General deck Flashcards
1
Q
what are the types of trigeminal autonomic cephalgia?
A
- cluster headache
- paroxysmal hemicrania
- hemicrania continua
- short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT syndrome)
- short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA)
2
Q
What is the initial tx for acute flare of UC?
A
1.) Intravenous fluid and electrolyte replacement
2.) Blood transfusion if required to maintain a haemoglobin >10g/dL
3.) Intravenous antibiotics ONLY if infection is considered or prior to surgery
4.) Subcutaneous heparin to reduce the risk of thromboembolism
5.) Intravenous corticosteroids (either hydrocortisone 100mg four times a day or methylprednisolone 60mg/day)
6.) Flexible sigmoidoscopy and biopsy within 72 hours to confirm diagnosis and exclude cytomegalovirus infection
7.) Daily monitoring with physical examination, recording of vital signs, stool chart, bloods (full blood count, c-reactive protein, serum electrolytes, serum albumin, liver function tests and glucose) and consider the need for daily abdominal X-ray.
3
Q
What is the predictor for need of surgery in UC?
A
At day three a c-reactive protein >45 mg/l or a stool frequency of >8/day predicts the need for surgery in 85% of cases.
4
Q
what is the tx of acute UC flare which has not responded to 72 hrs of IV steroids?
A
The National Institute for Clinical Excellence (NICE) recommends that if no improvement is seen after 72 hours of intravenous steroid treatment or if the patient deteriorates at any time despite corticosteroid treatment then an urgent surgical review is required ciclosporin (2mg/kg/day) should be added. NICE recommends that in this acute setting infliximab reserved for patients in whom ciclosporin is contraindicated or clinically inappropriate
5
Q
How are patients within 24 hours of onset of TIA or minor ischaemic stroke and with a low risk of bleeding managed?
A
clopidogrel (initial dose 300 mg followed by 75 mg od) + aspirin (initial dose 300 mg followed by 75 mg od for 21 days) followed by monotherapy with clopidogrel 75 mg od
6
Q
what are the causes of pulmonary eosinophilia?
A
Churg-Strauss syndrome
allergic bronchopulmonary aspergillosis (ABPA)
Loffler’s syndrome
eosinophilic pneumonia
hypereosinophilic syndrome
tropical pulmonary eosinophilia
drugs: nitrofurantoin, sulphonamides
less common: Wegener’s granulomatosis
7
Q
what are special findings on pleural fluid and its associated diagnosis?
A
low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis
8
Q
In T2Dm, what do you aim for Hba1c with just metformin and when do you add a second drug?
A
you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)
9
Q
how do you convert percentage Hba1c to mmol?
A
11(HbA1c %)-24 = (HbA1c mmol/mol)
10
Q
what are the CYP450 inducers and inhibitors?
A
CRAP GPS induce
Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
SICKFACES.COM inhibit
Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice
11
Q
how is cocaine toxicity managed?
A
benzodiazepines are generally first-line
12
Q
what drugs should be avoided in cocaine toxocity?
A
Beta-blockers should be avoided in cocaine-induced chest pain. The rationale is that beta-antagonism may result in unopposed alpha-mediated coronary vasospasm.
13
Q
what are the rare causes of pappiloedema
A
Rare causes include
hypoparathyroidism and hypocalcaemia
vitamin A toxicity
14
Q
what are factors that increase the risk of haemoptysis in goodpastures disease?
A
smoking
lower respiratory tract infection
pulmonary oedema
inhalation of hydrocarbons
young males
15
Q
what lung nodules spotted on CT scans do not need any further follow up?
A
Solitary, solid and non-calcified lung nodules of less than 5mm in size do not warrant further investigations or monitoring
16
Q
which lung nodules need follow up? and how do you follow up??
A
Nodule <5mm –> discharge
Nodule 5-6mm –> CT at 1 year
Nodule >6mm –> CT at 3 months
Nodule >8mm and/or high risk features (as per Brock model) –> Urgent CT PET +/- biopsy (if PET shows high uptake)
17
Q
what medication is used for executive and visuospatial dysfunction on a background of PD?
A
rivastigmine
18
Q
what are some acquired causes of Methaemoglobinaemia?
A
drugs: sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes
19
Q
How do you differentiate barter syndrome to gitelman’s syndrome?
A
Bartter’s syndrome presents early in life, with classical features of triangular facies, polyuria, polydipsia and renal failure. Serum renin and aldosterone levels are high despite a low or normal blood pressure. Urine calcium may be raised, and renal stones are a common feature.
In Gitelman’s syndrome patients may present later on in adulthood, but have a milder disease course or may be asymptomatic compared to patients with Bartter’s syndrome. Hypomagnesaemia and hypocalciuria differentiates Gitelman’s syndrome from Bartter’s syndrome.
20
Q
what are the causes of Hypokalaemia with acidosis
A
diarrhoea
renal tubular acidosis
acetazolamide
partially treated diabetic ketoacidosis
21
Q
what are the causes of Hypokalaemia with alkalosis
A
vomiting
thiazide and loop diuretics
Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
22
Q
what do you see on biopsy in polymyositis vs dermatomyosistis vs inclusion body myosistis?
A
- Endomysial CD8 positive T-cell mediated lymphocytic infiltrates that invade nonnecrotic muscle fibres = polymyositis
- Perimysial inflammation by CD4 positive T-lymphocytes and parafascicular atrophy = dermatomyositis
- Inflammatory infiltrates and inclusions within muscle fibres = inclusion body myositis
23
Q
what is the kings college criteria for liver transplant?
A
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
24
Q
What is macrophage activation syndrome?
A
Macrophage activation syndrome is a rare disorder that is associated with rheumatological conditions such as juvenile idiopathic arthritis, rheumatoid arthritis or systemic lupus erythematosus. It commonly presents with a pancytopenia and intercurrent infection - particularly EBV - and is usually initially treated as neutropaenic sepsis.
Left untreated, the disease is often fatal after two months.
Diagnosis: bone marrow aspiration can reveal haemophagocytosis as the key feature.
Other features: excessive hyperferritinemia, elevated triglycerides, deranged LFTs, and hypofibrinogenemia.
Treatment: immunosuppression.
25
What drug interacts with azathioprine and enhances its toxicity?
Allopurinol enhances the effects and increases the toxicity of azathioprine
Allopurinol enhances the effects and increases the toxicity of azathioprine.
one should reduce the dose of azathioprine to one-quarter of usual dose
Because of our natural genetic variability, some healthy people will just naturally have a deficiency of TPMT (around three in a thousand). Such people are at a significant risk of developing severe, potentially life-threatening, bone marrow toxicity when treated with conventional doses of azathioprine.
