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Inflammation > Inflammation > Flashcards

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

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2
Q

Give two differences between Ulcerative colitis and Crohns

A

UC - colon only. Crohns - mouth to anus

UC - mucosa only. Crohns - transmural

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3
Q

Give 2 first line treatments for ulcerative colitis

A

Steroids (prednisolone)

Aminosalicyclates

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4
Q

Give two first line treatments for Crohns

A

Steroids (use less than in UC)

Abx

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5
Q

What lifestyle modification has greatest impact on NAFLD?

A

Smoking cessation

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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
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7
Q

What is the finding of amyloidosis using Congo red staining of biopsey?

A

Apple green birefringence under polarised light

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8
Q

Give four blood findings of DIC

A

Low platelets
Prolonged PTT/bleeding time
Elevated fibrin degradation products
Schistocytes

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9
Q

What is the HbA1C cut off for diabetes?

A

48 mmol/mol

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10
Q

What is the random venous plasma glucose cut off for diabetes?

A

11.1 mmol/l

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11
Q

What is the fasting venous blood glc cut off for diabetes?

A

7 mmol/l

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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)

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13
Q

What is the inflammatory blood marker finding in SLE?

A

ESR 100

CRP 0

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14
Q

What differentiates HHS from DKA?

A

HHS doesn’t have acidosis or ketones

Just really hyperglyceamic 30mmol and volume deplete (massive thirst)

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15
Q

What is charcots triad for cholangitis?

A

Fever
Jaundice
RUQ pain

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16
Q

Which three hepatitis viruses are likely to cause chronic infection?

A

B,C,D

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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

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18
Q

what does raised ALT/AST mean

A

Liver damage. these enzymes are released from hepatocytes

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19
Q

what is the mode of transmission of Hep A

A

Faeco oral

Parenteral but only rarely

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20
Q

What is the diagnostic method of choice for Hep A

A

IgM Serology

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21
Q

What two groups are most at risk if they get infected by Hep E

A 
pregnant women (20-29% mortality)
Immunocompromised
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22
Q

Where is Hep B endemic to

A

Asia and Africa

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23
Q

what increases chance of developing chronic Hep. B infection/carrier state rather than it being self limiting?

A

Perinatal/early childhood acquisition

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24
Q

What carrier status does Hep B serology findings of HBsAg +ve , IgM -ve mean?

A

Chronic infection

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25
Q

What carrier status does Hep B serology findings of HBsAg +ve , IgM +ve mean?

A

Acute infection

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26
Q

What carrier status does Hep B serology findings of HBsAg -ve , IgM +ve mean?

A

resolving infection

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27
Q

What carrier status does Hep B serology findings of HBsAg -ve , IgM -ve, other antibody (eg. IgG) +ve mean?

A

past infection or vaccination

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28
Q

what condition does hep D need to infect

A

hep B carrier

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29
Q

what is the main source of transmission of Hep E

A

undercooked meat

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30
Q

Which Hepatitis virus has the highest chance of chronic injection

A

Hep C (75-80%)

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31
Q

What is the triad of haemolytic ureamic syndrome

A

AKI (low urnie output)
Thrombocytopeania (bruising)
Aneamia

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32
Q

What is a common clue of heamolytic ureamic syndrome causes by E. Coli in children?

A

Bloody Diahorrea

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33
Q

Give four signs of nephrotic syndrome

A

proteinurea
hypoalbuminaemia
odema
hyperlipidaemia

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34
Q

give 5 causes of nephrotic syndrome

A 
diabetic nephropathy
SLE
Amyloidosis
Malignancy
Drugs
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35
Q

What lupus autoantibody has high sensitivity/ low specificity?

A

Antinuclear

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36
Q

What lupus antibody has high specificity and low sensitivity?

