Formative 1 2020 Flashcards
What are the antibodies present in autoimmune hepatitis?
Type 1 (adults)
- ANA
- Anti-smooth muscle
- pANCA
Type 2 (kids)
- Anti-LKM1
Which antibodies are present in primary biliary cirrhosis?
Anti-mitochondrial, cANCA
What is the presentation of primary biliary cirrhosis?
- Female patient
- Jaundice
- Pruritis
- Xanthelasma
- Hepatosplenomegaly (if advanced)
What is the moa of Carbamazepine?
Anti-convulsant
Na+ channel inhibitor
What is the first step for someone presenting with suspected acute limb ischaemia?
Immediate IV unfractionated heparin, DO NOT delay treatment for investigations
What are the 6 Ps of acute limb ischaemia?
- Pale
- Pulseless
- Perishingly cold
- Paraesthesia
- Paralysis
- Pain
What is the management of actively bleeding peptic ulcer?
- Ensure the patient is haemodynamically stable
- Endoscopy
- IV PPI (some trusts use oral)
What is the management of actively bleeding variceal ulcer?
- Ensure the patient is haemodynamically stable
- Terlipressin or somatostatin analogue
- Broad spectrum antibiotic (ceftriaxone)
- Endoscopy with variceal band ligation
- Stent/ balloon tamponade
- Transjugular intrahepatic portosystemic shunt
What does a transjugular intrahepatic portosystemic shunt connect?
The hepatic portal vein with intrahepatic veins
What are the investigations for bladder cancer?
- Urinalysis to look for haematuria
- Urine cytoscopy- second voided preserved urine should be used
- Flexible cystoscopy
- Ultrasound kidneys, ureters, bladder for mets
- CT urogram
What is the most common complication of TURP?
Retrograde ejaculation
What are the investigations for pancreatic cancer?
- Pancreatic protocol CT
- Abdominal ultrasound
- LFTs
Why are LFTs done in suspected pancreatic cancer?
They can indicate the level of obstruction but can’t specify that it’s due to pancreatic cancer
What is cholestatic hepatitis?
Any form of liver disease that causes inflammation of the liver and issues with bile transport
Triad
- Pruritis
- Dark urine/ light stools
- Jaundice
What medications can lead to cholestatic hepatitis?
- Co-amoxiclav
- The -mycins
- The -floxacins
- The -itidines
- Phenytoin
Why can tuberculosis not be detected on gram-staining?
Because it has a high lipid content and therefore has to be detected via Ziehl-Neelsen staining
(Acid-fast bacillus)
When should anticoagulants be stopped preoperatively?
Anticoagulants should be stopped 2-4 days before surgery and commenced as soon as the surgery is over
When should antiplatelets be stopped preoperatively?
Antiplatelets should be stopped 5-7 days before surgery and commenced as soon as the surgery is over
What are the characteristics of neuropathic ulcers?
- Pressure loading sites
- Painless
- Risk factors of diabetes rather than cardiovascular
What is osteomalacia?
Softening of the bone in adults due to a lack of vitamin D, in children it is called Rickets
What is the difference between dihydropyridines and non-dihydropyridines?
Dihydropyridines (amlodipine) act primarily on the smooth muscles of the vasculature to encourage vasodilation
Non-dihydropyridines (verapamil) act primarily on the heart muscle to decrease strength of contraction and heart rate
Why are non-dihydropyridine calcium channel blockers contra-indicated in heart failure?
Because they can lead to bradycardia and reduced cardiac output which can lead to pulmonary effusion and increased breathlessness
Which drugs have a -sartan suffix?
Angiotensin II receptor blockers (ARBs)
What is the management of COPD?
What are the ECG changes for hyperkalaemia?
- Tented T waves
- Absent P waves
- Broad QRS complexes
What are the ECG changes for hypokalaemia?
- Flattened T waves
- U waves
- ST depression
What are the surgical management pathways of nephrolithiasis?
- <10mm that doesn’t pass with conservative management, show wave lithotripsy
- 10-20mm uretoscopy or show wave lithotripsy (uretoscopy more invasive)
- >20mm or staghorn stone percutaneous nephrolithotomy
What is the general management for atypical pneumonias?
Clarithromycin
What is the inheritance pattern of neurofibromatosis?
Autosomal dominant
Where does psoriasis tend to affect?
The extensor surfaces
Where does eczema tend to develop?
The flexor surfaces
Where does eczema tend to develop in kids?
The extensor surfaces
What is metaplasia?
Change in the cell type
What is dysplasia?
Change in the cell shape/ formation of abnormal cells
What is neoplasia?
Uncontrolled, abnormal growth of cells in tissues
What is granuloma annulare?
A hypersensitivity reaction with idiopathic origin
What is necrobiosis lipodica?
Usually associated with diabetes, it’s a disorder of collagen degeneration with a granulomatous response, thickening of blood vessels and fat deposition
What skin manifestation can indicate PCOS?
Acanthosis nigricans
What is De Quervain’s thyroiditis?
A viral infection of the thyroid that is characterised by a painful multinodular goitre and hyperthyroidism followed by hypothyroidism after viral induced cell death most commonly seen in women 20-50
How does infectious mononucleosis present?
- University student
- Splenomegaly (can’t play sport for 3-4 weeks)
- Bilateral grey exudate on the tonsils
What is the management of infectious mononucleosis?
Supportive + corticosteroids
If patients are given amoxicillin, they develop a widespread rash
How does a subphrenic abscess present?
- Fever (systemic symptoms)
- Costal margin tenderness
- Shoulder pain
- Dyspnea
- Upper quadrant pain
- Hiccoughs
What cancers is EBV a risk factor for?
Lymphona, particular Burkitt’s lymphoma
What is the most likely organism to cause encephalitis?
HSV1
What is a pilonidal sinus?
An abnormal sinus at the top of the natal cleft commonly due to friction causing folliculitis and the follicle extending into the subcutaneous tissue forming a sinus
How does a pilonidal sinus present?
Usually patient is afebrile and has noticed a tract/ bump/ pus at the top of their natal cleft
What is intertrigo?
Inflammation and rash of the areas of folded skin due to friction
Which murmur is Rheumatic fever associated with?
Mitral regurgitation (pan-systolic)