26
Treatment used to induce remission in crohn's disease?
Steroids
Steroids + enteral feeding with elemental diet (especially in young children)
2nd line - 5-ASAs (mesalazine)
3rd line - add on azathioprine/ mercaptopurine/ methotrexate
4th line - infliximab - for refractory disease and fistulating crohns
metronidazole - isolated perianal disease
27
Treatment for maintaing remission in crohn's disease?
Stop smoking
1st line - azathioprine or mercatptopurine
2nd line - methotrexate
28
what tests need to be done before starting ergot derived dopaminde receptor agonists in
echocardiogram, ESR, creatinine and chest x-ray
29
what are the causes of hypernatraemia?
dehydration
osmotic diuresis e.g. hyperosmolar non-ketotic diabetic coma
diabetes insipidus
excess IV saline
30
what is the soft tissue complication that you can develop with chicken pox infections?
necrotising fasciitis
A common complication is secondary bacterial infection of the lesions
NSAIDs may increase this risk
whilst this commonly may manifest as a single infected lesion/small area of cellulitis, in a small number of patients invasive group A streptococcal soft tissue infections may occur resulting in necrotizing fasciitis
31
Multifocal motor neuropathy with conduction block vs motor neuron disease??
Multifocal motor neuropathy with conduction block (MMN-CB) is an acquired immune-mediated demyelinating neuropathy.
pure motor peripheral neuropathy with multifocal areas of demyelination and motor block, with f waves and H-reflexes suggestive of late motor responses to electrical stimuli,
Features of MMN-CB may resemble motor neuron disease but in contrast MMN-CB may respond well to intravenous immunoglobulin.
32
what are the causes of stevens johnson syndrome?
penicillin
sulphonamides
lamotrigine, carbamazepine, phenytoin
allopurinol
NSAIDs
oral contraceptive pill
33
what is the treatment for CMV retinitis?
IV ganciclovir
treatment used to be life-long but new evidence suggests that it may be discontinued once CD4 > 150 after HAART
alternative: IV foscarnet or cidofovir
34
How do you differentaite sigmoid volvulus vs caecal volulus on Xray?
This man has a sigmoid volvulus as confirmed on his abdominal x-ray which shows the classic coffee bean sign. Note that a sigmoid volvulus will not retain haustra and typically originate in the left lower quadrant and extend to the right upper quadrant as is the case here.
A caecal volvulus will typically originate in the right lower quadrant and extend to the left upper quadrant. Additionally, caecal volvuli retain haustra. As both of these features are not present here, a sigmoid volvulus is a more likely diagnosis.
35
What is the criteria for LTOT?
Offer LTOT to patients with a pO2 of < 7.3 kPa or to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia
peripheral oedema
pulmonary hypertension
36
what is the non-erosive arthritis linked with SLE called?
Jaccoud's arthorpathy
Jaccoud arthropathy (JA), Jaccoud deformity or Jaccoud's arthopathy is a chronic non-erosive reversible joint disorder that may occur after repeated bouts of arthritis.
caused by inflammation of the joint capsule and subsequent fibrotic retraction, causing ulnar deviation of the fingers, through metacarpophalangeal joint (MCP) subluxation,primarily of the ring and little-finger.
the deformities result mainly from soft-tissue abnormalities, such as laxity of ligaments, fibrosis of the capsule, and muscular imbalance, rather than from destruction of the bone of joints
37
How do you diagnose CLL?
Flow cytometery - immunophenotyping
most cases can be identified using a panel of antibodies specific for CD5, CD19, CD20 and CD23
38
How do you treat myxoedema coma?
Administration of both liothyronine (T3) and levothyroxine (T4)
39
who needs a reduced dose of levothyroxine?
initial starting dose of levothyroxine should be lower in elderly patients and those with ischaemic heart disease. The BNF recommends that for patients with cardiac disease, severe hypothyroidism or patients over 50 years the initial starting dose should be 25mcg od with dose slowly titrated. Other patients should be started on a dose of 50-100mcg od
40
how do you differentiate microscopic polyangiitis vs wegners granulamatosis?
WG is unlikely with the absence of upper and lower airway involvement. Also, the absence of granuloma formation in the kidneys would not favour it.
In MPA -
pANCA (against MPO) - positive in 50-75%
cANCA (against PR3) - positive in 40%
41
what is typical respiratory presentation of Granulamatosis with poluangiitis?
chest x-ray: wide variety of presentations, including cavitating lesions
42
what are the causes of lung fibrosis and which lobes do they affect
upper zone fibrosis:
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
Acronym for causes of lower zone fibrosis:
ACID
A- Asbestosis
C- Connective tissue disorders (except ankylosing spondylitis) e.g. SLE, RA
I- Idiopathic pulmonary fibrosis
D- Drug-induced: amiodarone, bleomycin, methotrexate
43
what are the complications of ankylosing spondylitis?
Apical fibrosis
atlanto-axial
aortitis
achilles tendonitis
anterior uveitis
44
what is the cause of Q fever and how does it present?
Q fever is caused by Coxiella burnetii, a rickettsia
Features
typically prodrome: fever, malaise
causes pyrexia of unknown origin
transaminitis
atypical pneumonia
endocarditis (culture-negative)
45
what is the tx for Q fever?
Coxiella burnetii
Management- doxycycline
46
what tests are used for monitoring recurrence of cancer in medullary, no medullary thyroid, melanoma, carcinoid syndrome ?
Chromogranin - marker for Carcinoid syndrome
Thyroid transcription factor 1 - marker for lung adenocarcinoma
S100 - melanoma
Thyroglobulin - non medullary thryoid cancer
Calcitonin - medullary thyroid cancer
47
what is given to prevent fractures in cases of bone mets?
Oral bisphosphonates - firts line
If eFR < 30 - Denosumab (Monoclonal Ab against osetoclast development - inhibits RANKL)
48
who gets prophylactic antibiotics in SBP?
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'
49
How does HAS reduce mortality in SBP?
immune system uses the protein to bind to and fight infection.
Thus the IV albumin may promote immune function and defence against the infection
Intravenous albumin treatment has been shown to reduce in-hospital mortality of patients with uncomplicated SBP. Patients with associated renal dysfunction appear to derive the most benefit. Albumin decreases renal insufficiency, probably by increasing the circulatory volume and by binding pro-inflammatory molecules.
50
how is MS affected during pregnancy?
'relapse rates may reduce during pregnancy and may increase 3 to 6 months after childbirth before returning to pre-pregnancy rates
51
what are the contrainidications for flecainide?
