Deck 1 Flashcards
Common SE of cisplatin
Hypomag
NB: p
Common SE of taxels
e.g. docetaxel = neutropenia
Common SE cyclophosphamide
Haemorrhagic cystitis, myelosuppression, TCC
Which antipsychotics can be used vs shoudl be avoided in Lewy body dementia?
low-dose second-generation can be sued e.g. clozapine, quetiapine, aripiprazole
avoid haloperidol and tranylcpromine
Clotting results in antiphospholipid syndrome
(paradoxically) prolonged APTT + low platelets
NB: antiphospholipid antibodies interfere with phospholipid-dependent coagulation tests, leading to a prolonged APTT. The presence of thrombocytopenia is also a common finding in APS.
Lambert Eaton antibodies
Against voltage gated Ca channels
NB: commonly found as a paraneoplastic disorder , lower limbs first, symptoms improve with use
Anti JO antibodies
Polymyositis
Anti-Mi-2 antibodies
dermatomyositis
Anti-MuSK antibodies
Also MG but less common than anti-AChR
t(11:14)
Mantle cell - cyclin D1 expression
6% of all non-Hodgkin lymphomas
t(15;17)
Acute promyelocytic leukaemia (subtype of AML) - abnormal retinoic acid receptor alpha which blocks maturation of myeloid cells
Burkitt’s translocations
t(8;14), t(2;8), t(8;22)
t(9;22)
CML - causes BCR-ABL1
Philadelphia chromosome
Acetazolamide MOA
Carbonic anhydrase inhibitor used as diuretic
Causes bicarbonaturia and metabolic acidosis
PAH definition
resting mean pulm artery pressure of >=20mmHg - endothelin plays key role
Clinical signs of PAH
RV heave (RV hypertrophy or dilatation)
loud P2
Raised JVP with ‘a’ waves
TR
Before starting management for PAH
Acute vasodilator testing (inhaled nitric oxide or intravenous epoprostenol)
Positive response to vasodilator testing in PAH …
Oral CCB e.g. nifedipine
Negative vasodilator response to PAH….
Prostacyclin analogues (treprostinil, iloprost)
Endothelin receptor antaghonists - bosentan, ambrisentan
Phosphodiesterase inhibitors - sildenafil
Life threatening asthma features
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, less respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
Severe asthma features
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
Moderate asthma features
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
What would pH of 7.33 in acute asthma suggest ?
Carbon dioxide retention in tiring patient
Dermatomyositis antibodies
ANA
Anti-Scl-70 antibodies = ?
Diffuse systemic sclerosis
First line in delirium tremens/alcohol withdrawal
chlordiazepoxide, loraz/diazepam
Film of FBC in G6PD deficiency
Heinz bodies
Bite and blister cells
Medications to avoid in G6PD deficiency
Ciprofloxacin
Antimalarials
Sulph group drugs incl sulfonylureas
Inheritance of G6PD deficiency
X linked recessive - males only
Baclofen MOA
GABA agonist, acts in CNS
Genetic condition associated with renal angiomyolipomata
Tuberous sclerosis
Where is phosphate reabsorbed in the nephron
Proximal tubule
Anorexia features
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Bevacizumab MOA
ANti VEGF
Screening for hereditary angioedema
Serum C4m- will be low
(C1 always low, and C2 low)
Tx of hereditary angioedema
IV C1 inhibitor concentrate
FFP
Prophylactic: Danazol (anabolic steroid)
Gingival hyperplasia drug causes
phenytoin, ciclosporin, calcium channel blockers and AML
Gold standard tests for PNH (paroxysmal nocturnal haemoglobinuria)
Flow cytometry for CD59 and CD55
Causes of methaemoglobinaemia
Congenital causes
haemoglobin chain variants: HbM, HbH
NADH methaemoglobin reductase deficiency
Acquired causes
drugs: sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes
ABG features of methaemoglobinaemia
Normal PO2 but decreased oxygen saturation
Screen for which virus before starting rituximab ?
Hep B - can reactivate if present as rituximab binds to CD20 which is expressed on B cells
Fish tank granuloma
Myocobacterium marinum
Which tablets interact with levothyroxine absorption?
Iron and calcium carbonate - should be taken at least 4hrs apart
Blurred peripheral vision after panretinal photocoagulation for proliferative diabetic retinopathy?
Reduced rod cell function is a complication of panretinal photocoagulation
Inducers of the P450 system
antiepileptics: phenytoin, carbamazepine
barbiturates: phenobarbitone
rifampicin
St John’s Wort
chronic alcohol intake
griseofulvin
smoking (affects CYP1A2, reason why smokers require more aminophylline)
Inhibitors of P450
antibiotics: ciprofloxacin, erythromycin
isoniazid
cimetidine,omeprazole
amiodarone
allopurinol
imidazoles: ketoconazole, fluconazole
SSRIs: fluoxetine, sertraline
ritonavir
sodium valproate
acute alcohol intake
quinupristin
A new blood test is developed to screen for prostate cancer. Trials have shown it has a sensitivity for detecting clinically significant prostate cancer of 80% but a specificity of 60%. What is the likelihood ratio for a positive test result?
