Inflammation Flashcards
1
Q
Give 4 symptoms of IBD
A
Diahorrea
Fatigue
Abdominal pain (in Crohs may localise to R I loan fossa)
Weight loss
2
Q
Give two differences between Ulcerative colitis and Crohns
A
UC - colon only. Crohns - mouth to anus
UC - mucosa only. Crohns - transmural
3
Q
Give 2 first line treatments for ulcerative colitis
A
Steroids (prednisolone)
Aminosalicyclates
4
Q
Give two first line treatments for Crohns
A
Steroids (use less than in UC)
Abx
5
Q
What lifestyle modification has greatest impact on NAFLD?
A
Smoking cessation
6
Q
Give 7 commonly encountered opportunistic infections in HIV patients not on treatment
A
- TB
- Pneumocystis
- Toxoplasmosis
- Cryptococcal meningitis
- Cytomegalovirus
- Musculocutaneous candidiasis
- Disseminated M avian complex
7
Q
What is the finding of amyloidosis using Congo red staining of biopsey?
A
Apple green birefringence under polarised light
8
Q
Give four blood findings of DIC
A
Low platelets
Prolonged PTT/bleeding time
Elevated fibrin degradation products
Schistocytes
9
Q
What is the HbA1C cut off for diabetes?
A
48 mmol/mol
10
Q
What is the random venous plasma glucose cut off for diabetes?
A
11.1 mmol/l
11
Q
What is the fasting venous blood glc cut off for diabetes?
A
7 mmol/l
12
Q
What is the blood findings triad of DKA?
A
Glc > 11 or known diabetes
Ketones >3
pH<7.3 or HCO3- < 15 (23 - 30 is reference range)
13
Q
What is the inflammatory blood marker finding in SLE?
A
ESR 100
CRP 0
14
Q
What differentiates HHS from DKA?
A
HHS doesn’t have acidosis or ketones
Just really hyperglyceamic 30mmol and volume deplete (massive thirst)
15
Q
What is charcots triad for cholangitis?
A
Fever
Jaundice
RUQ pain
16
Q
Which three hepatitis viruses are likely to cause chronic infection?
A
B,C,D
17
Q
Give five symptoms of viral hepatitis
A
non specific/constitutional (eg. malaise, fever, nausea)
Right upper quadrant pain
Dark Urine
Clay coloured feaces (due to bilirubin being exreated in urine not feaces)
Jaundice
18
Q
what does raised ALT/AST mean
A
Liver damage. these enzymes are released from hepatocytes
19
Q
what is the mode of transmission of Hep A
A
Faeco oral
Parenteral but only rarely
20
Q
What is the diagnostic method of choice for Hep A
A
IgM Serology
21
Q
What two groups are most at risk if they get infected by Hep E
A
pregnant women (20-29% mortality) Immunocompromised
22
Q
Where is Hep B endemic to
A
Asia and Africa
23
Q
what increases chance of developing chronic Hep. B infection/carrier state rather than it being self limiting?
A
Perinatal/early childhood acquisition
24
Q
What carrier status does Hep B serology findings of HBsAg +ve , IgM -ve mean?
A
Chronic infection
25
What carrier status does Hep B serology findings of HBsAg +ve , IgM +ve mean?
Acute infection
26
What carrier status does Hep B serology findings of HBsAg -ve , IgM +ve mean?
resolving infection
27
What carrier status does Hep B serology findings of HBsAg -ve , IgM -ve, other antibody (eg. IgG) +ve mean?
past infection or vaccination
28
what condition does hep D need to infect
hep B carrier
29
what is the main source of transmission of Hep E
undercooked meat
30
Which Hepatitis virus has the highest chance of chronic injection
Hep C (75-80%)
31
What is the triad of haemolytic ureamic syndrome
AKI (low urnie output)
Thrombocytopeania (bruising)
Aneamia
32
What is a common clue of heamolytic ureamic syndrome causes by E. Coli in children?
Bloody Diahorrea
33
Give four signs of nephrotic syndrome
proteinurea
hypoalbuminaemia
odema
hyperlipidaemia
34
give 5 causes of nephrotic syndrome
```
diabetic nephropathy
SLE
Amyloidosis
Malignancy
Drugs
```
35
What lupus autoantibody has high sensitivity/ low specificity?
Antinuclear
36
What lupus antibody has high specificity and low sensitivity?
dsDNA Abs
37
What three types of skin rash occur in lupus
Discoid
Acute Subcutanous
Chilblains
38
Give three insulin regimes used for T2DM
Once daily long acting
Twice daily biphasic
Basal-Bolus
39
If patient is jaundiced and ALP is the primary raised LFT, what is the cause?
Cholestasis (obstructive jaundice)
40
If Pt is jaundiced but ALT is the main raised LFT, what is the cause?