- post myocardial infarction
- structural heart disease: e.g. heart failure
- sinus node dysfunction; second-degree or greater AV block
- atrial flutter
52
what is the treatment for atrial flutter
Cardioversion should be used first line
In patients who are not suitable for cardioversion beta blockers and calcium channel blockers can be used to slow AV node conduction
Digoxin used to be first line treatment for ventricular rate control in flutter. Now it is used mostly in patients with heart failure alongside a beta blocker. It is also used in patients whose rate has not been adequately controlled by a calcium channel blocker, a beta blocker or both.
53
how do you differentiate ostium primum vs secundum on ECG?
Ostium secundum (70% of ASDs)
associated with Holt-Oram syndrome (tri-phalangeal thumbs)
ECG: RBBB with RAD
Ostium primum
present earlier than ostium secundum defects
associated with abnormal AV valves
ECG: RBBB with LAD, prolonged PR interval
As primum is first it is on the LEFT (LAD), secundum is second (RAD)
54
what test do you need to do regularly with patients on cabergoline?
Dopaminergic drugs are associated with fibrotic reactions including pulmonary, retroperitoneal and pericardial fibrosis, but cabergoline also assocaited with development of new valvulopathy.
55
What do you see on different microscopes for membranous nephropathy?
Light microscopy - diffuse thickening of glomerular basement membrane throughout all glomeruli in absence of significant hyper-cellularity
Immunofluorescence microscopy - diffuse granular patter of IgG with c3 along GBM
Electron microscopy - depends on stage of disease. but stage 2 is the classical exam description: sub-epithelial electron-dense deposits with small GBM extensions (spikes); GBM spikes seen with silver staining (segments of GBM between dense deposits)
56
what medications can be used in lew body dementia?
Acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) can help alleviate the features of Lewy body dementia
57
what is the difference between loffler syndrome and lofgren's syndrome
Lofgren's syndrome is an acute form sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia.
Loeffler syndrome is when ascaris lumbricoides infects the lungs. transient CXR shadowing and blood eosinophilia. presents with a fever, cough and night sweats which often last for less than 2 weeks. Self limiting generally
58
what drugs do you avoid in renal failure?
Drugs to avoid in renal failure
antibiotics: tetracycline, nitrofurantoin
NSAIDs
lithium
metformin
59
how do you classify severity of UC?
mild: < 4 stools/day, only a small amount of blood
moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
severe: >6 bloody stools per day + features of systemic upset (pyrexia, tachycardia, anaemia, raised inflammatory markers)
60
what is the management of stills disaease?
NSAIDs
should be used first-line to manage fever, joint pain and serositis
they should be trialled for at least a week before steroids are added.
steroids
may control symptoms but won't improve prognosis
if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
61
what is the tx for pseudomonas infections?
Intravenous anti-pseudomonal antibiotic plus inhaled aminoglycoside for 14 days
A prolonged course of oral Ciprofloxacin (e.g. 6 weeks)
IV ceftazidime and nebulised tobramycin for 14 days
62
what is primary CNS lymphoma in HIV associated with and how is it treated?
associated with the Epstein-Barr virus
CT: single or multiple homogenous enhancing lesions
treatment generally involves steroids (may significantly reduce tumour size), chemotherapy (e.g. methotrexate) + with or without whole brain irradiation. Surgical may be considered for lower grade tumours
63
what are the drugs that may exacerbate myasthenia?
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
64
How long do you continue VTE for PE in provoked vs unprovoked?
if the VTE was provoked the treatment is typically stopped after the initial 3 months (3 to 6 months for people with active cancer)
if the VTE was unprovoked then treatment is typically continued for up to 3 further months (i.e. 6 months in total)
65
what is the Ix and treatment for carcinoid syndorme?
Investigation
urinary 5-HIAA
plasma chromogranin A y
Management
somatostatin analogues e.g. octreotide
diarrhoea: cyproheptadine may help
66
which disease is commonly assocaited with carcinoid tumours?
pellagra can rarely develop as dietary tryptophan is diverted to serotonin by the tumour
Pellagra is a rare condition in the United Kingdom but it is seen in patients with carcinoid syndrome. It is caused by a deficiency in vitamin B3, (Niacin) and classically presents as the '4 Ds' dermatitis, dementia, diarrhoea and death. Niacin can be absorbed through the diet or converted in vivo from tryptophan. Patients with carcinoid syndrome are at increased risk as tryptophan stores are metabolised to serotonin.
67
what is HIT?
immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin --> induce platelet activation by cross-linking FcγIIA receptors
usually does not develop until after 5-10 days of treatment
despite being associated with low platelets HIT is actually a prothrombotic condition
68
what are you worried about if some one presents with confusion along with valproate use?
hyperammonemic encephalopathy - L-carnitine may be used as treatement
69
what is an absolute contraindication of elctroconvulsive therapy for depression?
Raised ICP
70
what medication should be considered for T1Dm for over 10 years?
statins
71
what condition is assciated with sjogren's syndrome?
Primary biliary cholangitis
72
Who can you give lumacaftor/ivacaftor to in cystic fibrosis?
Lumacaftor/Ivacaftor (Orkambi) can be used to treat cystic fibrosis patients who are homozygous for the delta F508 mutation
73
What medications induce seizures or worsen seizure control?
The following drugs may worsen seizure control in patients with epilepsy:
alcohol, cocaine, amphetamines
ciprofloxacin, levofloxacin
aminophylline, theophylline
bupropion
methylphenidate (used in ADHD)
mefenamic acid
Some medications such as benzodiazepines, baclofen and hydroxyzine may provoke seizures whilst they are being withdrawn.
74
what is used to reduce ophthalmological complications of methanol poisoning?
folinic acid along with fomepizole
75
what are the surgical contraindications for non-small cell lung ca management?
assess general health
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
76
How often do you need monitor changes to TFTs after changing a dose?
8-12 weeks
77
what dose of levothyroxine do you start elderly patients and those with ischaemic heart disease on?
25mcg
while everyone else needs to be started on 50-100mcg
78
what changes to levothyroxine do you need to make during pregnancy?
women with established hypothyroidism who become pregnant should have their dose increased 'by at least 25-50 micrograms levothyroxine'* due to the increased demands of pregnancy. The TSH should be monitored carefully, aiming for a low-normal value
79
what are the side effects of thyroxine therapy?
- hyperthyroidism: due to over treatment
- reduced bone mineral density
- worsening of angina
- atrial fibrillation
80
what are the interactions of levothyroxine with other medications?
iron, calcium carbonate
- absorption of levothyroxine reduced, give at least 4 hours apart
81
what is the treatment for neuropathic pain?
