General deck Flashcards

Question

what are the causes of type 1 membranoproliferazive glomerulonephritis?

Answer 1

Immunoglobulin (IG)-mediated membranoproliferative glomerulonephritis (type 1 MPGN) cryoglobulinaemia, hepatitis C Associated with SLE, monoclonal gammopathy

Answer 2

subendothelial and mesangium immune deposits of electron-dense material resulting in a 'tram-track' appearance

Answer 3

Complement-mediated membranoproliferative glomerulonephritis Associated with dense deposit disease (IgG antibodies that stabilize C3 convertase, i.e., C3 nephritic factor, cause a persistent complement activation, leading to a depletion of C3) causes: partial lipodystrophy (patients classically have a loss of subcutaneous tissue from their face), factor H deficiency

Answer 4

-Both associated with HBV, HCV, and cryoglobulinemia -Hereditary diseases (e.g., sickle cell disease, α1-antitrypsin deficiency) [13] -Drugs (e.g., heroin, α-interferon) -Tumors (e.g., lymphoma) -Autoimmune diseases (e.g., SLE)

Answer 5

- Intramembranous C3 deposits (dense deposit disease) on basement membrane - ↓ Serum C3 complement levels - C3b nephritic factor is found in 70% an antibody to alternative-pathway C3 convertase (C3bBb) stabilizes C3 convertase causes: partial lipodystrophy (patients classically have a loss of subcutaneous tissue from their face), factor H deficiency

Answer 6

Metformin should be considered in addition to insulin therapy for adults with type 1 diabetes if they have a BMI of 25 kg/m2 or above (23 kg/m2 or above for people from South Asian and related family backgrounds) This is because overweight and obese patients will also likely have a degree of insulin resistance.

Answer 7

In adults with type 1 diabetes, blood pressure targets are governed by urine albumin:creatinine ratio (ACR) as follows: - For adults with an ACR less than 70 mg/mmol, aim for a clinic systolic blood pressure less than 140 mmHg (target range 120 to 139 mmHg) and a clinic diastolic blood pressure less than 90 mmHg. - For adults with an ACR of 70 mg/mmol or more, aim for a clinic systolic blood pressure less than 130 mmHg (target range 120 to 129 mmHg) and a clinic diastolic blood pressure less than 80 mmHg.

Answer 8

spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids

Answer 9

Anakinra: IL-1 receptor antagonist used in the management of rheumatoid arthritis Canakinumab: monoclonal antibody targeted at IL-1 beta used systemic juvenile idiopathic arthritis and adult-onset Still's disease

Answer 10

binds to sodium channels increases their refractory period

Answer 11

P450 enzyme inducer dizziness and ataxia drowsiness headache visual disturbances (especially diplopia) Steven-Johnson syndrome leucopenia and agranulocytosis hyponatraemia secondary to syndrome of inappropriate ADH secretion

Answer 12

Autosomal dominant epistaxis: spontaneous, recurrent nosebleeds telangiectasies : lips, oral cavity, fingers and nose Visceral lesions: gastrointerinal telegeictasisa, pulmonary AVM

Answer 13

FABRY'C disease: F - foggy lens A - angiokeratomas B - burning pain R - renal failure Y - youth death C - CV malformation x- linked recessive deficiency of alpha-galactosidase A

Answer 14

A-drenaline -> cyclic A-mp Nitric oxide: cGmp AcetyLcholine: L-igand gated

Answer 15

severe valvular incompetence aortic abscess (often indicated by a lengthening PR interval) infections resistant to antibiotics/fungal infections cardiac failure refractory to standard medical treatment recurrent emboli after antibiotic therapy

Answer 16

R-CHOP which consists of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone

Answer 17

alkylating agent that promotes cross-linking of DNA.

Answer 18

Inhibition of microtubule formation is the mechanism of drugs

Answer 19

Inhibition of topoisomerase II and DNA/RNA synthesis

Answer 20

Haemorrhagic cystitis, myelosuppression, transitional cell carcinoma

Answer 21

Rapid plasma reagin test (RPR) or VDRL - non-treponema specific based upon the reactivity of serum from infected patients to a cardiolipin-cholesterol-lecithin antigen assesses the quantity of antibodies being produced becomes negative after treatment

Answer 22

pregnancy SLE, anti-phospholipid syndrome tuberculosis leprosy malaria HIV

Answer 23

signet ring cells may be seen in gastric cancer. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis

Answer 24

red man syndrome; occurs on rapid infusion of vancomycin

Answer 25

nephrotoxicity ototoxicity thrombophlebitis red man syndrome; occurs on rapid infusion of vancomycin

Answer 26

rapid onset high fever pleuritic chest pain herpes labialis (cold sores)

Answer 27

full blood count: microcytic anaemia. Blood film shows red cell abnormalities including basophilic stippling and clover-leaf morphology

Answer 28

Management - various chelating agents are currently used: dimercaptosuccinic acid (DMSA) D-penicillamine EDTA dimercaprol

Answer 29

Silicosis upper zone fibrosing lung disease

Answer 30

contraindicated in patients with bradycardia

Answer 31

Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis

Answer 32

Common causes anxiety leading to hyperventilation pulmonary embolism salicylate poisoning* CNS disorders: stroke, subarachnoid haemorrhage, encephalitis altitude pregnancy *salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis. Early stimulation of the respiratory centre leads to a respiratory alkalosis whilst later the direct acid effects of salicylates (combined with acute renal failure) may lead to an acidosis

Answer 33

idiopathic (most common) polyarteritis nodosa systemic lupus erythematosus cryoglobulinaemia antiphospholipid syndrome Ehlers-Danlos Syndrome homocystinuria

Answer 34

fever, malaise, arthralgia weight loss hypertension mononeuritis multiplex, sensorimotor polyneuropathy testicular pain livedo reticularis haematuria, renal failure perinuclear-antineutrophil cytoplasmic antibodies (ANCA) are found in around 20% of patients with 'classic' PAN hepatitis B serology positive in 30% of patients medium-sized arteries with necrotizing inflammation leading to aneurysm formation

Answer 35

amiodarone cytotoxic agents: busulphan, bleomycin anti-rheumatoid drugs: methotrexate, sulfasalazine nitrofurantoin ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)

Answer 36

allergy to aspirin or sulphonamides (cross-sensitivity) 5-aminosalicylic acid compounds (e.g. mesalazine and sulfasalazine) are a cornerstone of treating ulcerative colitis. However, patients who are allergic to aspirin may also react to 5-aminosalicylic acid compounds as they share structural similarity.

