All revision Flashcards
1
Q
Presentation of flashes/floaters and spider webs.
Visual changes in left eye
Darkening of peripheral vision
No pain nor trauma
A
Retinal detachment
2
Q
Risk factors for primary open-angle glaucoma?
A
Family history Afro-carribbean ethnicity Myopia HyperT Diabetes mellitus
3
Q
Lisch nodules are an eye characteristic of which inherited condition?
A
Neurofibromatosis
4
Q
Mechanism of action of dorzolamide?
A
Carbonic anhydrase inhibitor
5
Q
New-onset inability to see near objects
Red patches on fundoscopy
PMH = life-long smoker and hyperT
A
Wet ARMD
Management = anti-VEGF
6
Q
Description of an ointment
A
Semi-solid grease (oil) with a high lipid content and no preservatives
7
Q
Description of a gel
A
Semi-solid thickened aqueous solutions
8
Q
What are Blaschko’s lines?
A
Lines that the embryological development of skin follow.
9
Q
Where are melanocytes derived from?
A
the neural crest
10
Q
Function of keratinocytes
A
Produce keratin
Synthesis of vit D
Immune function
11
Q
What is Breslow thickness?
A
the depth from the granular layer of the epidermis to the deepest melanoma cell
12
Q
Atopic triad
Name them now.
A
Asthma
Eczema
Hayfever
13
Q
Which types of HPV is found in warts and verrucas
A
1-4
14
Q
what do appocrine glands do?
A
scent glands
15
Q
what do eccrine glands do?
A
provide moisture to palms and soles fro grip
16
Q
which enzyme is deficient in erythropoietic protoporphria?
A
Ferrochelatane
17
Q
which enzyme is deficient in acute intermittent poryphoria?
A
PBG deaminase
18
Q
How long does it take for cells to migrate from the basal to keratin layer of the epidermis?
A
28 days
19
Q
What mediates type ii and type iii hypersensitivity reactions?
A
IgM and IgG
20
Q
what mediates type iv hypersensitivity reactions?
A
TH1 cells
21
Q
are topical steroids lypophillic?
A
yes
22
Q
what is the role of sebaceous glands?
A
maintain skin barrier
23
Q
name the contents of the dermis
A
collagen elastin ground substance fibroblasts lymphocytes macrophages Langerhans cells mast cells
24
Q
management ladder for psoriasis?
A
emollients vit d analogues (calcitrol) Dithranol coal tar steroids (mild) salicylate photodynamic therapy immunotherapy
25
What is bullous pemphigoid?
Autoimmune condition
Antibodies produced against hemi-desmosomes that are involved in the DEJ.
Formation of sub-epidermal blisters.
26
What is pemphigus vulgaris?
Autoimmune condition
Autoantibodies produced against desmoglein 3.
Loss of adhesion and splitting within the epidermis and loss of desmosomes.
Intra-epidermal blisters and acantholysis.
27
Antibody involved in dermatitis herpetiformis?
Anti-TTG
28
Name 2 prandial insulin analogues.
Novorapid
Humalog
Peak at 60-90 mins and last 4-5 hrs
29
Name 2 soluble prandial insulins.
Humulin S
Actarapid
Peak at 2-4 hours and last 5-8 hrs
30
Name 2 analogue basal insulins
Lantus
| Levemir
31
Which pro-inflammatory mediator stimulates acute inflammation?
TNF alpha
32
What is C3b?
An opsonin
33
Which type of immunological cell is involved in acute inflammation?
Neutrophils
34
How long after primary contact with an antigen are specific antibodies readily detectable in serum?
5-7 days
35
Which type of cell secrete antibodies?
Plasma cells
36
What is the basic antibody unit composed of?
2 identical heavy chains
2 identical light chains
37
Which cell expresses CD8+?
Cytotoxic T cells
| Kill virally infected body cells
38
What do B cells express before switching class?
IgM and IgD
39
What is an opsonin?
Extracellular protein that binds to cells and induce phagocytes to phagocytose the cells with the opsonins bound.
40
What do helper T cells produce?
CD4+
41
Where do leukocytes develop?
Primary lymphoid tissue
| Red bone marrow and thymus
42
What is the most abundant immunoglobulin?
