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Personal Revision > Commonly Forgotten set 2 > Flashcards

Commonly Forgotten set 2 Flashcards

1
Q

What is the most common cause of infective endocarditis?

A 
Strep. Viridans MOST COMMON 
other enterococci (Staph aureus/epidermis, strep Bovis, H Influenzae)
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2
Q

list 7 key ie features

A 
Splinter haemorrhages
Osler’s nodes
Janeway lesions
Roth’s spots
Fever
New murmur 
septic Emboli
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3
Q

How is DUKE’s diagnosis for Infective endocarditis used?

A

(DUKE’s need 2 major, 1 minor to diagnose OR 1 major and 3 minors)
Major
+ve blood culture (2 separate cultures or persistently +ve e.g. 3> 12 hours apart)
Endocardium involved as shown by +ve echo → vegetation, abscess, OR new valvular regurgitation
Minor
Predisposing (cardiac lesion/IVDU)
Fever >38 degrees
Valvular/immunological signs
+ve blood culture that doesn’t meet major criteria
+ve ECHO that doesn’t meet major criteria

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4
Q

What is typical infective endocarditis treatment?

A

(IV) (Amoxicillin + gentamicin)

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5
Q

Name most common CAP and HAP

A

CAP S.pneumoniae

HAP P. Aeruginosa

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6
Q

CAP and HAP treatments

A

CAP Antibiotics – amoxicillin (if severe co-amoxiclav) + Clarithromycin
HAP Antibiotics – If MRSA then use Vancomycin

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7
Q

Osteomyelitis initial treatment

A

ceftriaxone

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8
Q

Describe LP in Bacterial Meningitis

A

Low glucose, high protein, cloudy, polymorph white cells = Bacterial meningitis

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9
Q

Describe LP in viral Meningitis

A

Higher glucose, low protein, clear, mononuclear white cells = Viral meningitis

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10
Q

Lower UTI antibiotic

A

Trimethoprim

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11
Q

Upper UTI antibiotic

A

Ceftriaxone +- cefuroxime

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12
Q

Complicated malaria treatment

A

Artesunate or Quinine (both IV)

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13
Q

Uncomplicated malaria treatment

A

PO Riamet

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14
Q

Drug for Hypnozoite clearance

A

Primaquine

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15
Q

HIV test?

A

ELISA

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16
Q

HIV Treatment scheme?

A

HAART

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17
Q

Types of Necrotising Fasciitis

A

Type 1: POLYMICROBIAL → mixture of anaerobic (clostridium perfrigens) + aerobic bacteria
Type 2: Single bacteria (esp. group A strep)

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18
Q

Necrotising Fasciitis treatment

A

Empirical Abx’s: IV benzylpenicillin + clindamycin

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19
Q

Cellulitis treatment

A

Penicillin V (phenoxymethylpenicillin) + Flucloxacillin

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20
Q

Impetigo treatment

A

Topical or systemic antibiotics, erythromycin, or if allergic/MRSA doxycycline, clindamycin

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21
Q

Impetigo presentation

A

Fluid filled blisters (bullous), local swollen lymph nodes

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22
Q

What is the main infective agent in cellulitis?

A

Group A beta haemolytic streptococci: strep pyogenes

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23
Q

Describe gram staining process

A

Apply a primary stain such as crystal violet (purple) to heat fixed bacteria
Add iodide which binds to crystal violet and helps fix it to the cell wall
Decolorize with ethanol or acetone
Counterstain with safranin (pink)

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24
Q

Name some Gram positive Cocci

A

Staph, strep, entero

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25
Q

Name some Gram positive bacilli

A

Corynebacteria
Clostridia
Bacillus

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26
Q

Name some Gram negative Cocci

A

Neisseria

Moraxella

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27
Q

Name some Gram negative bacilli

A 
E coli
Campylobacter
Pseudomonas
Salmonella
Shigella
Proteus
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28
Q

name a G+ve, Streptococcus which is Beta haemolytic and lancefield group A

A

Strep. Pyogenes

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29
Q

name a G+ve, aerobic Streptococcus which is Beta haemolytic and lancefield group B

A

Strep. agalactiae

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30
Q

name a G+ve, aerobic Streptococcus which is Alpha haemolytic

A

Strep. pneumoniae
Strep. Oralis
Strep. milleri
Strep. sanguis

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31
Q

name a G+ve, aerobic Streptococcus which is non-haemolytic

A 
Strep Bovis
Enterococcus faecalis (lancefield D)
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32
Q