Answer 37

amiodarone isoniazid vincristine nitrofurantoin metronidazole

Answer 38

sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite 'poppers'), dapsone, sodium nitroprusside, primaquine

Answer 39

'chocolate' cyanosis dyspnoea, anxiety, headache severe: acidosis, arrhythmias, seizures, coma normal pO2 but decreased oxygen saturation

Answer 40

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

Answer 41

Cryptosporidium hominis Cryptosporidium parvum

Answer 42

stool: modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium

Answer 43

- is largely supportive for immunocompetent patients - if the patient has HIV and is not on antiretroviral therapy then this should be started and often will be enough to resolve the infection - nitazoxanide may be used for immunocompromised patients - rifaximin is also sometimes used for immunocompromised patients/patients with severe disease

Answer 44

high-dose benzylpenicillin or doxycycline

Answer 45

- serology: antibodies to Leptospira develop after about 7 days - PCR - culture 1. growth may take several weeks so limits usefulness in diagnosis 2. blood and CSF samples are generally positive for the first 10 days 3. urine cultures become positive during the second week of illness

Answer 46

spirochaete Leptospira interrogans (serogroup L. icterohaemorrhagiae)

Answer 47

The early phase is due to bacteraemia and lasts around a week: - may be mild or subclinical - fever - flu-like symptoms - subconjunctival suffusion (redness)/haemorrhage Second immune phase may lead to more severe disease (Weil's disease): - acute kidney injury (seen in 50% of patients) - hepatitis: jaundice, hepatomegaly - aseptic meningitis

Answer 48

Sulphonylureas e.g. gliclazide. Side effects include weight gain and hypoglycaemia. Gliptin's e.g. sitagliptin. Side effects include headaches, but are generally well tolerated. Thiazolidinedione e.g. pioglitazone. Side effects include fluid retention and weight gain. Sodium/glucose cotransporter 2 (SGLT-2) inhibitors e.g. canagliflozin. Side effects include urinary tract infections and increased risk of foot amputations (mainly with canagliflozin, but no evidence of a link with empagliflozin and dapagliflozin).

Answer 49

- previous diagnosis of asthma or atopy - a higher blood eosinophil count - substantial variation in FEV1 over time (at least 400 ml) - substantial diurnal variation in peak expiratory flow (at least 20%)

Answer 50

immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin

Answer 51

Mutations in the p53 gene result in a high risk of developing invasive cancer (about 50% by age 30 and 90% by age 70), particularly early-onset breast cancer, sarcoma, brain tumours (particularly glioblastoma), leukaemia and adrenocortical carcinoma.

Answer 52

STATIN: Steroids Thiazides Antipsychotics Tacrolimus/ciclosporin Interferon-alpha Nicotinic acid TASTINg Sugar( impared glucose tolerance) Thiazides, Antiphychotics, Steroids, T cell in inhibitors(tacrolimus |&| cyclosporin), interferon alpha, nicotinic acid. Sugar = impared glucose tolerance

Answer 53

impaired adduction of the eye on the same side as the lesion horizontal nystagmus of the abducting eye on the contralateral side

Answer 54

Hutchinson's sign: rash on the tip or side of the nose. Indicates nasociliary involvement and is a strong risk factor for ocular involvement

Answer 55

McArdle ........ M muscle C cramps After huRDLEs (after exercise) M= Muscle pain C=cramps Ar=autosomal recessive D=deficiency of myophosphorylase L=low lactate levels E=exercise related

Answer 56

prior antibiotic therapy Coxiella burnetii Bartonella Brucella HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)

Answer 57

> -1.0 = normal -1.0 to -2.5 = osteopaenia < -2.5 = osteoporosis

Answer 58

- hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency - x-linked recessive therefore only seen in boys - features: gout, renal failure, neurological deficits, learning difficulties, self-mutilatio

Answer 59

Allergies/ asthma: suffering from food/ environmental allergies or atopic dermatitis and asthma increases the risk of diagnosis Male sex Family history of eosinophilic oesophagitis or allergies Caucasian race Age between 30-50 Coexisting autoimmune disease e.g. coeliac disease

Answer 60

AV dissociation fusion or capture beats positive QRS concordance in chest leads marked left axis deviation history of IHD lack of response to adenosine or carotid sinus massage QRS > 160 ms

Answer 61

a nicotinic receptor partial agonist should be started 1 week before the patients target date to stop the recommended course of treatment is 12 weeks (but patients should be monitored regularly and treatment only continued if not smoking) has been shown in studies to be more effective than bupropion nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams varenicline should be used with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking varenicline contraindicated in pregnancy and breast feeding

Answer 62

viruses: herpes simplex virus (the most common cause), Orf* idiopathic bacteria: Mycoplasma, Streptococcus drugs: penicillin, sulphonamides, carbamazepine, allopurinol, NSAIDs, oral contraceptive pill, nevirapine connective tissue disease e.g. Systemic lupus erythematosus sarcoidosis malignancy

Answer 63

Bacillus anthracis, a Gram positive rod. Bacillus anthracis produces a tripartite protein toxin 1. protective antigen 2. oedema factor: a bacterial adenylate cyclase which increases cAMP 3. lethal factor: toxic to macrophages

Answer 64

the current Health Protection Agency advice for the initial management of cutaneous anthrax is ciprofloxacin

Answer 65

APC - adenomatous polyposis coli (APC) gene in Familial adenamotous polyposis HNPCC (Lynch syndrome), an autosomal dominant condition, is the most common form of inherited colon cancer. Around 90% of patients develop cancers, often of the proximal colon, which are usually poorly differentiated and highly aggressive. - MSH2 gene - HNPCC - MLH 1 gene - non-polyposis colorectal carcinoma (HNPCC)

Answer 66

The Amsterdam criteria are sometimes used to aid diagnosis: 1. at least 3 family members with colon cancer 2. the cases span at least two generations 3. at least one case diagnosed before the age of 50 years

Answer 67

The Amsterdam criteria are sometimes used to aid diagnosis: 1. at least 3 family members with colon cancer 2. the cases span at least two generations 3. at least one case diagnosed before the age of 50 years

Answer 68

Aortic dissection type A - ascending aorta - control BP (IV labetalol) + surgery surgical management, but blood pressure should be controlled to a target systolic of 100-120 mmHg whilst awaiting intervention type B - descending aorta - control BP(IV labetalol)

Answer 69

VWF disease - inherited bleeding disorder Activated protein C resitance - most common inherited thrombophilia

Answer 70

Primary: anti-PLA2R antibodies Secondary: -Infections (HBV, HCV, malaria, syphilis) - Autoimmune diseases (e.g., SLE) - Tumors (e.g., lung cancer, prostate cancer) - Medications (e.g., NSAIDs, penicillamine, gold)

Answer 71

membranous nephropathy - Biopsy would show subepithelial immune complex deposits Granular subepithelial deposits of IgG and C3 (dense deposits) → spike and dome appearance FSGS: Light microscopy: segmental sclerosis and hyalinosis

Answer 72

causes include idiopathic, rheumatoid arthritis, SLE, Sjogren's, amphotericin B toxicity, analgesic nephropathy complications include nephrocalcinosis and renal stones

Answer 73

type 1: inability to generate acid urine (secrete H+) in distal tubule The α-intercalated cells of the distal tubule are unable to secrete H+ (apical) → ↓ intracellular production of HCO3-; → ↓ HCO3-/Cl- exchanger activity (basolateral) → decreased concentration of HCO3- in the blood → metabolic acidosis causes hypokalaemia Type 2: decreased HCO3- reabsorption in proximal tubule The proximal convoluted tubule cells are unable to reabsorb HCO3- leading to increased HCO3- excretion in the urine. H+ secretion from α-intercalated cells in the collecting duct can acidify the urine, but cannot compensate for the excessive HCO3- excretion in the urine, thus resulting in distal tubular acidosis.