Pregabalin first line
amitriptyline, duloxetine and gabapentin
Tramadol - used as rescue tehrapy for exacerbations
topical capsaicin may be used for localised neuropathic pain
carbamezapine - trigeminal neuralgia
82
what are the possible CT findiings of a carbon monoxide poisoning?
The ischaemic change on CT head, particularly in the globus pallidus with haemorrhagic transformation, a classic neurological consequence of carbon monoxide poisoning
83
what are the prognostic meds to uptritrate and start for someone with HF?
ACEi
beta blockers
spironolactone - if ejection fraction < 35%
SGLT2 inhibitors
84
what is the topical treatment for basal cell carcinoma?
imiquimod, fluorouracil
85
what are the features of cholestrol embolisation?
eosinophilia
purpura
renal failure
livedo reticularis
86
what the work up for thyroid nodules?
1. Check TSH
2. TSH suppressed → Thyroid uptake scan → Cold/iso nodule → FNA cytology
2. TSH suppressed → Thyroid uptake scan →Hot nodule → No FNA required
2. TSH normal/elevated → Thyroid USS → Suspicious features → FNA cytology
3. FNA cytology is then graded using the Royal College of Pathologist classification on a spectrum from benign → malignant.
87
what when prescribed with SSRIs can trigger serotonin syndrome?
tramadol
St John's Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
88
what are the nerves affected in SOF vs carvenous sinus syndrome vs orbital apex syndorme?
SOF- Affects CN III, CN IV, CN V(1), CN VI
Carvenous sinus syndrome- Affects CN III, CN IV, CN V(1 &2), CNVI
Orbital apex syndrome- Affects CN II, CN III, CN IV, CN V(1), CN VI
i.e. Orbital apex syndrome is SOF plus visual loss
89
what are the different antibodies of limbic encephalitis associated with the different cancers?
NMDA receptor antibodies = ovarian cancer
Voltage-gated potassium channel antibodies = Thymoma or small cell lung cancer
Anti-Hu antibodies = Small cell lung cancer
Anti-GAD = Thymoma
anti-Ma2 antibodies = Germ-cell tumours of testis, non-small cell lung cancer
90
what is some possible treatment options
All children in developing countries should receive two dose of vitamin A.
replenishes the low levels of vitamin A caused be measles which can lead on to diarrhoea, corneal perforation and secondary bacterial pneumonia
91
what interaction does amiodarone have on your thyroids?
The pathophysiology of amiodarone-induced hypothyroidism (AIH) is thought to be due to the high iodine content of amiodarone causing a Wolff-Chaikoff effect*
an autoregulatory phenomenon where thyroxine formation is inhibited due to high levels of circulating iodide
92
whats the difference between amiodarone induced thyrotoxicosis type 1 vs type 2?
Type 1 results from excess iodine-induced thyroid hormone synthesis; a goitre is typically present. Type 2 results from amiodarone-related destructive thyroiditis and, as in this scenario, a goitre is absent.
Differentiation of the two types is important as they have different management. The ultrasound scan shows probable gland destruction, pointing towards type 2. Management involves the use of corticosteroids for type . However Type 1 is treated with carbimazole or potassium perchlorate
93
how does heparin use affect the thyroid?
Heparin leads to an increased release of lipoprotein lipase from the vascular endothelium, producing a rise in the levels of free fatty acid (FFA). High levels of FFA inhibit the binding of thyroid hormones to their plasma-binding proteins, producing a rise in measured quantities of thyroid hormones. Thyroid hormones return to normal after discontinuation of medication.
94
what type of blood transfusion should a person with hodkin's lymphoma recive?
If an immunocompromised patient receives red cells that are not irradiated, the donor's T cells can cause transfusion-associated graft-versus-host disease (TA-GvHD), in which the donor T lymphocytes mount an immune response against the recipient's lymphoid tissue causing tissue and organ damage, potentially leading to death.
Typical clinical features of TA-GvHD include fever, an erythematous maculopapular rash, abdominal pain and profuse diarrhoea.
Irradiation of blood products destroys the donors T lymphocytes thereby helping to prevent this potentially fatal complication.
95
Indications for gamma irradiated blood products
1. Immunocompromised marrow or organ transplant recipients
2. Patients with haematological disorders who will be undergoing allogeneic marrow transplantation imminently
3. Intrauterine transfusions
4. Patients with Hodgkin's disease
5. Patients treated with purine analogue drugs (e.g. fludarabine)
96
what drugs cause raised prolactin?
metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids
97
what are the causes of raised prolactin?
prolactinoma
pregnancy
oestrogens
physiological: stress, exercise, sleep
acromegaly: 1/3 of patients
polycystic ovarian syndrome
primary hypothyroidism (due to thyrotrophin releasing hormone (TRH) stimulating prolactin release)
98
what is the difference between bifascular vs trifasicular block?
RBBB +left anterior or posterior hemiblock - bifasciular block
RBBB +left anterior or posterior hemiblock + 1st-degree heart block = trifasicular block
99
what is the treatment of chlamydia infections?
doxycyline - 7 day course - 1st line
if contraindicated - azithromycin
if pregnant - azithromycin, erythromycin or amoxicillin
100
what precipitates thyroid storm?
thyroid or non-thyroidal surgery
trauma
infection
acute iodine load e.g. CT contrast media
101
what is the tx of thyrotoxic storm?
- symptomatic treatment e.g. paracetamol
- treatment of underlying precipitating event
- beta-blockers: typically IV propranolol
- anti-thyroid drugs: e.g. methimazole or propylthiouracil
- Lugol's iodine
- dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
102
what is the side effect of abacavir?
most concerning side effect of Abacavir is a hypersensitivity reaction that can lead to fever, malaise, nausea and skin rash which can be very severe. It is strongly associated with a specific allele at the human leukocyte antigen B locus, HLA-B*57:01.
103
what is the side effect of NRTIs such as lamuvdine and zidovudine?
they can cause a potentially fatal lactic acidosis & severe hepatomegaly with steatosis when used alone or in combination with other antiretrovirals.
104
what are the side effects of NNRTIs such as efavirenz and nevirapine?
P450 enzyme interaction (nevirapine induces), rashes
Efaverinz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) and is frequently known to cause disturbing dreams and other cognitive disturbances in 50% of patients in the first month of treatment.
105
30-years-old, central scotoma → loss of colour vision → rapid onset of significant visual impairment ?
Leber's optic atrophy
mitochondrial pattern of inheritance in which all children of an affected mother inherit the disease
Diagnosis of mitochondrial disease is confirmed by muscle biopsy showing ragged red fibres due to an increased number of mitochondria.
