Day 8

Question 1

Newly diagnosed patient with hypertension (>55 years)-

on atenolol & aspirin. what medication can be added for BP?

Answer 1

CCB

Question 2

What would you expect to find in a water deprivation test of a patient with nephrogenic DI

Answer 2

> urine osmolality after fluid deprivation: low

>urine osmolality after desmopressin: low

Question 3

Normal urine osmolality

Answer 3

wide range between 50 and 1200 mOsm/kg

Question 4

A rise in urine osmolality to >___ mOsm/kg is a normal response to dehydration.

Answer 4

700

Question 5

Side effect of lithium

Answer 5

nephrogenic DI

Question 6

risk factors for cranial DI

Answer 6

recent surgery
head injury
signs of pituitary tumour

Question 7

how is the water deprivation test performed?

Answer 7

Method
prevent patient drinking water
ask the patient to empty their bladder
hourly urine and plasma osmolalities

Question 8

Normal water deprivation test results

Answer 8

Starting plasma osm. : normal
Final urine osm: >600
Urine osm. post-DDAVP: >600

Question 9

Psychogenic polydipsia water deprivation test results

Answer 9

Starting plasma osm. : low
Final urine osm: >400
Urine osm. post-DDAVP: >400

Question 10

Cranial diabetes insipidus water deprivation test results

Answer 10

Starting plasma osm: high Final urine osm: <300

Urine osm. post-DDAVP: >600

Question 11

nephrogenic diabetes insipidus water deprivation test results

Answer 11

Starting plasma osm: high Final urine osm: <300

Urine osm. post-DDAVP: <300

Question 12

What is hodgkins lymphoma

Answer 12

malignant proliferation of lymphocytes characterised by presence of reed-stenberg cell

Question 13

What is the age distribution of hodgkins lymphoma

Answer 13

bimodal age

3rd and 7th decades

Question 14

What are the types of hodgkins?

Answer 14

Nodular sclerosing
Mixed cellularity
Lymphocyte predominant
Lymphocyte depleted

Question 15

What is nodular sclerosing HL associated with

Answer 15

good prognosis
common in women
associated with lacunar cells

Question 16

What is mixed cell HL associated with

Answer 16

good prognosis

large number reed-steenberg cells

Question 17

HL subtypes in order of descending frequency

Answer 17

Nodular sclerosing
Mixed Cellularity
Lymphocyte predominant
Lymphocyte depleted

Question 18

Which HL has the best prognosis

Answer 18

lymphocyte predominant

lymphocyte depleted

Question 19

what are ‘b’ symptoms

Answer 19

• weight loss >10% in last 6 months
• fever >38
• night sweats

Question 20

Factors associated with poor prognosis

Answer 20

• age > 45 years
• stage IV disease
• haemoglobin < 10.5 g/dl
• lymphocyte count < 600/µl or < 8%
• male
• albumin < 40 g/l
• white blood count > 15,000/µl

Question 21

Complications of MI

Answer 21

> cardiac arrest 
> cardiogenic shock
> chronic HF
> Tachyarrhythmia : VF
> bradyarrhythmias : AV block
> pericarditis 
> left ventricular aneurysms
> left ventricular free wall rupture
> ventricular septal defect
> acute mitral regurgitation

Question 22

when does pericarditis occur post-MI

Answer 22

first 48 hours following a transmural MI is common

Question 23

When does dressler syndrome occur

Answer 23

2-6 weeks after MI

Question 24

what causes dresslers syndrome?

Answer 24

autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.

Question 25

when would left ventricular free wall rupture occur after MI

Answer 25

1-2 weeks after

Question 26

what would you see in acute mitral regurgitation

Answer 26

acute hypotension and pulmonary oedema | early-to-med systolic murmur

Question 27

how is acute mitral regurg treated

Answer 27

vasodilator threrapy | surgical repair

Question 28

How is torsades de pointes treated?