Answer 74

causes include idiopathic, as part of Fanconi syndrome, Wilson's disease, cystinosis, outdated tetracyclines, carbonic anhydrase inhibitors (acetazolamide, topiramate)

Answer 75

sulfonylureas - glimepiride and glipizide SSRIs, tricyclics carbamazepine vincristine cyclophosphamide

Answer 76

PEFR < 33% best or predicted Oxygen sats < 92% 'Normal' pC02 (4.6-6.0 kPa) Silent chest, cyanosis or feeble respiratory effort Bradycardia, dysrhythmia or hypotension Exhaustion, confusion or coma

Answer 77

Criteria for discharge been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12–24 hours inhaler technique checked and recorded PEF >75% of best or predicted

Answer 78

stop oral hypglycaemics and start on IV insulin - sliding scale Manage hyperglycaemia in patients admitted to hospital for an acute coronary syndrome (ACS) by keeping blood glucose levels below 11.0 mmol/litre while avoiding hypoglycaemia. In the first instance, consider a dose-adjusted insulin infusion with regular monitoring of blood glucose levels.'

Answer 79

HIV Parkinson's disease

Answer 80

ECG changes including ST elevation may be seen this may be secondary to either autonomic neural stimulation from the hypothalamus or elevated levels of circulating catecholamines

Answer 81

if CT head is done within 6 hours of symptom onset and is normal - new guidelines suggest not doing a lumbar puncture - consider an alternative diagnosis if CT head is done more than 6 hours after symptom onset and is normal do a lumber puncture (LP) timing wise the LP should be performed at least 12 hours

Answer 82

imaging may demonstrate the 'double duct' sign - the presence of simultaneous dilatation of the common bile and pancreatic ducts

Answer 83

Enterobius vermicularis (threadworms)

Answer 84

clarithromycin

Answer 85

doxycycline

Answer 86

divide by 10

Answer 87

Genital warts - 90% are caused by HPV 6 & 11

Answer 88

- if one parent is affected by familial hypercholesterolaemia, arrange testing in children by age 10 - if both parents are affected by familial hypercholesterolaemia, arrange testing in children by age 5

Answer 89

deficiency of UDP glucuronosyltransferase

Answer 90

gold quinine thiazides

Answer 91

ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation

Answer 92

Nitrates and nicorandil

Answer 93

common: gingival hyperplasia (secondary to increased expression of platelet derived growth factor, PDGF), hirsutism, coarsening of facial features, drowsiness megaloblastic anaemia (secondary to altered folate metabolism) peripheral neuropathy enhanced vitamin D metabolism causing osteomalacia lymphadenopathy dyskinesia

Answer 94

Mycoplasma pneumoniae promotes the production of IgM antibodies by the immune system, which bind to red blood cells, causing them to agglutinate with each other. The IgM antibodies are termed cold agglutinins because they are most effective in causing agglutination at lower temperatures.

Answer 95

- Cold agglutins - haemolytic anaemia - erythema multiforme, erythema nodosum - meningoencephalitis - bullous myringitis - pericarditis/myocarditis - gastrointestinal: hepatitis, pancreatitis - renal: acute glomerulonephritis

Answer 96

anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision. Features of severe poisoning include: arrhythmias seizures metabolic acidosis coma ECG changes include: sinus tachycardia widening of QRS prolongation of QT interval

Answer 97

Co-trimoxazole steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third) IV pentamidine in severe cases

Answer 98

QANADAH Quinine, abciximab, NSAIDs, Antibiotics.PRS.NOT QRS, Diuretics, Anticonvulsants..VC, Heparin antibiotics: penicillins, sulphonamides, rifampicin anticonvulsants: carbamazepine, valproate

Answer 99

- sacroiliitis: subchondral erosions, sclerosis - squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) - syndesmophytes: due to ossification of outer fibers of - annulus fibrosus chest x-ray: apical fibrosis

Answer 100

. Doxycycline is the preferred antibiotic as patients with Chlamydia are at higher risk of co-infection with Mycoplasma genitalium,

Answer 101

In liver failure all clotting factors are low, except for factor VIII which is paradoxically supra-normal. This is because factor VIII is synthesised in endothelial cells throughout the body, unlike the other clotting factors which are synthesised purely in hepatic endothelial cells. Furthermore, whilst activated factor VIII is usually rapidly cleared from the blood stream, good hepatic function is required for this to occur, further leading to increases in circulating factor VIII.

Answer 102

Statins should be discontinued in women 3 months before conception due to the risk of congenital defects

Answer 103

Kearns-Sayre syndrome: onset in patients < 20 years old, external ophthalmoplegia, retinitis pigmentosa. Ptosis may be seen can't see ya syndrome mitochondrial inheritance

Answer 104

high temperatures and humdity

Answer 105

cool compresses emollients topical steroids

Answer 106

PICA stroke cerebellar signs, contralateral sensory loss & ipsilateral Horner's

Answer 107

<20 weeks and not immune: VZIG as soon as possible >20 weeks and not immune: VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

Answer 108

To keep it simple: administer VZIG to : 1. Pregnant women <20 weeks with exposure and no varicella antibodies 2. Newborn with peripartum exposure ( 7 days around birth) Administer Acicloveir to: 1. Pregnant women who develop chickenpox 2. Pregnant women >20 weeks with exposure and no varicella antibodies 3.Immunocompromised who develop chickenpox 4. Immunocompromised with exposure to chockenpox

Answer 109

Turners syndrome is linked with crohn's and autoimmune thyroiditis

Answer 110

procollagen type I N-terminal propeptide (PINP) serum C-telopeptide (CTx) urinary N-telopeptide (NTx) urinary hydroxyproline

Answer 111

- compression bandaging - oral pentoxifylline - peripheral vasodilator

Answer 112

koilocytes - enalrged nucleus - irregular nuclear membrane contour - nucleus stains darker than normal (hyperchormoasia) - perinuclear halo

Answer 113

- target cells - howell-jolly bodies - pappenheimer bodies - siderotic granules - acanthocytes

Answer 114

Tropheryma whipplei - gram positive rod bacteria

Answer 115

abdominal pain, diarrhoea, steatorrhoea, migrating polyarthralgia, photosensitivity, skin hyperpigmentation, petechiae and peripheral oedema

Answer 116

It is diagnosed by demonstrating macrophages containing Periodic acid-Schiff (PAS) granules on jejunal biopsy

Answer 117

The hyperpigmentation is typically due to vitamin B3 malabsorption and subsequent deficiency.

