Day before exam Flashcards
What is the genetic mutation in Friedreich’s Ataxia?
-tri-nucleotide repeat disorder GAA repeat
- frataxin’ gene
What is the criteria used to determine a TACS or PACS?
(total or partial anterior cerebral artery stroke)
Anterior stroke (either anterior or middle cerebral artery stroke)
Criteria:
1) contralateral hemiplegia
2) contralateral homonymous hemianopia
3) higher cognitive dysfunction
What cerebral arteries are associated with Anterior Circulation Stroke?
-anterior cerebral artery - lower limbs effected
-middle cerebral artery- upper limbs effected
What is the management of meningitis?
a) adults
b) children
IV cefTRIaxone + dexamethasone (adults)
IV ceFOtaxime + amoxicillin (children)
Facial nerve weakness and hearing loss in AICA stroke is on which side?
(Lateral Pontine Syndrome)
ipsilateral side
What are the x3 main features in Brown-Sequard Syndrome?
-ipsilateral motor loss
- ipsilateral loss of proprioception and vibration (DCML tract damage)
- contralateral sensory loss of pain and temperature (spinothalmic systems)
What are reflexes like in Brown-Sequard Syndrome?
-hyper-reflexia- acutely due to very stressed damaged muscle nerves
Sub-acute degeneration of the spine is also known as?
posterior cord syndrome
(b12 deficiency in vegans)
What is Arnold-Chiari malformation?
downwards displacement of the cerebellum
-associated with Syringomyelia (central cord syndrome)
What is Syringobulbia?
-fluid in the the medulla (lower brainstem)- RARE
What is the management of UTI in pregnancy?
1st trimester- nitrofuratonin (Trimethoprim is teratogenic is 1st trimester)
2nd trimester-nitrofuratonin
3rd trimester- trimethoprim
Split Hand syndrome is associated with?
-thenar wasting
-MND
Brisk jaw jerk reflex is associated with which type of MND?
-Pseudobulbar
‘hot potato speech’ is associated with MND
cortico-bulbar tract (above T6, pyramidal tract)
(associated with bulbar muscles, swallowing muscles)
Quadrantopias”
What are the main causes of upper and lower quadrant vision defects?
- upper quadrant vision defect >= pituitary tumour
- lower quadrant defect > = craniopharyngioma (*want to lower down a crane cos scary)
What is the 1st line management of Focal Seizures?
(men & women)
Focal Seizure:
1st line- lamotrogine or levetiricam
What features are associated with Posterior Circulation Strokes?
- Bilateral motor/sensory deficits
- Eye movement disorder
- Cerebellar dysfunction
- Isolated homonymous hemianopia
What is Pharmocodynamics?
Pharmaco-dynamics:
(dynamics- how things get on- dynamic)
- effect the drug has on the body- receptor binding and chemical interactions
What is Pharmoco-kinetics (move)
refers to the movement of a drug through the body –ADME
What is ‘First’ and ‘Zero’ Order Kinetics?
First Order Kinetics:
- elimination rate of a drug is directly PROPORTIONATE to the drug concentration
Zero Order Kinetics:
- elimination rate of a drug is a a CONSTANT rate
What is the management of Prolapse?
a) cystocele
b) rectocele
c) vaginal vault prolapse
Prolapse Management
Cystocele:
-anterior colporrhaphy (associated with urine incontinence)
Rectocele:
-posterior colporrhaphry (associated with faecal incontinence)
Vaginal vault prolapse:
- sacrocolpexy
Look at herniations diagram and learn it!
(do NOT be lazy)
What is the most common type of brain herniation?
Sub-Falcine
What type of herniation is associated with Anterior Cerebral Artery damage?
Sub-falcine herniation
What type of herniation is associated with ‘ipsilateral occulomotor’ nerve palsy
Uncal Herniation
Where is ‘uncle’ herniation associated with?
(“my uncle has a temper”)
medial temporal lobe
What is Transcalverial Herniation?
- bony defect change in the skull- ‘trans’
- brain compression and herniates through this bony defect
What is Central Herniation?
- downwards displacement of thedicephalon
- located in central area of brain
What finer is damaged in ‘internuclear ophthalmoplegia?’
medial longitudinal fasiculus fiber
What are the symptoms of Inter-Nuclear Opthalmoplegia?
- ISPILATERAL SIDE- impairment in ADDUCTION
- contralateral eye- nystagmus present
posterior communicating anyeursim causes what palsy
CN 3 palsy
Cavernous sinus thrombosis causes which palsy?
CN3 palsy
What is the gold standard diagnostic investigation for Sub-Arachnoid Haemorrhage?
-diagnostic- MR angiography
What investigation should be completed first in GBS?
MOST important investigation to do first- FVC
others:
-FVC
-Nerve conduction testing
-Lumbar puncture- isolated rise in protein
What do nerve conduction studies show if a patient has GBS?
loss of F wave
What neurological condition is associated with better with exercise and movement?
Lambert eaten syndrome- pre-synaptic
(*INCREASE MUSCLE TONE AND STENGTH temporarily due to excessive contractions)
What is the main cause of Lambert Eaten Syndrome?
small cell lung cancer > hypocalcemia > waddling gait
What antibodies are associated with Neuromyelitis optica spectrum disorder?
-Aquaporin-4 antibodies
”ring enhancing lesions” is associated with?
-Cerebral Abscess
-HIV toxoplasmosis
What is ‘Hoffmans Sign’
characterized by flexion and adduction of the thumb and flexion of the index finge
What is Babinski’s Reflex?
-this is when the toes do NOT curl when the plantar foot is stroked- Multiple sclerosis
-absence of descending inhibition
What is the management of:
a) Premature or Prolonged Rupture of Membranes
b) Chorioamnionitis confirmed strep.b infection
a) 1st line- oral erythromycin
b) IV benzylpenicillin Intra-Partum
What is Androgen Insensitivity Syndrome?
(they are male, whereas turners are girls)
Androgen insensitivity syndrome is an X-linked recessive condition due to end-organ resistance to testosterone causing genotypically male children (46XY) to have a female phenotype
When can POP and COCP be started after child birth?
-Can be Started immedietley after use of emergency contraception
What vaccination is offered in initial dating scan at 12 weeks?
hep.b vaccination
When is higher dose of folate (5mg) given in pregnancy?
