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1
Q

ACR values and when to refer

A

3 or more is significant
if 3-70, repeat test

refer:
- ACR 70 or more
- ACR 30 or more with persistent haematuria and no UTI
- ACR 3-29 with persistent haematuria and risk factors e.g. declining eGFR, CVD

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2
Q

managing proteinuria in CKD

A
  • ACEi if ACR > 30 and HTN
  • ACEi if ACR > 70 regardless of BP
  • SGLT2i
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3
Q

causes of diffuse proliferative glomerulonephritis

A

post strep
SLE

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4
Q

ECG territories

A

V1-V4: anteroseptal, LAD
II, III, aVF: inferior, R coronary
V1-V6, I, aVL: anterolateral, prox LAD
I, aVL: lateral, left cx
V1-V3: posterior, L cx, RCA

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5
Q

causes of metabolic acidosis

A

normal anion gap:
GI bicarb loss
RTA
acetazolamide, ammonium chloride
addison’s

raised anion gap:
lactate (shock, sepsis, hypoxia, metformin)
ketones (DKA, alcohol)
urate (renal failure)
acid poisoning (salicylates, methanol)

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6
Q

types of renal tubular acidosis

A

1 (distal):
- inability to secrete H+
- hypokalaemia, nephrocalcinosis
- RA, CLE, sjogrens, toxicity

2 (prox):
- reduced bicarb reabsorption in PCT
- hypokalaemia, osteomalacia
- fanconi, wilsons, carbonic anhydrase inhib

3 (mixed):
- carbonic anhydrase deficiency, hypokalaemia
- rare

4 (hyperkalaemic):
- reduced aldosterone, reduced PCT ammonia excretion
- hypoaldosteronism, diabetes

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7
Q

Multiple Endocrine Neoplasia

A

1: 3Ps
parathyroid, pituitary, pancreas
adrenal and thyroid
MEN1 gene

2a: 2Ps
parathyroid, phaeochromocytoma
medullary thyroid ca
RET oncogone

MEN 2b: 1P
phaeochromocytoma
marfinoid, neuromas, medullary thyroid
RET oncogene

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8
Q

causes of drug induced lupus

A

hydralazine
isoniazid
procainamide
minocycline
phenytoin

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9
Q

managing steroid induced osteporosis

A

offer bone protection if > 65y or fragility #
DEXA if < 65y

T between 0 and -1.5: repeat DEXA in 1-3y
T < - 1.5: offer bone protection

alendronate, calcium + vit D

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10
Q

causes of erythema multiforme

A

HSV, Orf
idiopathic
mycoplasma, strep
penicillin, sulfonamides, carbamazepine, allopurinol, NSAIDs, OCP, nevirapine
SLE, sarcoid, malignancy

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11
Q

gaucher’s disease features

A

defective glucocerebrosidase
most common lipid storage disorder
hepatosplenomegaly, aseptic necrosis of femur

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12
Q

tay sachs features

A

defective hexosaminidase A
accumulation of GM2 ganglioside within lysosomes
developmental delay, cherry red spot on macula
normal sized liver and spleen

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13
Q

niemann pick features

A

defective sphingomyelinase
hepatosplenomegaly, cherry red spot on macula

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14
Q

krabbes disease features

A

defective galactocerebrosidase
peripheral neuropathy, optic atrophy, globoid cells

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15
Q

fabry disease features

A

peripheral neuropathy (burning sensation)
angiokeratomas, lens opacities
proteinuria
x linked recessive

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16
Q

neurofibromatosis vs tuberous sclerosis

A

NF: iris hamartomas (lisch nodules), phaeochromocytoma
TS: retinal hamartomas, developmental problems, renal angiomyolipomata

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17
Q

webers syndrome

A

stroke from branches of posterior cerebral artery supplying midbrain
ipsi CNIII palsy
contralateral upper and lower weakness

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18
Q

diagnostic thresholds for gestational diabetes

A

fasting glucose 5.6 or more
2h glucose 7.8 or more

target fasting glucose: 5.3

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19
Q

MODY inheritance

A

Autosomal dominant

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20
Q

wernicke and korsakoff syndrome are a result of damage to what areas of brain?

A

medial thalamus and mamillary bodies of hypothalamus

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21
Q

what drugs may exacerbate myaesthenia gravis?

