Last minute random Flashcards
TOM TIP: If you are going to remember one thing about polycystic ovarian syndrome, remember the triad of [3]
TOM TIP: If you are going to remember one thing about polycystic ovarian syndrome, remember the triad of the Rotterdam criteria:
* anovulation
* hyperandrogenism (characterised by hirsutism and acne)
* polycystic ovaries on ultrasound.
An important feature of polycystic ovarian syndrome is hirsutism. Hirsutism can also be caused by: [4]
An important feature of polycystic ovarian syndrome is hirsutism. Hirsutism can also be caused by:
- Medications, such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
- Ovarian or adrenal tumours that secrete androgens
- Cushing’s syndrome
- Congenital adrenal hyperplasia
Which hormone is raised in PCOS? [1]
Explain how this contributes to the pathogenesis of PCOS [+]
Insulin resistance is a crucial part of PCOS.
Hyperandrogenism:
- When someone is resistant to insulin, their pancreas has to produce more insulin to get a response from the cells of the body.
- Insulin promotes the release of androgens from the ovaries and adrenal glands.
- -Therefore, higher levels of insulin result in higher levels of androgens (such as testosterone).
- Insulin also suppresses sex hormone-binding globulin (SHBG) production by the liver.
- SHBG normally binds to androgens and suppresses their function
Anovulation:
- The high insulin levels contribute to halting the development of the follicles in the ovaries, leading to anovulation and multiple partially developed follicles (seen as polycystic ovaries on the scan).
What hormonal blood tests would indicate PCOS? [1]
TOM TIP: The key thing to remember for your exams is the raised LH, and the raised LH:FSH ratio.
What is the investigation of choice for PCOS? [1]
What is the classical appearance of ^? [1]
Pelvic ultrasound is required when suspecting PCOS. A transvaginal ultrasound is the gold standard for visualising the ovaries.
String of pearls
TOM TIP: It is worth remembering the “string of pearls” description for your exams. It may come up in MCQs. It is also worth remembering that an [] indicate polycystic ovarian syndrome, even without the presence of cysts.
TOM TIP: It is worth remembering the “string of pearls” description for your exams.It may come up in MCQs. It is also worth remembering that an ovarian volume of more than 10cm3 can indicate polycystic ovarian syndrome, even without the presence of cysts.
The screening test of choice for diabetes in patients with PCOS is a []
The screening test of choice for diabetes in patients with PCOS is a 2-hour 75g oral glucose tolerance test (OGTT).
Women with polycystic ovarian syndrome have several risk factors for [] cancer:
Ovarian
Breast
Liver
Endometrial
Anal
Women with polycystic ovarian syndrome have several risk factors for [] cancer:
Ovarian
Breast
Liver
Endometrial
Anal
In CF: positive heel prick for CF:
- [] (a pancreatic enzyme) is released by the pancreas when there is damage due to CF as the pancreatic duct is blocked with mucus plugs
positive heel prick for CF:
- Immunoreactive trypsinogen (a pancreatic enzyme) is released by the pancreas when there is damage due to CF as the pancreatic duct is blocked with mucus plugs
A 17-year-old male with a history of cystic fibrosis presents to clinic for annual review. What is the most appropriate advice regarding his diet?
High calorie and low fat with pancreatic enzyme supplementation for every meal
High calorie and low fat with pancreatic enzyme supplementation for evening meal
Normal calorie and low fat with pancreatic enzyme supplementation for every meal
High calorie and high fat with pancreatic enzyme supplementation for evening meal
High calorie and high fat with pancreatic enzyme supplementation for every meal
High calorie and high fat with pancreatic enzyme supplementation for every meal
- Patients with cystic fibrosis (CF) have an increased energy requirement due to the chronic inflammation and infection associated with their disease
The parents of a 3-year-old boy with cystic fibrosis ask for advice. They are considering having more children. Neither of the parents have cystic fibrosis. What is the chance that their next child will be a carrier of the cystic fibrosis gene?
50%
100%
1 in 25
25%
66.6%
As cystic fibrosis is an autosomal recessive condition there is a 50% chance that their next child will be a carrier of cystic fibrosis (i.e. be heterozygous for the genetic defect) and a 25% chance that the child will actually have the disease (be homozygous).
