AMU Flashcards
1
Q
An alternative name for Bell’s Palsy?
A
Facial nerve palsy (CNVII)
2
Q
What is the most common mononeuropathy?
A
Facial Nerve palsy (CNVII)
3
Q
In what patient groups is there thought to be a slightly increased incidence of Bell’s Palsy?
A
During Pregnancy and in those with Diabetes
4
Q
How would you confirm whether a facial nerve weakness was due to an UMN lesion or a LMN lesion?
A
See if the Forehead was affected. Forehead sensation will be NORMAL in cases of UMN lesion due to its bilateral innervation
5
Q
Define the House-Brackman Scale
A
Scoring system (1-6) used to describe the degree of facial nerve paralysis
6
Q
What is the most common aetiology of Bell’s Palsy?
A
Infection - Herpes simplex or zoster
7
Q
What is the treatment for a facial nerve palsy?
A
Prednisolone (preferably within the first 72hours) and Aciclovir (anti-viral)
8
Q
Name a steroid medication
A
Prednisolone
9
Q
Give three poor prognostic indicators for Bell’s Palsy
A
- Age > 60 yrs
- No signs of recovery at 3 weeks
- Presence of comorbidities: Pregnancy, Diabetes, Hypertension
10
Q
Differentials for Bell’s Palsy
A
- Stroke
- Guillain-Barre syndrome
- Lyme Disease
11
Q
Define Febrile Neutropenia
A
Fever >38 degrees + an absolute neutrophil count of <1.0*10^9/L
12
Q
What causes neutropenia?
A
Bone marrow suppression
13
Q
Give 5 potential causes of bone marrow suppression
A
- Chemotherapy
- Anaemias
- Genetic Defects
- Drugs
- Infections
14
Q
In how many planes should a suspected fracture be imaged in?
A
At least 2 planes - AP and lateral X-rays
15
Q
How will a fracture appear on a bone scan and why?
A
Will appear dark on the scan as there is increased Tc uptake at sites of fracture
16
Q
Why can CT be useful in detecting stress fractures?
A
Good modality for detecting new bone growth
17
Q
Give 5 possible early complications that can be associated with a bone fracture
A
- DVT
- PE
- Compartment Syndrome
- Avascular necrosis
- Nerve injury
18
Q
What is considered to be the most common post-fracture complication?
A
DVT and PE
19
Q
In cases of late stage avascular necrosis, why will the bone appear darker on X-ray?
A
Collapse of subchondral bone
20
Q
Recall 4 signs of avascular necrosis
A
- Cold pulseless limb
- Ischaemia
- Paralysis
- Parasthesia of the limb
21
Q
Give 2 clinical signs associated with nerve damage to the common perineal nerve
A
- Foot drop
2. Loss of sensation to the dorsum of the foot
22
Q
Under what category do the majority of nerve injuries associated with bone fractures fall?
A
Traction neuropraxia
23
Q
Define traction neuropraxia
A
Nerve damage in which the nerve remains intact but is temporarily unable to transmit nerve impulses
24
Q
What is another name for Sudeck’s atrophy?
A
Reflex sympathetic dystrophy syndrome (also known as algodystrophy)
25
How does algodystrophy occur?
Trauma results in injury to the sympathetic nervous system which in turn will affect the blood supply to the affected region
26
Recall the 5 main features of algodystrophy
1. Burning pain in the affected area
2. Skin changes - skin often becomes thin and shiny
3. Swelling
4. Excessive sweating
5. Pain, stiffness and muscle wasting
27
To which brain region is consciousness (with relation to GCS) most closely related to?
Reticular activating system
28
What is Battle's sign and what does it indicate?
Bruising over the mastoid process which is indicative of a fracture of the base of the skull
29
What is the most common form of brain tumour?
Glioblastoma
30
Where are ~ 90% of brain tumours located?
Posterior Fossa
31
Treatment of brain tumour
1. Surgery
2. Radiotherapy
3. Chemotherapy
32
Give 5 intracranial causes of altered consciousness
1. Trauma
2. Neoplasms
3. Infection
4. Seizures
5. Vascular (either haemorrhage or stroke)
33
Define heart failure
The inability of the heart to pump adequate amounts of blood to meet the body's metabolic demands
34
What is the annual mortality rate for heart failure?