- BMI >30
- thalassemia - haemolysis > bilirubin elevated
- Anti-epileptic meds
- coeliac
Chickenpox in Pregnancy?
a) exposure
b) developed chickenpox
(*varciella zoster)
-exposure- oral aciclovir (7-14 days after exposure)
-develop acc chickenpox- oral aciclovir within 24 hrs!
What is the best contraceptive method for a trans male?
copper IUD
NIPT Testing:
What are results like in the following conditions?
a) Trisomy 21
b) Patau’s
c) Spina Bifiida
d) Edwards Syndrome
Trisomy 21- raised HCG and inhibin A
Patau’s- isolated rise in Inhibin A
Spina bifida, etc- Isolated elevation AFP
Edwards syndrome- ALL LOW
What is Mcroberts Position?
Mcroberts:
-Flexed and ABDUcted hips
What is cytology?
-same as cervical smear
Patient has confirmed HPV 16 and 18 but cytology is normal, what is next line investigation
repeat smear in 12 months (if still positive but normal cytology) the continue REPEATING every 12 months
What structure is at highest risk of damage in a C-Section?
uterine damage
What is the mechanism of these drugs:
a) mifepristone (oral)
b) misoprostol (vaginal)
a) mifepristone- anti-progesterone
b) misoprostol- prostaglandins- induce uterine contractions
What is the surgical management of:
a) Cystocele
b) Rectocele
c) Uterine prolapse
-Cystocele:
-anterior colporrhaphy,
-Rectocele:
-posterior colporrhaph
colposuspension
- uterine prolapse:
-hysterectomy - sacrohysteropexy
What type of prolapse is associated with recent hysterectomy?
vaginal vault prolapse
What criteria is associated with Lactational Ammenorea used as a contraceptive method?
- complete ammenhorea (secondary)
- nearly all feeds are breastfeeds
- <6 months since birth of baby
Cervical Ectropion:
a) 1st line investigation
b) 1st line management
Cervical Ectropion:
1st line investigation- colposcopy
1st line management- ablation
What is the MOST common cause of post menopausal bleeding?
b) what must be ruled out though?
-most common- vaginal atrophy
b) must rule out- endometrial cancer
Ovarian Cancer:
a) What is the 1st line investigation
b) what is the gold standard diagnostic investigation?
Ovarian cancer:
1st line- CA-125 levels (calculate RMI score)
diagnostic- laparotomy
What are LFT results like in ‘fatty liver disease of the liver’
liver damage- ends with T
elevation- AST and ALT
What are LFTs like in Obstetric Cholestasis?
elevated ALT, AST and GGT
-raised bile acids
What deficiency is there in Fatty Liver Disease in Pregnancy?
-long-chain 3-hydroxyacyl-CoA dehydrogenase(LCHAD)deficiencyin the fetus, which is anautosomal recessivecondition
What is the definitive management of Obstetric Cholestasis?
definitive management- birth the baby
Summarise FIGO Staging System in Ovarian Cancer:
Stage 1: Limited to the ovaries only
stage a- limited to one ovary
stage b- both ovaries
stage c - tumour limited to ovarian surfaces and does not spread beyond
Stage 2: Involving one or more ovaries + pelvic extension
2a- extend to Fallopian tubes
2b- extends to pelvic tissues
2c- pelvic extension with malignant implants and ascites
Stage 3: involving one or more ovary + outwith pelvic extension
3a- mICROscopic metastases beyond the pelvis
3b- mACROscopic metastases beyond the pelvis
3c- peritoneal metastases
Summarise the Glasgow Coma Scale:
(MoVE)
6,5,4
Motor: (6)
-spontanous/obeys commands
-away from site of pain
-normal flexion
-abnormal flexion
-abnormal extension
-no movement
Verbal: (5)
-orientated
-confused
-words
-noises
-none
Eyes:
-spontanoeus
-responds to voice
-responds to pressure
-none
What is the management of a Missed Miscarriage?
1st line- oral mifEpristone + 24/48hrs after- misoprostol
When can oral medication not be given for a miscarriage?
-evidence of infection
-haemorrhage
What is Postpartum Thyroiditis?
b) what is the management?
Three stages
- Thyrotoxicosis
- Hypothyroidism
- Normal thyroid function (but high recurrence rate in future pregnancies)
management:
symptom management- beta blockers
What is ‘tidal volume?’
-volume of air that enters and exits the lungs per breath
(*Increases during pregnancy)
What is ‘reichters transformation?’
CLL > non-hodgkins lymphoma
WBC mature at different stages is associated with which condition?
CML
(Philadelphia matures- Chronic myeloid leukemia)
What is the management of Infective Endocarditis?
a) Native valve (do not know cause)
b) cause if staph.a
c) penicillin allergy
d) Prosthetic heart valve (staph.epidermis)
Native valve:
amoxicillin (+/- gentamicin)
staph.a confirmed- fluclox
Pen-allergy/MRSA:
vancomycin (+/- gentamicin)
Prosthetic valve:
vancomycin + rifampicin + gentamicin (FRG
Revise Radiology images!
What condition is associated with:
-murmur louder on valsalva manœuvre and quieter when squatting
Hypertrophic Cardiomyopathy
What genetic conditions are associated with:
a) ST elevation
b) Dagger Q waves
a). brugada syndrome
b) hypertrophic cardiomyopathy
What is the 1st line management of Brugada Syndrome?
ICD
What is the management of Long QT Syndrome?
1st line- beta blocker
2nd line- ICD
What are the main bacterias located in the LARGE bowel?
(*all the food ones)
-c.difficile
-baciluus cerus
-e.coli
What bacteria is located in the ‘stomach’
-h.pylori
What bacteria is located on the skin?
staph.a
staph.epidermis
What does ‘specific’ mean
Specific - the ability test has to detect negatives (e.g 100% specific means there would be NO false positive results
What does ‘sensitive’ mean?
Sensitive - the ability the test is able to detect people with the condition
What bacteria are CF patients most susceptible to?
Pseudomonas aeruginosa
What is the mechanism of ‘FluroQUINolones’ antibiotics?
(Ciprofloxacin, Moxifloxacin, Levofloxacin, Ofloxacin)
‘quintuplets’- inhibits DNA synthesis
What is the mechanism of ‘SulFOnamide’ antibiotics?
