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General Flashcards

1
Q

Causes of drug induced photosensitivity

A

thiazides
tetracyclines, sulphonamides, ciprofloxacin
amiodarone
NSAIDs e.g. piroxicam
psoralens
sulphonylureas

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2
Q

Organophosphate poisoning

A

Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
also: small pupils, muscle fasciculation

Management - atropine (unclear benefit of pralidoxime)

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3
Q

Bactericidal abx

A

penicillins
cephalosporins
aminoglycosides
nitrofurantoin
metronidazole
quinolones
rifampicin
isoniazid

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4
Q

Bacteristatic abx

A

penicillins
cephalosporins
aminoglycosides
nitrofurantoin
metronidazole
quinolones
rifampicin
isoniazid

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5
Q

Mechanism of kidney injury by Gentamicin

A

Acute tubular necrosis

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6
Q

Tuberous Scelrosis

A

Autosomal dominant
Majority features are neurocutaneous

Cutaneous features:
depigmented ‘ash-leaf’ spots which fluoresce under UV light
roughened patches of skin over lumbar spine (Shagreen patches)
adenoma sebaceum (angiofibromas): butterfly distribution over nose
fibromata beneath nails (subungual fibromata)
(cafe-au-lait spots - more assocciated with neurofibromatosis)

Neurological features:
developmental delay
epilepsy (infantile spasms or partial)
intellectual impairment

retinal hamartomas: dense white areas on retina (phakomata)
rhabdomyomas of the heart
gliomatous changes can occur in the brain lesions
polycystic kidneys, renal angiomyolipomata
lymphangioleiomyomatosis: multiple lung cysts

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7
Q

P53 mutation (Li Fraumeni syndrome) Criteria need all 3

A

A sarcoma diagnosed before age 45

A first-degree relative, meaning a parent, sibling or child, with any cancer before age 45

A first-degree relative or second-degree relative, meaning a grandparent, aunt/uncle, niece/nephew, or grandchild, with any cancer before age 45 or a sarcoma at any age.

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8
Q

In subacute combined cord degeneration - which tracts are affected

A

Dorsal columns and lateral corticospinal tracts

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9
Q

Spinothalamic tracts

A

Pain, temperature, coarse touch and pressure sensations

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10
Q

Ventral horns of the spinal cord

A

motor neurones for skeletal muscles

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11
Q

CHARTS acronym for upper zone fibrosis

A

C - Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis

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12
Q

Extra renal features of ADPKD

A

liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly

berry aneurysms (8%): rupture can cause subarachnoid haemorrhage

cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection

cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary

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13
Q

How to differentiate Gout vs Pseudo gout?

A

Pseudogout may see - Presence of articular cartilage calcification on X-ray, (chondrocalcinosis)

Pseudgout - positively birefringent calcium pyrophosphate crystals

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14
Q

Early Xray changes RA

A

PLOSS
periarticular erosionsloss of joint space
juxta-articular osteoporosis
soft-tissue swelling
subluxation

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15
Q

Barters Syndrome

A

Inherited cause of hypokalaemia (recessive)

Defective chloride absorption at the Na+ K+ 2Cl- cotransporter (NKCC2) in the ascending loop of Henle

Not associated with hypertension

Would be same as if took tonnes of loop diuretics

Clinical features:
usually presents in childhood, e.g. Failure to thrive
polyuria, polydipsia
hypokalaemia
normotension
weakness

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16
Q

Ascites neutrophil cut off for SBP

A

250 cells/ul

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17
Q

Psoriasis exacerbating factors

A

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Streptococcal infection may trigger guttate psoriasis.

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18
Q

Relative risk

A

Ratio of an event in the experiment group, known as the experience event rate (EER), to the event in the control group known as the control event rate (CER) .