IgG
43
Which immunoglobulin is found in breast milk, saliva and mucosal secretions?
IgA
44
What are the two ways in which B cells can differentiate?
Become plasma cells which produce antibodies
Become memory B cells - immunological memory
45
What condition is characterised by 47 XXY?
Klinefelter syndrome
46
What is the chromosomal make-up of Turner syndrome?
45X
47
Signs and symptoms of Klinefelter's syndrome.
```
Infertility
Small, firm testes
Frontal baldness absent
Fewer chest hairs
Female pubic hair pattern
Long arms + legs
Poor beard growth
Anxiety + depression
```
48
How is Klinefelter's syndrome diagnosed?
Karyotyping
49
Symptoms and signs of Kallmann's syndrome
```
Small male sexual organs
Decreased body hair
High pitched voice
Low libido
Gynaecomastia
Tall, slim, long arms + legs
```
50
Diagnosis of Kallmann's syndrome?
MRI of pituitary
51
Which type of thyroid cancer produces calcitonin?
Medullary
| cancer of C cells
52
Which medication should be used in Grave's disease to help control symptoms while awaiting endocrinologist appt.?
Propranolol
53
Which diabetic medication is contraindicated in heart failure?
Pioglitazone
| causes fluid retention
54
Management of thyrotoxicosis and a tender goitre?
Naproxen
55
What is the appropriate insulin fluid regime for a patient presenting with diabetic ketoacidosis?
IV insulin 0.1 unit/kg/hr
56
Low dexamethasone test does not suppress cortisol levels but a high dexamethasone test does.
Where in the body is the problem?
Pituitary
Cushing's disease
57
Both a low and high dexamethasone test do not suppress cortisol levels.
What are the potential causes?
Ectopic ACTH production from a tumour (e.g. lung)
Adrenal adenoma
Corticosteroid therapy
58
What is first line management for a prolactinoma?
Cabergoline
59
Causes of tinnitus
Hearing loss
Noise damage
Ageing
Medication use
60
Which type of epithelium is found in a cholesteatoma?
Keratinising squamous epithelium
61
Symptoms of cholesteatoma
```
Foul smelling discharge
White mass behind intact tympanic membrane
Hearing loss
Resistance to antibiotics
Attic crust in retraction pocket
```
62
Which diseases can put you at risk of developing a cholesteatoma?
Down’s syndrome
| Turner syndrome
63
Definitive treatment of cholesteatoma
Surgery (mastoidectomy)
64
Which type of hearing loss does a vestibular neuroma result in?
Unilateral Sensorineural hearing loss
65
Symptoms of vestibular Schwannoma/acoustic neuroma
```
Asymmetrical hearing loss
Facial numbness
Progressive episodes of dizziness
Tinnitus
Difficulty localising sounds
```
66
Which nerve is affected in vestibular schwannoma
Vestibulocochlear nerve
67
Which disease increases risk of vestibular Schwannoma?
Neurofibromatosis type 2
| Autosomal dom
68
Diagnosis of vestibular Schwannoma
Audiogram - sensorineural hearing loss
Gadolinium enhanced MRI scan of head
CT head
69
What is the pathophysiology behind BPPV?
Otolith material floating into the vestibular canals and stimulating hair follicles during certain movements.
Duration = 30 secs to 1 min
70
How is BPPV diagnosed?
Dix-Hallpike manouvre
71
How is BPPV managed?
Epsley Manouvre
72
What does an audiogram in BPPV show?
NORMAL
73
Which test is positive in Ménière’s disease?
Romberg’s test
74
What is the treatment for Ménière’s disease?
Low salt diet
Diuretics
Anti-emetics
75
What is the difference between viral and bacterial labyrinthitis?
Viral (serous) = inflammation of the labyrinth only and usually presents with less severe hearing loss and vertigo
Bacterial (suppurative) = direct microbial invasion of the inner ear and usually presents with severe to profound hearing loss and vertigo.
76
Which bacteria most commonly cause acute otitis media?
Strep. Pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Strep. Pyrogens
77
Treatment for acute otitis media?
Watch and wait for 4 days
Amoxicillin
Erythromycin
78
How is glue ear diagnosed?