10%
35
Classical presentation of a patient with heart failure (3)
1. Shortness of breath
2. Fatigue
3. Ankle oedema
36
5 signs associated with heart failure
1. Peripheral oedema
2. Hepatomegaly
3. Tachycardia
4. Tachypnoea
5. Raised JVP
37
What is the association between ejection fraction and prognosis for heart failure patients?
The lower the ejection fraction the worse the prognosis
38
Define diastolic heart failure
Reduction in heart compliance in turn resulting in comprised ventricular filling and thus also ejection
39
Name 3 causes of diastolic heart failure
1. Pericardial disease
2. Restrictive cardiomyopathy
3. Tamponade
40
Give 2 potential causes of high-output heart failure
1. Anaemia - reduced blood oxygen carrying capacity
| 2. Thyrotoxicosis - increased metabolic demand
41
Causes of heart failure (11)
1. Ischaemia heart disease
2. Hypertension
3. Valvular disease
4. Pericardial disease
5. Drugs
6. Myocarditis
7. Thyrotoxicosis/ Myxedema
8. Arrhythmia
9. Cardiomyopathies
10. Severe anemia
11. Pulmonary Hypertension
42
How does hypertension contribute to an increased incidence of arrhythmia?
High afterload increases strain on the heart and leads to hypertrophy of cardiac tissue. Hypertrophy is a risk factor for arrhythmia.
43
Define restrictive heart failure
Reduced heart compliance without significant increase in muscle wall thickness. Leading to reduced EDV and CO.
44
What is the most common cause of restrictive heart failure?
Infiltrative disease
45
Give 4 examples of infiltrative disease
1. Sarcoidosis
2. Amyloidosis
3. Haemochromatosis
4. Endocardial Fibrosis
46
How does the medullary cardiovascular centre (MCVC) act to increase/ maintain MAP?
Reduced vagal tone and increases sympathetic tone, leading to increased heart contractility and rate and this also cardiac output
47
Though rare, what is the classic symptom of pulmonary oedema?
Pink frothy sputum
48
Define Pulsus Alternans
Alternating strong and weak pulse pressures in the arterial wave form during a sinus rhythm
49
What are the most common causes of Pulsus Alternans? (4)
1. Aortic and mitral valve stenosis
2. Congestive cardiomyopathy
3. Effusive pericarditis
4. General anaesthesia
50
Define BNP's
Brian natriuretic peptides = peptides that cause natriuresis, diuresis and vasodilation.
51
Enalapril, Lisinopril and Captopril
ACE inhibitors
52
Angiotensin II inhibitors
Candersartan, Valsartan and Losartan
53
3 examples of beta-blockers
bisoprolol, atenolol, cardedilol
54
Loop diuretic
Frusemide
55
Thiazide diuretics
Bendroflumethiazide, hydrochlorothiazide, Chlorthalidone or Indapamide
56
Potassium Sparing Diuretics
Amiloride and Spironolactone
57
Calcium channel blockers
Diltiazem, Verapamil and Amlodipine
58
Give 4 common pitfalls associated with the management of heart failure clinically.
1. Overuse of diuretics
2. Use of diuretics as a mono therapy (without use of an ACE-inhibitor)
3. Failure to treat underlying causes
4. Failure to monitor electrolyte and renal function
59
Possible contra-indications for an LP may include...
1. Raised ICP
2. Coagulopathy
3. Local infection at site of needle insertion
4. No consent
60
Suggest 5 symptoms associated with raised intracranial pressure
1. Headache
2. Impaired consciousness
3. Low pulse
4. Low BP
5. Papilloedema
61
What form of acid-base disturbance will severe hypovolaemia most commonly cause?
Metabolic acidosis resulting from peripheral anaerobic metabolism.
62
How do you carry out a fluid challenge?
