key notes Flashcards
investigation in GORD
24hr oesophageal pH monitoring is gold standard
Goodpasture’s syndrome
depostis?
IgG deposits on renal biopsy
anti-GBM antibodies
Acute angle closure glaucoma is associated with …?.. where as primary open-angle glaucoma is associated with ..?…..
hypermetropia,
myopia
Addison’s disease metabolic inbalance?
metabolic acidoosis
Acute myeloid leukaemia - good prognosis translocation
15:17
adenosine- what increases effect?
decreases effect?
dipyridamole enhances effect
aminophylline reduces effect
s/e phentolamine?
Adrenaline induced ischaemia
ADH site of action
collecting ducts
Bartter’s syndrome is associated with …regarding BP…
normotension
Bosentan moa?
endothelin-1 receptor antagonist
Burkitt’s lymphoma - gene translocation
c-myc
CLL - ? is investigation of choice
immunophenotyping
Chorea is caused by damage to the
basal ganglia, in particular the Caudate nucleus
H. pylori eradication:
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
Acute myeloid leukaemia - poor prognosis:
deletion of chromosome 5 or 7
Amiodarone - MOA:
blocks potassium channels
Angiodysplasia is associated with
aortic stenosis
Anti-ribonuclear protein (anti-RNP) =
mixed connective tissue disease
Antipsychotics in the elderly - increased risk of
stroke and VTE
Aortic stenosis -?…marker of severity
S4
Aspergillus clavatus causes
malt workers’ lung, a type of EAA Extrinsic allergic alveolitis
Bendroflumethiazide - mechanism of hypokalaemia:
increased sodium reaching the collecting ducts
activation of the renin-angiotensin-aldosterone
Benzodiazepines enhance the effect of
GABA, the main inhibitory neurotransmitter
Beta-blocker overdose management:
atropine + glucagon
most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
Bitemporal hemianopia
lesion of
upper quadrant defect > lower quadrant defect - tumor?
lower quadrant defect > upper quadrant defect - tumor?
optic chiasm
inferior chiasmal compression, commonly a pituitary
tumour
superior chiasmal compression, commonly a
craniopharyngioma
Brush border enzymes:
maltase:
sucrase:
lactase:
maltase: glucose + glucose
sucrase: glucose + fructose
lactase: glucose + galactose
cancer? common cause of tumour lysis syndrome
Burkitt’s lymphoma
CLL - treatment:
Fludarabine, Cyclophosphamide and Rituximab (FCR)
CLL is caused by
a monoclonal proliferation of B-cell lymphocytes
CML - Philadelphia chromosome -
t(9:22)
Causes of villous atrophy (other than coeliacs):
tropical sprue, Whipple’s, lymphoma, hypogammaglobulinaemia
Cetuximab - moa?
monoclonal antibody against the epidermal growth factor receptor
Chronic myeloid leukaemia tx? moa?
imatinib = tyrosine kinase inhibitor
cisplatin- s/e electorlyte inlabance/
hypomagnesemia, peripheral neuopthy
Clopidogrel moa?
inhibits ADP binding to platelet receptors
Collapse + ARF → dx? tx?
rhabdomyolysis - treat with IV fluids
Complete heart block following an inferior MI vs anterior MI… whihc can pace?
inferior is NOT an indication for pacing, unlike with an anterior MI
Congenital toxoplasmosis
features?
cerebral calcification
chorioretinitis
Contraindications to lung cancer surgery include
SVC obstruction, FEV < 1.5, MALIGNANT pleural effusion, and vocal cord paralysis
Cyclophosphamide -
s/e and how to prevent it?
haemorrhagic cystitis - prevent with mesna
most common and important viral infection in solid organ transplant recipients
CMV
DVLA cant drive until
ANIOPLASTY
TIA
POST MI
MULTIPLE TIA
ANIOPLASTY 1 week
TIA 1 month
POST MI 1 month
MULTIPLE TIA 3 months
Deletion of chromosome 15
what 2 genetic conditions?