Inhibits ‘FOlate’ synthesis
What is the management of OCD?
a) mild
b) severe OCD
Iffunctional impairment is mild
- low-intensity psychological treatments: cognitive behavioural therapy (CBT) including exposure and response prevention (ERP)
moderate-severe
1st line- SSRI
2nd line- increase SSRI dose
3rd line- alternative SSRI or SNRI
4th line- tri-cyclic- clomipramine
What type of drug class is ‘Mirtazipine’?
Noradrenergic and specific serotonergic antidepressants(NaSSAs). T
What is the mechanism of ‘Acamprosate’ in alcohol misuse disorders?
Acamprosate- A-Anti-craving medication
What is the mechanism of Di-sulfram in alcohol misuse disorders?
Disulfiram (also known as Antabuse) is an irreversible inhibitor of acetaldehyde dehydrogenase (alocohol chemical).
If alcohol consumed + di-sulfram-unpleasant symptoms (vomiting will occur)
Lithium medication:
a) how often are lithium levels monitored
b) how often are TFT and Renal tests monitored?
-lithium- every 3 months once levels established after weekly monitoring for 18 wees
-TFT and renal tests- every 6 months
What are the steps involved in ‘Opiate Replacement Therapy?’
- Induction- starting treatment
- Optimisation- finding the right dose
- Maintenance- stability and adherence for period of time
- Reduction- reducing the dose
What does ‘left shift’ in neutrophils mean?
Left Shift:
- immature less lobes
- cause- acute infection
What does ‘right shift’ in neutrophils mean?
- hypermaturity more >5 lobes caused by -
cause- chronic infection- adapted to be better
Where is Vitamin K absorbed?
Vitamin K is absorbed in the upper intestine
What is ‘Myelodysplasia?’
stem cell malignancy where these is ineffective haemopoietic stem cells (pluripotent)
What mucosa is damaged in pernicous anaemia
autoimmune disorder affecting the gastric mucosa that results in vitamin B12 deficiency
paroxysmal nocturnal haemoglobinurias:
a) what is the 1st line investigation?
b) what is the definitive management?
1st line investigation- Flow cytometry (CD59 and CD55 levels are low)
definitive management- bone marrow transplant
What is the gold standard diagnostic test in hereditary spherocytosis?
diagnostic (gold standard)- EMA binding test
early morning bloody urine is associated with?
paroxysmal nocturnal haemoglobinurias:
What is the underlying cause of paroxysmal nocturnal haemoglobinurias?
(early morning bloody urine)
Acquired mutation of PIGA on X chromosome of haematopoietic stem cells, causing loss of surface GPI proteins. Cells are vulnerable to complement system attack.
(intra-vascular haemolysis-G6PD and paroxysmal)
What type of haemolysis are these blood transfusions reactions?
a) acute haemolytic reaction (ABO incompatibility)
b) Delayed Haemolytic Reaction
a) intra-vascular haemolysis
b) extra-vascular haemolysis
What antibody is produced in Acute haemolytic reaction in blood transfusions?
IgM (mediate)
What is the cause of ‘febrile non-haemolytic reactions’
-non haemolytic cause by exCess production of cytokines
What is the preventative methodd for Febrile Non-haemolytic blood transfusion reaction?
prevention- -leukoreduction(stops wbc releasing cytokines)
What x2 conditions increases the risk of TACO?
Diagnosis of CKD or Congestive heart failure
What antibody is produced in an anaphylactic reaction in blood transfusions?
IgA
What type of hypersensitivity is febrile non haemolytic blood transfusion reaction?
Type 2 hypersensitivity(as non-haemolytic- caused by excess release of cytokines!)
What type of hypersensitivity are these Organ Transplant Rejections?
a) hyperacute
b) acute
c) chronic
Hyperacute- starts within minutes
- (**type 2 hypersensitivity)-
Acute:
type 4(mainly 4) and type 2 hypersensitivity, occurs weeks to months
Chronic- months to years after transplant,
type 4 and 2 hypersensitivity
What type of hypersensitivity is ‘Immune thrombocytopenic purpura (ITP)
Type 2
What type of parasites are associated with malaria?
parasite- plasmodium falciparim and ‘anopheles’ mosquito vecto
What condition is associated with a fever spiking every 48 hours?
malaria
What is the gold standard investigation for malaria?
Gold standard investigation- blood film (3 neg samples on 3 consecutive days)
What is the prophylaxis medication for Vaso-occlusive crisis?
(*also known as painful syndrome)
Mono-clonal antibody ‘mab’
‘pencil pokoloyytes’ and ‘target cells’ are associated with
iron deficiency anaemia
(target eat more iron)
Study all the blood film abnormalities
Auer rods are associated with?
-auer rods- acute myeloid leukemia (a cute metal rod)
What are the triad of symptoms in HUS?
Triad: N(Mneumonic HRT)
Triad of symptoms:
1) renal failure (uraemic part of HUS)
2) thrombocytopenia
3) haemolytic anaemia (hameolytic part of HUS)
Summarise the Ann-Arbour Staging System in Lymphoma
Ann-Arbour Staging System: Lymphoma
Stage 1:
- single lymph node involvement
Stage 2:
- 2 or more lymph node regions on the SAME side of the diaphragm
Stage 3:
- LN regions effected are on BOTH sides of the diaphragm
Stage 4:
- extra-lymph-organ involvement
What type of cancer are these conditions associated with?
a) pernicious anaemia
b) coeliac disease
- pernicous anaemia- increased risk gastric cancer
- coeliac- increased risk of T cell lymphoma
What is the main antibiotic to trigger G6PD
nitrofuratonin
What is the eradication management of H.pylori in MALT lymphoma?
(*same management as peptic ulcer disease)
a proton pump inhibitor + amoxicillin + (clarithromycin OR metronidazole
Study Neuro eye defect fundoscopies
optic disc cupping is associated with
glaucoma
What are the x5 criteria to be detained under the mental health act 2003
- Mental disorder (anorexia included, if physical illness is as a result of mental disorder)
- Impaired decision making ability- lack capacity
- Significant risk to themselves or others
- Informal or voluntary care is not appropriate
What criteria is used to assess capacity?
Capacity:
- Unable to retain information
- Cannot weigh up
- Cannot understand
- Cannot communicate their decision
What treatment cannot be given under detention?