Give the patient 500mls of 0.9% saline as quickly as possible e.g. over 5-10 minutes and then reassess their fluid status
63
Give 3 potential endogenous causes of meningism
1. Malignancy
2. Autoimmune disease
3. Subarachnoid haemorrhage
64
What is Kernig's sign?
Flex the hip, with the knee flexed. Now extend the knee. Positive test if there is spasm of the hamstring
65
Name the infective organism that causes Mollaret's Meningitis
Herpes simplex virus type 2
66
What are the two most common infective agents leading to meningitis in western Europe?
1. Streptococcus Pneumonia
| 2. Nisseria Meningitidis
67
Which infective organism more commonly causes meningitis in immunocompromised patients or those aged over 50?
Listeria
68
What is the best drug treatment combination for a Listeria infection?
Ceftriaxone and Ampicillin
69
Suggest an appropriate antibiotic for the initial treatment of meningitis
Third generation Cephalosporin IV ( as it is broad spectrum)
70
Give 2 third generation cephalosporins
1. Cefotaxime
| 2. Cephalexin
71
What prophylactic treatment is commonly given to household contacts of a patient with meningococcal meningitis?
Rifampicin
72
Which 3 conditions are considered to be acute coronary syndromes?
1. STEMI
2. NSTEMI
3. Unstable Angina
73
What is the common mechanism of pathology among the acute coronary syndromes?
Rupture or erosion of the fibrous cap of a coronary artery plaque
74
What % of ACS patients are expected to present without pain?
~30 %
75
In what form of ACS is vomiting and sinus bradycardia most commonly seen in?
Excessive vagal stimulation is most common in an inferior MI
76
What are the cardiac differentials of ACS?
1. Angina
2. Pericarditis
3. Myocarditis
4. Aortic dissection
77
What are the pulmonary differentials of ACS?
1. PE
2. Pneumothorax
3. Anything that causes pleuritic chest pain
78
What are the oesophageal differentials of ACS?
1. Oesophageal reflux
2. Oesophgeal spasm
3. Tumour
4. Oesophagitis
79
Physiologically, how do platelets induce localised vasoconstriction?
They release serotonin and thromboxane A2
80
Define a transmural MI
Infarct that causes necrosis of tissue through the full thickness of the myocardium
81
Excluding MI, suggest 3 conditions that can cause elevated troponin levels
1. PE
2. Myocarditis
3. Renal failure (troponin are chronically raised)
82
Name an anti-emetic
Metoclopramide
83
Name a low molecular weight heparin
Enoxaparin
84
Name a glycoprotein IIb/III inhibitor
Abciximab
85
Outline the components of the acute management of MI
MONA (C)
1. Morphine
2. Oxygen
3. Nitrates
4. Aspirin
5. Clopidogrel (for high risk NSTEMI or STEMI)
86
Recall the components for secondary prevention in ACS
COBRA-A
1. Clopidogrel
2. Omacar (omega 3)
3. Bisoprolol
4. Ramipril
5. Aspirin
6. Atorvostatin
87
Give an example of a potent statin
Atorvostatin
88
Define a mural thrombus
Thrombus attached to the wall of the endocardium in a damaged area, or attached to the aortic wall over an intimal lesion
89
Define Dressler's Syndrome
An autoimmune pericarditis provoked by MI
90
What is the important caution pharmokinetically when treating an opiate overdose with naloxone?
Half life of naloxone is significantly shorter than that of opiates
91
Give a contra-indication of Flumazenil
Long term Benzodiazepine abusers as it can induce withdrawal, including seizures
92
Give the 3 main causes of hepatic necrosis associated with a paracetamol overdose
1. Jaundice + RUQ pain
2. Encephalopathy
3. Hypoglycaemia
93
Give 4 signs of Aspirin toxicity
1. Tinnitus
2. Lethargy
3. Dizziness
4. Vomiting
94
What is the 'most fatal' hospital acquired infection?
Pneumonia
95
Give 3 potential causes of atypical pneumonia
1. Chlamydia
2. Legionella
3. Coxiella burnetti
96
Which two organisms are most commonly implicated in community acquired pneumonias?
