Corrections 2 Flashcards
Which artery is affected if a patient with a stroke has facial pain?
Posterior inferior cerebellar artery (i.e. lateral medullary syndrome).
This is due to damage to the medulla where the facial nerve nuclei are located.
Which artery is affected if a patient with a stroke has ataxia?
Posterior inferior cerebellar artery (i.e. lateral medullary syndrome).
This is due to damage to the medulla where the vestibular nuclei are located. The spinothalamic tracts also pass through the medulla.
What is the mechanism of action of rivaroxaban?
direct factor Xa inhibitor
What is the mechanism of action of apixaban?
direct factor Xa inhibitor
What is the mechanism of dabigatran?
Direct thrombin inhibitor
What is the mechanism of heparin?
Activates antithrombin III
Which type of diabetes drugs increases the levels of incretins?
DPP-4 inhibitors (-gliptins)
What is glucagon-like peptide-1 (GLP-1)?
A hormone released by the small intestine in response to an oral glucose load.
Which gut hormone acts as an incretin?
GLP-1
What is an incretin?
Incretin hormones are gut peptides that are secreted after nutrient intake and stimulate insulin secretion, resulting in a decrease in blood glucose levels.
Name 2 GLP-1 mimetics
Exenatide & liraglutide
Name a DPP-4 inhibitor
Sitagliptin
Mechanism of DPP-4 inhibitors?
These increase the levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown.
Mechanism of GLP-1 mimetics?
These mimic GLP-1 (an incretin), therefore increasing insulin secretion and inhibiting glucagon secretion.
What is one of the major advantages of GLP-1 mimetics?
Usually result in weight loss.
What is given in primary care for suspected meningococcal disease, as long as this will not delay transfer?
IM benzylpenicillin
Is a history of a rash with penicillin a contraindication to using IM benzylpenicillin in primary care for suspected meningococcal disease?
No - must be a true allergy causing anaphylaxis to be a contraindication.
Describe the ‘motor response’ section of the GCS score
- Obeys commands
- Localises to pain (hand needs to be meaningfully brought up to the painful stimulus meaning a response where the hand reaches above the level of the clavicle)
- Withdraws from pain
- Abnormal flexion to pain (decorticate posture)
- Extending to pain
- None
Mechansim of tetanus?
Prevents the release of GABA
In developed countries, who may tetanus be seen in?
IV drug users
Features of tetanus?
- prodrome fever, lethargy, headache
- trismus (lockjaw)
- risus sardonicus: facial spasms
- opisthotonus (arched back, hyperextended neck)
- spasms (e.g. dysphagia)
Fever, facial spasms, dysphagia in an intravenous drug user, what condition?
Tetanus
(Note - botulism would cause a flacid paralysis)
What is the 1st line treatment for early Lyme disease?
14-21 day course of oral doxycycline (amoxicillin if contraindicated e.g. pregnancy).
How are proximal aortic dissections generally managed?
Surgical aortic root replacement.
With dysphagia affecting BOTH solids and liquids from the start, what condition should you think of?
Achalasia
What is the 1st line mx option in achalasia?
Pneumatic (balloon) dilation.
Appearance of kidneys on US in HIV-associated nephropathy vs normal CKD?
HIV-associated nephropathy –> large/normal sized kidneys
CKD –> bilateral small kidneys
During Ramadan, how should metforim dose be altered?
Advise to take 1/3 of normal dose before sunrise and 2/3 after sunset.
Vaginal pH in BV?
> 4.5
What type of pneumonia can cause peripheral demyelinating condition similar to Guillain-Barre?
Mycoplasma pneumoniae
What type of pneumonia can cause immune-mediated neurological diseases?
Mycoplasma pneumoniae
1st line Mx of patients with heart failure with reduced LVEF?
Beta blocker + ACEi
What can be used as an alternative to spironolactone in n patients with troublesome gynaecomastia?
Eplerenone
How does spironolactone cause gynaecomastia?
Spironolactone inhibits free testosterone from binding to androgen receptors in cells located in the breast.
What should be offered n addition to an ACEi (or ARB) and beta-blocker, to people who have HF with reduced EF if they continue to have symptoms of HF?
a mineralcorticoid receptor antagonist e.g. spironolactone
Management of asymptomatic patients with an abnormal HbA1c or fasting glucose?
Must be confirmed with a 2nd abnormal reading before a diagnosis of type 2 diabetes is confirmed
What Abs are seen in primary biliary cholangitis?
Anti-mitochondrial antibodies (AMA) M2 subtype
What condition is primary biliary cholangitis most associated with?
Sjogren’s syndrome (seen in up to 80% of patients)
What is the screening test for adult polycystic kidney disease?
US
What 2 medications can be used in the PROPHYLAXIS of migrains?
Topiramate or propanolol
Mechanism of ondansetron?