Otoscopy - shows TM retraction, middle ear fluid bubbles
Tuning fork tests - conductive hearing loss
Audiometry - conductive hearing loss
Tympanometry - type B
79
Which bacterias cause otitis externa?
Staph. Aureus
Proteus spp.
Pseudomonas aeruginosa
80
Management of otitis externa
Aural toilet and debridement
Topical antimicrobial drops (Ciprofloxacin) if bacterial
Acitic acid/clottimazole if fungal
81
Diagnosis for nasal trauma
Review in ENT clinic after 5-7 days post-injury
| Exam immediately or after 5-7 days to avoid swelling
82
Which artery is most likely to cause epistaxis?
Anterior Ethmoidal artery
83
Name some causes of nasal polyps
Churgg strauss syndrome
| Non-allergic asthma
84
Treatment for nasal polyps
MILD
Intranasal corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
SEVERE
Short course oral corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
85
Name the two non-allergic rhinitis’s
Vasomotor rhinitis
| Non-allergic rhinitis with eosinophilia syndrome
86
How is non-allergic rhinitis diagnosed?
Allergic skin prick tests = negative
Serological specific IgE tests = negative
Nasal eosinophil smear = positive
87
What is seen on an x-ray displaying osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
88
What is seen on an x-ray displaying rheumatoid arthritis?
Loss of joint space
Erosions
Soft tissue swelling
Soft bones
89
what is an early sign of rheumatoid arthritis?
juxta-articular osteopenia
90
difference between acute viral and acute bacterial sinusitis?
acute viral = < 10 days
| acute bacterial = > 10 days but < 4 weeks
91
How is acute bacterial sinusitis treated?
Watchful waiting for 10 days and then antibiotics (amoxicillin)
92
what is chronic sinusitis?
Inflammation of the paranasal sinuses lasting > 12 weeks
93
two categories of chronic sinusitis?
With polyps
| Without polyps
94
Which pathway is blocked in chronic sinusitis?
Osteomeatal complex
95
How can chronic sinusitis be diagnosed?
```
Anterior rhinoscopy
Nasal endoscopy
Sinus CT
Sinus MRI
Nasal/sinus cultures
Allergy testing
```
96
How is chronic sinusitis treated?
1st line = amoxicillin/clavulanate + nasal saline irrigations
FAILED medical therapy = endoscopic sinus surgery
97
What are the signs of nephrotic syndrome?
Proteinuria > 3g/day
Hypoalbuminaemia (<30)
Oedema
Hypercholesterolaemia
Usually normal renal function
98
Which renal structures does nephrotic syndrome affect?
Podocytes
99
Which renal structures does nephritic syndrome affect?
Endothelial cells
100
What are the signs of nephritic syndrome?
Acute decline in kidney function
Oliguria
Oedema caused by fluid retention
Hypertension
'Active urinary sediment' - RBCx and RBC casts
101
What does minimal change nephropathy show on renal biopsy?
Normal renal biopsy on light microscopy and immunofluorescence.
Foot process fusion shown on electron microscopy.
102
Management of minimal change nephropathy.
1st - oral steroids
| 2nd - cyclophosphamide (for steroid resistant)
103
Risk factors for focal segmental glomerulonephritis?
- Idiopathic
- HIV
- Heroin use
- Alport's syndrome
- Obesity
- Reflux nephropathy
- Genetic
104
Causes of membranous nephropathy?
- Idiopathic
- Hep B
- Parasites
- Lupus
- Malignancies
- Gold/penicillamine
105
renal biopsy shows sub epithelial immune complex deposition in the basement membrane. Which disease?
Membranous nephropathy
106
What are the 2 mechanisms of membranoproliferative glomerulonephritis?
1. Immune complex deposition and complement activation.
| 2. Dysregulation of the alternative complement pathway
107
What is the most common glomerulonephritis in the world?
IgA nephropathy
108
What does IgA nephropathy show on biopsy?
Mesangial cell proliferation and expansion on light microscopy.
IgA deposits in mesangium on immunofluorescence.
109
What is the treatment for IgA nephropathy?
- Blood pressure control
- ACE inhibitors and ARBs
- Fish oil
110
Which condition is IgA nephropathy associated with?