Name a G+ve, aerobic staphylococcus which is coagulase/DNAse positive

A

Staph. aureus

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33
Q

Name a G+ve, aerobic staphylococcus which is coagulase/DNAse negative

A

all staph apart from staph. aureus

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34
Q

Name a G -ve, lactose fermenting bacillus

A

Coliforms
Escherichia coli
Klebsiella pneumoniae

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35
Q

Name a G -ve, non-lactose fermenting bacillus which is oxidase positive

A

Pseudomonas aeruginosa

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36
Q

Name a G -ve, non-lactose fermenting bacillus which is oxidase Negative

A

Enterobacteriaceae:

Shigella
Salmonella
Proteus

37
Q

Name an optochin sensitive aerobic alpha haemolytic gram positive coccus

A

Streptococcus pneumoniae

38
Q

Barrett’s Oesophagus

A

Metaplasia from squamous to columnar

39
Q

Stages of wound healing

A

Clotting phase
Healing of a wound begins with clot formation to stop bleeding and to reduce infection by bacteria, viruses and fungi. Clotting is followed by neutrophil invasion.

Inflammation phase
In the inflammatory phase, macrophages and other phagocytic cells kill bacteria.

Proliferative phase
In the proliferative phase, immature granulation tissue containing plump, active fibroblasts forms

Maturation phase
During the maturation phase of wound healing, unnecessary vessels formed in granulation tissue are removed by apoptosis, and type III collagen is largely replaced by type I.

40
Q

Stages of healing from inflammation damage

A

Recall phase
In the recall phase the adrenal glands increase production of cortisol which shuts down inflammation.

Resolution phase
In the Resolution phase, pathogens and damaged tissue are removed by macrophages (white blood cells).

Regeneration phase
In the Regeneration phase, blood vessels are repaired and new cells form in the damaged site similar to the cells that were damaged and removed.

Repair phase
In the Repair phase, new tissue is generated which requires a balance of anti-inflammatory and pro-inflammatory eicosanoids.

41
Q

Give an example of a 5-alpha-reductase inhibitor

A

Finasteride

42
Q

What might a 5-alpha-reductase inhibitor be used to treat?

A

BPH and hair loss

43
Q

Give a DOAC example

A

Rivaroxaban

44
Q

What system is used to assess BPH treatment?

A

The international prostate symptom score

45
Q

Of what is the The international prostate symptom score comprised?

A

8 questions, (7 symptom and 1 QOL) assessing progress and treatment of BPH

46
Q

A term given to an occupational lung disease caused by dust inhalation:

A

Pneumoconiosis

47
Q

What systems do a schistosomiasis infection affect?

A

UT, bowel

48
Q

Where is one likely to contract schistosomiasis ?

A

Tropical countries

49
Q

schistosomiasis treatment

A

praziquantel

50
Q

schistosomiasis significant features

A 
Blood in stool
Eggs in stool
Antibody present in blood
Multi-organ failure - ascites
Seizures, rash and fever
51
Q

Pathogen in Syphilis

A

Treponema pallidum

52
Q

Features of Systemic Inflammatory Response Syndrome (SIRS)

A

Temperature >38.3oC or <36oC
Heart rate >90
White Cell count >12x10^9 per L
Hypoxia

53
Q

What is the scoring system for peripheral vascular disease?

A

The Fontaine Classification (1-4)

54
Q

Classic features of CML

A 
Usually 40-60yrs age
Slow onset
Sometimes incidental finding
High WCC
Splenomegaly
Metabolic features
Philadelphia chromosome detected by BCR/ABL dual colour dual-fusion probe
55
Q

CML treaatment

A

Imatinib

56
Q

How is myeloma bone disease usually assessed?

A

Plain x-ray
Shows lytic lesions
Osteoclast-activating factors

OAFs include RANKL, IL-3 and TNF-α

57
Q

Signs of Sarcoidosis

A

Raised ACE
Raised Calcium with normal PTH
Bilateral lymph node enlargement
must exclude TB

58
Q

ECG evidence of Aortic Stenosis:

A

Bifid P-wave (P-mitrale)

59
Q

Gout pain medication

A

Colchicine

If intolerant, diclofenac (NSAID)

60
Q

What is used to calculate to possibility/extent of peripheral artery disease?

A

ankle-brachial pressure index (<0.5 is critical, 0.5<0.9 is some arterial disease)

61
Q

What is the treatment used for acute alcohol poisoning?

