All revision Flashcards
Presentation of flashes/floaters and spider webs.
Visual changes in left eye
Darkening of peripheral vision
No pain nor trauma
Retinal detachment
Risk factors for primary open-angle glaucoma?
Family history Afro-carribbean ethnicity Myopia HyperT Diabetes mellitus
Lisch nodules are an eye characteristic of which inherited condition?
Neurofibromatosis
Mechanism of action of dorzolamide?
Carbonic anhydrase inhibitor
New-onset inability to see near objects
Red patches on fundoscopy
PMH = life-long smoker and hyperT
Wet ARMD
Management = anti-VEGF
Description of an ointment
Semi-solid grease (oil) with a high lipid content and no preservatives
Description of a gel
Semi-solid thickened aqueous solutions
What are Blaschko’s lines?
Lines that the embryological development of skin follow.
Where are melanocytes derived from?
the neural crest
Function of keratinocytes
Produce keratin
Synthesis of vit D
Immune function
What is Breslow thickness?
the depth from the granular layer of the epidermis to the deepest melanoma cell
Atopic triad
Name them now.
Asthma
Eczema
Hayfever
Which types of HPV is found in warts and verrucas
1-4
what do appocrine glands do?
scent glands
what do eccrine glands do?
provide moisture to palms and soles fro grip
which enzyme is deficient in erythropoietic protoporphria?
Ferrochelatane
which enzyme is deficient in acute intermittent poryphoria?
PBG deaminase
How long does it take for cells to migrate from the basal to keratin layer of the epidermis?
28 days
What mediates type ii and type iii hypersensitivity reactions?
IgM and IgG
what mediates type iv hypersensitivity reactions?
TH1 cells
are topical steroids lypophillic?
yes
what is the role of sebaceous glands?
maintain skin barrier
name the contents of the dermis
collagen elastin ground substance fibroblasts lymphocytes macrophages Langerhans cells mast cells
management ladder for psoriasis?
emollients vit d analogues (calcitrol) Dithranol coal tar steroids (mild) salicylate photodynamic therapy immunotherapy
What is bullous pemphigoid?
Autoimmune condition
Antibodies produced against hemi-desmosomes that are involved in the DEJ.
Formation of sub-epidermal blisters.
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.
Antibody involved in dermatitis herpetiformis?
Anti-TTG
Name 2 prandial insulin analogues.
Novorapid
Humalog
Peak at 60-90 mins and last 4-5 hrs
Name 2 soluble prandial insulins.
Humulin S
Actarapid
Peak at 2-4 hours and last 5-8 hrs
Name 2 analogue basal insulins
Lantus
Levemir
Which pro-inflammatory mediator stimulates acute inflammation?
TNF alpha
What is C3b?
An opsonin
Which type of immunological cell is involved in acute inflammation?
Neutrophils
How long after primary contact with an antigen are specific antibodies readily detectable in serum?
5-7 days
Which type of cell secrete antibodies?
Plasma cells
What is the basic antibody unit composed of?
2 identical heavy chains
2 identical light chains
Which cell expresses CD8+?
Cytotoxic T cells
Kill virally infected body cells
What do B cells express before switching class?
IgM and IgD
What is an opsonin?
Extracellular protein that binds to cells and induce phagocytes to phagocytose the cells with the opsonins bound.
What do helper T cells produce?
CD4+
Where do leukocytes develop?
Primary lymphoid tissue
Red bone marrow and thymus
What is the most abundant immunoglobulin?
IgG
Which immunoglobulin is found in breast milk, saliva and mucosal secretions?
IgA
What are the two ways in which B cells can differentiate?
Become plasma cells which produce antibodies
Become memory B cells - immunological memory
What condition is characterised by 47 XXY?
Klinefelter syndrome
What is the chromosomal make-up of Turner syndrome?
45X
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
How is Klinefelter’s syndrome diagnosed?
Karyotyping
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
Diagnosis of Kallmann’s syndrome?
MRI of pituitary
Which type of thyroid cancer produces calcitonin?
Medullary
cancer of C cells
Which medication should be used in Grave’s disease to help control symptoms while awaiting endocrinologist appt.?
Propranolol
Which diabetic medication is contraindicated in heart failure?
Pioglitazone
causes fluid retention
Management of thyrotoxicosis and a tender goitre?
Naproxen
What is the appropriate insulin fluid regime for a patient presenting with diabetic ketoacidosis?
IV insulin 0.1 unit/kg/hr
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
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
What is first line management for a prolactinoma?
Cabergoline
Causes of tinnitus
Hearing loss
Noise damage
Ageing
Medication use
Which type of epithelium is found in a cholesteatoma?