Answer 118

Oral co-trimoxazole for a year is thought to have the lowest relapse rate, sometimes preceded by a course of IV penicillin

Answer 119

IV fluid resuscitation IV bisphosphonates may be used calcitonin - quicker effect than bisphosphonates

Answer 120

- 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) - café-au-lait spots* may be seen

Answer 121

Pneumonia + Alcoholic + Cavitation = Klebsiella Pneumonia + Prior Flu = Staph Pneumonia Pneumonia + Chicken Pox Rash = Varicella Pneumoniae Pneumonia + Hemolytic Anemia = Mycoplasma Pneumonia + Hyponatraemia + Travel History = Legionella Pneumonia + Fleeting opacities = Cryptogenic Pneumonia Pneumonia + Fits/LOC = Aspiration Pneumonia Pneumonia + HSV oral lesion = Strep Pneumonia Pneumonia + parrot = Chlamydia psitatssi Pneumonia + farm animals = Q fever (coxillea brunetii) Pneumonia + HIV = think pcp but if straight forward case strep pneumonia is still most common Pneumonia + Cystic fibrosis = consider pseudomonas/Burkholderia Pneumonia + COPD or exac = c1::Haemophilus Influenza Commonest cause of CAP = Strep Pneumonia

Answer 122

dengue virus is a RNA virus of the genus flavivirus transmitted by Aedes aegypti mosquito

Answer 123

Retro-orbital headache, fever, facial flushing, rash, thrombocytopenia in returning traveller → ?dengue myalgia, bone pain and arthralgia ('break-bone fever') facial flushing - dengue

Answer 124

abdominal pain hepatomegaly persistent vomiting clinical fluid accumulation (ascites, pleural effusion)

Answer 125

Form of disseminated intravascular coagulation (DIC) resulting in: - thrombocytopenia - spontaneous bleeding

Answer 126

- Raynaud's may be the first sign - scleroderma affects face and distal limbs predominately - associated with anti-centromere antibodies CREST - Calcinosis, Raynaud's phenomenon, oEsophageal dysmotility, Sclerodactyly, Telangiectasia

Answer 127

sceleroderma affects the trunk and proximal limb Anti-scl 70 antibodies most common cause of death - respiratory involvement - interstitial lung disease and pulmonary arterial hypertension

Answer 128

asthmatics - may induce bronchospams

Answer 129

- oligospermia - Stevens-Johnson syndrome - pneumonitis / lung fibrosis - myelosuppression, Heinz body anaemia, - - megaloblastic anaemia - may colour tears → stained contact lenses

Answer 130

Patients with orbital cellulitis require admission to hospital for IV antibiotics due to the risk of cavernous sinus thrombosis and intracranial spread

Answer 131

echocardiogram shows a degree of left ventricular impairment. It is important an ACE inhibitor is started in such patients. This will help to both control her blood pressure and also slow the deterioration in her cardiac function.

Answer 132

- bone marrow depression- consider a full blood count if infection/bleeding occurs - nausea/vomiting - pancreatitis - increased risk of non-melanoma skin cancer

Answer 133

A positive diagnosis of IBS should be made if the patient has abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms: 1. altered stool passage (straining, urgency, incomplete evacuation) 2. abdominal bloating (more common in women than men), distension, tension or hardness 3.symptoms made worse by eating 4. passage of mucus

Answer 134

Divided into 3 stages: Stage 1: symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness Stage 2: metabolic acidosis with high anion gap and high osmolar gap. Also tachycardia, hypertension Stage 3: acute kidney injury

Answer 135

fomepizole - inhibitor of alcohol dehydrogenase

Answer 136

- pseudoxanthoma elasticum - ehler - danlos syndrome - paget's disease - sickle cell anaemia - acromegaly

Answer 137

Churg-Strauss syndrome as evidenced by the asthma, mononeuritis and eosinophilia

Answer 138

Asymptomatic bacteriuria should not be treated except in pregnancy, children younger than 5 years or immunosuppressed patients due to the risk of complications

Answer 139

painful - HSV type 2, chancroid ( u/l painful inguinal l ) , Behcets painless - syphilis, LGV ( painful inguinal l )

Answer 140

Taenia solium - tapeworm Often transmitted after eating undercooked pork Treatment - bendazole

Answer 141

Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn Important for meLess important

Answer 142

Heerfordt syndrome Heerfordt's syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Answer 143

Consider glycopyrronium bromide to manage drooling of saliva in people with Parkinson's disease

Answer 144

- Disease duration > 10 years - Patients with pancolitis - Onset before 15 years old - Unremitting disease - Poor compliance to treatment

Answer 145

Alkaline phosphatase is normally raised in Paget’s disease but blood tests such as calcium, phosphate, vitamin D and parathyroid hormone are usually unaffected Other markers of bone turnover including hydroxyproline, which is raised in both the urine and serum, as well as procollagen type I N-terminal propeptide (PINP), C-telopeptide (CTx) and N-telopeptide (NTx).

Answer 146

Mechanical valves - target INR: aortic: 3.0 mitral: 3.5

Answer 147

- stage IIIb or IV (i.e. metastases present) - FEV1 < 1.5 litres is considered a general cut-off point* - malignant pleural effusion - tumour near hilum - vocal cord paralysis - SVC obstruction

Answer 148

P- Pseudolymphoma, pancytopenia, P450 interaction H-Hirsutism, Acne E-Enlarged gums N-Nystagmus-cerebellar syndrome Y-Yellow browning of skin T-teratogenic O-Osteomalacia I-Interference with folic acid absorption Idiosyncracy N-Neuropathies

Answer 149

Vomiting Alopecia Liver toxicity Pancreatitis/ Pancytopenia Retention of fats (weight gain) Oedema (peripheral oedema) Anorexia Tremor/teratogenicity Enzyme inhibition

Answer 150

secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230

Answer 151

there is stereotypically no mucosal involvement (i.e. the mouth is spared) in reality around 10-50% of patients have a degree of mucosal involvement. It would, however, be unusual for an exam question to mention mucosal involvement as it is seen as a classic differentiating feature between pemphigoid and pemphigus.

Answer 152

oral corticosteroids

Answer 153

if toxicity is suspected, digoxin concentrations should be measured within 8 to 12 hours of the last dose

Answer 154

1. hypokalaemia - digoxin binds to the ATPase pump on the same site as potassium. 2. increasing age 3. renal failure 4. mycocardial ischaemia 5. hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis hypoalbuminaemia hypothermia hypothyroidism

Answer 155

antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule

Answer 156

acantholysis on biopsy

Answer 157

Incubation period 1-6 hrs: Staphylococcus aureus, Bacillus cereus* 12-48 hrs: Salmonella, Escherichia coli 48-72 hrs: Shigella, Campylobacter > 7 days: Giardiasis, Amoebiasis *vomiting subtype, the diarrhoeal illness has an incubation period of 6-14 hours

Answer 158

lofflers syndromme presents with fever, cough and night sweats (TB) like picture with transient patches on CXR in a person with history of travel to tropics. A Self limiting disease.

Answer 159

- diuretics - thiazides, furosemide - ciclosporin - alcohol - cytotoxic agents - pyrazinamide - aspirin -

Answer 160

- skin necrosis following commencement fo warfarin when warfarin is first started biosynthesis of protein C is reduced. This results in a temporary procoagulant state after initially starting warfarin, normally avoided by concurrent heparin administration. Thrombosis may occur in venules leading to skin necrosis

Answer 161

1. treatment of underlying cancer 2. immunosuppression, for example with prednisolone and/or azathioprine 3. 3,4-diaminopyridine 4. intravenous immunoglobulin therapy and plasma exchange may be beneficial

Answer 162

schizonts on a blood film parasitaemia > 2% hypoglycaemia acidosis temperature > 39 °C severe anaemia

Answer 163

1. cerebral malaria: seizures, coma 2. acute renal failure: blackwater fever, secondary to 3. intravascular haemolysis, mechanism unknown 4. acute respiratory distress syndrome (ARDS) 5. hypoglycaemia 6. disseminated intravascular coagulation (DIC)