Likelihood ratio for a positive test result = sensitivity / (1 - specificity)
= 0.8 / (1 - 0.6) = 2
Ambrisentan MOA
endothelin receptor A antagonist
Subunits of troponins and their action
troponin C: binds to calcium ions
troponin T: binds to tropomyosin, forming a troponin-tropomyosin complex
troponin I: binds to actin to hold the troponin-tropomyosin complex in place
Name 3 cytokines in sepsis
IL-1, IL-6, and TNF-a
Which electrolyte abnormality increases digoxin levels and how
hypokalaemia - Digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia → digoxin more easily bind to the ATPase pump → increased inhibitory effects
Leptospirosis spread
Mainly contact with rat urine
Speech fluent but repetition poor = ?
autosomal dominant and typically affects young adults and causes replacement of normal bone by spongy tissue in the ear and as a result hearing loss
Otosclerosis
‘spike and dome’ appearance of the basement membrane due to subepithelial deposits = ?
Membraneous glomerulonephritis
Idiopathic membranous GN is associated with which autoantibodies?
anti-phospholipase A2 antibodies.
Anti-GQ1b antibodies ?
Miller-Fisher syndrome, a variant of Guillain-Barre syndrome characterised by ataxia, ophthalmoplegia and areflexia.
Anti-p62 antibodies?
Primary biliary cirrhosis
Anti-Ri antibodies?
opsoclonus-myoclonus syndrome, often in the context of breast cancer.
ANti Ro in pregnancy?
SLE in pregnancy can cause foetal bradycardia
Which drugs can induce thrombocytopenia?
quinine
abciximab
NSAIDs
diuretics: furosemide
antibiotics: penicillins, sulphonamides, rifampicin
anticonvulsants: carbamazepine, valproate
heparin
SUlfonylurea example?
GLiclazide
Gliclazide side effects?
Common adverse effects
hypoglycaemic episodes (more common with long-acting preparations such as chlorpropamide)
weight gain
Rarer adverse effects
hyponatraemia secondary to syndrome of inappropriate ADH secretion
bone marrow suppression
hepatotoxicity (typically cholestatic)
peripheral neuropathy
HAemophilia inheritance?
X-linked recessive disorder of coagulation
Haemophilia clotting results?
Blood tests
prolonged APTT
bleeding time, thrombin time, prothrombin time normal
Which are the main features of GPA?
Granulomatosis with polyangiitis (GPA) would cause sinus, pulmonary and renal symptoms. An asthma syndrome is not commonly described
Churg-Strauss syndrome features ?
i.e. eosinophilic granulomatosis with polyangiitis (EGPA).
The American College of Rheumatology has produced criteria for the diagnosis of EGPA:
asthma,
eosinophilia,
presence of mono-/polyneuropathy,
flitting pulmonary infiltrates,
paranasal sinus abnormalities
histological evidence of extravascular eosinophils.
The presence of four of these criteria is considered highly sensitive for a diagnosis of EGPA.
Pseudogout microscopic joint findings
Weakly positively birefringent rhomboid shaped crystals
Which tests are key to identify patients who will benefit from cardiac resynchronisation therapy in HF?
Echo
ECG - LBBB, QRS duration more than 120
Which antibody is deposited in the dermis in dermatitis herpetiformis?
IgA
Features of optic neuritis
unilateral decrease in visual acuity over hours or days
poor discrimination of colours, ‘red desaturation’
pain worse on eye movement
relative afferent pupillary defect
central scotoma
Ix for diagnosis of optic neuritis
MRI of the brain and orbits with gadolinium contrast is diagnostic in most cases NB: MRI: if > 3 white-matter lesions, 5-year risk of developing multiple sclerosis is c. 50%
Management of optic neuritis
high-dose steroids
recovery usually takes 4-6 weeks
Which type of anaemia does lead poisoning cause?
Lead interferes with several steps of haem synthesis leading to inhibition of heme biosynthesis and subsequent microcytic hypochromic anaemia.
Features of lead poisoning
abdominal pain
peripheral neuropathy (mainly motor)
neuropsychiatric features
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)
Hyperparathyroidism treatment
definitive management is total parathyroidectomy
conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage
- patients not suitable for surgery may be treated with cinacalcet, a calcimimetic
a calcimimetic ‘mimics’ the action of calcium on tissues by allosteric activation of the calcium-sensing receptor
What are the phases of a clinical trial?
0 - exploratory studies
I - safety assessment
II - assess efficacy - 2a = optimal dosing , 2b=assess efficacy
III - assess effectiveness
IV - postmarketing suverillance
Electrolyte causes of a prolonged QT?
Hypokalaemia
Hypocalcaemia
Hypomag
What is the MOA of red man syndrome?
The proposed mechanism is non IgE mediated mast cell degranulation.
NB: happens with vancomycin if given fast
Which nerve is affected in foot drop and what are some common causes?
Leg crossing, squatting or kneeling may cause a foot drop secondary to a common peroneal neuropathy
Which chromosomes are affected in ADPKD type 1 vs type 2?
Type 1 = chromosome 16 (85% of all cases)
Type 2 = Chromosome 4 (15% of all cases)
Indications for NIV
CIA-2
C: cardiogenic pulmonary oedema refractory to CPAP
I: Intubation weaning
A: Acidosis (respiratory) - COPD with pH 7.25-35 or <7.25 + HDU
2: Type II resp failure caused by OSA, neuromuscular weakness, chest wall deformity