A

penicillamine
quinidine, procainamide
beta blockers
lithium
phenytoin
gent, macrolides, quinolones, tetracyclines

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22
Q

site of lesion causing bitemporal hemianopia

A

upper quadrant defect: pituitary
lower quadrant defect: craniopharnygioma

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23
Q

demyelinating vs axonal peripheral neuropathies

A

axonal:
alcohol, DM, vasculitis, HSMN type 2, B12 def (may also be demyelinating)

demyelinating:
GBS, HSMN type 1, paraprotein neuropathy, amiodarone, chronic inflam demyelinating polyneuropathy

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24
Q

examples of G protein coupled receptors

A

generally slow transmission, metabolic processes

Gs (stimulates adenylate cyclase to increase cAMP): beta1, beta2, H2, D1, V2, ACTH, LH, FSH, PTH, PGs

Gi (inhibits adenylate cyclase to decrease cAMP): M2, alpha2, D2, GABAB

Gq (activates phospholipase C): alpha1, H1, V1, M1, M3

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25
Q

examples of ligand gated ion channel receptors

A

generally fast responses
nicotinic acetylcholine, GABAA, GABAC, glutamate

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26
Q

RAAS and where the hormones are secreted from

A

adrenal cortex GFR ACD
zona Glomerulosa: Aldosterone, mineralocorticoids
zona Fasciculata: Cortisol, glucocorticoids
zona Reticularis: androgrens, DHEA

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27
Q

nucleolus vs ribosome vs nucleus

A

nucleus: DNA maintenance, RNA transcription, RNA splicing
ribosome: RNA translation > proteins
nucleolus: ribosome production

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28
Q

T helper 1 vs T helper 2 cells

A

Th1: cell mediated response and type IV hypersensitivity, secrete IFN gamma, IL2, IL3

Th2: antibody (humoral) immunity e.g. IgE in asthma, secrete IL4, IL5, IL6, IL10, IL13

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29
Q

how to calculate standard error of the mean

A

standard deviation/sq root of n

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30
Q

causes of drug induced thrombocytopenia

A

quinine
abciximab
furosemide
penicillins, sulfonamides, rifampicin
carbamazepine, valproate
NSAIDs, heparin
linezolid

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31
Q

lyme disease management

A

doxy (amox if c/i e.g. pregnant)
ceftriaxone if disseminated

32
Q

what drugs can cause toxic epidermal necrolysis?

A

phenytoin, carbamazepine
sulfonamides
allopurinol
penicillins
NSAIDs

33
Q

chloramphenicol mechanism

A

binds to 50S > inhibits peptidyl transferase

34
Q

mechanism of macrolides

A

binds to 50S > inhibits translocation

35
Q

causes of autoimmune haemolytic anaemia

A

warm: SLE, lymphoma, CLL, methyldopa
cold: lymphoma, mycoplasma, EBV

36
Q

diagnosing paroxysmal nocturnal haemolysis

A

flow cytometry- low levels of CD59, CD55
mx: anticoag, eculizumab, stem cell

37
Q

leukaemioid reaction

A

caused by severe infection, haemolysis, haemorrhage or metastatic cancer with marrow infiltration
> immature cells pushed out into circulation

high ALP
toxic granulation (dohle bodies) in white cells
left shift of neutrophils

38
Q

membranoproliferative

A

type1: cryoglobulinaemia, hepC
type 2: partial lipodystrophy

39
Q

CLL treatment

A

FCR
fludarabine + cyclophosphamide + rituximab

40
Q

apremilast

A

PDE4 inhibitor
(reduces hydrolysis of cAMP)
used for psoriatic arthropathy

41
Q

criteria for starting statin in T1DM

A

over 40y or
diabetes > 10y or
established nephropathy or
other CVD risk factors

42
Q

management of multifocal atrial tachycardia

A

correct hypoxia and electrolytes
rate limiting CCB

43
Q

mechanism of thiazide diuretics

A

block NaCl symptorter
> inhibit Na reabsorption at beginning of DCT
increased delivery of sodium to distal DCT

44
Q

conditions associated w/ pseudogout

A

haemochromatosis
acromegaly
wilsons
hyperPTH
low Mg, low PO4

45
Q

codeine to morphine

A

divide by 10

46
Q

tramadol to morphine

A

divide by 10

47
Q

morphine to oxycodone

A

divide by 1.5 to 2

48
Q

PO morphine to SC diamorphine

A

divide by 3

49
Q

parts of JVP waveform

A

A- atrial contraction (large in TS, PS, pHTN; absent in AF)
cannon A- complete HB, VT, V ectopics, nodal rhythm, single chamber pacing

C- tricuspid closure
V- passive filling against closed tricuspid. (giant in TR)
X descent- fall in atrial pressure during ventricular systole
Y descent- opening of tricuspid valve

50
Q

dipyridamole mechanism

A

non specific phosphodiesterase inhibitor
decreases cellular uptake of adenosine

51
Q

which part of nephron is impermeable to water?

