Delta Med Flashcards
2020 q3:
When do you consider thyroxine replacement in pregnant women?
Consideration of thyroxine treatment in pregnant
women without a thyroid history is only considered if preconception TSH is > 4.0 IU/L or if both
TSH >2.5 IU/L and anti-TPO antibody titre is positive.
CT findings of
- HCC
- hemangiomas
- hepatic abscess
HCC: enhancement in arterial phase and washout in portal phase
Haemangioma: Nodular peripheral involvement in the arterial phase with progressive central enhancement in the portal phase.
Hepatic Abscess: peripheral enhancement with central hypoattenuation - double target sign
- Which of the following is NOT a supportive feature for a diagnosis of Dementia with Lewy
Bodies (DLB)?
A. Autonomic dysfunction
B. Fluctuating cognition
C. Poor cognitive response to cholinesterase inhibitor
D. Hypersensitivity to typical antipsychotics
C. Poor cognitive response to cholinesterase inhibitor
Meta-analysis revealed that donepezil and rivastigmine were superior to placebo in improving
cognitive function in DLB, and in fact DLB pts may even have a better response than AD pts.
Diagnostic criteria for antiphospholipid syndrome
Antiphospholipid syndrome is a clinico-pathological diagnosis of the presence
of the lupus anticoagulant and/or anticardiolipin/beta2 glycoprotein antibodies and
thrombosis.
- Primary or Secondary (often associated with SLE and rheumatoid arthritis) autoimmune disorder
- APS is diagnosed if at least 1 of the clinical criteria of vascular thrombosis or pregnancy morbidity is present in association with the presence of antiphospholipid antibodies (aPL) on 2 or more occasions, 12 weeks apart.
- Patients must have at least 1 clinical diagnostic criterion and 1 laboratory diagnostic criterion in order to meet the diagnosis.
CLINICAL CRITERIA
• History of thrombosis (arterial or venous) - can affect any vessel in the body
• Spontaneous abortion/miscarriages
- 3 or more unexplained consecutive spontaneous abortions <10 weeks
- 1 or more unexplained death of a morphologically normal fetus > 10 weeks
- 1 or more premature birth < 34 weeks because of eclampsia/pre-eclampsia or placental insufficiency
LAB FINDING
• Lupus anticoagulant on 2 or more occasions at least 12 weeks apart
• Anticardiolipin
• Anti-β2 glycoprotein
Tx: Warfarin
- A 22-year-old woman presents two days following removal of her right lower wisdom tooth
with unilateral tongue swelling on that side. This is on the background of a prior episode of
hand swelling after an appendicectomy for suspected appendicitis a year prior. As part of
her work-up, C4 was noted to be low at 0.06 g/L.
What would be the next best test to order?
A. Mast cell tryptase
B. Specific IgE to local anaesthetic
C. Skin prick and intradermal testing to local anaesthetic
D. C1-inhibitor function
D
History of swelling in setting of recent procedure as well as low C4 suggestive of hereditary
angioedema. Thus C1-inh is next best test to order. History is not suggestive of an IgE
mediated process, although tryptase is another test worth doing to exclude mastocytosis (it is however not the ‘best’ next test)
What are the BRCA1/2 malignancies
BRCA 1/2 related malignancies include cancers of the breast, pancreas, ovary, prostate.
- All of the following patients should be tested for Alpha1-Antitrypsin deficiency EXCEPT
A. A 30-year-old male with asthma that is well controlled on inhaled corticosteroid and
salbutamol therapy
B. A first-degree relative of a person with confirmed Alpha1-Antitrypsin deficiency
C. A 50-year-old female with c-ANCA vasculitis who is a current smoker
D. A 60-year-old male with COPD and a 50-pack-year smoking history
A. A 30-year-old male with asthma that is well controlled on inhaled corticosteroid and
salbutamol therapy
- AAT deficiency (proteinase inhibitor genotype MZ) has been associated with other clinical conditions including ANCA-associated vasculitis (answer C is incorrect), gallstone disease, emphysema (answer D is incorrect) and liver cirrhosis.