Treatment that cannot be given under detention:
- ECT
- Vagus nerve stimulation
- Neurosurgery
- Any medication intentionally which would reduce their sex drive
What genetic mutations is haemochromatosis associated with?
- HFE gene defect and chromosome 6
What bacteria is associated with ‘petting zoos small animals’
salmonella - ciprofloxacin
What bacteria is associated with bbqs?
Campylobacter.jejuni
What cranial nerves are damaged in pseudo bulbar MND?
9,10,12
What system activates the anti gravity extensor muscles- balance activated when fall.
Extra-pyramidal- vestibule-spinal
REM sleep disorders and BAD nightmares are associated with?
Lewy body dementia
Where does blood collect in Splenic rupture > haematoperitoneum?
hepatorenal recess
Where does the facial nerve exit the skull?
internal acoustic meatus (patronius part of the bone)
Forced contraction of what part of the leg causes an avulsion fracture?
ilipsoas muscle
How long must panic disorder be present to be diagnosed
panic disorder must be present > 1 month
What is the 1st line management of duct papilloma?
1st line- microrchoidectomy
What part of the lungs are most likely to be effected in aspiration pneumonia?
Theright middle and lower lung
What is the best anti-psychotic to give a patient with hypertension?
Aripiprazole- lowest side effect profile
What is the best SSRI to give a patient who has had recent MI?
sertraline- most cardio-protective SSRI
What is Transmural pressure gradient?
difference between intra-pleural and intra-alveolar pressure
What neurons are effected in MND?
-only motor
-no sensory deficits
What type of loss is associated with Charcot Marie tooth disease>
motor loss: (marie-m)
muscle atrophy, recurrent ankle sprains, -foot drop-strork leg deformity, pes cavus (high arched feet)
What type of neuronal loss is associated with Lambert eaten syndrome?
motor loss
-symmetrical asscending weakness, reduced motor reflexes
***-temporary increased muscle strength due to repeated muscle contractions
(better with exercise)
What is the management of a brain abscess?
(*ring enhancing lesion)
1st line- Ceftriaxone + metronidazole
What is the 1st and 2nd line anti-emetic management for Hyperemesis Gravidarum?
1st line antihistamines: oral cyclizine or promethazine
2nd line- oral ondansetron
NIPT in neural tube defects and Edwards syndrome, what level is inhibit A?
inhibin A-normal
thickened Nuchal Translucency is associated with?
Trisomy 21
What is the ‘quadruple’ NIPT testing used to screen of Trisomy 21?
1) AFP
2) HCG
3) Inhibin A
4) UE3 (unconjugated estriol)
what are key features of stage 3 lymphoma?
(Ann-Arbor staging)
lymph nodes on neck and groin
Obstetric cholestasis increases your risk of
still birth
Name a type of tocolytic drug
terbutaline- reduces contractions
What drug can be given alongside managing umbilical cord prolapse?
tocolytics- terbutaline (reduces contractions)
How many points out of Rotterdam Criteria can a PCOS diagnosis be made?
2/3
(associated with elevated LH:FSH)
When MUST genital mutilation (infibulation) be reported
under 18 years old- report to the police!
chorioamnionitis is associated with what foetal symptom
foetal tachycardia
Psammoma bodies is “buzzword” feature of which ovarian cancer tumour?
Epithelial- serous cystadenocarcinoma
“schiller-duval bodies” present on which type of ovarian germ cell tumour?
yolk sac tumour (germ cell tumour)
What is the triad of symptoms in Thrombotic Thrombocytopenic Purpura?
microangiopathic haemolysis, thrombocytopenia, and neurological abnomalities
(Deficiency in metalloproteases enzymes- usually breaks down VWB multimers-stciky VWB- excessive adhesion and increases risk of thrombosis)
What is the most common bacterial cause of gastroneteritis?
e.coli
What is the most common cause of travellers diarrhoea?
(*buzzword)
e.coli
What is the most common bacterial cause of neonatal jaundice
strep.b
(*associated with pathological Janice, <24hrs after birth)
What is the management of life threatening C.difficle
1st line- oral vancomycin + IV metronidazole
Patient had recent C.diff infection less 12 weeks ago what is the management?
-do not give oral vancomycin if been given for previous c.diff infection within 12 weeks
1st line- oral fixdaxomicin
What drug increases risk of iron deficiency anaemia and c.difficile
PPIs (omeprazole)
What bacterial infections are associated with the following incubation periods:
a) 1-6 hours
b) 12-48 hours
c) 48-72 hours
a) staph.a, bacillus cereus
b) salmonella, e.coli
c) campylobacter
What is the management of Chlamydia in pregnancy?
1st line- azithromycin or erythromycin
(doxycycline contra-indicated)
What is the management of PID
Oral ofloxacin + oral metronidazole
OR
intramuscular ceftriaxone + oral doxycycline + oral metronidazol
What is the management for Lymes Disease?
1st line- oral doxy
(*bullseye lesions)
When condition does dynamic airway compression occur alongside?
Dynamic airways compression- makes active expiration harder in patients with COPD.
this is because:
intra-pleural ressure rises during expiration compressing the airways more.
What effect does inspiration and expiration have on the trans-mural pressure gradient?
During Inspiration: (*opposite what i think)
-intra-pleural pressure falls
During Expiration:
-intra-pleural pressure rises
What effect can giving excess O2 have on patients with COPD?
lead to hypercapnaeic respiratory failure in COPD patients with chronic CO2 retention.
What condition is associated with a very high V/Q mismatch?
PE
mismatch and/or dead-space ventilation. (very mismatched between rate of air delivery and and gas exchange)
What is the more extensive list of Accessory respiratory muscles?
(*Mneumonic)
More Extensive list: (mneunonic 3SEP)
X3s:
-scalene
-sternocleidomastoid
-serratus anterior
E-Erector Spinae
P-Pectoralis Major and Minor muscle
In what condition do patients have ‘high pulmonary compliance?’
COPD patients- damaged elastic recoil
What is the FEV1:FVC ratio % in obstructive and restrictive airways disease?