106
patients < 20 years old, external ophthalmoplegia, retinitis pigmentosa. Ptosis may be seen?
Kearns-Sayre syndrome
107
what is the prophylaxis of cluster headaches?
verapamil is the drug of choice
there is also some evidence to support a tapering dose of prednisolone
108
what is the commonest cause of infection that can cause complete heart block?
Lyme disease
109
what is the cause of a failing transplant in a patient with aport syndrome?
presence of anti-GBM antibodies leading to a Goodpasture's syndrome
110
what is the BP target for diabetic and non-diabetic pateints?
For non diabetic age < 80yr BP target is <140
For non diabetic age >80 bp target is <150
For T2DM with out complications <140
For T2DM with complications <130
For T1DM without complications <135
For T1DM with complications <130
111
what are the typical features of familial mediterranean fever?
Autosomal recessive
pyrexia
abdominal pain (due to peritonitis)
pleurisy
pericarditis
arthritis
erysipeloid rash on lower limbs
Tx - colchicine
112
what is the gold standing for diagnosing venous sinus thrombosis?
MR venogram
113
what drugs can cause pleural effusion?
nitrofurantoin, methotrexate, and amiodarone
114
what drug is used in methotrexate toxicity?
folinic acid
115
how do you interpret the relationship between Fio2 and PaO2?
Pa02 on a gas should be ~10kPa less than the Fi02 if your lungs are working properly
i.e. on room air (Fi02 ~21%) Pa02 should be ~11-12 (hence reference range of ~ 10-14)
therefore; a patient on 100% should have Pa02 of ~80-85 kPa (depending on age etc) therefore this patient is severely hypoxic
116
what causes a painful sore in the ear?
Chondrodermatitis nodularis helicis
117
what is the difference between african tyrpanosomiasis and american trypanosomiasis?
African - painless subcutaneous nodulees, intermittent fever, cervical lymph node enlargement and somnolence, headaches
Tx - IV pentamidine or suramin
American - myocarditis, dysphagia and constipation
Tx - acute phase using azole or nitroderivatives such as benznidazole or nifurtimox
118
what do you need to check for before starting natalizumab?
Natalizumab is strongly associated with progressive multifocal leukoencephalopathy, an infection of the central nervous system with the John Cunningham virus (JCV). Therefore, JCV antibody status is an essential part of assessing an individual for treatment with natalizumab. Patient's who are seropositive for JCV are not treated with natalizumab or switched to another drug.
119
what are the indications for CRT-P insertion?
→ NYHA class three or four symptoms
They are in normal sinus rhythm with either
→ QRS duration of 150 ms or longer estimated by standard electrocardiogram (ECG)
→ QRS duration of 120-149 ms estimated by ECG and mechanical dyssynchrony that is confirmed by echocardiography.
They have a left ventricular ejection fraction of 35% or less.
They are receiving optimal pharmacological therapy.
120
what analgesics are safe in severe renal impairment?
My FAB is safe in severe renal impairment
Methadone
Fentanyl
Alfentanil
Buprenorphine
121
hwo do you treat insulinoma if patient is not for surgery?
diazoxide and somatostatin
122
what is the drug used in eosinophilic asthma?
Mepolizumab is an anti-IL5 monoclonal antibody
It binds to IL5 and prevents it from binding to its receptor. IL5 is a cytokine which promotes growth in eosinophil numbers and activity. By blocking IL5 mepolizumab down-regulates eosinophil activity and has been shown to significantly improve symptoms in resistant asthma.
Omalizumab is an anti-IgE monoclonal antibody, it is effective in treating resistant asthma with evidence of raised IgE and allergic symptoms and is often considered for similar patients to those treated with mepolizumab, although eosinophil count and IgE drive which of the two therapies are used
123
what can trigger lithium toxicity/
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.
124
who gets haemodialysis in lithium toxicity?
Dialysis should be considered in symptomatic lithium toxicity and:
A lithium concentration greater than 5.0 mmol/L in patients with acute lithium overdose and who are not prescribed lithium
A lithium concentration greater than 2.5 mmol/L in patients with chronic poisoning
125
what are drugs that worsen myasthenia gravis?
penicillamine
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
126
what is the treatment of choice in psoriasis aftter one has tried corticosteorids, vitamin D analogues and phototherapy?
Choice of drugs:
Offer methotrexate as the first choice of systemic agent for people with psoriasis who fulfil the criteria for systemic therapy (above)
Offer ciclosporin as the first choice of systemic agent for people who fulfil the criteria for systemic therapy (above) and who:
1. need rapid or short-term disease control (for example a psoriasis flare) or
have palmoplantar pustulosis or
2. are considering conception (both men and women) and systemic therapy cannot be avoided.
Consider changing from methotrexate to ciclosporin (or vice-versa) when response to the first-choice systemic treatment is inadequate.
Consider acitretin for adults, and in exceptional cases only for children and young people, in the following circumstances:
127
what can you give to a COPD patient if they are not controlled on SABA + SAMA + ICS?
Roflumilast should be used in COPD for patients who are losing control on triple inhaled therapy
128
what can you give in a massive terminal haemorrhage?
large dose of midazolam (10mg) can be given as part of 'crisis management' to relieve distress
129
What are the indications for treatment in CLL?
- progressive marrow failure: the development or worsening of anaemia and/or thrombocytopenia
- massive (>10 cm) or progressive lymphadenopathy
- massive (>6 cm) or progressive splenomegaly
- progressive lymphocytosis: > 50% increase over 2 months or lymphocyte doubling time < 6 months
- systemic symptoms: weight loss > 10% in previous 6 months, fever >38ºC for > 2 weeks, extreme fatigue, night sweats
- autoimmune cytopaenias e.g. ITP
130
what is Facioscapulohumeral muscular dystrophy?
Facioscapulohumeral muscular dystrophy (FSHMD) is an autosomal dominant form of muscular dystrophy.
- facial muscles are involved first - difficulty closing eyes, smiling, blowing etc
- weakness of the shoulder and upper arm muscles
- abnormal prominence of the borders of the shoulder blades - 'winging'
131
what are the features of behchet's disease?
classically: 1) oral ulcers 2) genital ulcers 3) anterior uveitis
thrombophlebitis and deep vein thrombosis
Arthritis
neurological involvemnet (aseptic meningitis)
132
what is the typical presentation of glucagonoma
They present with diabetes mellitus, venous thrombo-embolism and the classical rash of necrolytic migratory erythema - a red, blistering rash.
133
which cancers express TTF1?