A

dsDNA Abs

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37
Q

What three types of skin rash occur in lupus

A

Discoid
Acute Subcutanous
Chilblains

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38
Q

Give three insulin regimes used for T2DM

A

Once daily long acting
Twice daily biphasic
Basal-Bolus

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39
Q

If patient is jaundiced and ALP is the primary raised LFT, what is the cause?

A

Cholestasis (obstructive jaundice)

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40
Q

If Pt is jaundiced but ALT is the main raised LFT, what is the cause?

A

Hepatocellular Injury/ Hepatitis

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41
Q

What are the main raised LFTs in cholestasis?

A

ALP

Gamma GT

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42
Q

What combination of antivirals is used to treat Hep C?

A

Sofobuvir

Velpatasvir

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43
Q

What blood tests should you look for in heamochromatosis?

A

Raised serum ferritin

Raised serum transferrin saturation

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44
Q

What antibodies are universally present in primary biliary cholangitis?

A

Anti mitochondrial autoantibodies

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45
Q

Give two drugs used to treat primary biliary cholangitis?

A

Urodeoxycholic acid

Obeticholic acid

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46
Q

What three autoantibodies are present in autoimmune hepatitis?

A

Antinuclear antibody
Smooth muscle antibody
Liver kidney microsomal antibody

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47
Q

What cholestasic condition has a 75% association with IBD?

A

Primary sclerosing cholangitis

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48
Q

What blood findings common in lupus nephritis?

A

anti dsDNA

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49
Q

What drug is the bedrock of SLE treatment?

A

Hydroxychloroquin (anti malarial)

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50
Q

Give 5 management options for SLE

A 
hydroxychloroquin
topical steroids
sun avoidence
cortico steroids (prednisolone)
biologics
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51
Q

Give two presentations of antiphospholipid syndrome

A

thrombotic events

miscarriage

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52
Q

Give 6 complications/associated conditions of SLE

A 
Lupus atherolsclerosis
Pericarditis
Endocariditis
neurophyciatric lupus
Lupus nephritis
antiphospholipid syndrome
raunauds phenomenon
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53
Q

give four features of inflammatory joint pain

A

Worse in morning
stiffness improves with exercise
resolution of symtoms with NSAIDS
Pain causing waking in 2nd half of night

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54
Q

What two antibodies should you look for in Coeliac disease serology?

A

Endomysial Ab

IgA tissue transglutaminase

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55
Q

What two gene mutations are always present in coeliac patients?

A

HLA-DQ2/DQ8 (low positive predictive value though)

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56
Q

What is the gold standard diagnostic test for coeliac disease and what three things are you looking for on it?

A

Duodenal Biopsey

  • villous atrophy
  • Crypt hyperplasia
  • intraepithelial lymphocytes
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57
Q

What dermatological symptoms is suggetive of coeliac disease?

A

Dermatitis herpetiform

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58
Q

in coeliac disease investigation, if seroloyg is -ve but histology is +ve, how do you interpret?

A

consider other causes. If not, treat as coeliac

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59
Q

in coeliac disease investigation, if serology is +ve but histology is -ve, how do you interpret?

A

Repeat in a year or 2

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60
Q

What three cytokines causes the epithelial and mucosal damage seen in coeliac disease?

A

IL-15, IFN-gamma, TNF-alpha

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61
Q

What three drugs form the ‘Triple Therapy’ used in H pylori positive Peptic ulcer bleed

A

PPI
Amoxicillin
Metronidazole

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62
Q

What condition are oesophageal varicies a direct consequence of?

A

Portal hypertension

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63
Q

What drug do you use to aid resusitation in active bleeding oesophageal varicie?

