DeltaMed 2018 practice exam Flashcards
What is a contraindication to pregnancy for heart disease
- 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%
what evidence is there for teriparatide
increases bone mineral density
reduces vertebral fractures and non vertebral fracuture but NOT hip fractures
what is a retroperitoneal mass most likely to be
sarcoma
what syndrome is sarcomas part of
li fraumeni
(also has breast ca, brain tumours, adrenal cortical carcinomas)
how to calculate clearance
(volume distribution x 0.693)/half life
normal size of a kidney
11cm
how to assess transpulmonary gradient
mPAP - PCWP
pulmonary vascular resistance is in wood units and calculated by transpulmonary gradient/cardiac output
>3wood units + other pre-capillary findings
screening for colon cancer screening after diagnosis of PSC
annual colonoscopy
Type 2b von willebrand’s
- increase in the affinity of the Willebrand factor (von Willebrand factor; VWF) for platelets.
- 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.
what mAb are used in ank spond
(e.g. secukinumab) IL-17 and TNFalpha
listeria meningitis w penicillin anaphylaxis allergy
bactrim IV
patient on azathioprine with poor control of Crohn’s:
6-MMP 8000 (250-5700)
6TGN 100 (235-450)
shunting - add allopurinol
Allopurinol inhibits both xanthine oxidase and TPMT and increases active metabolites (6-TGN)
PET/SPECT scan in dementia with lew bodies
decreased dopamine uptake in basal ganglia
Role of FGF-23 in CKD bone disease
- 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
osteitis fibrosa cystica
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
Cause of adynamic bone disease in CKD
- Redued bone volume and mineralisation
- Excessive suppression of PTH and chronic inflammation
- Excessive calcium can precipitate in soft tissues causing “tumoral calcinosis”
Pathogenesis and clinical features of calciphylaxis
- 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
what conditions shows sulfur granules in infected tissue on staining
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.
Non tuberculous mycobacterium associated with cardiac surgery and heater-cooler devices
Mycobacterium chimaera
What phenomenon is shown in the graph? (pharmacology)
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)
Treatment of ankylosing spondylitis
- NSAIDs
- Biologics - TNF inhibitors or Il-17 (secukinumab)
- Limited role for opioids/steroids
haemoglobin abnormality in HbS
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
what causes a right shift of the Hb-O2 dissociation curve?
Increased temp
Increased 2-3 DPG (formed in response to hypoxia)
Increased H+
(CO and CO2 also cause shift to the left)
What is HbA2 and what happens to it in beta/alpha thalassaemia?
HbA2 is Alpha2Delta2
Increased in beta thalassaemia
Decreased in alpha thalassaemia (due to decrease in alpha chains available)
Empirical treatment for meningitis in adults
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)
Meningitis treatment if gram stain shows gram positive diplococci
ceft + dex + vanc
for risk of strep pneumoniae
empirical treatment for healthcare related meningitis
vanc + cefepime/ceftazidime
Management of stage III NSCLC
- Surgical resection if complete resection is feasible + adjunct platinum based chemo
- Otherwise, concurrent chemoradiation with platinum based chemo
what’s the difference between potency and efficiacious
efficacious = maximum possible effect
potency is dose related
AE sulfazalazine
vomiting, headache, skin rash, oligospermia
How to treat Cushing’s syndrome
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)
genetic defect in myotonic dystrophy
DM1: CTG expansion in DMPK gene
DM2: CCTG expansion in ZNF9 gene
weakness, myotonia, cardiac conduction abnormalities and cataracts diagnosis
myotonic dystrophy
prognosis of Inv(16) in AML
good prognosis
(HiDAC for consolidation)
what immunotherapy inhibits regulatory T cells?
CTLA-4
which is why they have the most autoimmune side effects
what is a type II statistical error?
false negative from an inadequate sample size
Diagnosis of chronic thromboembolic pulmonary hypertension
- 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.
Management of chronic thromboembolic pulmonary hypertension
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
CRB65 scoring
conscious state
respiratory rate >30
blood pressure SBP <90
Age >65
1 or more consider admit into hospital
Empirical therapy for mild pneumonia
amoxicillin 1g TDS monotherapy or amoxy + doxy
5-7 days
Empirical therapy of moderate severity CAP
benpen 1.2g Q6hr + doxy
empirical high severity CAP treatment
ceftriaxone 2g daily + azithromycin 500mg daily
Time off driving for:
- STEMI with no LVEF impairment
- PCI
- CABG
- criteria for truck drivers
- STEMI with no LVEF impairment: 2 weeks
- PCI - 2 days
- CABG - 1 month
- criteria for truck drivers - need stress test first