TTF-1 (thyroid transcription factor 1) is a protein which regulates the transcription of genes specific for the thyroid and lung
Lung adenocarcinomas and small cell carcinomas are usually TTF-1 positive
134
when can conservative management be considered in primary hyperparathyroidism?
conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage
135
what is the early sign of uncal herniation?
Uncal herniation results in pressure on the midbrain resulting in ipsilateral CN III palsy (mydriasis is the earliest sign) and contralateral hemiparesis
136
what is the treatment for leprosy?
multibacillary leprosy (>6 lesions)- triple therapy with rifampicin, dapsone and clofazimine (RDC) for 12 months.
For paucibacillary leprosy (5 or less lesions) you should give rifampicin and dapsone (RD) for 6 months.
137
how do we investigate SAH?
If CT head done within 6 hours of symptom onset - no need for LP
If Ct head done more than 6 hrs aafter symptom onset - perform LP atleast after 12 hours of symptom onset - xanthochromia
138
what are complications of severe malaria?
hypoglycaemia
acidosis
coma
convulsions
severe anaemia
pulmonary oedema
139
what is the way to test for hyperventilation syndrome?
Nijmegen questionnaire
140
what are the surgical contraindications in someone with non-small cell lung ca?
assess general health
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
141
Who gets antibiotic prophylaxis in ascites?
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'
142
what do you suspect when someone with HIV and raised lactate presents with normal CD4 count and nausea, breathessness and unwell?
NRTIs - in particular stavudine, didanosine and zidovudine - classically cause mitochondrial toxicity as an unwanted side effect. This can result in nausea, pancreatitis, lactic acidosis and lipoatrophy
143
what are drugs that worsen restless leg syndrome?
selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), diphenhydramine, and dopamine antagonists.w
144
what are the first line medications for dementia?
three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer's disease
145
when is donepezil contraindicated?
bradycardia or insomnia
use memantine instead
146
what are the side effects of cyclophosphamide?
haemorrhagic cystitis: incidence reduced by the use of hydration and mesna
transitional cell carcinoma
147
what does zinc deficiency present as?
Zinc deficiency causes a characteristic skin rash (mainly at the intertriginous and perioral areas), alopecia, taste impairment, glucose intolerance, and diarrhoea
148
how do you treat MODY with positive HNF1A?
MODY associated with HNF1A often respond well to treatment with low-dose sulfonylureas
149
what is the commonest side effect of cisplatin therapy?
Ototoxicity, peripheral neuropathy, hypomagnesaemia
150
Who gets offered transient elastography?
1. people with hepatitis C virus infection
2. men who drink over 50 units of alcohol per week and women who drink over 35 units of alcohol per week and have done so for several months
3. people diagnosed with alcohol-related liver disease
151
what other differentials do you consider when you think of cluster headache type symptoms?
Cluster headaches - come in clusters. about 5 attacks per day and last longer - 15 mins to 3 hours. treatment = high flow o2 100%
paroxysmal hemicrania - more attacks per day but shorter. i.e. over 5 attacks per day but each lasts only 2-30 mins. treatment = indomethacin
hemicrania continua - continuous one sided headache. also responses to indomethacin
152
what are the available treatments in vitiligo?
sunblock for affected areas of skin
camouflage make-up
topical corticosteroids may reverse the changes if applied early
there may also be a role for topical tacrolimus and phototherapy, although caution needs to be exercised with light-skinned patients
153
what is the difference between Type1, 2 and 3 autoimmune hepatitis?
Type 1 - Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA)
affects both adults and children
Type 2 - Anti-liver/kidney microsomal type 1 antibodies (LKM1)
affects children only
Type 3 - Soluble liver-kidney antigen
affects adults in middle-age
154
what is the treatment for tropical pulmonary eosinophilia?
associated with Wuchereria bancrofti infection
Treated with Diagnosis is aided by a clinical response to diethylcarbamazine, which is also the main treatmen
155
what are the medications that cause drug induced lupus?
SHIPPeD- sulfasalazine, hydralazine, isoniazid, phenytoin, procainamide, diltiazem
156
A person collapses after performing CPR on a resident of a house which was on fire after giving a mouth to mouth. what is the cause and how do you treat it?
Performing mouth to mouth resuscitation has led to the oral transmission of cyanide molecules from the resident. The absorption of cyanide is slower via the oral route as compared to inhalation, which explains why this patient had a relatively 'delayed' presentation of cyanide poisoning. Also, exposure to small amounts of cyanide can lead to a longer duration of symptoms before cardiopulmonary arrest. The antidote for cyanide poisoning is intravenous sodium thiosulfate (+/- hydroxocobalamin).
157
what are the causes of NAGMA?
1.gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
2. renal tubular acidosis
3. drugs: e.g. acetazolamide
4. ammonium chloride injection
5. Addison's disease
158
what are causes of hypokalaemia with alkalosis?
vomiting
diuretics
Cushing's syndrome
Conn's syndrome (primary hyperaldosteronism)
159
what are causes of hypokalaemia with acidosis?
diarrhoea
renal tubular acidosis (types 1 and 2)
acetazolamide
partially treated diabetic ketoacidosis
160
what are the metabolic abnormalities seen during the treatment of DKA?
Hypokalaemia
Hypophosphataemia
161
what is the typical iron study profile in haemachromatosis?
transferrin saturation > 55% in men or > 50% in women
raised ferritin (e.g. > 500 ug/l) and iron
low TIBC
162
what should be commenced in patients with disabling stroke complicated by AF?
Aspirin 300mg orally for the initial two weeks should be commenced in patients with a disabling stroke and atrial fibrillation.
163
what are the indications for treatment in pagets disease of the bone?
bone pain
skull or long bone deformity
fracture
periarticular Paget's
164
what can be used for refractory chemotherapy induced vomiting?
Dexamethasone with ondansetron is effective in refractory chemotherapy-induced vomiting
165
what is the percentage risk of developing breast and ovarian cancer in the presence of the BRACA 1 or 2 gene?
The percentage risk of developing breast cancer by age 70 is 55-65% for BRCA1 and 45% for BRCA2 mutations.
The percentage risk of developing ovarian cancer by age 70 is 40% for BRCA1 and 15% for BRCA2 mutations.
166
what treatment can be used to treat salmonella thyphoid infections?
ciprofloxacin
167
what effect does trimethoprim have on the kidneys?
transient rise in creatinine: trimethoprim competitively inhibits the tubular secretion of creatinine resulting in a temporary increase which reverses upon stopping the drug
trimethoprim blocks the ENaC channel in the distal nephron, causing a hyperkalaemic distal RTA (type 4). It also inhibits creatinine secretion, often leading to an increase in creatinine by around 40 points (but not necessarily causing AKI)
168
what is the TB treatment when isoniazid resistance is noted?