Rheumatic fever is which type of hypersensitivty reaction
Type 1
Type 2
Type 3
Type 4
Type 5
Rheumatic fever is which type of hypersensitivty reaction
Type 1
Type 2
Type 3
Type 4
Type 5
Which heart murmur would this heart histological change most likely cause? [1]
Aschoff body - mitral stenosis - diastolic murmur
Describe the initial presentation of rheumatic fever
Typically causes:
- tonsillitis
- migratory arthritis
- pericarditis / myocarditis / endocarditis
- subcut. nodules & erythema nodosum
- Sydenham chorea
How do you dx rheumatic fever?
Diagnosis is based on evidence of recent streptococcal infection accompanied by:
* 2 major criteria
* 1 major with 2 minor criteria
Evidence of recent streptococcal infection
* raised or rising streptococci antibodies,
* positive throat swab
* positive rapid group A streptococcal antigen test
Major criteria
* erythema marginatum
* Sydenham’s chorea: this is often a late feature
* polyarthritis
* carditis and valvulitis (eg, pancarditis)
* The latest iteration of the Jones criteria (published in 2015) state that rheumatic carditis cannot be based on pericarditis or myocarditis alone and that there must be evidence of endocarditis (the clinical correlate of which is valvulitis which manifests as a regurgitant murmur)
* subcutaneous nodules
Minor criteria
* raised ESR or CRP
* pyrexia
* arthralgia (not if arthritis a major criteria)
* prolonged PR interval
Describe how you treat rheumatic fever - specifically the GAS infection? [1]
Penicillin is the drug of choice for treating GAS infection.
After a stat dose of antibiotic, which antibiotic should be continued for ten days in patients with rheumatic fever? [1]
Phenoxymethylpenicillin
Which neurological disorder is associated with rheumatic fever?
Sydenham’s chorea
What are the major criteria for rheumatic fever?
JONES (J< 3NES) criteria:
- Joint pain (migratory arthralgias)
- < 3 (carditis, including endocarditis, myocarditis and/or pericarditis)
- Nodules (subcutaneous nodules over the extensor surfaces)
- Erythema marginatum (pink rash with cleared centres over trunk and limbs)
- Sydenham’s chorea (develops months later, characterised by involuntary movements).
Which class of drug is effective in alleviating the arthritic symptoms of rheumatic fever?
NSAIDs
Which antibodies (2) can be measured to investigate suspected scarlet fever, rheumatic fever, and post infectious glomerulonephritis? [2]
Anti-streptolysin O (ASO) antibodies and anti-DNAse B antibodies
Which rash is classically seen in rheumatic fever?
Erythema marginatum
Which of the following statements is correct regarding the life cycle of malaria?
Schizonts reproduce in the vascular endothelium and cause sequestration of blood cells
Gametocytes undergo sexual reproduction in hepatocytes
Sporozoites undergo asexual replication in the epithelial cells of the human stomach
Merozoites infect and cause rupturing of erythrocytes
Hypnozoites establish latent infection in the bloodstream
Which of the following statements is correct regarding the life cycle of malaria?
Schizonts reproduce in the vascular endothelium and cause sequestration of blood cells
Gametocytes undergo sexual reproduction in hepatocytes
Sporozoites undergo asexual replication in the epithelial cells of the human stomach
Merozoites infect and cause rupturing of erythrocytes
Hypnozoites establish latent infection in the bloodstream
G6PD is what type of inheritence? [1]
X-linked recessive
Tx for uncomplicated malaria falciparum (non-severe)? [1]
artemisinin-based combination therapies (ACTs):
- e.g. examples include artemether plus lumefantrine, artesunate plus amodiaquine, artesunate plus mefloquine, artesunate plus sulfadoxine-pyrimethamine, dihydroartemisinin plus piperaquine
A patient has ? malaria.
You perform a peripheral blood film and find schizonts to be 5% of the film. Tests reveal that it is Plasmodium falciparum.
What treatment do you give? [1]
What treatment would you give if parasite count > 10%? [1]
intravenous artesunate is now recommended by WHO in preference to intravenous quinine
if parasite count > 10% then exchange transfusion should be considered
How do you specifically rule out malaria in a suspected patient? [1]
3 negative diagnostic samples, with 12-24 hours between samples, are necessary to exclude malaria
Plasmodium malariae: is associated with [] syndrome.
Plasmodium malariae: is associated with nephrotic syndrome.