Henoch-Schonlein Purpura
111
What does rapidly progressive glomerulonephritis show on biopsy?
Glomerular crescents
112
Management of rapidly progressive glomerulonephritis.
- Immunosuppression (steroids and cytotoxics or Rituximab)
- Steroids and Azathioprine
- Supportive (dialysis if required)
113
What can cause membranoproliferative glomerulonephritis?
HIV
Hep C
Genetic
114
How is amyloidosis diagnosed?
Congo red staining - green birefringence
SAP scan
Biopsy of skin, rectal mucosa or abdominal fat
115
What is the role of calcium resonate?
Removes potassium from the body.
116
NICE criteria for an AKI?
- Rise in creatinine of > 25 mol
- Rise of creatinine of > 50% in 7 days
- Urine output of <0.5ml/kg/hour for > 6 hours
117
Pre-renal causes of AKI?
- Dehydration
- Hypotension
- Heart failure
- Bleeding
- Infection
118
Renal causes of AKI?
- Glomerulonephritis
- Vasculitis
- Interstitial nephritis
- Acute tubular necrosis
119
Post-renal causes of AKI?
- Kidney stones
- Masses
- Ureter or urethral strictures
- Enlarged prostate
- Prostate cancer
120
Management of AKI.
- IV fluids in pre-renal
- Stop nephrotoxic drugs (NSAIDs, ACEIs, ARBs, metformin, gentamicin, aminoglycosides, diuretics)
- Relieve obstruction
- Avoid contrast
- Treat underlying cause
121
What can cause IgA nephropathy?
- Respiratory/GI infection (pharyngitis/tonsillitis)
122
Most common organism involved in septic arthritis?
Staph aureus
123
Most common organism involved in septic arthritis in children < 5?
Haemophilus influenzae
124
Management of septic arthritis?
Antibiotics +/- surgical washout
Flucloxacillin IV for 2 weeks, then oral for 2-4 weeks
Penicillin allergy - Clindamycin
125
a) Organism involved in early and late post-op prosthetic join infection?
b) Organism involved in delayed post-op prosthetic joint infection?
a) staph aureus
| b) staph epidermis
126
How is an osteosarcoma treated?
- Chemotherapy
- Surgery
RESISTANT TO RADIOTHERAPY
127
How does Ewing's sarcoma present?
Warm swelling
Raised inflammatory markers
radiology: ONION RING sign
128
Which nerve is at risk of damage in a surgical neck of humerus fracture?
Axillary nerve damage
129
Management of compartment syndrome
Fasciotomoy
130
which nerve is at risk of damage in a humeral shaft fracture?
Radial nerve
| WRIST DROP
131
Which deformity is caused by a Colles fracture?
Dinner fork deformity
132
How is a Smith's fracture managed?
Open reduction and external fixation
133
Which classification system is used for intracapsular hip fractures?
Garden Classification
134
Management for reverse oblique transverse subtrochanteric hip fracture?
Intramedullary nail
135
Management for (frail, dependent on husband) lady with intracapsular hip fracture)?
Hemiarthroplasty
136
Pain on radial side of wrist
Tender at thumb base
Pain on ulnar deviation of the wrist
What is the diagnosis?
De Quervain's tenosynovitis
137
Middle-aged runner
Pain at the medial heel bed
Pain made worse when walking on toes
Diagnosis?
Plantar fasciitis
138
Which nerve is most commonly affected in meralgia parasthesia?
Lateral cutaneous nerve of the thigh
139
What is used for assessing risk of osteoporosis?
FRAX tool
140
What does a positive straight leg test suggest?
Sciatic nerve pain
141
What is the function of somatostatin?
- Stimulated by growth hormone
- Acts to increase growth
- Acts to regulate the secretion of insulin and glucagon
SECRETED BY DELTA CELLS
142
What is the normal fasting blood sugar level?
4.4-6.1 mol/l
| abnormal = > 7
143
Which tests are used to diagnose diabetes?
- Fasting glucose (overnight fast)
- 2-hour glucose tolerance test
- HbA1c (reflects blood sugar level over a 1-3 month period)
144
Normal HbA1c level?
