Forgotten things! Flashcards
Hep C treatment
If no cirrhosis, or pregnant - Maviret - “M for Mum”
Glecaprevir (protease inhibitor)
Pibrentasvir (NS5A inhibitor)
If cirrhotic - Epclusa “C for cirrhosis”
Velpatasvir (NS5a inhibitor)
Sofosbuvir (Nucleoside RNA polymerase inhibitors)
Hep B serology
Acute infection < 6 months
HBsAg +
HBcAb + IgM
HBsAb -
Chronic infection
HBsAG + > 6 months
HBcAB + IgG
HbsAB -
Resolved infection
HBsAg -
HBcAB+ IgG
HBsAB+ (marker of immunity!)
Vaccinated
HBsAg -
HBcAB -
HBsAB + (will wain over time, vaccination is titre at > 10 on ONE instance)
Susceptible
HBsAG -
HBcAB -
HBsAB -
MEN syndrome
Men 1 - Pituatory adenoma, parathyroid hyperplasia, pancreatic tumours - P’s!
Men 2a - Parathyroid hyperplasia, Medullary thyroid malignancies, pheochromocytoma - associated with RET gene gain of function mutation (loss of function Hirshsprung)
Men 2b - Mucosal neuromas, Marfans, Parathyroid Hyperplasia, Pheochromocytoma
Syphilis testing
Screening w trepenomal test;
- TP-EIA IgM and IgG serology
- TP-EIA will be confirmed in the lab against TPPA
Diagnosis w non-trepenomal tests
- RPR - Used to confirm diagnosis of new infection, old infection or re-infection
- VDRL - only used on CSF
Live Vaccines
MMR
Polio
Yellow fever - uses eggs, can cause hypersensitivity reaction (along with Q fever vaccine)
Varicella Zoster
Mb BCG
Typhoid
Tb treatment
Latent Tb (only treat immunocompromised, Health Care workers, Early infection or those < 35);
Isoniazid - 9 months, or
Rifampicin - 4 months, or
Isoniazid and Rifampicin -3 months
Active Tb
2 months - 4 drugs
Isoniazid + B6 if risk neuropathy
Rifampicin
Ethambutol
Pyrazinamide
followed by;
4 months - 2 drugs
Isoniazid w B6
Rifampicin
Tb Meningitis
Rx 12 months Rifampicin, Isoniazid w B6, Pyrazinamide and Moxifloxacin (better CNS penetration than Ethambutol)
HIV medications
Nucleotide reverse transcriptase inhibitors - stop RNA to DNA transcriptase via binding at deoxynucleotide binding site
Non-nucleotide reverse transcriptase inhibitors - stop RNA to DNA transcriptase by binding at an alternative site to the deoxynucleotide
Integrase inhibitors - stop viral replicated DNA being integrated with host DNA
Protease inhihbitors - stop budding and maturation of virus from host cells, main role is to inhibit CYP3A4 to increase efficiency of other HIV drugs
Mechanism of Anti-fungals
Azoles - inhibit D-14 alpha demethylase at CP450 to stop ergosterol synthesis at cell walls
Echinocandins - inhibit beta 1,3 D glucan to inhibit cell wall synthesis
Amphotericin (polyenes) - binds ergosterol to stop membrane function and create pores
Side effects of Tb Rx
Rifampicin - orange secretions and hepatitis
Isoniazid - Peripheral neuropathy and hepatitis
Ethambutol - Optic neuropathy
Pyrazinamide - Gout and hepatitis
Types of Lupus Nephritis
No Man Faces Diffuse Menstrual Situation
Normal - ACE/ARB
Mesengial - ACE/ARB
Focal - Methyl Pred induction -> Cyclophosphomide/MMF -> Ritux salvage
Diffuse - Methyl Pred induction -> Cyclophosphomide/MMF -> Ritux salvage
Membranous - Methyl Pred induction -> Cyclophosphomide/MMF -> Ritux salvage
Sclerosing - Dialysis
ANCA Vasculitis
- Granulomatosis with polyangitis (Wegners) - cANCA/PR3 - GN, Lung, Sinus, ENT
- Microscopic polyangitis - pANCA, MPO - GN and Lung
- Eosinophilic polyangitis Granulomatosis (Churg-Strauss) - pANCA - Asthma, Nasal polyps, atopy, GN
Types of GN
Nephrotic
- Membranous - Anti-PLA2R, ++ prothrombotic, associated with malignancy and SLE
- Minimal change - Podocyte effacement on Light microscopy, normal electron microscopy. Children and Elderly. Associated with thymoma, lymphoma
- FSGS - APOL1, < 50% sclerosis on electron microscopy
Nephritic
- IgA nephropathy
- Post-strep GN
- Membranoproliferative - Compliment activation. Type 1 - all compliment factors, Type 2 - only C3 (dense deposit disease, C3GN). Tram track appearance w subendothelial deposits
SLE - No Man Faces Diffuse Menstrual Situation
- Normal, Mesengial, Focal, Diffuse, Membranous, Sclerosing
ANCA GN
- pANCA - MPO - Microscopic polyangitis, Churgg Strauss/Eosinophilic
- cANCA - PR3 - Wegners/Granulomatous polyangitis
Anti-GBM - against alpha 3 Type 4 collagen, worsened by Alemtuzumab and Hydrocarbons
Dx Polycystic Kidney disease
PKD1 gene on Chromosome 16 - wrose prognosis, early ESRD
PKD2 gene on chromosome 4
If FHx
USS;
Total 3 cysts < 40
2 cysts each kidney 40 - 60
3 cysts each kidney > 60
If No FHX
> 10 cysts each kidney
On MRI;
If > 5 cysts < age 40
If no cysts on MRI by 18, diagnosis unlikely
Type 1 RTA
- Loss of H+ ATPase at collecting duct
- Increased retention H+ with metabolic acidosis
- Decreased Na+/H+ exchange, leading to overactivity of Na+/K+ exchange and hypoklaemia
- Hypercalcaemia as Ca drawn from bones to buffer H+, but consequence of reduced renal reabsorption calcium leading to Nephrocalcinosis
Electrolyte disturbances
- NAGMA
- Hypokalemia, urine pH > 5.5
- Hypercalcaemia
Rx with HCO3- which will increase urine pH and drive H+ excretion, reduces need for Na+/K+ exchange and decreasing hypokalaemia
Causes - Autoimmune conditions - Sjogrens, RA
Type 2 RTA
Decreased capacity to resorb HCO3- at proximal tubule resulting in increased K+ secretion at DCT as compensatory mechanism
Electrolyte disturbance
- Hypokalaemia - made worse with BiCarb Rx given ++ renal wasting
- Serum bicarb 12-20
- Lower urine pH
- Can occur with other defects including impaired resorption of phosphate, glucose, uric acid and amnio acids
Due to Fanconi’s syndrome, monoclonal gammopathies, Tenofovir