Prader-Willi - paternal
Angelman syndrome - maternal
Dentistry in warfarinised patients -
check INR 72 hours before procedure, proceed if INR < 4.0
Dermatomyositis antibodies:
most common?
most specific?
ANA most common
anti-Mi-2 most specific
Desmopressiin - moa?
used for cranial diabetes insipidis
induces release of von Willebrand’s factor from endothelial cells
Diffuse proliferative glomerulonephritis, causes:
post-streptococcal
SLE
Discoid lupus erythematous - tx 1st and second line?
topical steroids → oral hydroxychloroquine
Disproportionate microcytic anaemia - what condition could it be?
think beta-thalassaemia trait
Dosulepin antidepresesent why ito aviod?
dangerious if OD’d
Drug metabolism
phase I:
phase II:
Drug metabolism
phase I: oxidation, reduction, hydrolysis
phase II: conjugation
EBV: associated malignancies:
Burkitt’s lymphoma
Hodgkin’s lymphoma
nasopharyngeal carcinoma
cancer in association of HNPCC?
1st and 2nd most common
- colorectal
2.endometrial
ch head injury …lucid interval
Epidural haematoma - lucid interval
associated with a good prognosis in sarcoidosis
erythema nodosum
Ethylene glycol toxicity management -
fomepizole
Exenatide moa?
Glucagon-like peptide-1 (GLP-1) mimetic
used to monitor respiratory function in Guillain-Barre syndrome
FVC
Factor V Leiden mutation results in
activated protein C resistance
…?… is the investigation of choice for upper airway compression
Flow volume loop
Fomepizole - used in ethylene glycol and methanol poisoning -
MOA?
competitive inhibitor of alcohol dehydrogenase
Funnel plots -
show publication bias in meta-analyses
signet ring cells
Gastric adenocarcinoma -
Gitelman’s syndrome vs Liddle’s syndrome
BP? electrolyte?
normotension with hypokalaemia
Liddle’s syndrome: hypokalaemia + hypertension
think short man syndrome-always tense
HIV - multiple ring enhancing lesions =
toxoplasmosis
HOCM - drugs to avoid:
nitrates, ACE-inhibitors, inotropes
HOCM - poor prognostic factor on echo =
septal wall thickness of > 3cm
HUS or TTP? Neuro signs point towards
TTP Thrombotic Thrombocytopenic Purpura
Haemochromatosis is …GENTIC…?
autosomal recessive
Hashimoto’s thyroiditis = LOOK FOR WHAT IN BLOODS AND PRESENTAION?
hypothyroidism + goitre + anti-TPO
Hemiballism is caused by damage to the
subthalamic nucleus
Heparin-induced thrombocytopaenia -
moa?
antibodies form against complexes of platelet factor 4 (PF4) and heparin
Hepatorenal syndrome is primarily caused by
splanchnic vasodilation
Hereditary angioedema -
deficiency?
screening?
C1-INH deficiency
C4 is the best screening test inbetween attacks
Hodgkin’s lymphoma -
best prognosis
most common type
lymphocyte predominant
nodular sclerosing
Homocystinuria -
caused by a deficiency of ?
give what to correct it?
cystathionine beta synthase
vitamin B6 (pyridoxine)
Horner’s syndrome - anhydrosis determines site of lesion:
head, arm, trunk =
just face =
absent =
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast’s, cervical rib
absent = post-ganglionic lesion: carotid artery
Hypertension - step 4
what level of postassium to add the 4th line options?