Hepatocellular Injury/ Hepatitis
41
What are the main raised LFTs in cholestasis?
ALP
| Gamma GT
42
What combination of antivirals is used to treat Hep C?
Sofobuvir
| Velpatasvir
43
What blood tests should you look for in heamochromatosis?
Raised serum ferritin
| Raised serum transferrin saturation
44
What antibodies are universally present in primary biliary cholangitis?
Anti mitochondrial autoantibodies
45
Give two drugs used to treat primary biliary cholangitis?
Urodeoxycholic acid
| Obeticholic acid
46
What three autoantibodies are present in autoimmune hepatitis?
Antinuclear antibody
Smooth muscle antibody
Liver kidney microsomal antibody
47
What cholestasic condition has a 75% association with IBD?
Primary sclerosing cholangitis
48
What blood findings common in lupus nephritis?
anti dsDNA
49
What drug is the bedrock of SLE treatment?
Hydroxychloroquin (anti malarial)
50
Give 5 management options for SLE
```
hydroxychloroquin
topical steroids
sun avoidence
cortico steroids (prednisolone)
biologics
```
51
Give two presentations of antiphospholipid syndrome
thrombotic events
| miscarriage
52
Give 6 complications/associated conditions of SLE
```
Lupus atherolsclerosis
Pericarditis
Endocariditis
neurophyciatric lupus
Lupus nephritis
antiphospholipid syndrome
raunauds phenomenon
```
53
give four features of inflammatory joint pain
Worse in morning
stiffness improves with exercise
resolution of symtoms with NSAIDS
Pain causing waking in 2nd half of night
54
What two antibodies should you look for in Coeliac disease serology?
Endomysial Ab
| IgA tissue transglutaminase
55
What two gene mutations are always present in coeliac patients?
HLA-DQ2/DQ8 (low positive predictive value though)
56
What is the gold standard diagnostic test for coeliac disease and what three things are you looking for on it?
Duodenal Biopsey
- villous atrophy
- Crypt hyperplasia
- intraepithelial lymphocytes
57
What dermatological symptoms is suggetive of coeliac disease?
Dermatitis herpetiform
58
in coeliac disease investigation, if seroloyg is -ve but histology is +ve, how do you interpret?
consider other causes. If not, treat as coeliac
59
in coeliac disease investigation, if serology is +ve but histology is -ve, how do you interpret?
Repeat in a year or 2
60
What three cytokines causes the epithelial and mucosal damage seen in coeliac disease?
IL-15, IFN-gamma, TNF-alpha
61
What three drugs form the 'Triple Therapy' used in H pylori positive Peptic ulcer bleed
PPI
Amoxicillin
Metronidazole
62
What condition are oesophageal varicies a direct consequence of?
Portal hypertension
63
What drug do you use to aid resusitation in active bleeding oesophageal varicie?
Terlipressin
64
Give three blood findings in bacterial sepsis
Neutophilia
Thrombocytopaenia
Aneamia (DIC)
65
GIve two unique blood findings in malaria
Plasmodium Falciparum rings in RBC (headphone shaped rings)
| Gometocytes (banana shaped, more common upon recovery)
66
Give 5 malaria blood findings
```
Aneamia
Thrombocytopaenia
mild neutrophilia
Plasmodium Falciparum rings in RBC
Gometocytes (banana shaped)
```
67
Give three broad catagories of causes of eosinophilia
Parasitic infection
Allergy
Drug Hypersensitivity
68
give and example of a parasitic infection that can causes eosinophilia
Strongyloides Stercola
69
Give three blood findings in Clostridium Perfringens infection
Sphereocytes (small dense RBC)
DIC
Heamolyisis/aneamia
70
Give three clinical findings in Clostridium Perfringens infection
Gas Gangrene in liver
Septic Shock
Myonecrosis
71
What is Red cell Rouleux and whenn does it happen?
RBCs stack up like coins due to elevated blood protein eg. Abs.
A cause of aneamia in chronic inflammation
72
Give four causes of aneamia in chronic inflammation
Cytokines cause reduced erythropoesis
Kidneys reduce their erythropoetin release
Red Cell Roleux
IL-6 causes increased hepcidin release fro liver resulting in increased Fe sequesteration
73
Give 5 blood changes in chronic liver failiure
```
increased MCV
aneamia
thrombocytopaenia
neutropaenia
Acanthocytes
```
74
What are acanthocytes and when are they found?
RBC with jagged edges
| chronic liver failiure
75
Give two blood findings in chronic renal failiure
Aneamia
| Echinocytes
76
What are Echinocytes? and when are they present?