RR = EER/CER

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19
Q

Erythema nodosum causes

A

infection
streptococci
tuberculosis
brucellosis
systemic disease
sarcoidosis

inflammatory bowel disease
Behcet’s
malignancy/lymphoma

drugs
penicillins
sulphonamides
combined oral contraceptive pill
pregnancy

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20
Q

Acromegaly

A

Excessive GH secondary to pituitary adenoma

Features:
coarse facial appearance, spade-like hands, increase in shoe size
large tongue, prognathism, interdental spaces
excessive sweating and oily skin: caused by sweat gland hypertrophy
features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
raised prolactin in 1/3 of cases → galactorrhoea
6% of patients have MEN-1

Complications:
hypertension
diabetes (>10%)
cardiomyopathy
colorectal cancer

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21
Q

Which is the most common chromosome affected in ADPKD?

A

85% of cases are chromosome 16

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22
Q

Anion gap

A

(Na + K) - (Cl + HCO3)

Normal is 10-18 mmol/L.

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23
Q

Causes NAGMA

A

Addison’s
Bicarbonate loss: GI (e.g. diarrhoea) or renal (e.g. renal tubular acidosis)
Chloride excess
Diuretics (e.g. acetazolamide)

ABCD

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24
Q

Gastrin

A

G cells stomach

Increases stomach acid production
Increases Gastric motility

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25
CCK
I cells in small intestine Secretion enzyme rich fluid from pancreas Satiety
26
Secretin
S cells in upper small intestine Bicarb rich fluid from pancreas/hepatic cells
27
VIP
S cells in small intestine/Pancreas Stimulates secretion by pancreas/small intestin
28
Somatostatin
D cells in the pancreas & stomach Stimulates gastric mucous production Decreases most other things
29
Most common thyroid Ca
Papillary Follicular Medullary Anaplastic Lymphoma - rare - hashimotos
30
Gingival hyperplasia - med causes
phenytoin ciclosporin calcium channel blockers AML
31
Lateral medullary syndrome
Also called Wallenberg's syndrome Cerebellar features ataxia nystagmus Brainstem features ipsilateral: dysphagia, facial numbness, cranial nerve palsy e.g. Horner's contralateral: limb sensory loss Posterior inferior cerebellar artery
32
NF1 and NF2 associated chromasomes
NF1: chromosome 17 - as neurofibromatosis has 17 characters NF2: chromosome 22 - all the 2's
33
Upper zone fibrosis causes
Coal workers pneumoconiosis Hypersensitivity pneumonitis, histiocytosis Ankylosing spondylitis Radiation Tuberculosis Silicosis, sarcoidosis
34
Lower zone fibrosis causes
Causes of lower zone pulmonary fibrosis: Most connective tissue diseases (e.g. rheumatoid arthritis) Asbestosis Idiopathic pulmonary fibrosis Drugs (e.g. methotrexate)
35
Chlamydia psittaci treatment
Tetracycline eg doxy
36
Fanconi syndrome
generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule resulting in: type 2 (proximal) renal tubular acidosis polyuria aminoaciduria glycosuria phosphaturia osteomalacia Causes: cystinosis (most common cause in children) Sjogren's syndrome multiple myeloma nephrotic syndrome Wilson's disease
37
Homocystenuria
Autosomal recessive - deficiency of cystathionine beta synthase. This results in severe elevations in plasma and urine homocysteine concentrations. - fine fair hair - marfans features - learning disabilities - dislocation of lens - increased clot risk Measure urine levels homocysteine Cyanide-nitroprusside test: also positive in cystinuria Treatment is B6 - pyridoxine
38
Brugada Syndrome
Pathophysiology a large number of variants exist around 20-40% of cases are caused by a mutation in the SCN5A gene which encodes the myocardial sodium ion channel protein ECG changes convex ST segment elevation > 2mm in > 1 of V1-V3 followed by a negative T wave partial right bundle branch block the ECG changes may be more apparent following the administration of flecainide or ajmaline - this is the investigation of choice in suspected cases of Brugada syndrome