5-HT3 serotonin antagonist
What is the best test to diagnosis Cushing’s syndrome?
The low-dose (overnight) dexamethasone suppression test
Management of patients on warfarin with an INR of 5.0-8.0?
Withhold 1 or 2 doses of warfarin & reduce subsequent maintenance dose
What are the 3 causes of 2ary hyperaldosteronism?
1) renal artery stenosis
2) heart failure
3) liver cirrhosis & ascites
What secretes renin? Where is this found?
Juxtaglomerular cells found in the AFFERENT arterioles in the kidney.
What promotes renin secretion?
Low BP in the afferent arterioles in the kidney.
What dynamic function tests are used for Cushing’s syndrome?
Dexamethasone suppression tests
What should all patients with ascites 2ary to liver cirrhosis be given?
Aldosterone antagonist e.g. spironolactone
How does phenobarbital affect the P450 system?
Inducer
Which type of pneumonia causes a peripheral blood smear showing red blood cell agglutination?
Mycoplasma pneumoniae
Primary biliary cholangitis - the M rule:
1) IgM
2) anti-Mitochondrial antibodies, M2 subtype
3) Middle aged females
Typical presenting symptoms of primary biliary cholangitis?
- fatigue
- pruritus
- cholestatic jaundice
- LFTs: rise in ALP and γGT
What is calcitonin a tumour marker for?
Medullary thyroid cancer.
Which type of medication used in Parkinson’s disease has been most linked with impulse control disorders?
Dopamine receptor agonists
What does ambulatory blood pressure monitoring (ABPM) consist of?
at least 2 measurements per hour during the person’s usual WAKING hours (for example, between 08:00 and 22:00)
use the average value of at least 14 measurements
How can binge drinking lead to hypernatraemia?
Alcohol bingeing can lead to ADH suppression in the posterior pituitary gland subsequently leading to polyuria –> dehydration –> hypernatraemia.
During infection, why is ferritin an unreliable indicator of iron stored in the body?
What should be used instead?
As it is an acute phase protein.
Use transferrin saturation instead.
What does an MRC power score of 2 indicate?
that the muscle can work with gravity removed
Mx of BV?
Oral metronidazole 400mg BD for 7 days
What condition does the simultaneous dilatation of the common bile duct and pancreatic ducts on a CT abdomen indicate?
Pancreatic cancer
What is the most common organism found in central line infection?
Staph. epidermis
What is vitamin B3?
Niacin
What are the consequences of a niacin deficiency?
pellagra: dermatitis, diarrhoea, dementia
A 72-year-old woman presents to the emergency department. She describes to the doctors that a few minutes ago she felt a tingling sensation in her left little toe followed by jerking movements on the rest of her left side of the body.
Given the likely diagnosis, what part of her brain is affected?
Frontal lobe –> describes Jacksonian movement (clonic movements travelling proximally)
Mx of immunocompetent patients with toxoplasmosis?
Don’t usually require treatment
Watery travellers diarrhoea with stomach cramps and nausea - what organism?
E. coli
What type of stools does Campylobacter jejuni typically cause?
Bloody
When lactational mastitis is caused by infection, what is the most common bacterial cause?
What is the first-line antibiotic to treat this?
Staph. aureus
Flucloxacillin
What type of tumour can secrete oestrogen and cause gynaecomastia?
Leydig cell tumour (testicular cancer)
What antibiotic options do the NICE clinical knowledge summaries (updated January 2021) recommend for non-lactational mastitis? (2)
Co-amoxiclav, or
Erythromycin/clarithromycin plus metronidazole
What is involved in the NHS breast cancer screening program? (3)
Mammogram
Every 3 years
For women aged 50-71
What hormone is most important for breast milk secretion?
What hormone is most important for breast milk production?
Oxytocin –> secretion
Prolactin –> production
What condition involves a warty lesion growing within one of the ducts in the breast, resulting from the proliferation of epithelial cells?
Intraductal papilloma
What chromosomal abnormality is found in Klinefelter syndrome?
XXY sex chromosomes
What is the name for the benign condition where there is dilation of the large ducts in the breasts? (1)
What is the most notable modifiable risk factor? (1)
What is the typical presenting feature? (1)
Mammary duct ectasia
Smoking
Nipple discharge
Which common heart medications can cause gynaecomastia? (2)
Digoxin & spironolactone
What medications can be used to treat the symptoms of hyperprolactinaemia? (1)
Give two examples. (2)
Dopamine agonists
Bromocriptine & cabergoline
What type of analgesia is typically first-line to manage symptoms of cyclical breast pain (mastalgia)?
NSAIDs
What staging system is usually used for breast cancer?
TNM
What is the management of candidal infection of the nipple in a breastfeeding woman? (2)
Topical miconazole 2% to the nipple after each breastfeed
Plus treatment for the baby (e.g. oral miconazole get or nystatin)