Hypertension - step 4
K+ < 4.5 then spironolactone
K+ > 4.5 then higher-dose thiazide-like diuretic
means loss of HGV licence, regardless of the circumstances
ICD
IgM paraproteinaemia -
Waldenstrom’s macroglobulinaemia
In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of …percentage?…
> 40%
Insulinoma is diagnosed
with supervised prolonged fasting
Iron reduces the absorption of
thyroxine
are the most common cause of occupational asthma
Isocyanates
JVP:
C wave
giant v waves
x descent
y descent
C wave - closure of the tricuspid valve
giant v waves in tricuspid regurgitation
x descent = fall in atrial pressure during ventricular systole
y descent = opening of tricuspid valve
Kearns-Sayre syndrome
mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
retinitis pigmentosa
Keloid scars are most common on the
sternum
Klinefelter’s vs Kallman’s - LH & FSH
Klinefelter’s - LH & FSH raised
Kallman’s - LH & FSH low-normal
L5 lesion features =
loss of foot/big toe dorsiflexion + sensory loss dorsum of the foot
LH surge causes
ovulation
Lateral medullary syndrome
PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner’s
Leptin is secreted by
adipose tissue
Leptospirosis - give abx?
penicillin or doxycycline
Likelihood ratio for a positive test result
= sensitivity / (1 - specificity)
the safest TCA in overdosage
Lofepramine -
Long QT syndrome - usually due
to loss-of-function/blockage of K+ channels
Lung adenocarcinoma
most common in ?
location?
Lung adenocarcinoma
most common type in non-smokers
peripheral lesion
Magnesium sulphate - monitor ..?…
reflexes + respiratory rate
Massive PE + hypotension tx?
thrombolyse
Mechanical valves - target INR:
aortic:
mitral:
Mechanical valves - target INR:
aortic: 3.0
mitral: 3.5
Melanoma: single most important prognostic factor
the invasion depth of the tumour is the
Metastatic bone pain may respond to
NSAIDs, bisphosphonates or radiotherapy
Mitochondrial diseases follow ..?…inheritance pattern
a maternal
Most common cause of endocarditis:
Staphylococcus aureus
Staphylococcus epidermidis if < 2 months post valve surgery
Motion sickness - TX?
hyoscine > cyclizine > promethazine
Motor neuron disease - tx?
which is a better option
riluzole
NIV better
Mucocutaneous ulceration following travel?
Leishmania brasiliensis
basces in the mouth
Mycoplasma pneumonia if allergic/intolerant to macrolides -
doxycycline
Mycoplasma dx? -
serology is diagnostic
rises first following a myocardial infarction
Myoglobin
???.. required to diagnose dementia
Neuroimaging is
Nitric oxide - moa?
vasodilation + inhibits platelet aggregation
po2 level, sats level… characteristic of methaemoglobinaemia
Normal pO2 but decreased oxygen saturation is characteristic of methaemoglobinaemia
ethambutol eye s/e
OPTIC NURITIS
Osteoarthritis - first-line MX?
paracetamol + topical NSAIDs (if knee/hand)
Osteomyelitis: the imaging modality of choice
MRI
Painful third nerve palsy =
posterior communicating artery aneurysm
Paradoxical embolus -
common cuase?
dx?
PFO most common cause - do TOE
Patent foramen ovale (PFO) is a hole between the left and right atria (upper chambers) of the heart.
Paraneoplastic features of lung cancer
squamous cell:
small cell:
Paraneoplastic features of lung cancer
squamous cell: PTHrp, clubbing, HPOA
small cell: ADH, ACTH, Lambert-Eaton syndrome
Patients with Sjogren’s syndrome have an increased risk of ..?..malignancies
lymphoid
Phaeochromocytoma: dx?
do 24 hr urinary metanephrines,
Philadelphia translocation, t(9;22) - good prognosis in ..?..
poor prognosis in..?..
CML,
AML + ALL
Pneumocystis jiroveci pneumonia - ..?.. common complication
pneumothorax
Polycythaemia rubra vera is associated with a low ..inflammaroty marker..?
ESR
Post-exposure prophylaxis for HIV:
oral antiretroviral therapy for 4 weeks
Prinzmetal angina - treatment =
dihydropyridine calcium channel blocker
Progressive supranuclear palsy: what condition>
parkinsonism, impairment of vertical gaze
Psoriasis: common triggers are
beta-blockers and lithium
Pulmonary surfactant - main constituent is
dipalmitoyl phosphatidylcholine (DPPC)
Pulsus alternans - seen i
n left ventricular failure
Recommend Adult Life Support (ALS) adrenaline doses
anaphylaxis: cardiac arrest:
Recommend Adult Life Support (ALS) adrenaline doses
anaphylaxis: 0.5ml 1:1,000 IM
cardiac arrest: 10ml 1:10,000 IV or 1ml of 1:1000 IV
Refeeding syndrome causes …electrolyte inblance?