In confirmed isoniazid resistance, ethambutol is continued for 6 months of treatment
169
which diabetes drugs cause pancreatitis?
GLP 1 mimetics and DPP 4 inhibitors
170
what is an extremely sensitive marker of paget's disease of the bone?
procollagen type I N-terminal propeptide (PINP)
serum C-telopeptide (CTx)
urinary N-telopeptide (NTx)
urinary hydroxyproline
171
what is zieve syndrome?
Zieve syndrome is a triad of symptoms: haemolytic anemia, cholestatic jaundice, and transient hyperlipidemia
172
what is the indication for cardiac resynchronisation therpau?
Cardiac resynchronisation therapy can be used in patients with a QRS duration of >130 msec and LBBB morphology to improve symptomatology
173
what is the treatment for thyrotoxic storm?
Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone
steroid - prevent conversion of T4 to T3
beta bockers - for symptomatic relief
174
what are the different Types of meningitis that are native to different parts of the world?
Type A - Arabia, Africa
Type B,C - Europe, South America
175
what are features of severe falciparum malaria?
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
cerebral malaria: seizures, coma
acute renal failure: blackwater fever, secondary to intravascular haemolysis, mechanism unknown
acute respiratory distress syndrome (ARDS)
hypoglycaemia
disseminated intravascular coagulation (DIC)§
176
what medications should be avoided with trastuzumab?
The combination of trastuzumab + anthracyclines (both often used for breast cancer) is particularly cardiotoxic
Doxorubicin and cyclophosphamide
177
what is the treatment for thyphoid fever?
The treatment of choice is cefotaxime or ceftriaxone.
178
What is the treatment for Carbapenemase producing enterobacteriaceae such as klebsiella
Carbapenemase producing enterobacteriaceae (CPE) are multi-drug resistant coliforms.
They can be treated with polymyxins (e.g. colistin), tigecycline, fosfomycin or aminoglycosides (e.g. gentamicin)
179
what are the symptoms of organophosohate toxicity?
SLUDGE: salivation, lacrimation, urination, defecation, gastrointestinal pain, emesis, and also pupillary constriction, bronchoconstriction and bradycardia
180
what is the tx of papillary and follicular cancer?
total thyroidectomy
followed by radioiodine (I-131) to kill residual cells
yearly thyroglobulin levels to detect early recurrent disease
181
what is the tx for PCP infections?
co-trimoxazole
IV pentamidine in severe cases
aerosolized pentamidine is an alternative treatment for Pneumocystis jiroveci pneumonia but is less effective with a risk of pneumothorax
steroids if hypoxic (if pO2 < 9.3kPa then steroids reduce risk of respiratory failure by 50% and death by a third)
182
what can be used for fatigue in MS?
Amantadine is an anti-viral agent that slows viral replication. It is also known to have some dopaminergic effects; the mechanism of action for reducing fatigue in MS however, remains unclear
183
how is cutaneous leishmaniasis diagnosed?
Cutaneous leishmaniasis is typically diagnosed using a punch biopsy
184
what is the tx for Anti-GBM?
combination of corticosteroids, cyclophosphamide and plasmapheresis
185
What are the indications for tx for CLL?
1. The development of anaemia +/ thrombocytopaenia
2. Progressive or massive splenomegaly (6cm) +/ lymphadenopathy (10cm)
3. Progressive lymphocytosis [50% increase in 2 months or doubling time of less than 6 months]
4. Systemic symptoms [fever, night sweats, weight loss >10% in 6 months, extreme fatigue]
186
How do you calculate the maximal respiratory compensation for metabolic disturbance?
pCO2 (maximal response in kPa) = (0.2 * HCO3) + 1
187
what is the mode of delivery of pregant women with viral load <50?
- vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
- a zidovudine infusion should be started four hours before beginning the caesarean section
Neonatal antiretroviral therapy- zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
188
What are the different Renal tubular acidosis?
ABCD
Type 1 RTA: Acid secretion impairment at distal tubule, treatment with Alkali
Type 2 RTA: Bicarbonate wasting at proximal tubule, treatment with Base (alkali)
Type 3 RTA: Carbonic anhydrase deficiency, treatment with Citrate (sodium/potassium)
Type 4 RTA: AlDosterone disorDer, treatment with 4rosemide
189
what is the typical features of gitelman's syndrome?
normotension
hypokalaemia
hypocalciuria
hypomagnesaemia
metabolic alkalosis
190
what is the criteria for starting statins in T1DM?
NICE specifically state that we should not use QRISK2 for type 1 diabetics. Instead, the following criteria are used:
older than 40 years, or
have had diabetes for more than 10 years or
have established nephropathy or
have other CVD risk factors
191
What are the causes of NAGMA?
ABCD
Addison's disease
Bicarbonate loss via GI tract (e.g. diarrhoea) or renal tract (e.g. renal tubular acidosis)
Chloride excess - hyperchloraemic acidosis
Drugs e.g. acetazolamide
192
What are medications that can cause IIH?
TROLLS
T - Tetracyclines
R - Retinoids
O - Oral contraceptive pill
L - Lithium
L - Levothyroxine
S - Steroids
193
How is sulphnylurea overdose treated if still hypoglycaemic after glucose therapy?
In sulphonylurea overdoses, if the patient remains hypoglycaemic despite infusion of sufficient glucose, consider administration of octeotride
194
What is the indication of LTOT?
those with chronic hypoxaemia and a Pa02 between 7.3kPa and 8kPa and the presence of either secondary polycythaemia or clinical and/or echocardiographic evidence of pulmonary hypertension or pulmonary oedema
195
what is pleocytosis?
white cell increase in CSF
196
how do you treat DVT if they are for imminent surgery soon?
If a diagnosis of DVT is made less than 7 days before surgery, an IVC filter must be inserted pre-op
197
how much creatinine change is acceptable with ace-i use?
Up to an increase in creatinine of 30% can be tolerated following the start or increase in an ACE-inhibitor such as ramipril, but U&Es should be repeated in 1-2 weeks.
198
what treatment can be used once patients on COPD are on LABA + LAMA+ ICS and still uncontrolled?
Roflumilast should be used in COPD for patients who are losing control on triple inhaled therapy
This is an option for treating severe COPD in cases where the FEV1 is < 50% and the person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.
199
what is the treatment for lymphatic filariais?