Answer 28

Treat torsade de pointes VT immediately by stopping all drugs known to prolong the QT interval. Do not give amiodarone for definite torsade de pointes. Correct electrolyte abnormalities, especially hypokalaemia. Give magnesium sulfate 2 g IV over 10 min (= 8 mmol, 4 mL of 50% magnesium sulfate).

Question 29

Treatment for chlamydia

Answer 29

doxycycline 7 day course if pregnant then azithromycin, erythromycin or amoxicillin may be used

Question 30

How common is ALL

Answer 30

most common malignancy affecting children and accounts for 80% of childhood leukaemias

Question 31

What are the features of ALL

Answer 31

bone marrow failure > anaemia: lethargy and pallor > neutropaenia: frequent or severe infections > thrombocytopenia: easy bruising, petechiae And other features >bone pain (secondary to bone marrow infiltration) >splenomegaly >hepatomegaly >fever is present in up to 50% of new cases (representing infection or constitutional symptom) testicular swelling

Question 32

Types of ALL

Answer 32

common ALL, CD10 present, pre-B phenotype t-cell ALL b-cell ALL

Question 33

What are the poor prognostic factors of ALL

Answer 33

- age < 2 years or > 10 years - WBC > 20 * 109/l at diagnosis - T or B cell surface markers - non-Caucasian - male sex

Question 34

How are infantile spasms characteristed

Answer 34

repeated flexion of head/arms/trunk followed by extension of arms (sallam attacks) up to 50 times poor prognosis

Question 35

when does west syndrome present?

Answer 35

first 4 to 8 months

Question 36

management of west syndrome

Answer 36

poor prognosis vigabatrin is now considered first-line therapy ACTH is also used

Question 37

What is IgA nephropathy

Answer 37

commonest cause of glomerulonephritis worldwide. It classically presents as macroscopic haematuria in young people following an upper respiratory tract infection.

Question 38

What is associated with berger's disease

Answer 38

- alcoholic cirrhosis - coeliac disease/dermatitis herpetiformis - Henoch-Schonlein purpura

Question 39

Pathophysiology of IgA nephropathy

Answer 39

> mesangial deposition of IgA immune complexes > there is considerable pathological overlap with Henoch-Schonlein purpura (HSP) > histology: mesangial hypercellularity, positive immunofluorescence for IgA & C3

Question 40

presentation of IgA

Answer 40

> young male, recurrent episodes of macroscopic haematuria > typically associated with a recent respiratory tract infection > nephrotic range proteinuria is rare > renal failure is unusual and seen in a minority of patients

Question 41

How to differentiate between IgA nephropathy and post-streptococcal glomerulonephritis

Answer 41

> post-streptococcal glomerulonephritis is associated with low complement levels > main symptom in post-streptococcal glomerulonephritis is proteinuria (although haematuria can occur) > there is typically an interval between URTI and the onset of renal problems in post-streptococcal glomerulonephritis

Question 42

management of berger's

Answer 42

steroids/immunosuppressants not be shown to be useful

Question 43

Prognosis of bergers

Answer 43

> 25% of patients develop ESRF > markers of good prognosis: frank haematuria > markers of poor prognosis: male gender, proteinuria (especially > 2 g/day), hypertension, smoking, hyperlipidaemia, ACE genotype DD

Question 44

what are the features of COA

Answer 44

``` > infancy: heart failure > adult: hypertension > radio-femoral delay > mid systolic murmur, maximal over back > apical click from the aortic valve > notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children ```

Question 45

Associations of COA

Answer 45

> Turner's syndrome > bicuspid aortic valve > berry aneurysms > neurofibromatosis

Question 46

What are contraindications to IUD

Answer 46

PID

Question 47

Poorly controlled hypertension, already taking a calcium channel blocker

Answer 47

add an ACE inhibitor or an angiotensin receptor blocker or a thiazide-like diuretic