Uncomplicated malaria in 1st trimester = [1]
Uncomplicated malaria in non-pregnant & 2nd-3rd trimester = [1]
Uncomplicated malaria in 1st trimester = quinine
Uncomplicated malaria in non-pregnant & 2nd-3rd trimester = ACT
If a click replaces the first heart sound - what type of prosthetic valve is used and on which valve [1]
1st heart sound: mitral metal
2nd heart sound: metallic aortic
TAVI uses [metalic / bioprostheic] valves
TAVI uses bioprostheic valves
How do you manage a patient on wafarin who has a major bleed, such as a variceal haemorrage or intracranial haem? [3]
Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*
How do you manage a patient on wafarin and INR > 8.0 with:
- minor bleeding [3]
- no bleeding [4]
INR >8 and minor bleed:
* Stop warfarin
* Give intravenous vitamin K 1-3mg
* Repeat dose of vitamin K if INR still too high after 24 hours
* Restart warfarin when INR < 5.0
INR >8 and no bleed:
* Stop warfarin
* Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
* Repeat dose of vitamin K if INR still too high after 24 hours
* Restart when INR < 5.0
* INR 5.0-8.0
* Minor bleeding
How do you manage a patient on wafarin and INR 5-8.0 with:
- minor bleeding [3]
- no bleeding [2]
INR 5.0 - 8.0 and minor bleeding:
* Stop warfarin
* Give intravenous vitamin K 1-3mg
* Restart when INR < 5.0
INR 5.0 - 8.0 and no bleeding:
* Withhold 1 or 2 doses of warfarin
* Reduce subsequent maintenance dose
Single chamber pacemakers have a lead in which chambers [can be in one of two] [2]
Single-chamber pacemakers have leads in a single chamber, either the right atrium (SAN issue) or the right ventricle (AVN issue)
Biventricular pacemakers have leads in the []
Biventricular pacemakers have leads in the right atrium, right ventricle and left ventricle.
Pacemakers:
A line before either the P wave or QRS complex but not the other indicates a [] pacemaker
A line before either the P wave or QRS complex but not the other indicates a single-chamber pacemaker
Pacemakers:
A line before both the P wave and QRS complex indicates a [] pacemaker
A line before both the P wave and QRS complex indicates a dual-chamber pacemaker
Raised JVP with giant C-V waves are caused by which valvular pathology? [1]
Tricuspid Regurgitation
Raised JVP with giant A waves
Heart valve pathology? [1]
Pulmonary Stenosis
What are the two loci of ADPKD? [2]
What do they code for? [2]
PKD1 and PKD2, which code for polycystin-1 and polycystin-2 respectively
Tx for ADPKD? [1]
Tolvaptan, a selective vasopressin V2 receptor antagonist
ADPKD is associated with:
- Mitral stenosis
- Mitral regurg
- Pulmonary stenosis
- Atrial stenosis
- Atrial regurg
ADPKD is associated with:
- Mitral stenosis
- Mitral regurg
- Pulmonary stenosis
- Atrial stenosis
- Atrial regurg
APDKD is associated with which 4 extra-renal manifestations? [4]
ADPKD is associated with:
- Cerebral aneurysms
- Hepatic, splenic, pancreatic, ovarian and prostatic cysts
- Mitral regurgitation
- Colonic diverticula
[] is the most common cause of death in patients with ADPKD.
Cardiovascular disease is the most common cause of death in patients with ADPKD.
Which of the following genes is most commonly associated with Autosomal Dominant PCKD?
Polycystin 1
PKHD 1
PKD 4
PKD 1
APOL 1
PKD 1
A 36-year-old woman presents to A&E with a sudden onset severe headache, associated with nausea and blurred vision. When asked about family history she reports that her father needed dialysis for end-stage renal failure. On examination, she is photophobic and Kernig’s sign is positive. There are palpable masses in the flanks bilaterally.
Which of the following describes a possible complication of the underlying diagnosis?
Pericarditis
Anterior uveitis
Liver fibrosis
Polyarthritis
Irregular menstrual periods
Liver fibrosis
What is the mode of inheritance of the most common form of adult polycystic kidney disease?
X-linked recessive inheritance of the mutated copy of PKD2
Autosomal dominant inheritance of the mutated copy of PKD2
Autosomal recessive inheritance of PKD2
Autosomal recessive inheritance of the mutated copy of PKD1
Autosomal dominant inheritance of the mutated copy of PKD1
Autosomal dominant inheritance of the mutated copy of PKD1