Answer 164

- Leads to a condition termed neonatal lupus erythematosus - strongly associated withanti-Ro (SSA) antibodies

Answer 165

Generally asymptomatic, flat, slightly scaly, pink or brown rash usually found in the groin or axillae. It is caused by an overgrowth of the diphtheroid Corynebacterium minutissimum

Answer 166

coral red fluorscence

Answer 167

topical miconazole or antibacterial

Answer 168

Erythrasma : found in the groin or axillae, pruritis is rare , coral-red fluorescence color Pityriasis versicolor : most commonly affects trunk ,mild Pruritis is common, pale yellow to white fluorescence color

Answer 169

infliximab (anti-TNF): used in rheumatoid arthritis and Crohn's rituximab (anti-CD20): used in non-Hodgkin's lymphoma and rheumatoid arthritis cetuximab (epidermal growth factor receptor antagonist): used in metastatic colorectal cancer and head and neck cancer trastuzumab (HER2/neu receptor antagonist): used in metastatic breast cancer alemtuzumab (anti-CD52): used in chronic lymphocytic leukaemia abciximab (glycoprotein IIb/IIIa receptor antagonist): prevention of ischaemic events in patients undergoing percutaneous coronary interventions OKT3 (anti-CD3): used to prevent organ rejection

Answer 170

ACE-inhibitors should be avoided in patients with HOCM. Agents that reduce preload/afterload (such as nitrate, ACE inhibitors, nifedipine-type calcium antagonists) are contraindicated with HOCM due to possible aggravation of the outflow tract obstruction.

Answer 171

Amiodarone Beta-blockers or verapamil for symptoms Cardioverter defibrillator Dual chamber pacemaker Endocarditis prophylaxis*

Answer 172

t(9;22) is associated with chronic myeloid leukaemia t(8;14) is associated with Burkitt lymphoma t(11;14) is associated with mantle cell lymphoma t(15;17) is associated with acute promyelocytic leukaemia t(14:18) - Follicular lymphoma

Answer 173

Liddle's syndrome Cushing's syndrome Conn's syndrome (primary hyperaldosteronism) 11-beta hydroxylase deficiency

Answer 174

> 7.0 mmol/l - impaired fasting glucose OGTT - >11.1 mmol/l

Answer 175

dopamine agonists - ropinirole, pramipexole

Answer 176

Donepezil can cause cardiac conduction issues, hallucination, dizziness. Amitrip can cause cardiac conduction issues (long QT), dizziness, sedation. Therefore the combination of the two is a recipe for disaster.

Answer 177

Tri-CyCliCs: Convulsions, Coma, Cardiotoxicity (arrhythmia due to Na+ channel inhibition)

Answer 178

Associated with low plasma levels of the C1 inhibitor (C1-INH, C1 esterase inhibitor) protein. C1-INH is a multifunctional serine protease inhibitor - the probable mechanism behind attacks is uncontrolled release of bradykinin resulting in oedema of tissues.

Answer 179

C1-INH level is low during an attack low C2 and C4 levels are seen, even between attacks. Serum C4 is the most reliable and widely used screening tool

Answer 180

IV C1 inhibitor concentrate , FFP Does not respond to adrenaline, antihistamines or glucocorticoids

Answer 181

anabolic steroid Danazol

Answer 182

Streptococcus bovis the subtype Streptococcus gallolyticus is most linked with colorectal cancer

Answer 183

In pregnancy, anyone already on levothyroxine treatment should increase their dose. Thyroid doses should be adjusted in steps of 25-50mcg. In pregnancy, the increase in thyroid replacement is typically 20-50%, which normally equates to 25mcg-50mcg increase.

Answer 184

The medial longitudinal fasciculus is located in the paramedian area of the midbrain and pons

Answer 185

Both TTP and HUS as common symptoms of MAT, MAT: M=Microangiopathi hemolytic anemia, A=Acute kidney injury T= Thrombocytopenia Now, When there is MAT + Fever + Neurological signs = TTP and MAT + bloody diarrhea = HUS

Answer 186

>= 2 attacks in 12 months tophi renal disease uric acid renal stones prophylaxis if on cytotoxics or diuretics

Answer 187

it has traditionally been taught that urate-lowering therapy should not be started until 2 weeks after an acute attack, as starting too early may precipitate a further attack. The evidence base to support this however looks weak

Answer 188

metformin may cause lactic acidosis if taken during a period where there is tissue hypoxia. -recent myocardial infarction - sepsis - acute kidney injury - severe dehydration

Answer 189

- switch patient to the equivalent dose of diazepam - reduce dose of diazepam every 2-3 weeks in steps of 2-2.5 mg - time needed for withdrawal can vary from 4 weeks to a year or more

Answer 190

Propylthiouracil is used in the first trimester of pregnancy in place of carbimazole, as the latter drug may be associated with an increased risk of congenital abnormalities. At the beginning of the second trimester, the woman should be switched back to carbimazole

Answer 191

- Excessive exposure to sunlight / psoralen UVA therapy - Actinic keratoses and Bowen's disease - Immunosuppression e.g. following renal transplant, HIV - smoking - long-standing leg ulcers (Marjolin's ulcer) - genetic conditions e.g. xeroderma pigmentosum, oculocutaneous albinism

Answer 192

- inhibits phosphodiesterase, elevating platelet cAMP levels which in turn reduce intracellular calcium levels - other actions include reducing cellular uptake of adenosine and inhibition of thromboxane synthase

Answer 193

Increase in the levels of thyroxine-binding globulin (TBG). This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level.

Answer 194

Increase in the levels of thyroxine-binding globulin (TBG). This causes an increase in the levels of total thyroxine but does not affect the free thyroxine level.

Answer 195

drugs: minoxidil, ciclosporin, diazoxide congenital hypertrichosis lanuginosa, congenital hypertrichosis terminalis porphyria cutanea tarda anorexia nervosa

Answer 196

Phaeochromocytoma is associated with 1,2,3 NF-1, MEN 2, VHL (chromosome 3)

Answer 197

neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism. Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent

Answer 198

An acquired disorder leading to haemolysis (mainly intravascular) of haematological cells. It is thought to be caused by increased sensitivity of cell membranes to complement due to a lack of glycoprotein glycosyl-phosphatidylinositol GPI can be thought of as an anchor which attaches surface proteins to the cell membrane complement-regulating surface proteins, e.g. decay-accelerating factor (DAF), are not properly bound to the cell membrane due a lack of GPI thrombosis is thought to be caused by a lack of CD59 on platelet membranes predisposing to platelet aggregation

Answer 199

Flow cytometry of blood to detect low levels of CD59 and CD55

Answer 200

aspirin penicillins NSAIDs opiates

Answer 201

- blood product replacement - anticoagulation - eculizumab, a monoclonal antibody directed against terminal protein C5, is currently being trialled and is showing promise in reducing intravascular haemolysis - stem cell transplantation

Answer 202

supportive therapy

Answer 203

HSMN type 1 : demyelinating pathology HSMN type 2 : axonal pathology

Answer 204

defect in PMP-22 gene (encodes for myelin) motor symptoms predominate distal muscle wasting, pes cavus, clawed toes foot drop, leg weakness often first features

Answer 205

C1q, C1rs, C2, C4 deficiency predisposes to immune complex disease

Answer 206

drug reaction with eosinophilia and systemic symptoms morbilliform skin rash - 80% of cases - exfoliative dermatitis, high fever and inflammation Vesicles and bullae Erythroderma mucosal involvement facial swelling

Answer 207

Allopurinol, Anti-epileptics Antibiotics Immunosuppresants HIV treatment NSAIDS

Answer 208

sulfasalazine and hydroxychloroquine are considered safe in pregnancy

Answer 209

A rare autosomal recessive disease caused by a deficiency of cystathionine beta synthase. This results in severe elevations in plasma and urine homocysteine concentrations.