1. Streptococcus Pneumonias
| 2. Haemophilus Influenza
97
Which organism is most commonly associated with hospital acquired pneumonias?
Staphlococcus Aureus
98
Recall the 3 main signs associated with pleural effusion
1. Decreased chest expansion
2. Dullness to percussion
3. Reduced breath sounds
99
Suggest a typical antibiotic therapy for empyema
IV doses of cefuroxime and co-amoxiclav for 5 days (to cover both aerobes and anaerobes) followed by 3-5 weeks of metronidazole monotherapy
100
Give 4 potential causes of aspiration
1. Alcoholism
2. Inhaled foreign body
3. Oesophageal blockage
4. Bulbar palsy
101
Name 2 organisms associated with lung abscesses
1. Staph Aureus
| 2. Klebsiella Pneumoniae
102
What is 'rust coloured sputum' indicative of?
Pneumonia - Strep pneumonia as the infective organism
103
Suggest 5 potential causes of a secondary pneumothorax
1. COPD
2. Cystic Fibrosis
3. Lung Malignancy
4. Pneumonia
5. TB
104
Define a tension pneumothorax
Air in the pleural space and the volume continues to increase
105
Recall a sign seen on CXR associated with a tension pneumothorax
Trachea may be deviated away from the side of the pneumothorax
106
What are the 3 main signs of the haemodynamically unstable patient?
1. Hypotensive
2. Tachycardic
3. Elevated RR
107
5 patient groups considered to be at risk of postural hypotension
1. Elderly
2. Those with autonomic neuropathy
3. Antihypertensive medications
4. Overdiuresis
5. Multi-Systems atrophy (MSA)
108
Which cranial nerve innervates the carotid sinus baroreceptors?
CN IX
109
Which cranial nerve innervates the aortic arch baroreceptors?
CN X
110
What is the normal serum range for potassium?
3.5-5 mmol/L
111
Give 4 factors that will induce a potassium shift INSIDE cells
1. Insulin
2. Aldosterone
3. Beta-adrenergic stimulation
4. Alkalosis
112
Give 4 factors that will induce a potassium shift OUTSIDE cells
1. Addison's disease
2. Beta-blockade
3. Acidosis
4. Cell lysis
113
What are the main differentials of hypokalaemia?
1. Diarrhoea and vomiting
2. Diuretics
3. Excess mineralocorticoids
4. Intracellular shift
114
What are the main differentials for hyperkalemia?
1. Oliguric renal failure
2. Potassium sparing diuretics
3. Metabolic acidosis
4. Adrenal Insufficiency
5. Drugs
6. Rhabdomyolysis
7. Artefact due to haemolysis of sample
115
Define secondary hyperthyroidism
Thyroid gland is stimulated by pathologically high levels of TSH in the circulation.
116
What stimulates the release of TSH from the anterior pituitary gland?
TRH released from the hypothalamus
117
Recall the names of T3 and T4 respectively
T3 - Triiodothyronine
| T4 - Thyroxine
118
Where is T4 converted to T3?
Activation of T4 occurs peripherally in organs such as the kidneys and liver
119
The majority of T3 and T4 in the circulation is bound to which protein?
Thyroglobulin
120
What is the most common cause of thyrotoxicosis?
Grave's disease
121
Which form of thyrotoxicosis becomes more common in people aged over 60?
Toxic nodular goitre
122
Broadly speaking, what is the pathophysiology of thyroiditis?
Destruction of thyroid cells leads to excessive release of thyroid hormones into the circulation.
123
Give 3 gene regions commonly linked to Grave's disease
1. Human leukocyte antigen region
2. CTLA4
3. PTPN22
124
What is thyrotoxic periodic paralysis?
Serious complication of hyperthyroidism characterised by muscle paralysis and hypokalaemia due to a massive intracellular shift of potassium
125
Hyperthyroidism can lead to what change in a patients reflexes?
Brisk reflexes may be present
126
Alongside thyrotoxic symptoms, what 2 main additional symptoms are associated with the development of a thyrotoxic crisis?
1. Hyperthermia
| 2. Acute mental disturbances
127
Give 4 'precipitating events' that can be associated with a thyrotoxic storm?
