Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2a > Last week key info > Flashcards

Last week key info Flashcards

1
Q

In a haemorrhagic stroke what happens in response to high intracranial pressure

A

Cushing’s triad

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name Cushing’s triad, and when it is seen

A

In haemorrhagic stroke causing raised intracranial pressure

Bradycardia
Hypertension
Irregular respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the treatment for raised intracranial pressure (haemorrhagic stoke - Cushing’s triad)

A

Mannitol - osmotic diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name the stroke that occurs in the basal ganglia

A

Intracerebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does an intracerebral stroke occur

A

Basal ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the main risk factor for an intracerebral stroke

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is seen on a non-contrast CT head of a intracerebral stroke

A

Hyper density (fresh red blood)
Midline shift if large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the general management of haemorrhagic strokes except one

A

ABCDE management
Supportive management
Burr-Hole craniotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What stroke has a different management than other strokes

A

Subarachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Summarise a intracerebral stroke

Occurs
Main risk factor
Seen on Non-contrast CT head

A

Occurs - basal ganglia

Main rf = hypertension

Hyper density (fresh blood)
Midline shift if large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the main risk factors of a subarachnoid stroke

A

Berry aneurysms - anterior communicating artery

PKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which stroke would berry aneurysms/PDK be a risk factor

A

Subarachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What artery do berry aneurysms affect

A

Anterior communicating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What stroke is described as a thunderclap headache

A

Subarachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the investigations of a subarachnoid

A

Non-contrast CT head - after 48 hours - star sign (cistern and ventricles), hyperdense

Lumbar puncture (12 hours after) - bilirubin to breakdown - xanthochromia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In a subarachnoid haemorrhage how long do you wait before doing a CT head

A

48 hours

Star sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which type of stroke has a star sign

A

Subarachnoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is seen on a lumbar puncture of subarachnoid haemorrhage

A

Xanthochromia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the treatment of a subarachnoid haemorrhage

A

Nimodipine (CCB) - prevents vasospasm

Surgery (coiling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define a subdural stroke

A

Dura mater and arachnoid mater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What type of stroke is caused by rupture of the bridging veins

A

Subdural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 3 reasons there are rupture of the bridging veins and what stroke is it seen in

A

Subdural

Brain atrophy elderly
Alcohol abuse (brain walls thinner)
Shaken baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the CT scan of a subdural stroke

A

Hypodense (old blood)
Crescent shaped (concave)
Bleeding occurs across suture lines
Midline shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What stroke shows concave (crescent shaped) CT

A

Subdural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Summarise a subdural stroke

Cause

CT head

A

Rupture of the bridging veins - elderly, shaken baby, alcohol abuse

Hypodense, concave (crescent shaped), crosses suture lines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Summarise a extradural stroke

Where

Symptoms

CT head

A

Middle meningeal artery - skull fracture low impact

Lucid interval

Hyperdense (fresh)
Lemon shaped (convex)
Not cross suture lines
Midline shift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What type of stroke causes a lemon shaped (convex)

A

Extradural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What type of stroke causes a lucid interval

A

Extradural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Define Bamford classification - total anterior circulation stroke (TACS)

A

ALL 3

Unilateral weakness
Homonymous hemianopia
Dysphasia, visuospatial disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Define Bamford classification - partial anterior circulation stroke (PACS)

A

2 OF (same category as TACS)

Unilateral weakness
Homonymous hemianopia
Dysphasia, visuospatial disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Define Bamford Classification - lacunar stroke

A

ONE of

Pure sensory
Pure motor
Sensori-motor
Ataxic

No loss of higher

Small vessel disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Define Bamford Classification - Posterior circulation syndrome (POCS)

A

One of

Cranial nerve palsy
Bilateral motor/sensory deficit
Gaze (conjugate eye movement)
Cerebellar dysfunction e.g. vertigo
Isolated hemianopia or cortical blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the 2 tools of strokes

A

FAST - community

ROSIER - hospital

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What stroke do you not want to lower BP and why

A

Ischemic

Do not want to decrease perfusion to the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Describe the management of ischaemic stroke

A

< 4.5 hours = thrombolysis with alteplase

< 24 hours = medical thrombectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe the rules on driving after a TIA/stroke

A

No driving 1 month following a stroke/TIA no need to inform DVLA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Name 2 investigations and why in TIA strokes

A

MRI head - within 24 hrs

Carotid doppler - determine of suitable for carotid endarterectomy if > 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What % occlusion makes a patient suitable for a carotid endarterectomy

A

> 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe the management of a review in a TIA

A

1 or more TIA = urgent seen

Suspected TIA < 7 days = within 24 hours

Suspected TIA > 7 days = within 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe the medical management of TIA

A

Immediate 300mg aspirin

Already on aspirin - wait for review

If on anticoagulant = CT head - check for bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Describe features of Guillain-Barre Syndrome

A

Symmetrical + ascending muscle weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Name the key cause of Guillain-Barre Syndrome

A

Autoimmune to campylobacter jejuni (gastroenteritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What antibody is associated with Guillain-Barre Syndrome

A

Anti-GM1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Describe the 2 investigations of Guillain-Barre Syndrome

