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Green book 1 flashcards

1
Q

In iodine sufficient areas, is hyper or hypothyroidism from amiodarone therapy more common

A

Hypothyroidism

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2
Q

What are the types of amiodarone induced thyrotoxicosis

A

Type 1: abnormal gland w pre existing pathology (e.g. multinodular goiter or latent Graves’) increased synthesis of T3/4

Type 2: a destructive thyroiditis that results in excess release of T3/4. Due to direct toxic effect of amiodarone on thyroid follicular epithelial cells.

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3
Q

Manifestations of amiodarone induced thyrotoxicosis

A

Atrial arrythmias
Exacerbation of IHD/HF
Unexplained weight loss, restlessness, or low grade fever

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4
Q

How to distinguish between Type 1 and 2 amiodarone induced thyrotoxicosis

A

Doppler US - type I increased vascularity, II decreased

Type I have goiters

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5
Q

Treatment of type 1 amiodarone induced thyrotoxicosis

A
  1. Complex decision making re stopping amiodarone - how essential is amiodarone, long half life (100 days),
  2. Thionamides
  3. Radioiodine (but increased uptake)
  4. Surgery - thyroidectomy
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6
Q

Treatment of type 2 amiodarone induced thyrotoxicosis

A

Steroids

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7
Q

Nephrotic syndrome + RA - what systemic disease

A

Amyloidosis

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8
Q

Nephrotic syndrome and myeloma - what systemic disease

A

Amyloidosis

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9
Q

How to diagnosis amyloidosis

A

Biopsy - fat pad or rectal or involved site

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10
Q

Light chain amyloidosis - pathophysiology and organs involved

A

Primary amyloidosis from plasma cell dyscrasia w monoclonal immunoglobulin
Associated with MM or waldenstrom’s or non Hodgkin’s lymphoma

Organs involved:
Mucocutaneous - petechia/ecchymosis, raccoon eyes, allopecia, papules/nodules
Tongue - macroglossia
Heart - ischaemic, arrhythmia, orthostatic hypotension,
Other vascular: claudication
Renal-  proteinuria, nephrotic syndrome
GI - haemorrhage/malabsorption
Hepatomegaly
Neuropathies - autonomic/sensory
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11
Q

Serum amyloid A protein amyloidosis - pathophysiology and manifestations

A

Secondary amyloidosis to inflammatory/infective chronic conditions

Organs involved:

  • Kidney - 90% of patients
  • Liver and spleen (howell jolly bodies)
  • GI (rare)
  • Cardiac - AA deposites (less than AL amyloidosis)
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12
Q

What titre of ANA is more suggestive of autoimmune disorder

A

> 1:640

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13
Q

What ANA pattern is linked to limited scleroderma

A

Anti-centromere

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14
Q

What antibodies are found in primary Sjogren’s

A

Ro/La

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15
Q

What ENAs are SLE specific

A

dsDNA, anti Sm

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16
Q

What ENA is found in mixed CTD

A

U1RNP

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17
Q

What ENA is found in diffuse systemic sclerosis

A

SCL-70

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18
Q

What ENA is found in anti-synthetase syndrome

A

Jo-1

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19
Q

What ENA is associated with congenital heart block

A

anti Ro (SSA)

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20
Q

What at the antiphospholipid antibodies

A

Lupus anticoagulant
Anticardiolipin antibodies
Beta2-glycoprotein-1 antibodies

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21
Q

Most common venous thrombus site in antiphospholipid syndrome

A

Calf

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22
Q

Most common arterial thromboses site in antiphospholipid syndrome

A

Cerebral vessels

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23
Q

Diagnostic criteria for antiphospholipid syndrome

A

+ve antiphospholipid antibody (need repeat measurement 12 weeks apart)
AND
At least 1 clinical feature (venous/arterial thromboses, recurrent foetal loss, thrombocytopenia)

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24
Q

Primary thrombosis prevention in patients who have antiphospholipid antibodies

A

Not indicated if they have not had a thrombotic event or if they have only had a pregnancy morbidity
Aspirin may have a role in cardiovascular risk reduction