1. Withdrawal of anti-thyroid drugs
2. Radio-iodine therapy
3. Infection
4. Surgery
128
What are the 4 components to the management of a thyrotoxic crisis?
1. IV Fluids
2. Beta blockers
3. Anti-thyroid drugs
4. Steroids
129
What are the differentials diagnoses for thyrotoxicosis?
1. Grave's disease
2. Toxic nodular goitre
3. Ovarian teratomas
4. Pheochromocytoma
5. Other causes of weight loss
6. Some medications
130
Give 3 medications which can cause thyrotoxic symptoms
1. Amiodarone
2. Lithium
3. Exogenous Iodine
131
What is the first line anti-thyroid drugs used for the treatment of hyperthyroidism? (2)
1. Carbimazole
| 2. Propylthiouracil
132
Give 4 potential causes of an enlarged atrium
1. Hypertension
2. Valvular heart disease
3. Lung disease
4. AF
133
Broadly, what are the 3 categories of complications following an MI?
1. Reduced heart contractility
2. Electrical instability
3. Tissue necrosis
134
What are the main components of granulation tissue? (4)
1. Fibroblasts
2. Inflammatory cells
3. Proliferating capillaries
4. Type III collagen
135
Scar tissue is formed from what type of collagen?
Type I collagen
136
Recall the lab tests considered for a confusion screen (9)
1. FBC
2. CRP
3. U and E
4. Bone profiles (calcium and phosphate levels)
5. B12 and folate
6. TFT's
7. Glucose
8. LFT's
9. Coagulation/ INR
137
What type of anaemia can be caused by hypothyroidism?
Macrocytic anemia
138
Define refeeding syndrome
Potentially fatal shift in fluids and electrolytes brought about in malnourished patients that are given artificial refeeding (enterally or parenterally)
139
Give 4 general features of connective tissue disease
1. Inflammation
2. Fibrosis/scarring
3. Vasospasm (including Raynaud's syndrome)
4. Vascular thrombosis
140
Suggest 4 haematological disorders that are associated with SLE
1. Leukopenia
2. Lymphopenia
3. Haemolytic anemia
4. Thrombocytopenia
141
Outline the 3 aspects of Whipple's Triad for the diagnosis of hypoglycaemia
1. Plasma hypoglycaemia
2. Symptoms attributed to a low blood sugar level
3. Resolution of symptoms with correction of hypoglycaemia
142
What is the most common non-iatrogenic cause of hypoglycaemia?
Excess alcohol
143
Suggest 4 drugs/ toxins that can induce hypoglycaemia
1. Pentamidine
2. Quinine
3. Paracetamol
4. Toadstools
144
Give an example of an extrapancreatic IGF-II secreting neoplasm
Adrenal tumour
145
Give 2 hormone deficiencies that can lead to hypoglycaemia
1. Hypoadrenalism
| 2. Hypopituitarism
146
Define strabismus
Condition in which the eyes do not align with each other when looking at an object.
147
For what condition is Diazoxide prescribed to treat?
Chronic intractable hypoglycaemia
148
According to Patient UK, what are the top 3 most common chronic illnesses among adolescent females?
1. Obesity
2. Asthma
3. Anorexia Nervosa
149
Things to include when examining a patient with anorexia (5)
1. Height, weight and BMI
2. Core temperature
3. Peripheral vascular (oedema and circulation)
4. Cardiovascular exam (pulse and BP, check for postural hypotension)
5. Test muscle power
150
List 10 potential causes of hypomagnesaemia
1. Malabsorption syndromes
2. Protein calorie malnutrition
3. Disorders of the parathyroid gland
4. Chronic alcoholism
5. Long term PPI therapy
6. Diabetes
7. Acute pancreatitis
8. Re-feeding syndrome
9. Severe burns
10. Renal tubular acidosis
151
Outline the components of the Meningism triad
1. Headache
2. Nuchal rigidity
3. Photophobia
152
Give the 6 potential causes of cardiac stunning
1. Post reperfusion of a blocked coronary artery
2. Post cardiac surgery
3. Post cocaine OD
4. Post cardiac arrest
5. Post cardioversion
6. In association with phaeochromoctymoa
153
Define cranial diabetes insipidus
Condition in which the hypothalamus fails to produce sufficient levels of anti-diuretic hormone.