- [ ] asthma FEV1:FVC- less 70%
- [ ] restrictive more than 70%
What ligaments does a Laminectomy go through?
supraspinous ligaments
interspinous ligaments
ligamentum flavum
What injury would cause ‘foot drop’
fibular fracture (common ‘fibular’ nerve)
What is Toxic Shock Syndrome
excess release of staphylococcal exotoxins from tampons
management:
IV fluids
IV antibiotics
What is 2nd order kinetics
(harder not same as first and zero order)
Second order kinetics is where doubling the concentration of the reagents quadruples the reaction rate
whereas
first order-elimination rate is DEPENDENT on the concentration of the durg
zero order- drug is eliminate at a CONSTANT rate
What are the x3 key symptoms in thrombotic thrombocytopenia purpura?
-microangiopathic haemolysis
-neurological impairment
-thrombocytopenia (low platelets)
In Immune thrombocytopenia purpura what is the pathophysiological process
antibodies are produced against glycoprotein IIb-IIIa or Ib complex
What is the mechanism of LMWH? (‘rin’ drugs’)
activates anti-thrombin III and factor Xa
What deficiency is veganism and pervious anaemia associated with
B12 deficiency
What types of haemorrhage are these features associated with?
a) labial periods
b) fluctuating consciousness, recent head trauma, alcoholics and old
a) extra-dural
b) sub-dural
State the x2 antibodies present in Anti-phospholipid syndrome?
b) What blood test is prolonged?
anticardiolipin antibodies
anti-beta2 glycoprotein I (anti-beta2GPI) antibodies
b) APTT- this is when increased due to the antibodies interacting with the clotting factors during blood test
What do antibodies in Anti-Phospholipid Syndrome target?
glycoprotein IIb/IIIa
Polycythaemia Rubra, essential thrombocythaemia and myelofibrosis is at risk of transformation into what type of leukaemia
(Myelodysplatic syndromes)
AML
Name the X2 preventative medications for Tumour Lysis Syndrome
allopurinol or rasburicase
(before chemo always give allopurinol and fluids)
Name x3 conditions associated with Howell-jolly bodies
1) sickle cell anaemia
2) coeliac
3) hyposplenism (Post splenectomy)
What autoimmune condition can cause neutropenia?
SLE
What drug causes neutrophillia, and increased neutrophil distribution?
prednisone (steroids)
What are bloods like in DIC
- ↓ platelets
- ↓ fibrinogen
- ↑ PT & APTT
- ↑ fibrinogen degradation products
increased fibrinogen degradation products and d-dimer is associated with?
DIC
how long should prophylactic DVT therapy be continued for?
- provoked (e.g. recent surgery): 3 months
- unprovoked: 6 months
What are hb and reticulocyte levels like in sickle cell anaemia
-low hb and high reticulocyte
What is the gold standard definitive diagnostic investigation used in Sickle Cell Anaemia?
definitive diagnosis of sickle cell disease is byhaemoglobin electrophoresis
How does acute chest syndrome present on an CXR?
pulmonary infiltrates on chest x-ray, l
What is the most common type of Hodgkins Lymphoma?
-nodular sclerosing- most common type- lacunar cell
What type of Hodgkins lymphoma has best and worst prognosis?
best and worst prognosis:
lymphocyte predominant- best type
lymphocyte depleted - worst type (depleted and feel sad)
What is the most common cause of thrombophillia (DVT etc)
- factor V Leiden (activated protein C resistance):most common cause of thrombophilia
(**Protein C not S resistance)
What excess cell proliferation is associated with myelofibrosis?
myelofibrosis- abnormal megakaryocytes
Aquagenic itch is mainly associated with which one condition?
polycythaemia vera
What is molecule do antibodies target in Immune Thrombocytopenia Purpura (ITP)
(*characterised by isolated thrombocytopenia)
-antibodies produced against glycoprotein IIb/IIIa or Ib-V-IX complex
type 2 hypersensitivity
What is the management of major bleeding in a patient on warfarin?
Stop Warfarin
Give IV vitamin K + pro-thrombin complex
What is the management if INR is <8?
<8 (between 5-8)
Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose
What is the management if INR is >8
STOP warfarin
IV Vitamin K
What is the prophylaxis of Vaso-occlusive crisis? (Pain syndrome)
‘mab’
What type of haemolysis is Paroxysmal Nocturnal Haemoglobinuria
intra-vascular haemolysis
What is the 1st line investigation of Paroxysmal Nocturnal Haemoglobinuria
(what cells does it detect)
-flow cytometry-CD59 abd CD55
What is the management of Paroxysmal Nocturnal Haemoglobinuria?
1st line- Blood replacement
dar urine in the morning is a buzzword for?
Paroxysmal Nocturnal Haemoglobinuria
What are bloods like in G6PD deficiency?
-low gluathione
low NADPH (as not converted back)
-low G6PD enzyme
Why is intravascular haemolysis associated with G6PD deficiency?
-G6PD is not there to convert NADP > NAPDH so glutathione (anti-oxidant) cannot bind to the free radicals.
-therefore RBCs are exposed to oxidative stress > intravascular haemolysis
What defects are associated with microcytic anaemia and microcytic anaemia
microcytic anaemia- cytoplasmic defect
microcytic anaemia- delayed DNA maturation and defective DNA synthesis
What is the underlying pathology of Pernicious Anaemia?
autoimmune damage to the gastric mucosa. results in B12 deficiency
What is the most common cause of B12 deficiency
Pernicious Anaemia
What type of mutation is present:
a) alpha thalassemia
b) beta thalassemia
alpha- deletion mutation
beta-point mutation (codon 6-defectibe beta globulin production)
What is Spurious (false macrocytosis)
-cold agglutinins causes the RBCs to clump together > high MCV
What are sex hormone levels like in anorexia?
Hypothalamic axis Failure
-low FSH and Low LH
-low oestrogen and progesterone
What is the main symptom of mania
flight of ideas
What level are WBCs in anorexia?
low
What are CT scan features if Normal Pressure Hydrocephalus?
Enlarged ventricles
Absent sulci
What are the CT scan features of Alzheimers?
Enlarged ventricles and prominent sulci seen on CT brain scan
(alzheimers has prominent sulk and normal pressure hydrocephalus they are absent)
How does Huntingtons present on a CT scan
flattening of the convex walls of the lateral ventricles.
Bipolar like mood swings within 2 weeks after childbirth is most likely?]
(*always answer this for bipolar post pregnant mum)
Puerperal psychosis
Features include severe swings in mood (similar to bipolar disorder) and disordered perception (e.g. auditory hallucinations)
management:
-emergency admission to mother and baby unit + anti-psychotics
What is the 1st line management for Acute Stress Disorder?