A

Brighton criteria
Lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is seen on a lumbar puncture of Guillain-Barre syndrome

A

Increased protein

Normal WCC + glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the management of Guillain Barre syndrome

A

IV IG or plasma exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Describe Miller Fisher Syndrome

A

Variant of GBS

Triad
- ophthalmoplegia
- ataxia
- areflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is a key complication of Gulilain-Barre syndrome and how do you measure it

A

Resp failure

Monitor FVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What type of hypersensitivity reaction is multiple sclerosis

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Name the 3 key symptoms of multiple sclerosis

A

Optic neuritis
Uthoff’s phenomenon
Lhermitte’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Define Uhthoff’s phenomena

A

Symptoms worse after heat e.g. shower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What condition may a patient complain that the symptoms are worse after heat e.g. a hot shower

A

Multiple sclerosis

Uhthoff’s phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Define Lhermitte’s sign

A

Electric shock sensation down the spine when flexing the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What criteria is used in multiple sclerosis

A

McDonald’s criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Describe McDonalds criteria

A

> 24 hours apart

Disseminated in time > 1 month apart

Disseminated by space - MRI scan (visualise lesion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Describe the treatment of acute relapse of multiple sclerosis

A

Corticosteroids e.g. methylprednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Describe the long term management of multiple sclerosis

A

Natalizumab, interferon-beta, fingolimod

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Define sensitivity

A

Ability of a test to correctly identify people with the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Define specificity

A

Ability of a test to correctly identify people without the disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What condition causes ‘worse with activity (fatigability) improves with rest

A

Myasthenia Gravis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Define myasthenia gravis

A

Worse with activity. Improves with rest

AchR antibodies - bind to post synaptic receptors of the neuromuscular junction = block and prevent acetylcholine binding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is myasthenia gravis associated with

A

Thymomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the GS investigation in myasthenia gravis

A

AchR (acetylcholine receptor antibodies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is the 1st line management of myasthenia gravis

A

Pyridostigmine

Long acting acetylcholinesterase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Name a complication of myasthenia gravis and describe it and why it occurs

A

Myasthenic crisis

Illness can cause acute worsening of symptoms

Resp failure - measure ABG, FVC

Treatment - IV IG + plasmapheresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Define lambert Eaton syndrome

A

Autoimmune affects neuromuscular junction
Muscle contractions get stronger with use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Describe the pathophysiology of lambert eaton syndrome

A

Antibodies against voltage-gated calcium channels in presynaptic membrane of neuromuscular junction

Less acetylcholine release into the synapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is lambert eaton syndrome associated with

A

Small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is the GS investigation for lambert eaton syndrome and what would be seen

A

EMG

Incremental response to repetitive electrical stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What does motor neurone disease not affect

A

The eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the diagnosis of MND

A

Diagnosis of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the treatment of MND

A

Riluzole - glutamate antagonist

+ non-invasive ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Describe the presentation of Parkinson’s disease

A

Male 70 + TRAP BF

Tremor - resting tremor
Rigidity - cogwheel rigidity
Akinesia - lack of movement
Postural instability
Bradykinesia - slow and small movements
Festination’s - shuffling gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the mnemonic used to remember the symptoms of Parkinson’s

A

TRAP BF

Tremor - resting tremor
Rigidity - cogwheel rigidity
Akinesia - lack of movement
Postural instability
Bradykinesia - slow and small movements
Festination’s - shuffling gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What does TRAP BF stand for

A

Tremor - resting tremor
Rigidity - cogwheel rigidity
Akinesia - lack of movement
Postural instability
Bradykinesia - slow and small movements
Festination’s - shuffling gait

Symptoms of Parkinson’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Name the treatment for Parkinson’s

A

Levodopa +peripheral decarboxylate inhibitor (carbidopa) = co-carbidopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Name the symptoms of Parkinson’s plus syndrome

A

Multiple system atrophy
Progressive supranuclear palsy
Dementia Lewy Body
Corticobasal degeneration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Describe the cause of Huntington’s Disease

A

Degeneration of the nerve cells in the brain

Autosomal dominant - mutation in Huntington (HTT) gene on chromosome 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Describe why anticipation occurs

A

Earlier + more severely due to unstable triplet repeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Name the symptoms of Huntington’s Disease

A

Chorea
Dysarthria
Dysphagia
Personality changes - irritable, outburst, impulsiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Name 3 medications which can help with chorea

A

Dopamine depleting agent - tetrabenazine
Benzodiazepines - diazepam
Anti-psychotics - olanzapine, risperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

How is a AKI confirmed

A

One of

Rise in serum creatinine > 28 micromol/L within 48 hours

> = 50% rise in serum creatinine in 7 days

Urine output < -0.5ml/kg/hour for more than 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Describe how an AKI is diagnosed off urine criteria

A

Urine output < 0.5ml/kg/hour

Stage 1 > 6 hours

Stage 2 > 12 hours

Stage 3 > 24 hours or 12 hour anuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Describe how an AKI is diagnosed off creatinine criteria