154
Define nephrogenic diabetes insipidus
Condition in which the kidneys fail to respond to anti-diuretic hormone
155
Give 3 differentials for a chronic primary headache
1. Tension headache
2. Migraine headache
3. Cluster headache
156
Give 3 differentials for a chronic secondary headache
1. Cervical degenerative joint disease
2. Temperomandibular joint syndrome
3. Headaches associated with substances or their withdrawal
157
Give 4 substances that can be associated with chronic secondary headache
1. Caffeine
2. Nitrates
3. Analgesics (often presenting as chronic daily headaches)
4. Ergotamine
158
Give the two potential causes of medical morning headaches
1. Sleep disturbances
| 2. Night-time hypoglycaemia
159
Recall the components of the pneumonic 'DAVID' that denote the specific causes of peripheral vascular disease.
```
D - Diabetes (most common)
A -Alcoholism
V - Vitamin deficiency B12
I - Infective/ inherited i.e. Gullian-Barre/ Charcot-Marie-Tooth
D - Drugs e.g. Isoniazid
```
160
What are the 6 main mechanisms of peripheral nerve degeneration?
1. Demylination
2. Axonal degeneration
3. Wallerian degeneration
4. Compression
5. Infarction
6. Infiltration
161
What changes to heart sounds are associated with mitral regurgitation?
Split S2
162
What type of abnormality is shown in an ECG with a constant PR interval with the occasional P wave that is not follow by a QRS complex?
Second degree heart block - Mobitz type 2
163
The S4 heart sound is associated with which heart abnormality?
Aortic stenosis
164
Which cardiovascular disorders are associated with a collapsing pulse? (2)
1 - Patent ductus arteriosus
| 2 - Aortic regurgitation
165
Soft S1 heart sound is characteristic of which cardiovascular disorder?
Mitral regurgitation
166
Soft S2 heart sound is characteristic of which cardiovascular disorder?
Aortic stenosis
167
What is the first line treatment for the management of hypertension in < 55 Caucasians?
ACE inhibitors
168
Name 2 drugs that can cause bronchospasm as an adverse effect
1 - Beta-blockers
| 2 - Adenosine
169
List the 4 contraindications for the prescription of beta- blockers
1 - Uncontrolled heart failure
2 - Asthma
3 - Sick Sinus syndrome
4 - Concurrent use of verapamil
170
What are the 5 clinical features of mitral stenosis?
```
1 - Mid to late diastolic murmur (heard best on expiration)
2 - Loud S1 with opening snap
3 - Low volume pulse
4 - Malar flush
5 - Atrial fibrillation
```
171
Which important electrolyte imbalance is associated with the use of loop diuretics?
Hypokalemia
172
Name 2 drug types that can potentially induce diabetes
1. Steroids
| 2. Thiazide diuretics
173
Give 2 endocrine conditions that can subsequently lead to diabetes
1. Cushing’s syndrome
| 2. Hyperthyroidism
174
Outline 6 complications associated with the subacute presentation
1. Staphylocccal skin infections
2. Retinopathy
3. Polyneuropathy
4. Erectile dysfunction
5. Arterial disease
6. Inflammation of the genital - secondary to Candida infection
175
Classify the bacteria Escherichia Coli
Gram negative rod
176
Name the gram positive cocci (2)
1. Staphylococci
| 2. Streptococci
177
Name the gram negative cocci (3)
1. Neisseria Meningitidis
2. Neisseria gonorrhoea
3. Moraxella catarrhalis
178
Recall the bacteria classified as gram positive rods/bacilli using the mnemonic [ABCD L]
A - Actinomyces
B - Bacillus anthracis
C - Clostridium
D - Diphtheria
L - Listeria monocytogenes
179
Name the 2 main components of mast cell granules
1. Histamine
| 2. Heparin
180
Give 4 complications associated with Coeliac disease
1. Anemia
2. Hyposplenism
3. Osteoporosis
4. Lactose intolerance
181
Give an example of a class 1a antiarrhythmic drug
Quinidine
182
Give 3 conditions that class 1a antiarrhythmics can be used to treat
1. Supraventricular reentry tachycardias e.g. AVNRT and AVRT
2. AF and atrial flutter
3. Ventricular tachycardia (VT)
183
Classify and briefly outline the action of class 1a antiarrhythmics
Class: Fast sodium channel blockers
Mechanism: Negative dromotrophy
184
Give an example of a class 1b antiarrhythmic drug
Lidocaine
185
Give an example of a class 1c antiarrhythmic drug
Flecainide
186
Name a contra-indication for the prescription of a class 1c antiarrhythmic such as Flecainide
Post MI as this drug class can be proarythmiaogenic
187
Class II antiarrhythmic drugs are otherwise known as?