1st line- trauma-focused cognitive-behavioural therapy (CBT) is usually used first-line
What is 1st and 2nd line management of alzheimers?
b) what is the drug class of 2nd line
1st line- ACH inhibitors ((donepezil, galantamine and rivastigmine)
2nd line- memantine (NDMA receptor antagonist)
What x2 parameters must be monitored when starting an SSRI or SNRI
-urea and electrolytes (can cause hyponotremia)
-blood pressure
What is the most common cause of meningitis in unvaccinated children?
h.influenza
What is the underlying cause of botulism?
-exotoxin (chemical released) acts on the motor neurone terminals blocking the pre-synaptic membrane and release of ACH
-bulbar palsy
What chemical is released in botulism?
exotoxin
What is the most likely cause of brain abscesses from recent sinus infections?
haematogenous spread
What is the management of Kawasaki Disease?
b) what are the main features
- Kawaski diease- immunoglobulins + aspirin (risk of coronary artery anyeurism)
b) bilateral conjunctivitis and unexplained fever >5 days
What are lumbar puncture signs of Aseptic Meningitis?
(seems like there is no infection)
*A low number of WBC
*A minimally elevated protein
*A normal glucose
What chromosome abnormalities are associated with:
-Downs Syndrome
-Edwards Syndrome
-Patau’s Syndrome
Trisomy 21- chromosome 21
Edward’s Syndrome- chromosome 18
Patau’s Syndrome- chromosome 13
How does an amniotic fluid embolism present on a CXR?
pulmonary oedema
What is the 1st line management of Renal Colic?
diclofenac (NSAIDs)
What does the Broad Ligament Connect to
Uterus, fallopian tubes and ovaries to the pelvic wall
-double layered
What does the round ligament connect to?
Uterine fundus to the labia majora
-embryological remnant
What ligament attached Cervix to the lateral pelvic wall
cardinal ligament
When does puberty occur in boys and girls
girls- between 8-14 years old
boys- between 9-15 years
When are girls investigation for failure to menstruate or develop secondary characteristics
-no period by 15
-no breast or secondary seal characteristics by 15
How can uterine cancer spread and can this condition spread and therefore present with superficial inguinal node swelling?
round ligament- connects uterine funus and labia majora
What is the risk of vertical transmission from a HIV positive mother to baby?
risk of HIV transmission is reduced to less than 2%, this is if treatment is taken and correct advice is followed
pus cells on swabs from the vagina or endocervix is associated with
PID
what type of cellularity is Reed-Sternberg Hodgkins Lymphoma
mixed cellularity
‘coffee bean’ nuclei’ is associated with
Brenners Tumour (transitional cell epithelium)
-epithelial ovarian tumour
What hormones does sex cord tumours release?
Fibroma- produces oestrogen
Sertoli Leydig- produces progesterone
What hormones does germ cell tumours release
AFP and HCG
When is surgical excision required for fibroadenoma?
> 3cm
What number of placentas and amniotic sacs are associated with identical twins?
Monochorionic diamniotic
(one placenta separate amniotic sacs)
if was monochorionic monoamniotic- mean baby’s would be co-joined attached
what type of cause for Large for gestational date is associated with vaginal bleeding?
molar pregnancy
*If patient been treated for molar pregnancy and experiences vaginal bleeding > indicates molar pregnancy
When is IV potassium chloride required for an abortion
> 22 weeks
Ovarian Cancer:
a) what is the 1st line investigation
b) what is the gold standard diagnostic investigation
a) CA-125 glycoprotein
b) gold standard diagnostic- tissue laparotomy
PCOS increases the risk of which cancer
endometrial cancer- excess oestrogen
What is the 1st line investigation of patient complaining of heavy periods?
1st line-FBC (detects iron deficiency anaemia)
What is the management of atrophic vaginitis?
vaginal oestrogen cream (not ring
What are the clinical features of a patient with androgen insensitivity syndrome?
little or no axillary and pubic hair
undescended testes causing groin swellings
-short vagina
-pelvic masses (Undescended testes)
-high androgens
(man -XY chromosomes but with a female phenotype)
Endometrial Cancer:
a) What is 1st line investigation
b) what is the diagnostic investigation, and excludes a diagnosis too
a) TV US
b) endometrial biopsy and hysteroscopy
What are the X4 stages of Female Genital Mutilation:
stage 1- cliterodiectomy
stage 2- excision
stage 3- infibulation
stage 4- jewellery and piercings
MUST report to police if under 18 years when it was carried out
What is the main clinical feature associated with Ovarian Cyst Rupture or Uterine Hyperstimulation Syndrome?
hypotension/hypotensive crisis
‘erythematous’ cervix is associated with what STI
strawberry cervix - trichiomonas vaginalis (parasitic infection)
yellow/green, frothy discharge colour is associated with?
Trichiomonas vaginalis
What type of biopsy in Triple Assessment for Breast Cancer is used?
Core needle biopsy
How do you distinguish between fibroadenoma and phyllodes tumour?
both- firm mobile masses
phyllodes tumour - much more rapidly growing
What is Sclerosing Breast Lesion
· Sclerosing lesion- disorderly proliferation of acini and stroma
(benign breast conditon)
What are the x2 main components of breast tissue?
-fibroglandular and adipose tissue
Bloody discharge from the nipple which can present with/without a palpable mass, is known as
Intra-ductal papilloma
patient reports breasts to be “lumpy” breasts, most commonly in the upper outer quadrant.
Breast pain.
fibrocystic change
metaplasia- squamous cells >apocrine cells
What time is used to monitor LMWH? (e.g heparin)
Activated partial thromboplastin time (APTT)
What artery is at risk when draining bartholins cyst?
Internal pudendal artery
What is a key feature which suggest congenital abnormality in a newborn?
delay in femoral pulses- coarction of the aorta
What chemical is low in depression
5 HT is low in depression (5-hysroxytryptamine)
What chemical causes a seizure in a patient with drug withdrawal?
withdrawal from sedatives-GABA (slows brain)
delirium trements- 36hrs peak seizure- lack of GABA as no longer drinking alcohol
What should be assessed before starting the COCP?
blood pressure and BMI
How fast should RBCs be transfused in non emergency scenario
non-urgent scenario, a unit of RBC is usually transfused over 90-120 minutes
What type of translocation is associated with Burketts Lymphoma?