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25
CHADS2 risk criteria score
``` Prior stroke Age >65 score 1 >75 score 2 HTN DM HF EF <40% Valvular heart disease Female sex Vascular disease ```
26
Consensus practice guidelines for warfarin bridging in surgery
No bridging for CHADS2 <4 | Can bridge for CHADS2 5/6 or high bleeding risk procedures
27
How to bridge warfarin if required
stop warfarin 5 days before procedure and bridge w LMWH 3 days before and restart LMWH 24 hours after procedure and up to 10 days while warfarin reintroduced
28
Aims of rate control in AF
60-80 bpm at rest and 90 to 115 beats per minute during moderate exercise
29
How long to anticoagulate for before and after cardioversion
3 weeks before and 4 weeks after
30
What agents can be used in maintenance of sinus after DC cardioversion?
Amiodarone Sotalol Flecanide (<60yr and no structural heart disease)
31
Ends of DMARDs: - cept - mab - ximab - zumab - tinib
``` cept - fusion mab - mAb ximab - chimeric mAb zumab - humanized mAb tinib - tyrosine kinase inhibitor ```
32
Secukinumab mechanism of action
IL 17
33
Ustekinumab mechanism of action
IL 12/23
34
Requirement for PBS biologic for RA
Methotrexate 20mg weekly for 6 months and additional DMARD for 3 months Raised inflammatory markers 20 tender swollen joints or 4 major joints
35
Requirements for PBS biologic for ank spond
Reduced ROM Raised inflammatory markers High BASDAI (visual analogue score of pain and stiffness) Significant sacroiliitis proven on Xray Failed 2 consecutive NSAIDs over 3 months with a concurrent exercise program Raised inflammatory markers (ESR 25, CRP 10)
36
What biologic DMARD exacerbates severe heart failure
TNF inhibitors
37
Perioperative management for biologics for surgical procedures
Withhold treatment with etanercept for 2-4 weeks and adalimumab, certolizumab, golimumab and infliximab 4-8 weeks prior to major surgery. Treat may be started post operatively once wound healing is satisfactory and there is no evidence of infection/wound healing
38
Aetiologies of HFrEF
Ischaemic heart disease (2/3rds of cases) HTN Dilated cardiomyopathy
39
HFpEF aetiologies
``` HTN Female Elderly IHD Hypertrophic cardiomyopathy Aortic stenosis ```
40
Precipitants of acute exacerbation of HF
``` Ischaemia Non adherence Arrythmia AKI SYstemic infections Anaemia Hyperthyroidism NSAIDs PE ```
41
Aims of treatment for HFrEF
Manage fluid Reduced hospital admissions/HF exacerbations Reduced morbidity Reduce mortality
42
Primary prevention indication for implantable cardioverter-defibrillator (ICD)
1 month post myocardial infarction and LVEF <30% | HFrEF and ischaemic or dilated cardiomyopathy LVEF <35%
43
How to present kidney staging/classification
Stage x kidney w norm/mic/macalbuminuria secondary to diabetic nephropathy
44
What are CKD blood pressure targets
<140/90 | w diabetes/albuminuria 130/80
45
Mx of albuminuria
ACEi/ARB Reduction in salt intake Spironolactone Glycaemic control (BGL 6-8 post prandial, HbA1C <7%)
46
Relationship of CKD and dyslipidaeia
CKD associated with abnormalities of lipid metabolism More severe in albuminuria - especially nephrotic syndrome Statin for anyone >50 years w CKD or <50 years w other risk factors
47
When to use calcitriol
suppression of secondary hyperparathyroidism - PTH >3-5 upper limit of normal
48
When is cinacalcet used
Hyperparathyroidism in patients on dialysis
49
When does anaemia develop in CKD
eGFR <60
50
When does acidosis develop in CKD
eGFR <30
51
why is acidosis in CKD bad
demineralisation ofbone and increased protein degradation
52
Bicarb aims in CKD
>22
53
Adverse effects of sodibic
fluid retention, worse BP control
54
Modifiable causes of depression in CKD
Insomnia Medication SE Inadequate dialysis