Beta-blockers
188
What is the mechanism of action of class III antiarrhythmic agents?
Potassium channel blockers
189
Name 3 examples of class III antiarrhythmic agents
1. Amiodarone
2. Sotalol
3. Ibutilide
190
What is the mechanism of action of class IV antiarrhythmic agents?
Calcium channel blockers
191
Give 3 examples of class IV antiarrhythmic agents
1. Verapamil
2. Diltiazem
3. Nifedipine
192
Give 3 examples of class V antiarrhythmic agents
1. Adenosine
2. Digoxin
3. Magnesium sulphate
193
What is the mechanism of action of the I(f) channel blocker Ivabradine?
Lowers the heart rate by blocking the I(f) channels in the pacemakers cells of the SA node
194
Give 3 potential adverse effects associated with Ivabradine
1. Visual changes
2. Bradycardia
3. Hypertension
195
In what 4 medical conditions is the administration of magnesium sulphate indicated in?
1. Torsades de Pointes
2. Eclampsia
3. Constipation
4. Tocolysis
196
What is the general mechanism of action of digoxin?
Inhibition of Na+/K+/ ATPases
197
Give 3 contra-indications for the administration of adenosine
1. Pre-excitation syndromes e.g. WPW
2. AV block
3. Asthma
198
Which disease state can cause a pulsatile liver to be noted on clinical examination?
Tricuspid regurgitation
199
Define Cadasil syndrome
A rare inherited defect in the NOTCH3 gene that leads to stroke and vascular dementia
200
Define Amaurosis fugax
A sudden loss of vision in one eye due to an infarct in the retinal artery
201
A difference in brachial blood pressures between right and left can be indicative of what disease state?
Subclavian artery stenosis (also known as steal syndrome)
202
What are the 3 key differentials for a TIA?
1. Mass lesion
2. Epilepsy
3. Migraine
203
To which receptor type do HIV viruses bind?
CD4
204
Give 4 examples of cell types that express CD4 receptors
1. T- cells
2. Monocytes
3. Macrophages
4. Neural cells
205
What is the main clinical difference between HIV-1 and HIV-2
HIV-2 has a much greater latency period
206
Outline the 5 principle modalities of HIV transmission
1. Sexual intercourse
2. Blood products
3. IV drug use
4. Needlestick injury
5. Vertical transmission
207
Categorise the HIV virus
RNA retrovirus
208
What are the 4 stages of HIV infection?
1. Seroconversion
2. Asymptomatic infection
3. AIDS related complex (ARC)
4. AIDS
209
Give 4 prodromal features associated with AIDS related complex
1. Opportunistic infections (e.g. candida or herpes simplex
2. Night sweats
3. High temp
4. Diarrhoea
210
HIV is an important differential to consider in any patient presenting with which triad of symptoms?