RBC with jagged edges but not as irregular as Acanthocytes
| Chronic renal failiure
77
Give three proinflamatory cytokines
IL-1
IL-6
TNF-a
78
Give two antiinflammatory cytokines
IL-10
| IL-4
79
Which cytokines stimulates release of acute phase proteins
IL-6
80
Give 3 function of TNF-a/IL-1
Fever
release stress hormones (renin ect)
Stimulate IL-8, IL-6 and IFN-g
81
give 4 functions of IL-1, IL-6 and IL-8
chemotaxis
neutophil degranulation
Causes granulocytes to leave blood vessles
Fever
82
Give 3 functions of IL-8 and TNF-a
Fever
Leukocytosis
Increase prostaglandin production
83
Give four acutes phase proteins that go up in inflammation
CRP
Serum amyloid A
Haptoglobin
Procalcetonin
84
Which acute phase protein goes up the quickest
Procalcetonin
85
What acute pahse protein is a good indicator of Bacterial sepsis
Procalcetonin (there are algorithms that can tell you if its bacterial or viral sepsis from the procalcetonin)
86
Give a selective COX-2 antagonist
Celecoxib
87
Give three measures that must be taken before starting a patient with significant cardiovascular risk on COX inhibitors???
PPI
Prostaglandin analougues (to aid vasodilation)
Apply topically as opposed to orally
(but you start angina Pts on aspirin??? Dont understand)
88
What is the standard traditional DMARD used in RA?
Methotrexate
89
Give one con of DMARDS as opposed to NSAIDS
DMARDS take weeks to months to kick in whereas NSAIDS are immedicate. Hard to get people to seitch over. May give NSAIDS in the meantime while DMARD is kicking in
90
Give three methotrexate side effects
pancytopeania
increased infection risk
decreased intestine/liver function
91
Give two non biologic targeted DMARDS
Janus Kinase Inhibitor
| Apremilast (Phosphodiesterase 4 inhibitor - stops arachadonic acid synthesis)
92
Give 5 side effects of steroid use
```
Osteoporosis
Diabetes
Glaucoma
Infection risk
Adrenal Atrophy
```
93
In steroid sparing regimes for RA, when do you use steroids?
In flare ups only
94
What is the diagnostic criteria for systemic inflammatory response syndrome (SIRS)
+2 of:
Temp >38, <36
HR >90
RR >20
WBc >12000, <4000 (rr is 4500 - 10000)
95
What is the defintion of Sepsis syndrome
SIRS with presumed or confirmed infection
96
What is septic shock?
Sepsis with hypotension/hypoperfusion despite adequate fluid resus
97
What is the main syndrome that results in viral sepsis
heamhorragic fever (eg. from Ebola)
98
What are the Sepsis 6 that must be done in the first hour?
```
High flow O2
Blood cultures
Broad Spectrum Abx
Hourly urine output
IV fluids
Measure Hb and Serum Lactate
```
99
What is a standard combination of broad spectrum Abx to give in sepsis
Co-amoxiclav
Gentamycin
Vancomycin
100
What type of virus are Varicella zoster and EBV?
Herpes (alpha and gamma respectively)
101
Where does varicella zoster virus lay dormant?
Dorsal root or cranial nerve ganglia
102
how long is the varicella prodrome
10-21 days
103
give three features that may occur in the varicella prodrome
Fever
Malaise
Pharyngitis
104
What does the lab testing for varicella consist of
Sample the lesion fluid
| Directly detect the virus (PCR) --abs no good
105
When is a varicella patient infective?
from prodrome to until all lesions are crusted over
106
Give five complications of Varicella
```
Heamhorragic varicella
pneumonia
cerebellar Ataxia
Encephalitis
secondary bacterial infection of the lesions
```
107
What is a common complication of Zoster affecting the CN5a?
Acute retinal necrosis
| (if eye involved refer to ophthalmologist)
108
What is the most common dermatome infected by zoster?
CN5a
109
Give 3 features of the Zoster presentation
Unilateral rash
affecting 1 or 2 dermatomes
May have pain at site preceeding rash
110
Give one complication of Zoster after resolution
Post herpetic neuraligia (pain at site continues)
111
Give three things given for post exposure prophylaxis for zoster in susceptible individuals
Aciclovir
Varivax Vaccine
VZIG (immunoglobulins for passive immunisation)
112
What is the nature of OKA vaccine for VZV
Live attenuated
113
Give three indications for offering Oka vaccine
succeptibile healthcareworkers
households of immunocompromised Pts
Routinely to 70-79 yros to prevent VZV reawakening
114
Give 2 signs/ symptoms of psoraisis
Plaques (symetrical, scaley, silver)
| Nail changes
115
Give 5 precipitating factors of psoraisis
```
Emotional stress
Infection eg. Streptococcal pharyngitis
Physical skin trauma
Drugs
HIV infection
```
116
Give 2 first line treatments for psoraisis
Topical steroids
| Vitamin D analouges
117
Give 4 conditions that psoraisis has increased risk of
Depression/ suicidality
Anxiety
CVD (MI Stroke)
Psoriatic Artheritis
118
Give 4 second line treatments for Psoraisis (3 drugs)
Phototherapy
Methotrexate
Acitretin (oral retinoid)
Fumeric acid ester (Anti inflammatory)
119
what is the defintion of erythroderma
90% of body surface is red
120
Why is erythroderma dangerous
Cant regulate body temp of fluid balence
121
What is the management for erythroderma?