Diethylcarbamazine
200
what is the treatment for cryptosporiadiosis?
nitazoxanide / rifaximin
201
what is the treatent for radiotherapy induced mucositis?
benzydamine mouthwash
202
when do you start N-acetylcysteine in patients over 24 hrs after intake?
if presentation > 24 hours after an overdose start acetylcysteine if the patient is jaundiced, has hepatic tenderness or an elevated ALT
Acetylcysteine should be started immediately in all patients if it is thought that 150 mg/kg or more paracetamol (or an unknown amount) has been ingested as an acute overdose (i.e. all doses taken within one hour) or if they are symptomatic with jaundice or hepatic tenderness.
203
what are the causes of pseudo cushings and how is it diagnosed?
pregnancy, polycystic ovarian syndrome, chronic alcohol abuse, depression, and severe physical stress (e.g. infection, surgery)
normal or mildly raised serum cortisol, maintained diurnal variation in serum cortisol, a raised urine free cortisol, and a rise in cortisol levels of >170nmol following an insulin stress test.
204
how do you differentiate cryptococcal meningtis from Tb meningitis on LP?
In cryptococcal meningitis, CSF shows high opening pressure and elevated protein. The white cell count may vary according to HIV status
Distinguishing TB meningitis from cryptococcal meningitis based on clinical and laboratory features can be a real challenge. TB meningitis also results in a WBC pleocytosis (early neutrophils then lymphocytes), low glucose, and elevated protein.
205
which antiobiotic is to be avoided during aminophylilne use?
Co-administration of aminophylline and ciprofloxacin can cause significant toxicity and should be avoided
206
what are the drugs that can cause TEN?
Drugs known to induce TEN
phenytoin
sulphonamides
allopurinol
penicillins
carbamazepine
NSAIDs
207
what platelets are used for platelets refractory to platelet transfusions?
HLA-matched platelets and single-donor platelets are used for individuals that are refractory to platelet transfusions and have developed anti-HLA or antiplatelet antibodies
208
what is the typical feature of pseudohypoparathyroidism?
Short fifth metacarpals, short stature, learning difficulties + ↑ PTH, ↓ calcium, ↑ phosphate → pseudohypoparathyroidism
209
what are the typical features of pseduopseduohypoparathyoridism?
In pseudopseudohypoparathyroidism, you often see skeletal abnormalities and phenotypical features of type 1A pseudohypoparathyroidism, however, the biochemistry is normal. This is due to the genetic phenomenon of imprinting
210
what is caplan syndrome?
Rheumatoid arthritis causes a severe form of coal workers pneumoconiosis called Caplan's syndrome
211
how does theophylline posinoing presnt
hypokalaemia, hyperglycaemia, tachycardia and increased myocardial contractility
212
what genes are affected in colorectal cancer?
Sporadic - APC gene (50%), K-ras, p53, DCC tumour suppressor gene
- HNPCC - DNA mismatch repair gene (MSH2 > MLH1)
- FAP - APC gene
213
hwo is warm autoimmune haemolutic anaemai diagnosed?
presence of anaemia, spherocytes on blood film and positive direct Coombs test for IgG or C3d
214
which antiepileptic is avoided in general if the type of seizure is uncertain?
carbamazepine can aggravate juvenile myoclonic epilepsy and absence seizures1. In general, carbamazepine should always be avoided in patients where the type of seizure is uncertain. It is otherwise a useful AED in the treatment of partial or secondary generalised seizures.
215
what are the extravascular causes of haemolysis?
Extravascular = the Hs: (HOT OUTSIDE)
HDNB (hemolytic disease of newborn)
Hereditary Spherocytosis
Haemoglobinopathies (sickle cell, thalassemia)
Hot AIHA
216
what are the intravascular causes of haemolysis
MRCGP
Mismatched blood transfusion
Red cell fragmentation: heart valves, TTP, DIC, HUS
Cold autoimmune haemolytic anaemia
G6PD deficiency*
Paroxysmal nocturnal haemoglobinuria
217
what is the treatment of hypertrophic obstructive cardiomyopathy?
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*
Beta-blockers and verapamil can help with symptom management as they control the heart rate to the point where ventricular outflow obstruction is unlikely to occurg
218
what autoimmune conditions are usually assoicated with each other
type 1 diabetes mellitus
Addison's disease
autoimmune thyroid disorders
pernicious anaemia
alopecia areata
vitiligo
219
what is the treatment for relapse of graves disease
Radioiodine therapy is the treatment of choice for patients with a relapse of Graves disease in the absence of contraindications, such as pregnancy (should be avoided for 4-6 months following treatment) and active severe Graves ophthalmopathy
220
what tests can be used for hyperprolactinaemia, acrogemaly and for growth hormone deficiency test?
1. Domperidone test: Hyperprolactinemia and macroplolactinemia
2. IGF-1 test + Glucose tolerance test: Acromegaly
3. Insulin Tolerance test: Growth Hormone Deficiency
4. Arginine- GHRH stimulation test: Growth hormone deficiency for cardiac patients
221
what are the antibodies associated with paraenoplastic neurological syndrome?
anti-Hu: small cell lung cancer - painful sensory neuropathy, cerebellar syndromes, encephalitis
anti-Yo: ovarian, breast cancer - cerebellar syndrome
anti-Ri: small cell lung cancer - retinal degeneration
Lambert-Eaton myasthenic syndrome - anti-voltage gated calcium channel - small cell lung cancer
222
what are some contraindications for NIV?
- Recent facial or upper airway surgery or facial injuries.
- Recent upper gastrointestinal surgery.
- Confusion/agitation.
- Bowel obstruction.
- Upper airway obstruction.
- Excessive upper airway secretions.
- Patient actively vomiting.
223
what can be given to reduce high output stoma diarrhoea?
Octreotide may reduce high output diarrhoea following ileostomy or colectomy. It can be given by continuous subcutaneous infusion
224
how do you calculate FiO2 and PaO2?
FiO2 = 20% + (4 * Oxygen Flow Rate)
PaO2 for any given inspired concentration should be approximately 10 less than the inspired concentration (%). For example, in this case, 15L O2 is equivalent to approximately 80-85% so we would expect the PaO2 to be around 70 kPa.
225
what is the testing that can show positive syphilis?
basically sum syphillis ix
1. screening: RPR (risk false positive in SLE/pregnant/TB/ malaria)
2. confirm : TPHA
3. EIA: good for dx of early primary syphilis
RPR +/ TPHA - = false positive
RPR - / TPHA+/EIA - =previous infection (EIA might not be in ques)
RPR - / TPHA+/EIA + = early primary syphilis
RPR +/ TPHA + = acute infection
Enzyme immunoassay (EIA)
Treponema Pallidum particle agglutination assay (TPPA)
Rapid plasma reagin (RPR)
226
what do you think of when you see atypical pneumonia with transaminitis in a farmer?
Q fever - coxiella burnetii
227