< 41
145
Diabetic HbA1c level?
> 48
146
Normal and abnormal glucose tolerance test result?
```
Normal = < 7.7
Abnormal = > 11.1
```
147
Type 1 diabetes autoantibodies?
Anti-GAD
Anti IA2
Anti ZnT8
148
Target HbA1c for a type 1 diabetic?
48-59 mmol/l
149
Sick day rules for type 1 diabetics?
- Don't stop insulin
- Eat/drink as much as possible
- Increase blood sugar monitoring to 4x a day at least
150
What is metabolic syndrome?
Type 2 diabetes with at least 2 of:
- Hypertension
- Central obesity
- Dyslipidaemia
- Micro-albuminuria
151
Glycaemic control aims for type 2 diabetes?
48-53
152
Features of MODY
- Young onset
- Family history
- No autoantibodies
- Normal BMI
- Assoc. conditions = renal cysts
153
Background retinopathy changes?
- Microaneurysms (dots)
- Blot haemorrhages ( <3 or =3)
- Hard exudates
154
Pre-proliferative retinopathy?
- cotton wool spots - soft exudates
- > 3 blot haemorrhages
- venous bleeding/looping
- deep/dark cluster haemorrhages
155
definition of hypoglycaemia?
blood sugar level < 4mmol/l
156
symptoms of hypoglycaemia?
- sweating
- anxiety
- hunger
- tremor
- nausea
- palpitations
- dizzy
- confusion
- lack of concentration
157
presentation of DKA?
- reduced GCS
- deep, sighing breathing
- sweet smelling breath
- dehydration
158
management of DKA?
- Fluid resuscitation (0.9% NaCl 10ml/kg)
- IV insulin (0.1 unit/kg/hr)
- Monitor and replace K+ if needed
- Monitor bicarbonate and pH
- Long-acting insulin should be continued and short-acting stopped
159
Autoantibody most common in Grave's disease?
TRAB-stimulating antibody
160
Grave's disease goitre description?
Smooth, symmetrical
161
DeQuervain's thyroiditis features.
- Post-viral
- Patients got from hyper to hypo and then normal
- Painful goitre
- Pyrexia
- Raised inflammatory markers
162
Autoantibodies in Hashimoto's thyroiditis
Anti-thyroid peroxidase
163
Management of myxoedema coma?
- Correct hypoglycaemia
- Actively warm patient
- Give T3 infusion
- Give hydrocortisone
164
Most common type of thyroid cancer?
Papillary
165
Features of medullary thyroid cancer.
- Calcitonin production
- High calcium levels
- MEN 2A and 2B
166
Presentation of anapaestic thyroid cancer
- Older patients (60-80)
- Undifferentiated
- Fast growing
- Aggressive
- Hard, craggy mass
- Haematological spread
167
Complication of thyroidectomy
Hypocalcaemia (long QT syndrome)
168
Name the enzyme that produces calcium phosphate in bones.
Alkaline phosphatase (ALP)
169
Name the biologically active form of vitamin D
Calitriol
| produced in kidneys via activity of 1 alpha hydroxylase
170
Which DEXA score indicates osteoporosis?
T score < -2.5
171
Management of osteoporosis
Alendronate, Risendronate
(taken once a week)
Strontium Ranelate
(given when patient unable to tolerate bisphosphonates)
Teriparatide
(given to those who don't respond to oral therapies)
Denosumab
172
Presentation:
- Elderly patient
- Deep, boring, bone pain
- Pain worse at night + on weight bearing
- high ALP
- normal calcium
- normal phosphate
Diagnosis?
Paget's disease
BONE ENLARGEMENT
DEFORMITY OF BONES
Management:
Anlagesia
Bisphosphonates (Risedronate)
173
Rickets presentation
```
Bowed legs
Knocked-kneed
Hypotonia
Apathy
Growth retardation
```
174
Osteomalacia presentation
Bone pain
Fractures
Proximal myopathy
Waddling gait
175
Which organism is associated the most with UTIs in children and adults?
E. coli
176
UTI management for a non-pregnant woman?
Trimethoprim or Nitrofurantoin for 3 days
177
UTI management in symptomatic pregnant women?
