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FRACP Shuyu > Dunedin 2019 > Flashcards

Dunedin 2019 Flashcards

1
Q

How many neurons in Horner’s and where do they synapse from and to

A

Horner’s is a 3 neuron arc

1st order – posterolateral hypothalamus, descend through midbrain and pons, terminate in intermediolateral cell column of the spinal cord at C8-T2 aka ciliospinal centre of Budge

2nd order – originates ciliospinal centre of Budge, exits at T2 and enters cervical sympathetic chain (close proximity to pulmonary apex and subclavian artery), ascend sympathetic chain and synapse in superior cervical ganglion at bifurcation of common carotid artery

3rd order – postganglionic pupillomotor fibres exit superior cervical ganglion and ascend along internal carotid artery

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2
Q

Mifepristone MOA and indication

A

Glucocorticoid receptor antagonist - blocks the effect of cortisol at flucocorticoid receptor

Used to treat hyperglycaemia in Cushing’s syndrome

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3
Q

Ambrisentan MOA

A

Endothelin receptor antagonist

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4
Q

Sildenafil MOA

A

Inhibits PDE-5 in smooth muscle of pulmonary vasculature

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5
Q

Riociguat MOA

A

Dual mode of action

  1. Sensitises soluble guanylate cyclase to endogenous NO by stabilising NO-sGC binding
  2. Directly stimulates sGC independent of NO
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6
Q

Iloprost MOA

A

Prostacyclin analogue

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7
Q

VRE resistance mechanism

A

Change in cell wall structure from d-ALA d-ALA to d-ALA d-LAC

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8
Q

Most specific antibody for RA

A

Anti-CCP 95-98% specificity

RF not specific, but similar sensitivity to anti-CCP

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9
Q

Type II error

A

Falsely accepting the null hypothesis = false negative

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10
Q

Genetic defect a/w autoimmune polyendocrine syndrome type 1

A

AIRE

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11
Q

Mutation in which gene a/w IPEX

A

FOX P3

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12
Q

Reed Sternberd Cell surface immunophenotype

A

CD15 and CD30 positive

CD45 negative

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13
Q

Ipilimumab MOA

A

CTLA-4 inhibitor

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14
Q

Antigen in HIT

A

Platelet factor 4

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15
Q

Levetiracetam MOA

A

Binds to synaptic vesicle protein SV2A, altering vesicle fusion

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16
Q

Ethosuximide MOA

A

Diminishes T-type calcium currents in the thalamic neurons

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17
Q

Carbamazepine

A

Inhibits voltage gated sodium channels

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18
Q

Clobazam MOA

A

Binds to GABA receptor and facilitate the attachment of GABA to the receptor

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19
Q

Signal two in T-cell activation

A

Interaction between CD28 and CD80/86 on APC

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20
Q

Edwards syndrome

A

Trisomy 18 - detectable by karyotype

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21
Q

PBC management

A

Ursodeoxycholic acid

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22
Q

Uveal melanoma commonly metastasises to which site

A

Liver

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23
Q

Mechanism of red man syndrome

A

Vancomycin directly causes mast cell degranulation

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24
Q

What extraintestinal manifestation of IBD is associated with active GI inflammation

A

Large joint arthritis

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25
Q

Positive predictive value formula

A

sensitivity x prevalence

[sensitivity x prev] + [(1-spec) x (1xprev)]

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26
Q

Negative predictive value formula

A

specificity x (1-prevalence)

[(1-sensitivity) x prev] + [spec x (1-prev)]

27
Q

Unfractionated heparin MOA

A

Binds to antithrombin III -> enhanced ability to inhibit factor Xa and IIa

Also inactivates thrombin and other proteases

28
Q

Ticagrelor side effects

A

Resp: dyspnoea

CVS: ventricular pause on ECG, presyncope, syncope

CNS: dizziness, LOC

GI: nausea

Haem: haemorrhage - major and minor

Renal: increased serum Cr (transient)

29
Q

Liddle’s syndrome

A

Dysregulation of epithelial ENaC channels in renal collecting ducts

30
Q

PML treatment

A

IV hydrocortisone

Stop offending drug

31
Q

What size adrenal incidentaloma would require adrenalectomy

A

>=4cm

32
Q

Next step in management in adrenal incidentaloma <4cm

A

Hormonal testing - PAC/PRA; plasma-free metanephrines and normetanephrines; overnight 1mg dexamethasone suppression test

If hormonally active then adrenalectomy

33
Q

Precautions for VZV pneumonitis

A

Negative pressure isolation for disseminated zoster

Negative pressure isolation for immunocompromised pt with dermatomal zoster

34
Q

A-a gradient

A

PAO2 - PaO2

PAO2 = FiO2 (Patm - PH2O) - PCO2/0.8

35
Q

Standard Mx for ARDS

A

Low tidal volume ventilation and PEEP

36
Q

MGUS Dx

A

Monoclonal protein spike <3g/dL

Plasma cells <10% of bone marrow

No CRAB features

37
Q

Smouldering MM diagnosis

A

Monoclonal protein spike >3g/dL

PC >10% of bone marrow

No CRAB features

38
Q

Multiple myeloma diagnosis

A

Monoclonal spike

PC >10% or plasmacytoma

CRAB features

Or PC >60% or SFLC >100

Or more than one focal lesion on MRI

39
Q

PR3-ANCA association

A

GPA (in 80-90% of cases)