Translocation between chromosomes 8 and 14 is associated with which type of lymphoma
c-myc gene translocation is associated with
burketts lymphoma (non Hodgkins)
What is the name for the staging system used in lymphoma?
Lugano staging
What does low haptoglobulin indictate?
Decrease
intravascular haemolysis
(G6PD deficiency and paroxysmal nocturnal haemoglobinuria)
What condition is also known as ‘Christmas Disease?’
haemophilia B
How long do RBCs in G6PD deficiency last?
30 days
Chronic Leukemia:
a) Chronic Lymphocytic Leukemia
b) Chronic Myeloid Leukemia (philidelphia)
What is the management?
a) Watch and wait (*trick question)
b) CML-tyrosine kinase inhibitors
Myeloproliferative disorders, give examples
b) are these malignancies
-polycythaemia vera
-essential thrombocythmeia
-myelofibrosis
What are Myelodysplastic disorders?
Myelodysplastic syndromes (MDSs) are clonal hematopoietic stem cell (HSC) malignancies that are characterized by ineffective hematopoiesisand immature cells in the bone marrow that do not mature
What gene codes for the philidelphia chromosomes?
BCRABL gene (BRA and ABL gene combined)
What types of haemolysis is warm and cold autoimmune haemolysis?
(*think location)
Warm- extra-vascular (Antibodies- SLE)-MORE COMMON
Cold- intra-vascular
What is the difference between intra-vascular an extra-vascular haemolysis?
Intra-vascular- intra-vascular - haemolysis occurs in the blood stream
Extra-vascular extra-vascular - in the spleen in the liver
Question states the father has the condition, what do you think?
biological father
- In exam- X-linked recessive
(G6PD, haemophilia)
What is elevated in anaemia of chronic disease?
Hepcidin
What is the most common blood type?
b) what is the universal blood donor
a) O positive
b) O negative (as no anti-d for patient to react to)
What is the management of Myelofibrosis?
1st line- JAK2 inhibitor
What is the Polycythaemia Vera management?
1st line- venesection + JAK2 inhibitor
prophylaxis- aspirin
What chromosome are antigens A and B on in blood types?
chromosome 9
What chromosome is effected in beta thalassemia and sickle cell anaemia?
chromosome 11
(As sickle cell- beta globulin is damaged)
What type of lymphoma is worse when drinking alcohol
Hodgkins
What symptoms are associated with tumour lysis syndrome?
increased serum creatinine (1.5 times upper limit of normal)
cardiac arrhythmia or sudden death
seizure-important (due to hypocalcemia and hyPERkalemia)
What type of haemolysis is associated with cold and wam weather?
cold haemolysis- 4 degrees- IgM antibody most active
warm temp (body temp)- warm haemolysis - IgG
blood is stoed at 4 degrees celcius
a) What is the most common type of plasma?
b) What is the most common blood type
c) what is the universal blood donor type
a) AB neg
b) O positive
c) O neg
What are the symptoms of Parkinsonism as an Extra-Pyramidal Side effect?
Slowness of movements (bradykinesia)
Muscle stiffness (rigidity)
Tremor that appears when the limb is at rest
Impaired postural reflexes (imbalance and falls)
Stooped posture (camptocormia)
Freezing of movements (short lasting episodes during which movements are blocked – e.g. legs feel like they are “glued” to the ground
What is the management of Secondary PPH?
(24hrs after-6 weeks)
management: 1st line- co-amoxiclov
penicillin allergy- co-trimoxazole + metronidazole
cause- endometritis or retained placenta
investigation required- Endocervical and high vaginal swabs for infection
What is the management of Neuroleptic Malignancy Syndrome?
Neuroleptic malignancy syndrome- caused by dopamine blockade
Management- IV fluids and dantrolene
Retrospective and Prospective studies ate sub-types of which study?
Cohort Study
What is the mechanism of the Tomato-Sensory System?
(NEED TO KNOW DO NOT BE LAZY)
system mediates pain (noiception) and itch (pruriception)?
Is there metabolic compensation in Panic Attacks Acid-Base disorders?
no metabolic compensation with panic attacks as resolves fast
What genes are defective in:
a) Wilsons Disease
b) Haemochromatosis
a) ATP-7B
b) HFE
Kayser flesher rings are associated with?
(excessive copper)
-Wilsons Disease
What are investigations and the associated levels in Wilsons Disease?
(excess copper)
-low serum caeruloplasmin
-reduced serum total copper
-HIGH copper urinary secretion
What is the management of Wilson’s disease?
Management- Penicillamine
What is the 1st line investigation for haemochromatosis?
1st investigation- transferrin saturation
What is the management of Haemochromatosis?
1st line- venesection
2nd line- iron chealtors (as required)
What are the x3 main clinical features of Brown-Sequard Syndrome?
ipsilateral motor loss and hyperreflexia (BELOW Level of lesion)
ipsilateral DCML damage
contralateral sensort loss (SPINOTHALMIC system)-(**know this)
What are the spinal level landmarks for the nipple and umbilicus?
(*T8-T10 regions overlap, pain in T9 could be caused by t10)
nipple-T4
umbilicus- T10
What are the clinical features of Erbs and Klumpe’s palsy?
Erbs: (‘waiter’s tip)
-shoulder AdDuction
-wrist flexion
Klumpe’s Palsy:
-weakness in the intrinsic muscles in the hands
What type of sleep is associated with ‘dreaming’
REM Sleep
What is the difference between:
a) Non-REM sleep
b) REM sleep
Non-REM:
-Start of the night
-relaxation of the muscles and reduced cerebral perfusion
REM: (this is where dreams occurs)
-increased cerebral blood flow
-dreaming occurs here
What is Circadian Rhythm?
-refers to sleep-wake pattern over a 24hr day
-controls your daily schedule for sleep and wakefulness
What is Sleep Latency Test?
b) what conditions is this the 1st line investigation for?
4 twenty five minute naps are scheduled about two hours apart
b) sleep disorders- narcolepsy, parasomnias, cataplexy
low hypocretin levels on lumbar puncture indicates?
narcolepsy - chronic sleep disorder tiredness
Carbemazipine is a sodium channel blocker, does it increase or reduce their refractory period?
increases refractory period
A) What glial cells are damaged in MS?
b) what glial cell provides physical support
-oligodendrocytes- damaged in MS
-astrocytes- provides physical support
What is the mechanism of mesenchymal cells?
develop into the tissue cells such as bone marrow and adipose tissue
What glial cell undergoes phagocytosis?