Keratinising squamous epithelium
Symptoms of cholesteatoma
Foul smelling discharge White mass behind intact tympanic membrane Hearing loss Resistance to antibiotics Attic crust in retraction pocket
Which diseases can put you at risk of developing a cholesteatoma?
Down’s syndrome
Turner syndrome
Definitive treatment of cholesteatoma
Surgery (mastoidectomy)
Which type of hearing loss does a vestibular neuroma result in?
Unilateral Sensorineural hearing loss
Symptoms of vestibular Schwannoma/acoustic neuroma
Asymmetrical hearing loss Facial numbness Progressive episodes of dizziness Tinnitus Difficulty localising sounds
Which nerve is affected in vestibular schwannoma
Vestibulocochlear nerve
Which disease increases risk of vestibular Schwannoma?
Neurofibromatosis type 2
Autosomal dom
Diagnosis of vestibular Schwannoma
Audiogram - sensorineural hearing loss
Gadolinium enhanced MRI scan of head
CT head
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
How is BPPV diagnosed?
Dix-Hallpike manouvre
How is BPPV managed?
Epsley Manouvre
What does an audiogram in BPPV show?
NORMAL
Which test is positive in Ménière’s disease?
Romberg’s test
What is the treatment for Ménière’s disease?
Low salt diet
Diuretics
Anti-emetics
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.
Which bacteria most commonly cause acute otitis media?
Strep. Pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Strep. Pyrogens
Treatment for acute otitis media?
Watch and wait for 4 days
Amoxicillin
Erythromycin
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
Which bacterias cause otitis externa?
Staph. Aureus
Proteus spp.
Pseudomonas aeruginosa
Management of otitis externa
Aural toilet and debridement
Topical antimicrobial drops (Ciprofloxacin) if bacterial
Acitic acid/clottimazole if fungal
Diagnosis for nasal trauma
Review in ENT clinic after 5-7 days post-injury
Exam immediately or after 5-7 days to avoid swelling
Which artery is most likely to cause epistaxis?
Anterior Ethmoidal artery
Name some causes of nasal polyps
Churgg strauss syndrome
Non-allergic asthma
Treatment for nasal polyps
MILD
Intranasal corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
SEVERE
Short course oral corticosteroid with leukotrine receptor antagonist
Surgical polypectomy
Name the two non-allergic rhinitis’s
Vasomotor rhinitis
Non-allergic rhinitis with eosinophilia syndrome
How is non-allergic rhinitis diagnosed?
Allergic skin prick tests = negative
Serological specific IgE tests = negative
Nasal eosinophil smear = positive
What is seen on an x-ray displaying osteoarthritis?
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is seen on an x-ray displaying rheumatoid arthritis?
Loss of joint space
Erosions
Soft tissue swelling
Soft bones
what is an early sign of rheumatoid arthritis?
juxta-articular osteopenia
difference between acute viral and acute bacterial sinusitis?
acute viral = < 10 days
acute bacterial = > 10 days but < 4 weeks
How is acute bacterial sinusitis treated?
Watchful waiting for 10 days and then antibiotics (amoxicillin)
what is chronic sinusitis?
Inflammation of the paranasal sinuses lasting > 12 weeks
two categories of chronic sinusitis?
With polyps
Without polyps
Which pathway is blocked in chronic sinusitis?
Osteomeatal complex
How can chronic sinusitis be diagnosed?
Anterior rhinoscopy Nasal endoscopy Sinus CT Sinus MRI Nasal/sinus cultures Allergy testing
How is chronic sinusitis treated?
1st line = amoxicillin/clavulanate + nasal saline irrigations
FAILED medical therapy = endoscopic sinus surgery
What are the signs of nephrotic syndrome?
Proteinuria > 3g/day
Hypoalbuminaemia (<30)
Oedema
Hypercholesterolaemia
Usually normal renal function
Which renal structures does nephrotic syndrome affect?
Podocytes
Which renal structures does nephritic syndrome affect?
Endothelial cells
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
What does minimal change nephropathy show on renal biopsy?
Normal renal biopsy on light microscopy and immunofluorescence.
Foot process fusion shown on electron microscopy.
Management of minimal change nephropathy.
1st - oral steroids
2nd - cyclophosphamide (for steroid resistant)
Risk factors for focal segmental glomerulonephritis?
- Idiopathic
- HIV
- Heroin use
- Alport’s syndrome
- Obesity
- Reflux nephropathy
- Genetic
Causes of membranous nephropathy?
- Idiopathic
- Hep B
- Parasites
- Lupus
- Malignancies
- Gold/penicillamine
renal biopsy shows sub epithelial immune complex deposition in the basement membrane. Which disease?