39
Side effects Sulfasalazine
GI upset headache agranulocytosis pancreatitis interstitial nephritis Infertility (rare)
40
Pregnant GDM patients glucose aim
Pregnant women with GDM should be advised to maintain their CBGs below the following target levels: fasting: 5.6mmol/L AND 1 hour postprandial: 7.8 mmol/L or 2 hours postprandial: 6.4 mmol/L If not meeting targets on diet/exercise/metformin for insulin
41
What is Ebstein abnormality?
Ebstein's anomaly → tricuspid regurgitation → pansystolic murmur, worse on inspiration Lithium in preg RHF on clinical exam
42
McArdles disease
Mike mcardle Autosomal recessive - type V glycogen storage issue Cramps, get better with exercise 'second wind' Dark urine - rhabdomyolysis and myoglobinurea
43
Common shin lesions (4)
Erythema nodosum symmetrical, erythematous, tender, nodules which heal without scarring most common causes are streptococcal infections, sarcoidosis, inflammatory bowel disease and drugs (penicillins, sulphonamides, oral contraceptive pill) Pretibial myxoedema symmetrical, erythematous lesions seen in Graves' disease shiny, orange peel skin Pyoderma gangrenosum initially small red papule later deep, red, necrotic ulcers with a violaceous border idiopathic in 50%, may also be seen in inflammatory bowel disease, connective tissue disorders and myeloproliferative disorders Necrobiosis lipoidica diabeticorum shiny, painless areas of yellow/red skin typically on the shin of diabetics often associated with telangiectasia
44
Gitelmans Syndrome
Gitelman's syndrome is due to a defect in the thiazide-sensitive Na+ Cl- transporter in the distal convoluted tubule. Features normotension hypokalaemia hypocalciuria hypomagnesaemia metabolic alkalosis No faltering growth like Bartter's
45
MOI (Monoamine oxidase inhibitors) and food hypertensive reactions
tyramine containing foods e.g. cheese, pickled herring, Bovril, Oxo, Marmite, broad beans
46
What surface cell protein is found on reed sternberg cells?
CD15 is found on Reed-Sternberg cells
47
Mechanism of action aspirin
decreases the formation of thromboxane A2 resulting in decreased platelet aggregation
48
Pityriasis rosea
Self limiting rash herald patch HHV 7
49
Thymoma
Most common cancer of the anterior mediastinum. Usually detected 60s/70s Associated with myasthenia gravis (30-40% of patients with thymoma) red cell aplasia dermatomyositis also : SLE, SIADH Causes of death compression of airway cardiac tamponade
50
What malignancy is Hashimoto's related to?
MALT Lymphoma
51
Second heart sound
loud: hypertension soft: AS fixed split: ASD reversed split: LBBB
52
NF2
The '2' syndrome: 2 sides accustic neuroma---> NFM 2 --> 22 chromosome
53
NF1
chromosome 17
54
Pulsus Paradoxus
greater than the normal (10 mmHg) fall in systolic blood pressure during inspiration → faint or absent pulse in inspiration severe asthma, cardiac tamponade
55
Slow-rising/plateau Pulse
AS
56
Collapsing pulse
aortic regurgitation patent ductus arteriosus hyperkinetic states (anaemia, thyrotoxic, fever, exercise/pregnancy)
57
Pulsus alternans
regular alternation of the force of the arterial pulse severe LVF
58
Bisferiens pulse
'double pulse' - two systolic peaks mixed aortic valve disease
59
'Jerky' pulse
hypertrophic obstructive cardiomyopathy
60
Best SSRI post MI
Sertraline
61
MMF mechanism of action
inhibits of inosine-5'-monophosphate dehydrogenase which is needed for purine synthesis
62
63
Kenner phenomenon conditions
Vitiligo Lichen plans Lichen sclerosis Molluscum contangiosun Warts Psoriasis
64
Most common organism COPD exec
h.influenzae
65
FAT RN for TTP
Fever Anaemia Thrombocytopenia Renal injury Neuro type symptoms - confusion
66
4 Radiological Stages of Sarcoid
Stage 1 BHL Stage 2 BHL +infiltrates Stage 3 infiltrates Stage 4 fibrosis
67
4 Radiological Stages of Sarcoid
Stage 1 BHL Stage 2 BHL +infiltrates Stage 3 infiltrates Stage 4 fibrosis
68
Gene for FAP
APC gene
69

MRCP (3 decks)

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