Answer 210

1. increased homocysteine levels in serum and urine 2. cyanide-nitroprusside test: also positive in cystinuria

Answer 211

- have fine, fair hair - MSK - marfoanoid features, osteoporosis, kyphosis - neurological - learning difficulities, seizures - ocular - downward dislocation of the lens, severe myopia - increased risk of arterial and venous thromboembolism

Answer 212

B6 - pyridoxine

Answer 213

head, arm, trunk = central lesion: stroke, syringomyelia just face = pre-ganglionic lesion: Pancoast's, cervical rib absent = post-ganglionic lesion: carotid artery

Answer 214

- urinary histamine - raised serum tryptase levels

Answer 215

Abdo pain, flushing and diarrhoea may be similar however, the urticaria pigmentosa - Darier's sign is unique to systemic mastocystosis

Answer 216

haemochromatosis hyperparathyroidism low magnesium, low phosphate acromegaly, Wilson's disease

Answer 217

- coagulse-negative staphylococci - staph. epidermidis

Answer 218

the BNF recommends vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid OR vancomycin added to dialysis fluid + ciprofloxacin by mouth aminoglycosides are sometimes used to cover the Gram negative organisms instead of ceftazidime

Answer 219

OS primum- LBBB= when in Primary school, you are LEFT alone by your parents OS secundum- RBBB= when in Secondary school, you take the RIGHT path to success

Answer 220

nitazoxanide may be used for immunocompromised patients rifaximin is also sometimes used for immunocompromised patients/patients with severe disease

Answer 221

- metoclopramide, domperidone - phenothiazines - haloperidol very rare: SSRIs, opioids

Answer 222

Polycythaemia rubra vera - around 5-15% progress to myelofibrosis or AML

Answer 223

1. MTX 2. Ethambutol 3. ergot-DA agonists eg bromocriptine, cabergoline, pergolide 4. Sulfasalazine 5. Bleomycin/Busulphan 6. Amiodarone 7. Nitrofurantoin

Answer 224

Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural' - exceptions: Gilbert's, hyperlipidaemia type II

Answer 225

HOP Hypomagnesaemia Ototoxicity peripheral neuropathy

Answer 226

1- pseudogout: chondrocalcinosis 2- gout: larg punched out erosions in x-ray (tophi), double contour sign on US 3- Psoriatic arthritis: Erosive changes and new bone formation Periostitis Pencil in cup appearances 4- Ankylosing spondylitis: Syndismocytes formation Subchondoral erosions Sclerosis Squiring of vertebra Romanus leasion Bamboo spine 5- Rheumatoid arthritis: Soft tissue swelling Subchondoral osteoporosis Joint space narrowing Subluxation and Ankylosis 6- Osteoarthritis: Joint space narrowing Osteophytes Subchondoral cyst 7- Paget's disease: Lytic and sclerotic lesions on skul e.g. 8- Rickets: Winding of wrist joint Cupping, fraying and ...... Widening of epiphysis 9- osteopetrosis: Bone on bone lesions 10- Osteomalacia: Translucent bands (looser's zones or pseudofracture)

Answer 227

CATCH22: C - Cardiac abnormalities A - Abnormal facies T - Thymic aplasia C - Cleft palate H - Hypocalcaemia/ hypoparathyroidism 22 - Caused by chromosome 22 deletion

Answer 228

T-cell deficiency and dysfunction. at risk of viral and fungal infections parathyroid gland hypoplasia → hypocalcaemic tetany thymus hypoplasia T-lymphocyte deficiency/dysfunction

Answer 229

severe tonsillitis, neck swelling (lymphadenopathy - bull's neck) Sequelae include myocarditis and rhythm abnormalities (in particular heart block)

Answer 230

Management is often difficult, but often involves a low-fat diet and the introduction of bile acid sequestrants, such as Cholestyramine, to bind the excess bile acids and thus preventing lower gastrointestinal signs.

Answer 231

POSTCARDS: pyelonephritis, obstruction of the urogenital tract sickle cell disease tuberculosis, cirrhosis of the liver analgesia/alcohol abuse, renal vein thrombosis diabetes mellitus, systemic vasculitis.

Answer 232

CI in epilepsy, pregnancy and breast feeding

Answer 233

CAT MUDPILES C- carbon monoxide, cyanide, CHD A - Aminoglycosides T - Theophylline M- methanol U- Uraemia D - Dibetic, alcohol and starvation ketoacidosis P - paracetamol, I - Iron, isoniazid, inborn errors of metabolism L - lactic acidosis E - ethanol, ethlene glycol S - salicylate

Answer 234

Type I (25%): monoclonal - IgG or IgM associations: multiple myeloma, Waldenstrom macroglobulinaemia Type II (25%) mixed monoclonal and polyclonal: usually with rheumatoid factor associations: hepatitis C, rheumatoid arthritis, Sjogren's, lymphoma Type III (50%) polyclonal: usually with rheumatoid factor associations: rheumatoid arthritis, Sjogren's

Answer 235

HLA-B*5801 allele testing is the most appropriate next step in management. risk factors include diuretic use, ethnicity (Thai descent), and chronic kidney disease

Answer 236

Primaquine is used in non-falciparum malaria to destroy liver hypnozoites and prevent relapse

Answer 237

peripheral neuropathy

Answer 238

inflammation extending beyond limiting plate 'piecemeal necrosis', bridging necrosis

Answer 239

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

Answer 240

idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis 'RAID'- rheumatological conditions, asbestos exposure, idiopathic and drug-induced.

Answer 241

hypoxanthine-guanine phosphoribosyl transferase (HGPRTase) deficiency x-linked recessive therefore only seen in boys features: gout, renal failure, neurological deficits, learning difficulties, self-mutilation

Answer 242

vasoactive mediators cause splanchnic vasodilation which in turn reduces the systemic vascular resistance. This results in 'underfilling' of the kidneys. This is sensed by the juxtaglomerular apparatus which then activates the renin-angiotensin-aldosterone system, causing renal vasoconstriction which is not enough to counterbalance the effects of the splanchnic vasodilation

Answer 243

- paracentesis: neutrophil count > 250 cells/ul - the most common organism found on ascitic fluid culture is E. coli

Answer 244

IV cefotaxime

Answer 245

- patients who have had an episode of SBP - patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome - NICE recommend: 'Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved'

Answer 246

'B' symptoms also imply a poor prognosis weight loss > 10% in last 6 months fever > 38ºC night sweats

Answer 247

- acute onset (within 1 week of a known risk factor) - pulmonary oedema: bilateral infiltrates on chest x-ray ('not fully explained by effusions, lobar/lung collapse or nodules) - non-cardiogenic (pulmonary artery wedge pressure needed if doubt) - pO2/FiO2 < 40kPa (300 mmHg)

Answer 248

Calcification of the triangular fibrocartilage suggests chondrocalcinosis

Answer 249

Anyone with pO2 < 7.3kPa pO2 7.3-8kPA: - secondary polycythemia - peripheral oedema - pulmonary hypertension

Answer 250

if troublesome clonazepam may be used

Answer 251

NODOSUM NO: NO causes in 80% of cases D : Drugs (sulfonamides; amoxicillin) O : Oral contraceptive pills S : Sarcoidosis/ Tuberculosis U : Ulcerative colitis; Crohn's disease; Behcet disease M: Micro Viral : HSV; EBV; Hep B; Hep C Bacterial: campylobacter; salmonella; streptococci; Brucellosis Parasite : Amoebiasis; Giardiasis

Answer 252

In pregnancy, there is an increase in thyroid-binding globulin (TBG), an increase in urinary iodine excretion and deiodinase activity of the placenta which increase thyroid hormone metabolism.