Membranous nephropathy
What are the 2 mechanisms of membranoproliferative glomerulonephritis?
- Immune complex deposition and complement activation.
2. Dysregulation of the alternative complement pathway
What is the most common glomerulonephritis in the world?
IgA nephropathy
What does IgA nephropathy show on biopsy?
Mesangial cell proliferation and expansion on light microscopy.
IgA deposits in mesangium on immunofluorescence.
What is the treatment for IgA nephropathy?
- Blood pressure control
- ACE inhibitors and ARBs
- Fish oil
Which condition is IgA nephropathy associated with?
Henoch-Schonlein Purpura
What does rapidly progressive glomerulonephritis show on biopsy?
Glomerular crescents
Management of rapidly progressive glomerulonephritis.
- Immunosuppression (steroids and cytotoxics or Rituximab)
- Steroids and Azathioprine
- Supportive (dialysis if required)
What can cause membranoproliferative glomerulonephritis?
HIV
Hep C
Genetic
How is amyloidosis diagnosed?
Congo red staining - green birefringence
SAP scan
Biopsy of skin, rectal mucosa or abdominal fat
What is the role of calcium resonate?
Removes potassium from the body.
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
Pre-renal causes of AKI?
- Dehydration
- Hypotension
- Heart failure
- Bleeding
- Infection
Renal causes of AKI?
- Glomerulonephritis
- Vasculitis
- Interstitial nephritis
- Acute tubular necrosis
Post-renal causes of AKI?
- Kidney stones
- Masses
- Ureter or urethral strictures
- Enlarged prostate
- Prostate cancer
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
What can cause IgA nephropathy?
- Respiratory/GI infection (pharyngitis/tonsillitis)
Most common organism involved in septic arthritis?
Staph aureus
Most common organism involved in septic arthritis in children < 5?
Haemophilus influenzae
Management of septic arthritis?
Antibiotics +/- surgical washout
Flucloxacillin IV for 2 weeks, then oral for 2-4 weeks
Penicillin allergy - Clindamycin
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
How is an osteosarcoma treated?
- Chemotherapy
- Surgery
RESISTANT TO RADIOTHERAPY
How does Ewing’s sarcoma present?
Warm swelling
Raised inflammatory markers
radiology: ONION RING sign
Which nerve is at risk of damage in a surgical neck of humerus fracture?
Axillary nerve damage
Management of compartment syndrome
Fasciotomoy
which nerve is at risk of damage in a humeral shaft fracture?
Radial nerve
WRIST DROP
Which deformity is caused by a Colles fracture?
Dinner fork deformity
How is a Smith’s fracture managed?
Open reduction and external fixation
Which classification system is used for intracapsular hip fractures?
Garden Classification
Management for reverse oblique transverse subtrochanteric hip fracture?
Intramedullary nail
Management for (frail, dependent on husband) lady with intracapsular hip fracture)?
Hemiarthroplasty
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
Middle-aged runner
Pain at the medial heel bed
Pain made worse when walking on toes
Diagnosis?
Plantar fasciitis
Which nerve is most commonly affected in meralgia parasthesia?
Lateral cutaneous nerve of the thigh
What is used for assessing risk of osteoporosis?
FRAX tool
What does a positive straight leg test suggest?
Sciatic nerve pain
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
What is the normal fasting blood sugar level?
4.4-6.1 mol/l
abnormal = > 7
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)
Normal HbA1c level?
< 41
Diabetic HbA1c level?
> 48
Normal and abnormal glucose tolerance test result?
Normal = < 7.7 Abnormal = > 11.1
Type 1 diabetes autoantibodies?
Anti-GAD
Anti IA2
Anti ZnT8
Target HbA1c for a type 1 diabetic?
48-59 mmol/l
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
What is metabolic syndrome?
Type 2 diabetes with at least 2 of:
- Hypertension
- Central obesity
- Dyslipidaemia
- Micro-albuminuria
Glycaemic control aims for type 2 diabetes?
48-53
Features of MODY
- Young onset
- Family history
- No autoantibodies
- Normal BMI
- Assoc. conditions = renal cysts
Background retinopathy changes?
- Microaneurysms (dots)
- Blot haemorrhages ( <3 or =3)
- Hard exudates
Pre-proliferative retinopathy?
- cotton wool spots - soft exudates
- > 3 blot haemorrhages
- venous bleeding/looping
- deep/dark cluster haemorrhages
definition of hypoglycaemia?
blood sugar level < 4mmol/l
symptoms of hypoglycaemia?
- sweating
- anxiety
- hunger
- tremor
- nausea
- palpitations
- dizzy
- confusion
- lack of concentration
presentation of DKA?
