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FRACP Shuyu > DeltaMed 2018 practice exam > Flashcards

DeltaMed 2018 practice exam Flashcards

1
Q

What is a contraindication to pregnancy for heart disease

A
  • bicuspid valve with aortic diametter >50mm
  • severe MS
  • previous post partum cardiomyopathy with any residual cardiac dysfunction
  • severe AS
  • Marfan’s with aortic root >45mm
  • Native severe coarctation
  • LVEF <50%
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2
Q

what evidence is there for teriparatide

A

increases bone mineral density

reduces vertebral fractures and non vertebral fracuture but NOT hip fractures

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3
Q

what is a retroperitoneal mass most likely to be

A

sarcoma

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4
Q

what syndrome is sarcomas part of

A

li fraumeni

(also has breast ca, brain tumours, adrenal cortical carcinomas)

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5
Q

how to calculate clearance

A

(volume distribution x 0.693)/half life

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6
Q

normal size of a kidney

A

11cm

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7
Q

how to assess transpulmonary gradient

A

mPAP - PCWP

pulmonary vascular resistance is in wood units and calculated by transpulmonary gradient/cardiac output

>3wood units + other pre-capillary findings

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8
Q

screening for colon cancer screening after diagnosis of PSC

A

annual colonoscopy

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9
Q

Type 2b von willebrand’s

A
  1. increase in the affinity of the Willebrand factor (von Willebrand factor; VWF) for platelets.
  2. Spontaneous binding of high molecular weight VWF multimers to platelets leading to rapid clearance of both the platelets (increasing the risk of thrombocytopenia) and the high molecular weight VWF multimers from the plasma.
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10
Q

what mAb are used in ank spond

A

(e.g. secukinumab) IL-17 and TNFalpha

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11
Q

listeria meningitis w penicillin anaphylaxis allergy

A

bactrim IV

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12
Q

patient on azathioprine with poor control of Crohn’s:

6-MMP 8000 (250-5700)

6TGN 100 (235-450)

A

shunting - add allopurinol

Allopurinol inhibits both xanthine oxidase and TPMT and increases active metabolites (6-TGN)

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13
Q

PET/SPECT scan in dementia with lew bodies

A

decreased dopamine uptake in basal ganglia

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14
Q

Role of FGF-23 in CKD bone disease

A
  • Secreted by osteocytes
  • Promotes renal phosphate excretion
  • Suppress 1,25(OH)2D3 (calcitriol) -> decreased phosphorus absorption from GI tract
  • Stimulate PTH - also increase renal phosphate excretion
  • Increase early in the course of CKD, even before phosphate retention and hyperphosphatemia
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15
Q

osteitis fibrosa cystica

A

Increased bone turnover caused by hyperparathyroidism

CF: bone pain and fragility, brown tumors (bone cysts with haemorrhagic elements), compression syndromes, and erythropoietin (EPO) resistance in part related to the bone marrow fibrosis

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16
Q

Cause of adynamic bone disease in CKD

A
  • Redued bone volume and mineralisation
  • Excessive suppression of PTH and chronic inflammation
  • Excessive calcium can precipitate in soft tissues causing “tumoral calcinosis”
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17
Q

Pathogenesis and clinical features of calciphylaxis

A
  • livedo reticularis and advances to patches of ischemic necrosis, especially on the legs, thighs, abdomen, and breasts
  • vascular calcification and endothelial injruy leading to cutaneous infarcts
  • poorly understood pathogenesis but risk factors are hyperparathyroidism, increased phosphate calcium product, active vitamin D administration and warfarin
  • associated with high mortality
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18
Q

what conditions shows sulfur granules in infected tissue on staining

A

Actinomyce - chronic disease characterized by abscess formation, draining sinus tracts, fistulae, and tissue fibrosis. It can mimic a number of other conditions, particularly malignancy and granulomatous disease.

19
Q

Non tuberculous mycobacterium associated with cardiac surgery and heater-cooler devices

A

Mycobacterium chimaera

20
Q

What phenomenon is shown in the graph? (pharmacology)

A

Repeat administration

Same dose

Diminished physiological effect

Develops over a short period of time

Not dose-dependent (i.e. giving a larger dose of the drug may not restore the maximum effect)

Rate-sensitive (i.e. requires frequent dosing)

21
Q

Treatment of ankylosing spondylitis

A
  1. NSAIDs
  2. Biologics - TNF inhibitors or Il-17 (secukinumab)
  3. Limited role for opioids/steroids
22
Q

haemoglobin abnormality in HbS

A

Hemoglobin S (HbS) is an abnormal hemoglobin that results from a point mutation in the beta globin gene that causes the substitution of a valine for glutamic acid as the sixth amino acid of the beta globin chain. The resulting hemoglobin tetramer (alpha2/beta S2) becomes poorly soluble when deoxygenated

23
Q

what causes a right shift of the Hb-O2 dissociation curve?