A

Terlipressin

64
Q

Give three blood findings in bacterial sepsis

A

Neutophilia
Thrombocytopaenia
Aneamia (DIC)

65
Q

GIve two unique blood findings in malaria

A

Plasmodium Falciparum rings in RBC (headphone shaped rings)

Gometocytes (banana shaped, more common upon recovery)

66
Q

Give 5 malaria blood findings

A 
Aneamia
Thrombocytopaenia
mild neutrophilia
Plasmodium Falciparum rings in RBC
Gometocytes (banana shaped)
67
Q

Give three broad catagories of causes of eosinophilia

A

Parasitic infection
Allergy
Drug Hypersensitivity

68
Q

give and example of a parasitic infection that can causes eosinophilia

A

Strongyloides Stercola

69
Q

Give three blood findings in Clostridium Perfringens infection

A

Sphereocytes (small dense RBC)
DIC
Heamolyisis/aneamia

70
Q

Give three clinical findings in Clostridium Perfringens infection

A

Gas Gangrene in liver
Septic Shock
Myonecrosis

71
Q

What is Red cell Rouleux and whenn does it happen?

A

RBCs stack up like coins due to elevated blood protein eg. Abs.
A cause of aneamia in chronic inflammation

72
Q

Give four causes of aneamia in chronic inflammation

A

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
Q

Give 5 blood changes in chronic liver failiure

A 
increased MCV
aneamia
thrombocytopaenia
neutropaenia
Acanthocytes
74
Q

What are acanthocytes and when are they found?

A

RBC with jagged edges

chronic liver failiure

75
Q

Give two blood findings in chronic renal failiure

A

Aneamia

Echinocytes

76
Q

What are Echinocytes? and when are they present?

A

RBC with jagged edges but not as irregular as Acanthocytes

Chronic renal failiure

77
Q

Give three proinflamatory cytokines

A

IL-1
IL-6
TNF-a

78
Q

Give two antiinflammatory cytokines

A

IL-10

IL-4

79
Q

Which cytokines stimulates release of acute phase proteins

A

IL-6

80
Q

Give 3 function of TNF-a/IL-1

A

Fever
release stress hormones (renin ect)
Stimulate IL-8, IL-6 and IFN-g

81
Q

give 4 functions of IL-1, IL-6 and IL-8

A

chemotaxis
neutophil degranulation
Causes granulocytes to leave blood vessles
Fever

82
Q

Give 3 functions of IL-8 and TNF-a

A

Fever
Leukocytosis
Increase prostaglandin production

83
Q

Give four acutes phase proteins that go up in inflammation

A

CRP
Serum amyloid A
Haptoglobin
Procalcetonin

84
Q

Which acute phase protein goes up the quickest

A

Procalcetonin

85
Q

What acute pahse protein is a good indicator of Bacterial sepsis

A

Procalcetonin (there are algorithms that can tell you if its bacterial or viral sepsis from the procalcetonin)

86
Q

Give a selective COX-2 antagonist

A

Celecoxib

87
Q

Give three measures that must be taken before starting a patient with significant cardiovascular risk on COX inhibitors???

A

PPI
Prostaglandin analougues (to aid vasodilation)
Apply topically as opposed to orally

(but you start angina Pts on aspirin??? Dont understand)

88
Q

What is the standard traditional DMARD used in RA?

A

Methotrexate

89
Q

Give one con of DMARDS as opposed to NSAIDS

A

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
Q

Give three methotrexate side effects

A

pancytopeania
increased infection risk
decreased intestine/liver function

91
Q

Give two non biologic targeted DMARDS

A

Janus Kinase Inhibitor

Apremilast (Phosphodiesterase 4 inhibitor - stops arachadonic acid synthesis)

92
Q

Give 5 side effects of steroid use

A 
Osteoporosis
Diabetes
Glaucoma
Infection risk
Adrenal Atrophy
93
Q

In steroid sparing regimes for RA, when do you use steroids?

A

In flare ups only

94
Q

What is the diagnostic criteria for systemic inflammatory response syndrome (SIRS)

A

+2 of:

Temp >38, <36
HR >90
RR >20
WBc >12000, <4000 (rr is 4500 - 10000)

95
Q

What is the defintion of Sepsis syndrome

A

SIRS with presumed or confirmed infection

96
Q

What is septic shock?