A

Metadoxine is used for clearance

Thiamine is used to prevent wernicke-korsakoff syndrome

62
Q

Name a v2 receptor antagonist

A

Tolvaptan

63
Q

Describe complement:

A

The complement system consists of a number of small proteins found in the blood, synthesised by the liver, which circulate as inactive precursors (pro-proteins)

When stimulated by one of several triggers, proteases in the system cleave specific proteins to release cytokines and initiate an amplifying cascade of further cleavages. The end result of this complement activation or complement fixation cascade is stimulation of phagocytes to clear foreign and damaged material, inflammation to attract additional phagocytes, and activation of the cell-killing membrane attack complex.

64
Q

Functions of complement

A

Complement triggers the following immune functions:[5]

  1. Phagocytosis – by opsonizing antigens. C3b has most important opsonizing activity
  2. Inflammation – by attracting macrophages and neutrophils
  3. Membrane attack – by rupturing cell wall of bacteria
65
Q

What does the Membrane Attack complex (MAC) do?

A

The membrane-attack complex (MAC) forms transmembrane channels. These channels disrupt the cell membrane of target cells, leading to cell lysis and death.

Active MAC is composed of the subunits C5b, C6, C7, C8 and several C9 molecules

66
Q

What is the role of opsonisation?

A

It enhances phagocytosis by marking an antigen for an immune response or marking dead cells for recycling

67
Q

What drug is used to treat a focal seizure?

A

Carbamazepine

68
Q

What drugs are used to treat focal and generalised seizures?

A

Valproate

Lamotrigine

69
Q

What drugs are used to treat generalised seizures?

A

Ethosuximide (absence only)

Rufinamide

70
Q

What protein aggregations can be observed in the cytoplasms of AML blast cells?

A

Auer rods

71
Q

Term given for the easy bruising seen in leukaemia

A

Petechiae

72
Q

The term given to the treatment scheme for high - grade non-Hodgkin’s lymphoma

A

R-CHOP Combined chemotherapy and monoclonal antibodies - kill or cure

Rituximab

Zevalin - Radioimmunotherapy

73
Q

Diagnostic signs of Multiple Myeloma:

A

Rouleaux stacks - aggregated erythrocytes in blood film
High ESR
Monoclonal protein in blood and urine (Bence Jones protein)
Light chain deposition in the kidneys
Pepperpot skull

74
Q

Clinical signs of Multiple Myeloma:

A 
CRAB:
High calcium
Renal
Anaemia 
Bone disease
Amyloidosis
75
Q

What are the two categories of Polycythaemia?

A

Relative Polycythaemia: ↓Plasma volume, normal RBC Mass

Absolute Polycythaemia: ↑RBC Mass, normal plasma volume

76
Q

Test to characterise blood clotting (intrinsic pathway)

A

activated partial thromboplastin time

77
Q

Test to characterise blood clotting (extrinsic pathway)

A

The prothrombin time (PT)—along with its derived measures of :

  • Prothrombin ratio (PR)
  • International normalised ratio (INR)
78
Q

What are the main platelet disorders (with a primary cause)

A

ITP - Immune thrombocytopenia - antiplatelt Autoantibodies - low clotting
TTP - Thrombotic Thrombocytopenic Purpura - SLE - too much clotting

79
Q

pathology of thalassaemia

A

Unbalanced production of Hb chains, with one being less abundant than the other. divided into 𝞪 and 𝜷 thalassaemia, for obvious reasons.

80
Q

Parkinson’s signs

A 
Festinating gait
Bradykinesia
Rigidity
Tremor
off/on dyskinesia
It is assymetrical
81
Q

Antibodies found in Coeliac’s

A

Anti TTG, anti-endomysial and anti-alpha gliadin

82
Q

What does a “tinkling” bowel sounds indicate?

A

Obstruction

83
Q

What investigation is used to look for diverticulitis?

A

A barium enema

84
Q

test for H pylori

A

the rapid urease test

85
Q

What is a Mallory- Weiss tear?

A

An oesophageal tear due to coughing or vomiting or alcoholism
Urgent endoscopy

86
Q

Cardioprptective drug before treatment of Hyperkalaemia of Hypercalcaemia

A

Calcium Gluconate

87
Q

Ascending cholangitis - classic presentation:

A

Reynold’s Pentad: right upper quadrant pain, jaundice, and fever (charcot’s triad), Low blood pressure (or shock) and confusion

88
Q

Famous wilson’s disease sign

A

Kayser-Fleischer rings

89
Q

Common Primary Biliary Cirrhosis signs

A

For cirrhosis in general: CLAPS - Clubbing, Leukonychia, Ataxia, Palamar erythema, Scratch marks

For PBC, AMA +ve, high ALP,
Xanthoma (fatty collections around eyes)

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