Deltamed 2017 Flashcards
Timing of revascularisation after NSTEMI
- Immediate
- APO, ventricular arrythmias, haemodynamic instability, going ST dynamic changes
- <12 hours
- GRACE >140 or TIMI >5
- <48 hours
- Everyone else
Aminodaroine in p-glycoprotein interactions
Inhibitor
Digoxin in P-glycoprotein interactions
Substrate
Verapamil in P-glycoprotein interactions
Substrate and inhibitor
Dabigatran in P-glycoprotein interactions
Substrate
Atorvastatin P-glycoprotein interactions
Substrate, inhibitor
St John’s worth and P-glycoprotein interactions
Inducer
Grapefruit juice and P-glycoprotein interactions
Inhibitor
What is the formula for clearance?
CL = (0.7 x volume of distribution) / half-life
Volume of distribution = dose given / concentration at time 0
What method is employed in case controlled studies to reduce randomisation?
Matching
What method is used in clinical trials to reduce confounders?
Randomisation
What is channeling bias?
When a patient’s prognosis or degree of illness influences which group he or she is put into a study
What is the effect of selection bias?
Reduces generalisability
What does blinding/masking reduce?
Information bias
What is attrition bias and what’s an example of how it occurs?
When participants leave during a study
Losses may be influenced by such factors as unsatisfactory treatment efficacy or intolerable adverse effects
What is the genetic defect and clinical characteristics of MODY1?
Mutations in the HNF4A gene on chromosome 20
primary genetic defect in insulin secretion
at risk for the microvascular and macrovascular complications
initial good response to sulfonyureas
What is the genetic defect and clinical features of MODY2?
Glucokinase gene - results in a higher threshold for glucose stimulated insulin secretion and insulin secretory deficit
Hyperglycaemia is stable, mild, and is not associated with the vascular complications. Diet controlled
What MODY can be adequately controlled with sulfonylurea monotherapy?
mutations in the HNF1A gene on chromosome 12 was formerly called MODY3
- TSH is low and only serum T3 is high (normal free T4 concentration)
- TSH is low, free T4 is high, and T3 is normal
- TSH is low and only serum T3 is high (normal free T4 concentration)
- Graves’ disease or autonomously functioning thyroid adenoma or exogenous T3
- TSH is low, free T4 is high, and T3 is normal
- Hyperthyroidism with concurrent nonthyroidal illness, amiodarone-induced thyroid dysfunction, or exogenous T4 ingestion
What patients are at risk of HBV reactivation?
HBsAg +ve
HBcAb +ve
What is the first line test to investigate for pancreatic insufficiency?
Faecal elastase-1 (low levels)
Cancer screening in PSC
- Cholangiocarcinoma:
- US or MRI every 6-12 months
- Bowel cancer
- W/ IBD colonoscopy every 1-2 years
- No IBD colonoscopy every 3-5 years
Immediate immunosuppression in GPA or MPA
Pred and rituximab or cyclophosphamide and rituximab
What level of complete spinal cord injury would result in acute respiratory collapse
C3 and above (diaphragm C3, 4, 5)
What happens to bladder and bowel function in acute spinal cord injuries?
Reflex emptying of the bladder may be lost, resulting in urinary retention and bladder distention. In lesions that occur above the sacral level leaving the spinal bladder center in the conus medullaris intact, automatic, reflex emptying of the bladder returns days to weeks after the injury.
Similarly, bowel function ceases immediately after complete cord transection at any level, with loss of rectal tone and the anal “wink” reflex. Spontaneous bowel peristalsis returns within a few days as a rule, as do the anal and bulbocavernosus reflexes when the cord lesion lies above the sacral level.
What is the mechanism of hypercalcaemia in renal cell carcinoma?
Paraneoplastic hypercalcaemia by tumour cells secreting parathyroid hormone related protein
What does C4D positive staining indicate in renal transplant biopsy
Antibody mediated rejection
MOA of omalizumab
Monoclonal antibody binding to IgE receptor
What is the mean sleep latency in narcolepsy?
8min or less