A

Sepsis with hypotension/hypoperfusion despite adequate fluid resus

97
Q

What is the main syndrome that results in viral sepsis

A

heamhorragic fever (eg. from Ebola)

98
Q

What are the Sepsis 6 that must be done in the first hour?

A 
High flow O2
Blood cultures
Broad Spectrum Abx
Hourly urine output
IV fluids
Measure Hb and Serum Lactate
99
Q

What is a standard combination of broad spectrum Abx to give in sepsis

A

Co-amoxiclav
Gentamycin
Vancomycin

100
Q

What type of virus are Varicella zoster and EBV?

A

Herpes (alpha and gamma respectively)

101
Q

Where does varicella zoster virus lay dormant?

A

Dorsal root or cranial nerve ganglia

102
Q

how long is the varicella prodrome

A

10-21 days

103
Q

give three features that may occur in the varicella prodrome

A

Fever
Malaise
Pharyngitis

104
Q

What does the lab testing for varicella consist of

A

Sample the lesion fluid

Directly detect the virus (PCR) –abs no good

105
Q

When is a varicella patient infective?

A

from prodrome to until all lesions are crusted over

106
Q

Give five complications of Varicella

A 
Heamhorragic varicella
pneumonia
cerebellar Ataxia
Encephalitis
secondary bacterial infection of the lesions
107
Q

What is a common complication of Zoster affecting the CN5a?

A

Acute retinal necrosis

(if eye involved refer to ophthalmologist)

108
Q

What is the most common dermatome infected by zoster?

A

CN5a

109
Q

Give 3 features of the Zoster presentation

A

Unilateral rash
affecting 1 or 2 dermatomes
May have pain at site preceeding rash

110
Q

Give one complication of Zoster after resolution

A

Post herpetic neuraligia (pain at site continues)

111
Q

Give three things given for post exposure prophylaxis for zoster in susceptible individuals

A

Aciclovir
Varivax Vaccine
VZIG (immunoglobulins for passive immunisation)

112
Q

What is the nature of OKA vaccine for VZV

A

Live attenuated

113
Q

Give three indications for offering Oka vaccine

A

succeptibile healthcareworkers
households of immunocompromised Pts
Routinely to 70-79 yros to prevent VZV reawakening

114
Q

Give 2 signs/ symptoms of psoraisis

A

Plaques (symetrical, scaley, silver)

Nail changes

115
Q

Give 5 precipitating factors of psoraisis

A 
Emotional stress
Infection eg. Streptococcal pharyngitis
Physical skin trauma
Drugs
HIV infection
116
Q

Give 2 first line treatments for psoraisis

A

Topical steroids

Vitamin D analouges

117
Q

Give 4 conditions that psoraisis has increased risk of

A

Depression/ suicidality
Anxiety
CVD (MI Stroke)
Psoriatic Artheritis

118
Q

Give 4 second line treatments for Psoraisis (3 drugs)

A

Phototherapy
Methotrexate
Acitretin (oral retinoid)
Fumeric acid ester (Anti inflammatory)

119
Q

what is the defintion of erythroderma

A

90% of body surface is red

120
Q

Why is erythroderma dangerous

A

Cant regulate body temp of fluid balence

121
Q

What is the management for erythroderma?

A

Rest and supportive care

122
Q

What gene is defective in some cases of genetic atopic ecsema and how does this causes the disease?

A

Fillagrin

Impaired integrity of epidermis allows antigens/allergens to access

123
Q

What site is ecsema most common in infants?

A

Face/cheeks

124
Q

What three sites in ecsema common in children

A

Face
Neck
Flexures

125
Q

what three sites is ecsema common in adults?