Refeeding syndrome causes hypophosphataemia
Renal stones on x-ray
cystine stones:
urate + xanthine stones:
Renal stones on x-ray
cystine stones: semi-opaque
urate + xanthine stones: radio-lucent
Renal tubular acidosis causes a ..?.. anion gap
normal
Restless leg syndrome - management includes
dopamine agonists such as ropinirole
Rheumatoid arthritis - HLA ?
key in pathophysiology ?
HLA DR4
TNF is key in pathophysiology
Rituximab - moa?
Rituximab - monoclonal antibody against CD20
SLE: markers
sensitive ?
specific ?
ANA is 99% sensitive
anti-Sm & anti-dsDNA are 99% specific
Schistosoma haematobium causes?
Schistosoma haematobium causes haematuria
Screening for haemochromatosis
general population:
family members:
Screening for haemochromatosis
general population: transferrin saturation > ferritin
family members: HFE genetic testing
..?…is the investigation of choice for bile acid malabsorption
SeHCAT
Second heart sound (S2)
loud:
soft:
fixed split:
reversed split:
Second heart sound (S2)
loud: hypertension
soft: AS
fixed split: ASD
reversed split: LBBB
Severe falciparum malaria - tx
intravenous artesunate
Statins and what abx? an important and common interaction
+ erythromycin/clarithromycin -
..?… treatment in Cryptosporidium diarrhoea
Supportive therapy
Symptom control in non-CF bronchiectasis -
inspiratory muscle training + postural drainage
Syringomyelia - presentaion?
spinothalamic sensory loss (pain and temperature)
TTP - first-line tx?
plasma exchange
Tear-drop poikilocytes =
myelofibrosis
diagnostic test for acromegaly
is an oral glucose tolerance with growth hormone measurements
what component in co-trimoxazole causes haemolysis in G6PD
sulfamethoxazole
Topical steroids
moderate:
potent:
very potent:
moderate: Clobetasone butyrate 0.05%
potent: Betamethasone valerate 0.1%
very potent: Clobetasol propionate 0.05%
Trastuzumab (Herceptin) - ??..?..toxicity is common
cardiac
Trimethoprim may cause …to do with blood cells..?
pantcytopaenia
Urinary histamine is used to diagnose
systemic mastocytosis
too many mast cells in body
normal pressure hydrocephalus
presentation?
Urinary incontinence + gait abnormality + dementia
Vincristine - s/e
peripheral neuropathy
Visual field defects:
left homonymous hemianopia?
homonymous quadrantanopias: ?
incongruous defects ?
congruous defects?
Visual field defects:
left homonymous hemianopia means visual field defect to the left, i.e. lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects = optic tract lesion;
congruous defects= optic radiation lesion or occipital cortex
Vitamin B12 is actively absorbed in the
terminal ileum
Warfarin - clotting factors affected mnemonic -
1972 (10, 9, 7, 2)
used to identify patients at risk of pressure sores
Waterlow score -
Wiskott-Aldrich syndrome
triad?
recurrent bacterial infections (e.g. Chest)
eczema
thrombocytopaenia
X-linked recessive conditions - transmission?
no male-to-male transmission
Affected males can only have unaffected sons and carrier daughters.
Zero-order (saturation) kinetics
drugs?
phenytoin
alcohol
tia managemnt long term
clopedogil only after the 300mg aspirin
tca overdose?
IV bicarb
Hirschsprung’s disease presentation?
a 10-day-old
abdominal distension and vomiting. He first passed meconium at 72 hours and has not opened is bowels since. An abdominal x-ray shows a dilated colon
omphalomesenteric band
mikels diverticulum