Answer 253

- muscle pain and stiffness following exercise - muscle cramps - myoglobinuria - low lactate levels during exercise

Answer 254

with risk factors (T2DM, BP etc): > 35 kg/m^2 no risk factors: > 40 kg/m^2

Answer 255

Tropica = Topical Braziliensis = Buccal Dono-V-ani = Visceral

Answer 256

aortic stenosis and angiodysplasia resulting in chronic gastrointestinal blood loss

Answer 257

microscopic collitis

Answer 258

The classic triad of symptoms are oral ulcers, genital ulcers and anterior uveitis

Answer 259

Corneum Lucidum Granulosum Spinosum Basale (germinativum) come lets get sun burnt

Answer 260

Liddle's syndrome is a rare autosomal dominant condition that causes hypertension and hypokalaemic alkalosis. It is thought to be caused by disordered sodium channels in the distal tubules leading to increased reabsorption of sodium. Treatment is with either amiloride or triamterene

Answer 261

post-streptococcal glomerulonephritis subacute bacterial endocarditis systemic lupus erythematosus mesangiocapillary glomerulonephritis

Answer 262

1. COPD with respiratory acidosis pH 7.25-7.35 - the BTS guidelines state that NIV can be used in patients who are more acidotic (i.e. pH < 7.25) but that a greater degree of monitoring is required (e.g. HDU) and a lower threshold for intubation and ventilation should be used 2. type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea 3. cardiogenic pulmonary oedema unresponsive to CPAP 4. weaning from tracheal intubation

Answer 263

P. knowlesi has the shortest erythrocytic replication cycle, leading to high parasite counts in short periods of time

Answer 264

Riedel's thyroiditis previous radiotherapy sarcoidosis inflammatory abdominal aortic aneurysm drugs: methysergide

Answer 265

Blackwater fever is a rare complication of malaria which can be fatal. It is caused by large intravascular haemolysis resulting in haemoglobinuria, anaemia, jaundice and acute kidney injury. Urine is classically black or dark red in colour.The cause of the massive haemolysis is unknown. The treatment is with antimalarials, intravenous fluids and in some cases dialysis. Urinalysis reveals blood which is not seen on microscopy as it is haemoglobinuria. Schistosomiasis has an acute onset which includes symptoms of fever, chills, headache and fatigue but symptoms of haematuria do not come till the chronic phase as a result of bladder fibrosis and calcification, this presents more insidiously. In addition, in schistosomiasis, urine microscopy would show red cell casts.

Answer 266

The treatment for latent tuberculosis is 3 months of isoniazid (with pyridoxine) and rifampicin OR 6 months of isoniazid (with pyridoxine)

Answer 267

INR > 1.3 Platelet count < 75 Pulmonary bullae Pleural adhesions

Answer 268

procainamide hydralazine isoniazid minocycline phenytoin SHIMP Sulphonamides Hydralazine (renal involvement) Isoniazid Phenytoin, Penicillin, Procainamide

Answer 269

NADH methaemoglobinaemia reductase deficiency: ascorbic acid IV methylthioninium chloride (methylene blue) if acquired

Answer 270

Peutz-Jeghers syndrome is an autosomal dominant condition characterised by numerous hamartomatous polyps in the gastrointestinal tract pigmented lesions on lips, oral mucosa, face, palms and soles

Answer 271

age > 55 years hypocalcaemia hyperglycaemia hypoxia neutrophilia elevated LDH and AST

Answer 272

doxycycline and streptomycin

Answer 273

sacroiliitis - spinal tenderness complications - osetomyelitis, infective endocarditis, orchitis

Answer 274

BLAST Barbiturate Lithium Alcohol (inc methanol, ethylene glycol) Salicylates Theophyllines (charcoal haemoperfusion is preferable)

Answer 275

acute hepatitis: fever, jaundice amenorrhoea ANA/SMA/LKM1 antibodies, raised IgG levels

Answer 276

liver biopsy: inflammation extending beyond limiting plate 'piecemeal necrosis', bridging necrosis

Answer 277

Burkholderia pseudomallei distributed environmental saprophyte in soil and fresh surface water in endemic regions

Answer 278

Diabetes mellitus (the strongest risk factor) Chronic renal, liver, or lung disease (e.g., cystic fibrosis) Immunocompromised states (e.g., malignancy, long-term glucocorticoid use) Occupational exposure: agricultural work

Answer 279

Initial intensive therapy: IV ceftazidime, imipenem, or meropenem for 10–14 days eradication therapy: oral TMP/SMX (plus doxycycline) for 3–6 months

Answer 280

rifampicin, dapsone and clofazimine

Answer 281

radiofrequency ablation of the tricuspid valve isthmus

Answer 282

amoxicillin + ciprofloxacin + metronidazole

Answer 283

Nucleoside analogue reverse transcriptase inhibitors (NRTI) - tenofivir, abacavir , 'ines' - zidovudine... Non-nucleoside reverse transcriptase inhibitors - NNRTI - nevirapine, efavirenz Protease inhibitors - virs integrase inhibitors - raltegravir, elvitegravir, dolutegravir

Answer 284

Visceral leishmaniasis Leishmania donovani grey skin - 'kala-azar' means black sickness pancytopaenia secondary to hypersplenism the gold standard for diagnosis is bone marrow or splenic aspirate Textbooks Links DermNet NZ71 Leishmaniasis review Royal College of Physicians42 2011 Leishmaniasis review Report broken link Media YouTube What is Leishmaniasis? An introduction and overview Let's Learn About Bugs - YouTube97

Answer 285

1. Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage. 2. The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage. 3. Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage

Answer 286

uric acid > 475umol/l or 25% increase potassium > 6 mmol/l or 25% increase phosphate > 1.125mmol/l or 25% increase calcium < 1.75mmol/l or 25% decrease

Answer 287

vancomycin (or teicoplanin) + ceftazidime added to dialysis fluid OR vancomycin added to dialysis fluid + ciprofloxacin by mouth

Answer 288

FAB L3 type T or B cell surface markers Philadelphia translocation, t(9;22) age < 2 years or > 10 years male sex CNS involvement high initial WBC (e.g. > 100 * 109/l) non-Caucasian

Answer 289

PCSK9-mediated LDL receptor degradation.