Nitrofurantoin (not in 3rd trimester)
Amoxicillin or Cefalexin
178
UTI management in asymptomatic pregnant women?
Nitrofurantoin (not in 3rd trimester) - 7 days
Amoxicillin, Cefalexin - 7 days
179
UTI management for men?
Trimethoprim or Nitrofurantoin
180
Most common type of bladder cancer?
Transitional cell carcinoma (90%)
181
Risk factors for transitional cell carcinoma?
Smoking
| Carcinogens (Rubber, leather, motor workers, hair dye)
182
Causes of squamous cell carcinoma?
Schistosomiasis
| Smoking
183
Symptoms of prostate cancer?
Haematuria
Weight loss
Erectile dysfunction
Fatigue
184
Which staging system is used in prostate cancer?
Gleason grading system
185
Which type of prostate cancer tumour looks like a potato?
Seminoma
186
Which type of prostate cancer grows hair and is malignant in males but not females?
Teratoma
187
Which type of prostate cancer is 100% bHCG positive?
Trophoblast (choriocarcinoma)
188
When should APGAR scores be assessed?
1, 5 and 10 minutes after delivery
189
Presentation:
- 3 year old child
- loud, harsh stridor
- barking cough
- hoarseness
- restless
- cyanosis
Diagnosis?
croup
caused by para-influenza virus most commonly
190
Management of croup?
Oral dexamethasone
moderate/severe = nebuliser adrenaline, oxygen (severe)
191
Which organism causes epiglottitis?
H. influenzae type B
192
Investigations for epiglottitis?
Lateral neck x-ray (thumb-print sign)
193
Management of epiglottitis?
oxygen mask
call anaesthetist -> rigid laryngoscopy and intubation
Supportive care and IV antibiotics (ceftriaxone)
194
management for a child with bronchiolitis?
Supportive
Urgent admission to hospital if grunting
195
Which virus typically causes bronchiolitis?
RSV
196
Which virus causes hand, foot and mouth disease?
Coxsackie virus
197
Machinery murmur is caused by which cardiac pathology...
Patent ductus arteriosus
198
Which vaccines are given in the '6-1 vaccines' at the ag elf 2 months?
Diptheria, tetanus, polio, whooping cough, HiB, Hep B, one dose of the rotavirus vaccine
199
At what age would the average child begin to say 'mama' or 'dada'?
9 months
200
What is the first sign of puberty in girls?
Breast development
201
At which age should a child be able to crawl?
9 months
202
Which virus is associated with tonsillar SCC?
HPV
203
Presentation:
- 35 year old male
- worsening hearing
- dad has always had hearing aids
- normal Rhinne's and Weber's tests
- pure-tone audiometry shows bilateral conducive hearing loss at low frequencies
Diagnosis?
Otosclerosis
204
Which diagnostic criteria is used in the diagnosis of tonsillitis?
CENTOR criteria
205
Name the cells which detect an NaCl change in the tubular fluid.
Macula densa cells
206
What is isotonic contraction and what is it used for?
- When muscle contraction stays the same but the muscle length changes.
- Used for moving objects and body movements
207
What is isometric contraction and what is it used for?
- When muscle tension develops at a constant muscle length
| - Used for supporting objects in fixed positions and maintaining posture.
208
Name the 3 types of skeletal muscle fibres.
Slow-oxidative (type I)
Fast-oxidative (type IIa)
Fast-glycolytic (type IIb)
209
Example of a cartilaginous joint?
Intervertebral discs
210
Example of a synovial joint?
Elbow
211
Functions of synovial fluid
- Lubricates joint
- Facilitates joint movement
- Helps minimise wear and tear of joints
- Aids in nutrition of articular cartilage
- Supplies chondrocytes with oxygen and nutrients and removes CO2 and waste products
212
NICE criteria for an AKI?
- Rise in creatinine of >25micromol/l in 48 hours
- Rise in creatinine of > 50% in 7 days
- Urine output of < 0.5ml/kg/hr for > 6 hours
213
Treatment for anterior uveitis?
Topical steroids - reduce inflammation and prevent complications
Mydriatic drops (cyclopentolate) - pupil dilation reduces pressure and pain in the eyes