- reduced GCS
- deep, sighing breathing
- sweet smelling breath
- dehydration
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
Autoantibody most common in Grave’s disease?
TRAB-stimulating antibody
Grave’s disease goitre description?
Smooth, symmetrical
DeQuervain’s thyroiditis features.
- Post-viral
- Patients got from hyper to hypo and then normal
- Painful goitre
- Pyrexia
- Raised inflammatory markers
Autoantibodies in Hashimoto’s thyroiditis
Anti-thyroid peroxidase
Management of myxoedema coma?
- Correct hypoglycaemia
- Actively warm patient
- Give T3 infusion
- Give hydrocortisone
Most common type of thyroid cancer?
Papillary
Features of medullary thyroid cancer.
- Calcitonin production
- High calcium levels
- MEN 2A and 2B
Presentation of anapaestic thyroid cancer
- Older patients (60-80)
- Undifferentiated
- Fast growing
- Aggressive
- Hard, craggy mass
- Haematological spread
Complication of thyroidectomy
Hypocalcaemia (long QT syndrome)
Name the enzyme that produces calcium phosphate in bones.
Alkaline phosphatase (ALP)
Name the biologically active form of vitamin D
Calitriol
produced in kidneys via activity of 1 alpha hydroxylase
Which DEXA score indicates osteoporosis?
T score < -2.5
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
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)
Rickets presentation
Bowed legs Knocked-kneed Hypotonia Apathy Growth retardation
Osteomalacia presentation
Bone pain
Fractures
Proximal myopathy
Waddling gait
Which organism is associated the most with UTIs in children and adults?
E. coli
UTI management for a non-pregnant woman?
Trimethoprim or Nitrofurantoin for 3 days
UTI management in symptomatic pregnant women?
Nitrofurantoin (not in 3rd trimester)
Amoxicillin or Cefalexin
UTI management in asymptomatic pregnant women?
Nitrofurantoin (not in 3rd trimester) - 7 days
Amoxicillin, Cefalexin - 7 days
UTI management for men?
Trimethoprim or Nitrofurantoin
Most common type of bladder cancer?
Transitional cell carcinoma (90%)
Risk factors for transitional cell carcinoma?
Smoking
Carcinogens (Rubber, leather, motor workers, hair dye)
Causes of squamous cell carcinoma?
Schistosomiasis
Smoking
Symptoms of prostate cancer?
Haematuria
Weight loss
Erectile dysfunction
Fatigue
Which staging system is used in prostate cancer?
Gleason grading system
Which type of prostate cancer tumour looks like a potato?
Seminoma
Which type of prostate cancer grows hair and is malignant in males but not females?
Teratoma
Which type of prostate cancer is 100% bHCG positive?
Trophoblast (choriocarcinoma)
When should APGAR scores be assessed?
1, 5 and 10 minutes after delivery
Presentation:
- 3 year old child
- loud, harsh stridor
- barking cough
- hoarseness
- restless
- cyanosis
Diagnosis?
croup
caused by para-influenza virus most commonly
Management of croup?
Oral dexamethasone
moderate/severe = nebuliser adrenaline, oxygen (severe)
Which organism causes epiglottitis?
H. influenzae type B
Investigations for epiglottitis?
Lateral neck x-ray (thumb-print sign)
Management of epiglottitis?
oxygen mask
call anaesthetist -> rigid laryngoscopy and intubation
Supportive care and IV antibiotics (ceftriaxone)
management for a child with bronchiolitis?
Supportive
Urgent admission to hospital if grunting
Which virus typically causes bronchiolitis?
RSV
Which virus causes hand, foot and mouth disease?
Coxsackie virus
Machinery murmur is caused by which cardiac pathology…
Patent ductus arteriosus
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
At what age would the average child begin to say ‘mama’ or ‘dada’?
9 months
What is the first sign of puberty in girls?
Breast development
At which age should a child be able to crawl?
9 months
Which virus is associated with tonsillar SCC?
HPV
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
Which diagnostic criteria is used in the diagnosis of tonsillitis?
CENTOR criteria
Name the cells which detect an NaCl change in the tubular fluid.
Macula densa cells
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
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.
Name the 3 types of skeletal muscle fibres.
Slow-oxidative (type I)
Fast-oxidative (type IIa)
Fast-glycolytic (type IIb)
Example of a cartilaginous joint?
Intervertebral discs
Example of a synovial joint?
Elbow
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
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
Treatment for anterior uveitis?
Topical steroids - reduce inflammation and prevent complications
Mydriatic drops (cyclopentolate) - pupil dilation reduces pressure and pain in the eyes