Rest and supportive care
122
What gene is defective in some cases of genetic atopic ecsema and how does this causes the disease?
Fillagrin
| Impaired integrity of epidermis allows antigens/allergens to access
123
What site is ecsema most common in infants?
Face/cheeks
124
What three sites in ecsema common in children
Face
Neck
Flexures
125
what three sites is ecsema common in adults?
Neck
Hands
Feet
126
Give 2 pros of using Biguanides (eg . metformin) over other T2DM drugs
No increasedd appetite/ weight gain
| No hypoglyceamia risk
127
Give 2 sulphonylureas
Glipizide
Gliclazide
Glibencimide
128
What is the main risk of sulphonylureas
Hypoglyceamia
129
Give one pro of using Meglinitides as opposed to sulphonyl ureas
Less potent so reduced hypoglycaemia risk
130
When should pt take meglintidines
Before meals to deal with post prandial hyperglycaemia
131
How do Glitazones work?
Upregulates insulin receptors in perifery
132
give 2 Sx of glitazones
Weight gain
| Bladder cancer risk (pioglitazone)
133
Give an example of a Glitazone
Pioglitazone
134
How do gliptins work and give two pros of using them
Reduced breakdown of endogenous incretins (substances that stimulate insulin relased when glc sensed in gut)
No hypoglycamia risk
No weight gain
135
which class of T2DM drugs causes weight gain?
Glitazones
136
Which class of T2DM drugs causes hypoglycaemia risk
Sulphonylureas
137
How do a-glucosidease inhibitors and Sodium glucose transporter inhibitors work in T2DM?
Block gut absorbtion and renal reabsorbtion of glc respectively
138
Give one pro of using a-glucosidase inhibitors
no hypoglycaemia
139
Give 2 Sx of a glucosidase inhibitors
flatuence
| Diahorrea
140
Give 2 symptoms of hrnoch Scorlein Purpura
heamaturia
| Rash
141
What is the most likely causes of nephrotic syndrome in children and how does it classically present?
Minimal change disease
| Sudden onset of odema
142
How do you treat minimal change disease
Steroids
143
What is Focal segemental glomerularsclerosis
Injury/lesion to podocytes resulting in nephrotic syndrome
144
What is Membranous Nephropathy
Autoimmue mediated thickening of BM which paradoxically causes nephrotic syndrome
145
Give 2 signs/symptoms of goodpastures disease (Anti GBM disease)
Absolute anuria
| Heampotysis (pulmonary heamhorrage)
146
What is the first thing that must be treated in renal disease and how do you treat it?
Hyperkalaemia
Insulin + dextrose
Calcium Glucanate (protects heart)
147
give 8 causes of nephrotic syndrome
```
Minial change disease
Focal Segmental Glomerular sclerosis
Membranous nephropathy
Daibetic nephropathy
SLE
Amyloidosis
Drugs
Malignancy
```
148
Give 4 indications for dialysis
```
Hyperkalaemia (treatment resistant)
pulmonary odema (diuretic resistant)
uraemia symptoms (poor apetite, weight loss, lethargy, vomit, pruritis)
```
149
Give 2 adipose derived substances that increase insulin sensitivity and 2 that contribute to resistence
Leptin and adiponectin increased sensitivity
| FFA/DAG and TNF alpha contribute to resistence
150
give three processes in obesity that contribute to insulin resistence
```
chronic inflammation
Oxidative stress (increased ROS)
Lipotoxicity (increased TAG, FFA ect downregulates the IRS phosphorylation pathway)
```
151
what is the main distinguishing feature of Psoriatic arthritis
Dactylitis
152
Give 5 features of reactive arthritis
```
No rheumtoid factor
Hx of GI or genitourinary infecction
Conjunctivitis
Urethritis
Arthritis (asymetrical oligoarticular)
```
153
What group of Pt get enteropathic arthritis
IBD pts
154
What is the primary investigation for suspected ankylosing spondylitis?
Xray for sacroileitis
155
What is the marker for RA?
Anti CCP antibodies!!
156
Which 2 genes confer an increaed risk of RA if mutated?
HLA- DR1/ DR4