55
Salt restriction CKD
6g/day
56
Treatment approach to chronic pain syndrome
Rehab Physical therapy Occupational therapy - including desensitisation techniques Recreation therapy Medical rapport, realistic treatment goals, psychological evaluation, involvement of family members/carers
57
Analgesia in chronic pain syndrome
Simple analgesia Avoid opioids Amitriptyline/pregabalin/gabapentin SSRI or duloxetine
58
Organs that cystic fibrosis affect
``` Lungs Sinuses Pancreas Reproductive system Liver Intestine - meconium ileus ```
59
CF complications in the respiratory system
``` Bronchiectasis Recurrent infections Sinusitis Pulmonary haemorrhage Pulmonary HTN Spontaneous pneumothorax ```
60
Pancreatic complications of Cystic Fibrosis
exocrine - malabsorption | endocrine - diabetes
61
What diagnoses CF
Sweat chloride value greater than 60 mEq/L
62
Names of CFTR modulators
Ivacaftor Lumancaftor/Ivacaftor Tezacaftor/lumacaftor
63
Indication for transplant in cystic fibrosis
FEV1 <30% Severe hypoxaemia or hypercapnia after recovery from an acute illness Increasing functional impairment Life threatening pulmonary complication - recurrent massive haemoptysis
64
What is the major risk factor for microvascular disease in diabetes
hyperglycaemia
65
What type of diabetes is associated with microvascular and macrovascular
T1DM - microvascular | T2DM - macrovascular
66
Most important RF for diabetic retinopathy
hyperglycaemia and hypertension
67
How to treat diabetic retinopathy
Laser photocoagulation
68
What DOAC is sensitive to coagulation tests
Dabigatran to APTT/TT/TCT
69
Dose reduction for dabigatran
``` Age >75 or CrCl 30-50mL 110mg bd (normally 150mg bd) ```
70
What is granulomatosis with polyangiitis?
Systemic vasculitis of the medium and small arteries, as well as the venules, arterioles and occasionally large arteries
71
What to classify granulomatosis with polyangiitis?
Classic GPA - Upper and lower respiratory tract + kidneys Limited GPA - Upper respiratory tract with majority progressing to GN - less likely to be ANCA positive
72
Organ involvement in granulomatosis with polyangiitis
Lungs - nodules - alveolar/pleural opacities - haemorrhage Kidneys - renal impairment - GN Upper and lower airways Joints Eyes - conjunctivitis, corneal ulceration, episcleritis, optic neuropathy, nasolacrimal duct obstruction Skin Nervous system - CNS, eye, Cranial nerves, mononeuritis multiplex
73
Granulomatosis with polyangiitis diagnostic criteria
2 or more of: - Nasal/oral inflammation - Radiographic chest changes (nodules/infiltrates/cavities) - Abnormal urinary sediment - Granulomatous inflammation on biopsy of an artery or perivascular area
74
How proportion of people with granulomatosis with polyangiitis are ANCA positive
~90%
75
Treatment of GPA
Induction - Cyclophosphomide, steroids, rituximab Maintenance of remission - methotrexate, azathioprine Plasma exchange
76
Indications for plasma exchange in granulomatosis with polyangiitis
anti-GBM antibodies as well as ANCA severe pulmonary haemorrhage on presentation advanced renal dysfunction
77
haemachromatosis mutation gene
HFE gene
78
Haemachromatosis inheritance
autosomal recessive
79
Most common manifestations of haemachromatosis
``` Liver function abnormalities Systemic - weakness/lethargy Skin hyperpigmentation Diabetes Arthralgia Impotence ECG abnormalities ```
80
What manifestations of haemachromatosis doesn't respond to Fe removal?
Arthritis Diabetes (partial)
81
Diagnosis of haemachromatosis
Organ involvement Ferritin >1000, transferritin >50% C282y mutation
82
Preventative measures in haemachromatosis
Avoid ETOH | Monitor for HCC

FRACP clinicals (24 decks)

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