A

Increased temp

Increased 2-3 DPG (formed in response to hypoxia)

Increased H+

(CO and CO2 also cause shift to the left)

24
Q

What is HbA2 and what happens to it in beta/alpha thalassaemia?

A

HbA2 is Alpha2Delta2

Increased in beta thalassaemia

Decreased in alpha thalassaemia (due to decrease in alpha chains available)

25
Q

Empirical treatment for meningitis in adults

A

ceftriaxone 2g bd + dex 10mg IV

add benpen 2.4g Q4hrly for those at risk of listeria (patients who are older than 50 years, immunocompromised, pregnant or debilitated, or those with a history of hazardous alcohol consumption)

26
Q

Meningitis treatment if gram stain shows gram positive diplococci

A

ceft + dex + vanc

for risk of strep pneumoniae

27
Q

empirical treatment for healthcare related meningitis

A

vanc + cefepime/ceftazidime

28
Q

Management of stage III NSCLC

A
  • Surgical resection if complete resection is feasible + adjunct platinum based chemo
  • Otherwise, concurrent chemoradiation with platinum based chemo
29
Q

what’s the difference between potency and efficiacious

A

efficacious = maximum possible effect

potency is dose related

30
Q

AE sulfazalazine

A

vomiting, headache, skin rash, oligospermia

31
Q

How to treat Cushing’s syndrome

A

1. Surgical resection of ACTH or adrenal secreting tumour

  • First line

2. Medical therapy

“Block and replace therapy”

  • Adrenal enzyme inhibitors: ketoconazole, metyrapone, etomidate
  • Adrenolytic agents: mitotane (used primarily for the treatment of adrenal carcinoma)
  • Requiring glucocorticoid replacement

Targeting pituitary tumour (only used for Cushing’s disease):

  • Cabergoline (dopamine agonist) or pasireotide (somatostatin analogue)
32
Q

genetic defect in myotonic dystrophy

A

DM1: CTG expansion in DMPK gene

DM2: CCTG expansion in ZNF9 gene

33
Q

weakness, myotonia, cardiac conduction abnormalities and cataracts diagnosis

A

myotonic dystrophy

34
Q

prognosis of Inv(16) in AML

A

good prognosis

(HiDAC for consolidation)

35
Q

what immunotherapy inhibits regulatory T cells?

A

CTLA-4

which is why they have the most autoimmune side effects

36
Q

what is a type II statistical error?

A

false negative from an inadequate sample size

37
Q

Diagnosis of chronic thromboembolic pulmonary hypertension

A
  • Pulmonary hypertension, defined as a mean pulmonary arterial pressure (PAP) >20 mmHg at rest in the absence of an elevated pulmonary capillary wedge pressure (ie, PCWP is ≤15 mmHg).
  • Thromboembolic occlusion of the proximal or distal pulmonary vasculature must exist and be the presumed cause of the pulmonary hypertension.
38
Q

Management of chronic thromboembolic pulmonary hypertension

A

1st line - surgery

  • Only curative therapy
  • 1-5% mortality
  • Can only operative segmental PEs and more proximal

2nd line - medical therapy

  • Warfarin
  • Medications to treat pulmonary hypertension - riociguat, prostanoid
39
Q

CRB65 scoring

A

conscious state

respiratory rate >30

blood pressure SBP <90

Age >65

1 or more consider admit into hospital

40
Q

Empirical therapy for mild pneumonia

A

amoxicillin 1g TDS monotherapy or amoxy + doxy

5-7 days

41
Q

Empirical therapy of moderate severity CAP

A

benpen 1.2g Q6hr + doxy

42
Q

empirical high severity CAP treatment

A

ceftriaxone 2g daily + azithromycin 500mg daily

43
Q

Time off driving for:

  • STEMI with no LVEF impairment
  • PCI
  • CABG
  • criteria for truck drivers
A
  • STEMI with no LVEF impairment: 2 weeks
  • PCI - 2 days
  • CABG - 1 month
  • criteria for truck drivers - need stress test first
44
Q
A

FRACP Shuyu (65 decks)

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