A

ascending limb of Henle

52
Q

inducing remission in UC

A

mild/mod: rectal aminosalicylate > add PO aminosalicylate > add corticosteroid

extensive disease: rectal aminosalicylate + PO aminosalicylate > PO aminosalicylate + PO steroid

severe colitis: IV steroids or ciclosporin

53
Q

maintaining remission in UC

A

mild/mod: topical aminosalicylate
mild/mod extensive or left sided: PO aminosalicylate
severe or 2 exacerbations last year: PO azathioprine or mercaptopurine

54
Q

inducing and maintaining remission in crohn’s

A

glucocorticoids
5 ASA drugs second line
azathioprine/mercaptopurine/MTX add ons
infliximab
metronidazole for isolated perianal disease

maintaining: azathioprine/mercaptopurine 1st line, MTX second line

55
Q

rapidly progressive glomerulonephritis

A

AKA crescenteric
causes: Goodpastures, ANCA vasculitis

56
Q

membranoproliferative glomerulonephritis

A

AKA mesangiocapillary
presents as mixed nephrotic/nephritic
1: cryoglobulinaemia, hep C
2: partial lipodystrophy

57
Q

glucose and protein in CSF in meningitis

A

protein:
high in bacterial/TB and fungal
normal/high in viral

glucose:
< 1/2 plasma in bacterial/TB
60-80% plasma in viral. lower in HSV and mumps

58
Q

amiodarone induced thyrotoxicosis

A

type 1: goitre present, excess iodine. mx w/ carbimazole or percholate

type 2: destructive. no goitre. mx w/ steroids

stop amiodarone in both types

59
Q

addisons investigations

A

ACTH stimulation test
hyperK, hypoNa, metabolic acidosis

60
Q

cushing’s investigations

A

dexa suppression test
24h urinary cortisol x2
hypoK metabolic alkalosis

61
Q

drugs that can exacerbate MG

A

penicillamine
procainamide, quinidine
beta blockers
aminoglycosides, macrolides, quinolones, tetracylines
phenytoin
lithium

62
Q

ciclosporin and tacrolimus mechanism

A

inhibit calcineurin in T cells
> decrease IL2

63
Q

mycophenolate mofetil mechanism

A

inhibits inosine monophosphate dehydrogenase

64
Q

cutanea larva migrans mx

A

thiabendazole

65
Q

PRV may progress into what?

A

AML or myelofibrosis

66
Q

tetanus management

A

immunoglobulin + metronidazole IV

67
Q

leprosy management

A

rifampicin + dapsone + clofazimine
12 months

68
Q

sarcoidosis indications for steroids

A

CXR stage 2/3 disease and symptomatic
hypercalcaemia
eye/heart/neuro involvement

69
Q

TB management

A

active TB:
2 months RIPE then 4 months R+I

latent TB:
3 months RIP or 6 months IP

70
Q

features of MS

A

mid-late diastolic murmur
loud S1
low volume pulse
opening snap if leaflets are still mobile
longer murmur if more severe
AF from left atrial enlargement

71
Q

causes of diabetes insipidus

A

nephrogenic:
ADH receptor or aquaporin 2 channel defects
hypercalcaemia
hypokalaemia
lithium
demeclocycline
tubulointerstitial disease (obstruction, sickle cell, pyelonephritis)

cranial:
head injury, pituitary surgery, craniopharyngiomas
histiocytosis X, sarcoidosis
DIDMOAD
haemochromatosis

72
Q

causes of membranous GN

A

hep B, malaria, syphilis
malignancy
gold, penicillamine
SLE, RA, AI thyroiditis

73
Q

drugs to avoid in HOCM

A

nitrates
ACEi
inotropes

74
Q

argyll robertson pupil

A

small bilaterally
accommodates but doesn’t react to light
may occur in syphilis, wernickes

75
Q

adie’s tonic pupil

A

80% unilateral
dilated
once constricted it remains small for a long time
slowly reactive to accommodation but poorly reactive to light
holmes adie syndrome includes absent knee/ankle reflexes

76
Q

causes of horners syndrome

A

central (anhidrosis of face, arm, trunk):
stroke, syringomyelia, MS, tumour, encephalitis

preganglionic (anhidrosis of face): pancoast tumour, thyroidectomy, trauma, cervical rib

post ganglionic (no anhidrosis):
carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis, cluster headache

77
Q

drugs working on nuclear receptors

A

prednisolone
thyroxine

must be lipid soluble

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