Immunology & Metabolic Flashcards
Allergy tests: uses
- skin prick (1)
- radioallergosorbent test (RAST)
- skin patch (1)
- when to use RAST over the others? (1)
- food allergies, pollen
- determines IgE that reads, useful for foods, inhales allergens (e.g. Pollen), wasp/bee
- contact dermatitis
- RAST can be used in anaphylaxis/ extensive eczema/ patient taking antihistamines
Anaphylaxis:
- initial management? (dose+time) (3)
- management of refractory? (1)
- IM adrenaline every 5 mins
- 500 micrograms
- IV adrenaline infusion AFTER 2 doses of IM
Adrenaline doses
- <6 months
- 6m - 6years
-6-12years
- >12 years
- 100-150 micrograms
- 150 micrograms
- 300 micrograms
- 500 micrograms (0.5 ml of 1 in 1,000)
Allergy tests:
- skin prick test control? (1)
- skin prick when to read? (1)
- skin patch when to read? (1)
- RAST how does it work? (1)
- histamine
- after 15-20 mins
- 48 hr
- IgE
Most useful test to determine anaphylaxis
serum tryptase
Hyponatraemia:
- causes of pseudohyponatraemia? (2)
- if urinary sodium >20? if hypovolaemic (3) and euvolaemic (2)
- if sodium <20?
- hyperlipidaemia
- taking blood from drip arm
Sodium >20
HYPOVOLAEMIC
- diuretics, Addisons, diuretic stage of renal failure
EUVOLAEMIC
- SIADH, hypothyroid
Sodium <20
- diarrhoea, vomiting, sweating
burns, adenoma of rectum
water excess, psychogenic polydipsia
SIADH and cancer - what type of lung? (1)
others? (2)
small cell lung cancer
(also pancreas and prostate)
SIADH causes:
- cancer (1)
- neurological (4)
- infectious (2)
- drugs (5)
- other (2)
CANCER:
- SCLC
HEAD:
- stroke
- SAD
- sub dural
- meningitis/ encephalitis/ abscess
INFECTION:
- TB
- pneumonia
DRUGS:
- sulfonylureas
- SSRIs, tricyclics
- carbamazepine
- vincristine
- cylophosphamide
OTHER:
- positive end-expiratory pressure
- prophyrias
SIADH
- investigations (2)
- management (4)
INVESTIGATIONS:
- urine osmolality
- urine sodium concentration
MANAGEMENT:
- slow correction (pontine myelinolysis)
- fluid restrict
- demeclocycline
- ADH vasopressin receptor antagonist
raised ALP and normal LFTs?
- raised calcium (2)
- low calcium (2)
- bone cancer/ mets
or hyperparathyroidism - osteomalacia or renal failures
statins and pregnancy
discontinue for 3 months before conception and during pregnancy
what 3 CVD conditions do you get high statin therapy (80mg) (3)
IHD, stroke, PVD
Hypocalaemia
- features? (4)
- Trousseau/ Chvosteks (2)
- tetany: muscle twitching, cramping and spasm
- perioral paraesthesia
- if chronic: depression, cataracts
- ECG: prolonged QT interval
- carpal spasm + wrist flexion
- tapping over parotid causes pain
ECG hyperkalaemia
tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
Hyperkalaemia:
- causes? (7)
- what type of acid/alkali disorder (1)
acute kidney injury
drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin**
metabolic acidosis
Addison’s disease
rhabdomyolysis
massive blood transfusion
Management hyperkalaemia:
- initial? (1)
- delayed effect (2-3 days)? (1)
- other (2)
- IVF
- bisphosphonates
- calcitonin
- steroids for sarcoidosis
Familial hyperlipidaemia:
- diagnosis? (2)
- a total cholesterol level greater than 7.5 mmol/l
AND/ OR
- a personal or family history of premature coronary heart disease (an event before 60 years in an index individual or first-degree relative)
Deficiencies:
- B1 (2)
- B3 (niacin) (3)
THIAMINE (B1):
- polyneuropathy
- Wernicke-Korsakoff syndrome
- heart failure
NIACIN (B3): AKA pellegra
- dementia
- dairrhoea
- dermatitis
isolated high uric acid with no Sx of gout: how to treat? (1)
No treatment needed (don’t treat asymptomatic hyperuricaemia)
Parathyroid and ALP: how are the two related?
HYPERparathyoridism –> high ALP
Alkaline phosphatase (ALP) is an enzyme that is present in many tissues throughout the body, but primarily in the liver, bile ducts and bone. A rise in ALP levels can be caused by conditions that produce injury or inflammation to these tissues. Hypoparathyroidism, which involves decreased function of the parathyroid glands leading to low levels of parathyroid hormone (PTH), does not typically cause a rise in ALP. Instead, it leads to hypocalcaemia and hyperphosphatemia due to reduced bone turnover and renal phosphate excretion.
what happens to albumin in infection
can decrease
Familial hypercholesterolaemia inheritance pattern? (1)
autosomal dominant
Familial hypercholesterolaemia features (3)
- elevated LDL cholesterol (>5 mmol/L)
- tendon xanthomata (pathognomonic for FH)
- strong family history of premature cardiovascular disease (father’s MI at age 45)
(for mixed hyperlipidaemia: The presence of tendon xanthomata and the strong family history are not typical features of mixed hyperlipidaemia)
what vitamin deficiency causes Diarrhoea, confusion and eczematous skin
niacin
what vitamin def causes bleeding gums
Vit C
chronic kidney disease leading to secondary hyperparathyroidism
Important for me blood s
Low serum calcium, raised serum phosphate, raised ALP and raised PTH -
helps to distinguish pseudogout from gout
Chondrocalcinosis
( a painful type of arthritis that causes calcium pyrophosphate crystal deposits in the joint tissues)
osteoporosis bloods
all normal