A

Neck
Hands
Feet

126
Q

Give 2 pros of using Biguanides (eg . metformin) over other T2DM drugs

A

No increasedd appetite/ weight gain

No hypoglyceamia risk

127
Q

Give 2 sulphonylureas

A

Glipizide
Gliclazide
Glibencimide

128
Q

What is the main risk of sulphonylureas

A

Hypoglyceamia

129
Q

Give one pro of using Meglinitides as opposed to sulphonyl ureas

A

Less potent so reduced hypoglycaemia risk

130
Q

When should pt take meglintidines

A

Before meals to deal with post prandial hyperglycaemia

131
Q

How do Glitazones work?

A

Upregulates insulin receptors in perifery

132
Q

give 2 Sx of glitazones

A

Weight gain

Bladder cancer risk (pioglitazone)

133
Q

Give an example of a Glitazone

A

Pioglitazone

134
Q

How do gliptins work and give two pros of using them

A

Reduced breakdown of endogenous incretins (substances that stimulate insulin relased when glc sensed in gut)
No hypoglycamia risk
No weight gain

135
Q

which class of T2DM drugs causes weight gain?

A

Glitazones

136
Q

Which class of T2DM drugs causes hypoglycaemia risk

A

Sulphonylureas

137
Q

How do a-glucosidease inhibitors and Sodium glucose transporter inhibitors work in T2DM?

A

Block gut absorbtion and renal reabsorbtion of glc respectively

138
Q

Give one pro of using a-glucosidase inhibitors

A

no hypoglycaemia

139
Q

Give 2 Sx of a glucosidase inhibitors

A

flatuence

Diahorrea

140
Q

Give 2 symptoms of hrnoch Scorlein Purpura

A

heamaturia

Rash

141
Q

What is the most likely causes of nephrotic syndrome in children and how does it classically present?

A

Minimal change disease

Sudden onset of odema

142
Q

How do you treat minimal change disease

A

Steroids

143
Q

What is Focal segemental glomerularsclerosis

A

Injury/lesion to podocytes resulting in nephrotic syndrome

144
Q

What is Membranous Nephropathy

A

Autoimmue mediated thickening of BM which paradoxically causes nephrotic syndrome

145
Q

Give 2 signs/symptoms of goodpastures disease (Anti GBM disease)

A

Absolute anuria

Heampotysis (pulmonary heamhorrage)

146
Q

What is the first thing that must be treated in renal disease and how do you treat it?

A

Hyperkalaemia
Insulin + dextrose
Calcium Glucanate (protects heart)

147
Q

give 8 causes of nephrotic syndrome

A 
Minial change disease
Focal Segmental Glomerular sclerosis
Membranous nephropathy
Daibetic nephropathy
SLE
Amyloidosis
Drugs
Malignancy
148
Q

Give 4 indications for dialysis

A 
Hyperkalaemia (treatment resistant)
pulmonary odema (diuretic resistant)
uraemia symptoms (poor apetite, weight loss, lethargy, vomit, pruritis)
149
Q

Give 2 adipose derived substances that increase insulin sensitivity and 2 that contribute to resistence

A

Leptin and adiponectin increased sensitivity

FFA/DAG and TNF alpha contribute to resistence

150
Q

give three processes in obesity that contribute to insulin resistence

A 
chronic inflammation
Oxidative stress (increased ROS)
Lipotoxicity (increased TAG, FFA ect downregulates the IRS phosphorylation pathway)
151
Q

what is the main distinguishing feature of Psoriatic arthritis

A

Dactylitis

152
Q

Give 5 features of reactive arthritis

A 
No rheumtoid factor
Hx of GI or genitourinary infecction
Conjunctivitis
Urethritis
Arthritis (asymetrical oligoarticular)
153
Q

What group of Pt get enteropathic arthritis

A

IBD pts

154
Q

What is the primary investigation for suspected ankylosing spondylitis?

A

Xray for sacroileitis

155
Q

What is the marker for RA?

A

Anti CCP antibodies!!

156
Q

Which 2 genes confer an increaed risk of RA if mutated?

A

HLA- DR1/ DR4

Inflammation (1 decks)

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