrom

A

DIDMOADDiabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness

114
Q

LUTS

A

mod / severe voiding symtpoms IPSS > / =8
give alpha blocker ( eg doxasozin, tamsulosin)
enlarged prostate and risk of progression - give 5 alpha reductase inhibitor (finasteride / dutasteride) 6 months before symptoms improve.

115
Q

pityriasis rosea

A

ovoid scaly herald patch, 2 weeks before christmas tree rash upper back / chest. ?HHV7.

116
Q

pityriasis versicolor

A

yeast infection, antifungal shampoos.

117
Q

bariatric surgery

A

First line BMI >50
6 months trying BMI >40 or
BMI >35 and co-morbidities (T2DM, HTN, mobility probs)

118
Q

orlistat

A

BMI >30
BMI >28 with T2DM, HTN, dyslipideamia.
only continue over 3 months if over 5% weight loss.

119
Q

stage 1 HTN

A

140/90 clinic or 135 / 85 average.

offer treatment if <80 and target organ damage, CVdisease, renal disease, 20% CV 10yr risk.

120
Q

stage 2 HTN

A

160/100 or 150/95 average

offer meds any age

121
Q

medical treatment HTN

A

A under 55 / C (over 55 / black)
add the other
( if B-blocker) add C not D (diabetes risk)
A+C+D, then
4th line increase D if K>4.5, or spironolactone.

122
Q

acanthosis nigricans

A

sign of insulin resistance

123
Q

diabetes intercurrent illness

A

admit if glucose over 20 sustained
ketosis sustained
not drinking / diarrhoae

124
Q

on orals with intercurrent illness

A

increase monitoring frequescy
seek med advice if over 13
stop metformin if dehydrated

125
Q

on insulin with intercurrent illness

A

22 increase 4 units each injection

126
Q

targets for glycaemic control adults

A

4-7 pre eating

<9 1 hr post prandial

127
Q

targets for glycaemic control children

A

4-8

<10 1 hr post prandial

128
Q

HBA1C targets

A

<6.5% (48 mmol/mol)

129
Q

type 1 error

A

rejecting null hypothesis when true

130
Q

type 2 error

A

accepting null hypothesis when false

131
Q

power of a study

A

probability of correctly rejecting null hypothesis when false.
1- probability of type 2 error.

132
Q

still birth

A

over 24 weeks

133
Q

parametric data tests

A

student’s T-test, pearsons

134
Q

non-parametric

A

chi squared, wilcoxon matched pairs, spearmans rank

135
Q

miosis

A

pupil constriction (helps acute glaucoma)

136
Q

horners

A

damage to sympathetic pathway
miosis (constricted pupil)
anhidrosis
ptosis

137
Q

acute glaucoma triggers

A

pupil dilated
hypermetropia ( long sightedness) / short
meds which dilate pupil

138
Q

DM2 aims of treatment

A

antihypertensives for macro and microvascular complications
lower hba1c for microvascular comps
lipid lowering for macrovascular comps as main population

139
Q

heart failure diagnosis

A

previous MI: echo
no MI :serum BNP, if raised then echo
echo normal, consider other cause for raised BNP, then treat

140
Q

heart failure treatment ( all types)

A

diuretics,
calcium channel blockers amlodipine( not verapamil / diltiazem) for comorbid HTN / angina
anticoags, for sinus rhythm and hx of VTE, intracardiac thrombus, left ventricular aneurysm
aspirin 75-150mg with atherosclerotic arterial disease
amiodarone ? on specialist advice. needs 6 monthly clinical review for thyroid and LFT

141
Q

left ventricular heart failure

A

one drug at a time
ACE eg if diabetic / fluid overload
BB eg if angina / HTN (bisoprolol, carvedilol nebivolol)
then specialist advice for hydralazine, nitrate, ARB, dig, ivrabradine

142
Q

ARB

A

eg candesartan, losartan, valsartan

143
Q

aldosterone antagonists

A

spironolactone, epleronone

144
Q

stable angina

A

give b-blocker or calcium channel blocker.
if intolerant / not working consider long acting nitrate (ivrabradine, nicorandil, ranolazine)
assess every 2-4 weeks.
antiplatelet therapy: 75mg aspirin or if stroke / PVD clopidogrel
ACEi if stable angina and HTN, DM, heart failure,

145
Q

anitplatelets for secondary prevention of CVD

A 
in pts with 
angina
MI
stroke / TIA
peripheral arterial disease
AF ( usually anticoagulants)
146
Q

MI

A

aspirin long term
non ST elevation: add clopidogrel for 12 months
ST elevation: clopidogrel for a month

147
Q

intention to treat analysis

A

analyses all patients randomised to study eg patient fall out may bias things

148
Q

Relative Risk Reduction

A

absolute risk reduction / control event rate

149
Q

efficacy

A

effect in ideal / lab conditions

150
Q

effectivenes

A

effect in real world

151
Q

incidence

A

new cases over fixed time

152
Q

prevelence

A

rate of a disorder in fixed population at a specific time

153
Q

ancova

A

co-variance between populations

154
Q

chi squared

A

comparing proportions

155
Q

ANOVA

A

analysis of variance

156
Q

ANOCOVA

A

analysis of covariance

157
Q

t - test

A

compare means of 2 groups with continuous variables

158
Q

phimosis

A

tight foreskin, ok up to 4 years. betamethasone cream

Gp Akt (2 decks)

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