1. Fever
2. Malaise
3. Widespread lymphadenopathy
211
Give 8 examples of AIDS defining infections
1. Candidiasis of respiratory tract or oesophagus
2. Chronic HSV
3. Disseminated TB
4. Toxoplasmosis of the brain
5. Recurrent salmonella
6. Pneumocytosis jiroveci pneumonia (PJP)
7. Lymphoma of the brain
8. Invasive cervical cancer
212
Outline the 2 stages of HIV antibody testing
1. ELISA (screening test)
| 2. Western Blot test (secondary diagnosis test)
213
Newly diagnosed patients with HIV should be routinely screened for which conditions? (7)
1. Hepatitis B
2. Hepatitis C
3. TB
4. Toxoplasmosis
5. CMV
6. Syphilis
7. Full STI screen
214
Which values should be monitored every 3 months in patients with HIV?
1. HIV RNA levels (measure viral load)
| 2. CD4 count
215
ART (antiretroviral therapy) consists of what combination of antiviral drugs?
1. 2 * NRTI's (Nucleoside analogue reverse transcriptase inhibitors
2. Either a protease inhibitor (PI) OR a non nucleoside reverse transcriptase inhibitor
216
Give 5 examples of NRTI drugs
1. Zidovudine
2. Didanosine
3. Lamivudine
4. Emtricitabine
5. Tenofovir
6. Abacavir
217
Give 7 potential side effects associated with NRTI therapy
1. Leucopenia
2. GI disturbance
3. Rashes
4. Myalgia
5. Neuropathies
6. Pancreatitis
7. Anemia
218
Give 4 examples of protease inhibitors
1. Indavir
2. Ritonavir
3. Saquinavir
4. Lopinavir
219
What are the 3 components of metabolic syndrome?
1. Insulin resistance
2. Hyperglycaemia
3. Dyslipidaemia
220
Give 2 examples of NNRTI's
1. Nevirapine
| 2. Efavirenz
221
Give 2 side effects associated with NNRTI
1. Hepatitis
| 2. Dizziness
222
What is an important contra-indication for NNRTI
Pregnancy
223
Recall Virchow's triad of risk factors for DVT
1. Stasis
2. Hyper coagulability
3. Vessel wall injury
224
What are the 4 main signs/ symptoms associated with DVT?
1. Red swollen leg (particularly in the calf)
2. Tenderness
3. Pitting oedema
4. Fever
225
What are the 3 main differentials for DVT?
1. Ruptured Baker's cyst
2. Cellulitis
3. Lymphadenopathy
226
Apart from DVT, list 6 other potential causes of a raised D-Dimer test
1. Malignancy
2. Post MI
3. Pregnancy
4. Stroke
5. Inflammation
6. Any form of trauma (including post-operatively)
227
Give 4 things to assess on clinical examination of patient presenting with confusion
1. Level of consciousness (GCS/AVPU)
2. Evidence of head trauma
3. Sources of infection (e.g. suprapubic tenderness in cases of UTI)
4. Asterexis (uremia/ encephalopathy)
228
What form of anemia can be caused by hypothyroidism?
Macrocytic anemia
229
Why can chronic kidney injury lead to anemia?
Reduced EPO production
230
Haematinic investigations include what 4 components?
1. B12 and Folate
2. Ferritin
3. Serum iron
4. Total iron binding capacity (TIBC)
231
What clinical markers are required in order to confirm a diagnoses of SIADH? (3)
1. Serum Osmolality
2. Urine Osmolality
3. Urinary sodium and potassium levels
232
Which disorder of the thyroid can lead to hypocalcemia?
Hypoparathyroidism
233
Which 3 lab tests are indicated when investigating a patient fo potential refeeding syndrome?
1. U and E's (hyponatremia/ hypokalaemia)
2. Bone profile (hypophosphataemia/ hypocalcaemia)
3. Magnesium (hypomagnesaemia)
234
What 3 viruses should be considered when screening the liver for a potential viral infection?
1. Hepatitis serology (A/B/C)
2. CMV
3. EBV
235
Define DIC ( disseminated intravascular coagulopathy)
Systemic activation of blood coagulation, which generates intravascular fibrin, leading to thrombosis of small and medium sized vessels. This eventually leads to organ dysfunction and death.
236
What is Horman's sign and what does it indicate?
Increased resistance/ pain on forced dorsiflexion of the foot. Clinical sign of DVT.
Note - should not be routinely tested for in patients as there is a risk of dislodging a clot if present.