Answer 290

B cell disorders of 1o immunodeficiency = 'Sh*tty B Cells' 1. Selective IgA deficiency 2. Brutons 3. CVID Combined B&T cell disorders = 'WASH your Bs and Ts' 1. Wiskott-Aldrich syndrome 2. Ataxic Telangiectasia 3. SCID 4. Hyper IgG syndromes T cell disorder = Di George

Answer 291

1 - Black patches (AN)- Gastric CA 2 - Woody and hot red skin (AI and dermatomyositis) - Lymphoma 3 - Hairy skin (AHL) - Lung and ovary CA 4 - complex design/pattern skin (EGR) - Lung CA 5 - Multiple VTE (MT) - Pancreatic CA 6 - Gangrene and sweet syndrome (PG) - Haem malignancies 7 - Hard dark yellow skin (Tylosis) - Esophegeal CA 8 - Generalised/migratory erythema (NME) - Glucagonoma

Answer 292

The lack of abdominal pain, rectal bleeding or extra-intestinal manifestations make a diagnosis of ulcerative colitis or Crohn's disease less likely. . The history of proton-pump inhibitor use associated with the development of watery diarrhoea, suggests microscopic colitis.

Answer 293

Anaplastic thyroid cancer is rare (1-2% of thyroid cancers). - can cause compression symptoms Mucosa-associated lymphoid tissue (MALT) lymphoma is correct. Although this is a rare form of thyroid lymphoma it is associated with a previous history of Hashimoto's thyroiditis and histology shows extranodal marginal B-cells.

Answer 294

high or normal

Answer 295

1st trimester - propylthiouracil 2nd trimester - carbimazole

Answer 296

seen in Giant cell arteritis occlusion of the posterior ciliary artery (a branch of the ophthalmic artery) → ischaemia of the optic nerve head. Fundoscopy typically shows a swollen pale disc and blurred margins

Answer 297

classically disseminated intravascular coagulation + AML blood picture

Answer 298

Antidopaminergic agents (e.g. Haloperidol) are the mainstay of treatment

Answer 299

Combined HIV antibody/antigen tests are now the first-line test for HIV screening of asymptomatic individuals or patients with signs and symptoms of chronic infection

Answer 300

most people develop antibodies to HIV at 4-6 weeks but 99% do by 3 months

Answer 301

CADASIL = migraine + multiple strokes MELAS = lactic acidosis + multiple strokes mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS)

Answer 302

Serotonin and noradrenaline reuptake inhibitors

Answer 303

joint space and juxta-articular osteopaenia.

Answer 304

lymphocytic CSF with high protein and low glucose in this case could be due to both cryptococcal and TB meningitis, however the insidious onset of symptoms, very high protein and low glucose compared to the plasma glucose (<1/3 of plasma) points more towards TB meningitis. Also this man has a relatively high CD4 count (240) and only a mildly raised opening pressure which makes cryptococcal meningitis more unlikely. TB and HIV co-infection are common, especially in sub-Saharan Africa and should always be considered.

Answer 305

topical steroid cream oral antimalarials may be used second-line e.g. hydroxychloroquine

Answer 306

dyspnoea - due to the impaired clearance of adenosine

Answer 307

Ticagrelor is contraindicated in patients with a: 1. high risk of bleeding, those with a history of intracranial haemorrhage, 2. and those with severe hepatic dysfunction. It is also to be used with caution in those with acute asthma or COPD, as ticagrelor-treated patients experience higher rates of dyspnoea.

Answer 308

Creatine kinase (CK-MB) remains elevated for 3 to 4 days following infarction. Troponin remains elevated for 10 days. This makes CK-MB useful for detecting re-infarction in the window of 4 to 10 days after the initial insult

Answer 309

Anthrax or Rickettsia

Answer 310

hyperkalaemia hyperphosphataemia hypocalcaemia hyperuricaemia acute renal failure

Answer 311

pyrexia abdominal pain (due to peritonitis) pleurisy pericarditis arthritis erysipeloid rash on lower limbs

Answer 312

ustekinumab (targets both IL-12 and IL-23) and secukinumab (targets IL-17) apremilast: phosphodiesterase type-4 (PDE4) inhibitor → suppression of pro-inflammatory mediator synthesis and promotion of anti-inflammatory mediators

Answer 313

hypopigmented skin lesions nerve thickening peripheral nerve palsies

Answer 314

Low degree of cell mediated immunity → lepromatous leprosy ('multibacillary') extensive skin involvement symmetrical nerve involvement High degree of cell mediated immunity → tuberculoid leprosy ('paucibacillary') limited skin disease asymmetric nerve involvement → hypesthesia hair loss

Answer 315

rifampicin, dapsone and clofazimine

Answer 316

high-dose benzylpenicillin or doxycycline

Answer 317

doxycycline and streptomycin

Answer 318

intravenous cefotaxime

Answer 319

1st line - anti acetylcholinesterase - donepezil, galantaine or rivastigmine 2nd line - memantine (NMDA antagonist)

Answer 320

- oral metronidazole - lumnial agent - diloxanide furoate

Answer 321

prior antibiotic therapy Coxiella burnetii Bartonella Brucella HACEK: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella

Answer 322

ciprofloxacin

Answer 323

- Steroids - Hyperthyroidism, hyperparathyroidism, hypercalciuria - Alcohol and tobacco - Thin (BMI < 18.5) - Testosterone deficiency - Early menopause - Renal or liver failure - Erosive/inflammatory diseases (e.g. myeloma, RA) - Dietary Ca deficiency/malabsorption, DM type 1

Answer 324

PUNCH Parenchymal lung involvement Uveitis Neuro involvement Cardio involvement Hypercalcaemia

Answer 325

Sarcoidosis mainly causes hypercalcaemia through forming increased concentrations of calcitriol, the active component of vitamin D. This is as a result of increased activity of 1α hydroxylase produced by the sarcoid macrophages.

Answer 326

Hypothermia features: Jesus, Its Bloody Freezing J wave Irregular pattern (long QT interval, atrial and ventricular arrhythmias) Bradycardia First degree and higher heart blocks

Answer 327

1. beta blocker - IV propanolol 2. anti-thyroid drugs - methimazole or propylthiouracil 3. Lugol's iodine 4. dexamethasone - blocks conversion of T4 - T3

Answer 328

Argyll Robertson pupils are bilateral small pupils that reduce in size on a near object (i.e., they accommodate), but do not constrict when exposed to bright light (i.e., they do not react to light). (ARP=accommodation reflex present), in DM, syphilis Holmes-Adie syndrome, is a rare neurological disorder affecting the pupil of the eye. In most patients the pupil is larger than normal (dilated) Absent or poor tendon reflexes

Answer 329

P3 LGBtQ P3--Procainamide/penicillamine/phenytoin L -lithium G- gentamicin B- beta blockers Q - quinidine

Answer 330

iron deficiency anaemia, dysphagia due to esophageal webs, and atrophic glossitis

Answer 331

BCG MMR oral polio yellow fever oral typhoid

Answer 332

penicillin sulphonamides lamotrigine, carbamazepine, phenytoin allopurinol NSAIDs oral contraceptive pill

Answer 333

AA amyloid A for precursor serum amyloid A protein, an acute phase reactant seen in chronic infection/inflammation e.g. TB, bronchiectasis, rheumatoid arthritis features: renal involvement most common feature