40
Q

How does fluconazole affect metabolism of some other drugs

A

Inhibits CYP450

41
Q

Multiple cystic changes through bilateral lung fields

A

LAM

  • Associated with tuberous sclerosis
42
Q

Creutzfeldt-Jakob disease

A

Rapid onset dementia over months

Behavioural change, myoclonus

EEG - generalised periodic sharp wave pattern

MRI - cortical ribboning, caudate and putamen T2 hyperintensity and diffusion restriction on DWI/ADC

43
Q

Difference between NMS and serotonin syndrome

A

NMS - lead pipe rigidity, reduced reflexes, onset over days

Serotonin syndrome - increase tone ++, increased reflexes and clonus, onset over hours

44
Q

What is the only proven benefit of IV pre-endoscopic PPI in acute UGIB

A

Reduced endoscopic intervention

No reduction in mortality or rebleeding rate

45
Q

What bacteria in reactive arthritis are HLA-B27 associated

A

Chlamydia trachomatis

Clostridium difficile

Salmonella

Shigella

Campylobacter

Yersinia

Intravesical BCG

46
Q

What type of SpA would you use conventional DMARDs in?

A

Peripheral SpA

No role in axial SpA

Sulfasalazine or MTX

47
Q

What TNFi do you use in SpA if pt has uveitis or IBD

A

Infliximab or adalimumab

NOT etanercept

48
Q

Secukinumab MOA + indication

A

IL-17A inhibitor - also ixekizumab

Used in axial SpA and psoriatic arthritis

Similar efficacy to TNFi

49
Q

Ustekinumab MOA and indication

A

IL-12/IL-23 monoclonal antibody

Effective for enthesitis and psoriasis

Not useful for axial SpA

50
Q

What management reduces mortality in COPD

A

Long-term oxygen therapy in pts with PaO2 <55mmHg

51
Q

What benefits does pulmonary rehab give in COPD pts

A

Reduction in symptoms (dyspnoea + fatigue), anxiety and depresseion, exercise capacity, peripheral muscle function

Reduces exacerbations requiring hospitalisation

NO improvement in mortality

52
Q

King’s College Criteris for liver transplant in paracetamol-induced liver failure

A

Arterial pH <7.3

OR

Grade III or IV encephalopathy AND prothrombin time >100s AND serum Cr >301micromol/L

53
Q

King’s College Criteria for liver transplant in non-paracetamol induced liver failure

A

Prothrombin time >100s (INR >6.5)

OR

Any 3 of the following:

  1. Age <10 years or >40 years
  2. Non hep A or B viral hepatitis, halothane hepatitis, idiosyncratic drug reactions
  3. Duration of jaundice before encephalopathy >7 days
  4. PT >50s
  5. Bili >18mg/dL (308micromol/L)
54
Q

Dermatomyositis antibodies

A

Anti-mi2

TIF-1gamma - associated with malignancy

MDA-5 - cutaneous ulceration overlying Gottron papules, mechanic’s hands - a/w rapidly progressive ILD

MJ

55
Q

Reason for giving anti-androgen treatment with goserelin (GnRH agonist) for prostate cancer

A

Reduce flare symptoms related to increase in LH production

56
Q

Measles incubation period

A

6-21 days

57
Q

Cerebral venous sinus thrombosis management

A

LMWH or UFH

Presence of haemorrhage NOT contraindications for anticoagulation

Long term anticoagulation - wafarin or dabigatran

58
Q

Tacrolimus ADR

A

Hyperglycaemia, diabetes

Diarrhoea headache tremor nausea

Alopecia, hirsutism

Nephrotoxicity - dose-related in acute, can be irreversible in chronic

Metabolised by CYP 3A4

59
Q

ECG findings of ARVD

A

V1-5 T wave inversion and epsilon waves

Exercise or stress can precipitate CT

60
Q

Define extensively drug-resistant TB

A

MDR TB + resistance to moxifloxacin and amikacin

61
Q

Hummingbird sign

A

PSP

62
Q

Hot cross bun sign MRI

A

MSA - cerebellar type

63
Q

What features are seen in atypical parkinsonism rather than idiopathic PD

A

Rapid progression of gait impairment <5 years

No response to high-dose levodopa despite mod severity of disease

Severe autonomic failure in first 5 years

Recurrent falls from imbalance within 3 years

Absence of common non-motor features of PD despite 5 years of disease

Early bulbar dysfunction

Inspiratory respiratory dysfunction

64
Q
A

FRACP Shuyu (65 decks)

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