Microglia
What ell produces the lining of the lateral ventricles where CSF is produced (choroid plexus)
produced the CSF and forms the lining of the ventricle
What are the x3 main components of the neuron?
- Dendrites
- The cell body
- Axons
What is the myelination and speed of conducion like in A, B and C fibres?
- A fibres are wide and heavily myelinated with fast conduction. They are both sensory and motor fibres of the somatic nerves. (FASTEST CONDUCTION)
- B fibres are moderately myelinated with moderate conduction speed and form fibres of the autonomic nervous system.
- C fibres are unmyelinated and have the slowest conduction and narrowest diameter. They are sensory only and conduct pain and temperature sensation.
What is the mechanism of the messier and paciniaan mechanoreceptor cells?
- meissners- vibration
- Paciniaan- pressure (P_Pie many layers in shape)
Alpha neurones are also known as?
LMNs
What is the order of organisation of muscle?
Myofibrils make up muscle fibers
1)Sarcomere-smallest functional unit (located between x2 Z lines)
2)Myofibrils
3)Muscle fibers
4)Motor units
5)Muscle
What is the route of CSF fluid?
(*need to known this)
Route of CSF Fluid:
-choroid plexus (lateral ventricles) 3rd venricle > cerebral aquaduct > 4th ventricle > sub-arachnoid space (this is where CSF fluid is stored)
CSF is produced by the lateral ventricles (choroid plexus) and stored in the sub-arachnoid plexus.
What type of weakness is GBS associated with?
-bilateral weakness in lower limbs
(could be confused with lower anterior cord transection below the lesion)
What is the mechanism of cerebellar layers?
vestibulo-cerebellum- balance and vestibulo-occular reflexes
Spino-cerebellum- maintains muscle and posture
Cerebro- cerebellum- coordination betwen movements and corrects them
What side should carotid endarterectomy be carried out on?
carotid stenosis must be >70%
-carry out on the CONTRALATERAL side of symptoms in the stroke or TIA
empty delta sign is a CT sign indicates
dural venous sinus thrombosis
a) What antibodies are present in Neuromyelitis Optica Spectrum Disorder?
anti-aquaporin antibodies
condition-
What is the process of Neuromyelitis Optica Spectrum Disorder?
autoimmune disorder where there is de-myelination of the spinal cord and optic nerve
What is the management of Myelofibrosis, and give an example of the drug given?
jakinib (JAK 2 inhibitors)
What is the management of Listeria and pregnant?
b) what antibiotics are given if patient has a penicillin allergy?
a) Ampicillin and gentamicin
b) Trimethoprim and sulfamethoxozole
What is the 1st line investigation and management of a dural venous sinus thrombosis?
1st line- MR venogram
management- LMWH (pregnant is best option, DVT, PE swap from warfarin to LMWH)
What is the management of Atypical Pneumoniae?
1st line-doxycyline
What beta blocker is used 1st line in Long QT syndrome?
Nadolol (preferred) Propranolol. Metoprolol.
What is the management of Hypertrophic Cardiomyopathy?
1st line- Beta blockers
2nd line- ICD
What is the gold standard investigation for Alpha and Beta Thalassemia?
1st line investigation- electrophoresis
(*identifies abnormal alpha and beta globulin chains)
What is the gold standard investigation for Multiple Myeloma?
1st line- electrophoresis (identifies bench jones proteins and m paraprotein)
What do ‘schistocyte’/helmet cells indicate?
b) what type of hameolysis and give x2 examples
-intra-vascular haemolysis
x2 associated conditions- G6PD deficiency and Paroxysmal nocturnal haemoglobinuria
low haptoglobulin indicates what process?
G6PD or Paroxysmal nocturnal haemoglobinuria
(indicates intra-vascular haemolysis is taking place)
What do “Burr cells (echinocytes)” on blood film indicate?
Uraemia
Pyruvate kinase deficiency
What do ‘Acanthocytes’ on blood film indicate?
Abetalipoproteinemia
Aplastic anaemia:
a) what is the 1st line investigation
b) what is the 2nd line investigation
Full Blood Count (FBC): Reveals pancytopenia.
Bone Marrow Aspiration and Biopsy
What does FBC show in the presence of Aplastic anaemia?
panytopenia- hypo cellular bone marrow
-low hb and low reticulocytes
Name the specific prophylactic treatment used to prevent episodes of vaso-oclusive crisis
Crizanlizumab I(mab-cry)
What type of drug is Hydroxycarbamide?
Ribonucleotide reductase inhibitor that increases the levels of FOETALhaemoglobin (Hb F)
foetal hb- has higher affinity for O2 than HBA
(left curve shift on dissociation curve)
Bone marrow in leukemia is ……..
hypercellular- high WBC and panocytopenia other cells
The ……. pathway is activated when blood comes into contact with collagen on an injured vessel wall
intrinsic- damaged vessel wall
How does Acute Chest Syndrome present on a CXR?
CXR-pulmonary infiltrates
What is the Acute Management of a Sickle Cell Crises?
General management
analgesia e.g. opiates
rehydrate
oxygen
consider antibiotics if evidence of infection
blood transfusion
How to differentiate between VWB and Haemophillia?
both have prolonged APTT
(factor 8 is reduced in VWB)
symptoms- bruising is ONLY present in VWB disease
What are clotting levels and factor 8 levels like in VWB?
APTT prolonged but factor VIII is actually normal
What is the best diagnostic investigation for haemophilia A or B?
factor VIII/IX assay/factor IX
What is the mechanism of desmopressin in VWB?
Releases von Willebrand factor from its storage sites in endothelial cells
a) what is the most common inherited bleeding disorder
b) what is the most common thrombophillic disorder
a) Von Willebrand disease is the commonest inherited bleeding disorder
b) protein-c resistance (factor v Leiden)
what is the 1st line management of VWB?
1ST LINE-Desmopressin (released VWB factor from endothelial storage cells)
2nd line- tranaexemic acid and factor VIII
What is the management of haemophilia?
a) acute disease
b) severe disease
acute:
1st line-desmopressin- increases release of VWB
2nd line- replace clotting factors