- Patients with poorly responsive asthma should be considered for AAT deficiency testing (answer A is correct as this patient has well controlled asthma). It is recommended that first-degree relatives of people with AAT deficiency should undergo testing (answer B is incorrect).
- A 36-year-old man with seropositive rheumatoid arthritis comes to see you in the
outpatient clinic to discuss starting a family. He is currently well controlled on
Hydroxychloroquine 200mg mane, Methotrexate 20mg weekly, Folic Acid 5mg daily except
the day of Methotrexate, and Tofacitinib 5mg BD.
Which of the following medications (if any) should be ceased prior to conception?
A. Hydroxychloroquine
B. Methotrexate
C. None of these medications
D. Tofacitinib
D. Tofacitinib
15. Proton pump inhibitors such as esomeprazole may interact with which of the following cardiac medications? A. Aspirin B. Beta blockers C. Clopidogrel D. Diuretics
Both clopidogrel and PPIs are prodrugs that use the same metabolic pathway (CYP2C19) for
metabolism – hence they may compete. Multiple systematic reviews have shown that when
PPIs and clopidogrel are routinely co-administered, rates of major adverse cardiovascular
outcomes (stent thrombosis, requirement for revascularization) increase.
NB that pantoprazole has the lowest CYP2C19 affinity and has been shown to not increase
rates of MACE when assessed on its own. It is typically the go-to PPI when there is an
indication for both DAPT and PPI
What metabolic pathway does clopiogrel involve?
CYP2C19
17. During pregnancy, which maternal condition confers the highest risk of foetal thyrotoxicosis? A. Gestational thyrotoxicosis B. Toxic multinodular goitre C. Graves’ disease D. Subacute thyroiditis
17. During pregnancy, which maternal condition confers the highest risk of foetal thyrotoxicosis? A. Gestational thyrotoxicosis B. Toxic multinodular goitre C. Graves’ disease D. Subacute thyroiditis
C. Graves’ disease
- Which of the following variants would most likely result in a single amino acid change?
A. Single nucleotide deletion
B. Substitution of the 2nd nucleotide in a codon
C. Substitution of the 3rd nucleotide in a codon
D. 6 nucleotide deletion
- ANS: B
- A single nucleotide deletion will interrupt the downstream reading frame and cause a protein
truncating change.
- A 6-nucleotide deletion will disrupt 2 amino acids.
- Substitution of the 2nd nucleotide in a codon will result in a single amino acid change.
- Substitutions of the 3rd nucleotide is less likely to cause an amino acid change than substitutions of the 1st or 2nd nucleotide because of redundancy for amino acid codes with the 3rd nucleotide being more variable in its coding for the same amino acid
- Which of the following is LEAST likely to be found in late-onset Alzheimer’s dementia
(LOAD)?
A. Increased CSF Aβ42
B. Increased CSF tau
C. Hypometabolism in the medial temporal lobe
D. Amyloid deposition on PET Amyloid imaging
A. Increased CSF Aβ42
CSF Aβ42 is usually decreased.
- In which of the following patient populations is the measles, mumps and rubella vaccine
safe to be administered?
A. Received recent chemotherapy
B. Solid organ transplant
C. Asymptomatic HIV with CD4+ count of 250 cells/uL
D. Receiving 25mg daily prednisolone for the last 16 days
C
Option C – MMR vaccine is allowed to be given if “asymptomatic HIV” and CD4+ count equal
or greater than 200 cells/uL (assume they are on therapy with virologic control and do not have OI if asymptomatic). MMRV is not recommended.
Option D - ≥20 mg per day of prednisolone for ≥14 days – not safe, must wait at least 1
month before giving vaccine.
Other options – A, B – all contraindicated