A

Stage 1 - Rise in creatinine > 28 micromol/L in 48 hours

OR

Rise in serum creatinine in last 7 days by

Stage 1 - 50-99%
Stage 2 - 100-199%
Stage 3 - > 200% / creatinine > 354 micromol/L with one other criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is the main cause of an intrinsic AKI

A

Acute tubular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Name 7 nephrotoxic drugs

A

Aminoglyside antibiotics e.g. gentamycin

ACE-i

ARB

Bisphosphonates

NSAIDs

Loop diuretics

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Name 2 drugs which are renally excreted and should be stopped where possible in an AKI

A

Metformin
Opiates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the functions of the kidney

A

A WET BED

Acid-base balance
Water removal
Erythropoiesis
Toxin removal
Blood pressure control
Electrolyte balance
Vitamin D activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is the mnemonic for remembering kidney functions

A

A WET BED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Define eGFR

A

Total amount of fluid filtered through all functioning kidney nephrons within a set unit of time

Based of age, sex etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Describe the diagnosis of CKD

A

One of

eGFR < 60ml/min/1.73^2 > 3 months

Urine ACR (albumin: creatinine ratio) > 3 mg/mmol

Presence of kidney damage markers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What does A score indicate

A

Proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Describe the main symptoms seen in nephritic syndrome

A

HOPS (2XHs)

Haematuria
Hypertension
Proteinuria
Oliguria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Describe the main symptoms seen in nephrotic syndrome

A

HOP

Hypoalbuminemia
Oedema
Proteinuria > 3g/24 hour - measure protein: creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is the general management of nephritic syndrome

A

Will see increased CRP and ESR

BP control - ACEi/ARBs

Corticosteroids - inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the general management of nephrotic syndrome

A

Fluid restriction

Loop diuretics - furosemide

ACEi/ARB

Treat cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Name the conditions which are nephritic

A

IgA nephropathy
Goodpasture’s
Post-strep
Henoch Schoenlein purpura
SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

IgA nephritic or nephrotic

A

Nephritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Goodpasture’s nephritic or nephrotic

A

Nephritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Post-strep nephritic or nephrotic

A

Nephritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Henoch Schoenlein purpura nephritic or nephrotic

A

Nephritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

SLE nephritic or nephrotic

A

Nephritic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

IgA nephropathy

Definition
Symptoms
Investigation
Treatment

A

Deposition into mesangium

Asymptomatic - microscopic haematuria

Diagnosis = biopsy

General management. > 6 months and persistent proteinuria = fish oil + steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Goodpasture’s

Definition
Symptoms
Investigation
Treatment

A

Autoantibodies to type IV collagen in glomerular + alveolar membranes

SOB, oliguria < 400mL a day

Anti-GBM + biopsy

Plasma exchange, steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the antibody present in Goodpasture’s

A

Anti-GBM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Henoch Schoenlein purpura

Definition
Symptoms
Investigation
Treatment

A

Small vessel vasculitis - effect kidney + joint due to IgA deposition

Purpuric rash on legs, joint pain

Clinical + confirm with biopsy

Corticosteroids, BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

SLE

Definition
Symptoms
Investigation
Treatment

A

Multisystem disorder

Rash, arthralgia, kidney failure

Anti-nuclear (ds-DNA)

Immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What antibody is seen in SLE

A

Anti-nuclear (ds-DNA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Name conditions which are secondary to nephrotic syndrome

A

DDANI

Diabetes
Drugs
Autoimmune
Neoplasia
Infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Name 2 complications of nephrotic syndrome

A

Hyperlipidaemia = high cholesterol to compensate for albumin = statins

VTE = Increased clotting factors = heparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Name the nephrotic syndromes

A

Minimal change disease
Focal segmental glomerulonephritis
Membranous nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Minimal change disease

Definition
Investigation
Treatment

A

Idiopathic nephrotic syndrome

Biopsy - electron microscopy = appearance normal,, function abnormal

Prednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Focal segmental glomerulonephritis

Definition
Causes
Investigation
Treatment

A

Most common cause

Causes scaring in the kidneys filtering units.

Caused by idiopathic or secondary - HIV, malaria, heroin, lithium

Biopsy - microscopy = scaring of the glomeruli

Steroids, ACEi/ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Membranous nephropathy

Definition
Investigation
Treatment

A

Immunoglobulin mediated

Renal biopsy - thickened basement membrane
Antiphospholipid A2 receptor antibody (80% patients)

Steroids - prednisolone, ACEi/ARBs, cyclophosphamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What antibody is linked to membranous nephropathy

A

Antiphospholipid A2 receptor antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

In BPH what cells does it affect

A

Stromal and epithelial cells of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is the DRE of BPH

A

Enlarged, smooth, symmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What are the 2 factors influencing BPH

A

Static = increase in tissue = narrowing of urethral lumen

Dynamic = increase smooth muscle tone mediated by alpha-adrenergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Name 3 treatments for BPH

A

Tamsulosin - alpha blocker (alpha 1 receptor antagonist)

Finasteride - 5-alpha reductase inhibitor

Surgery - transurethral resection of prostate (TURP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Describe the mechanism of action of tamsulosin

A

BPH

Alpha blocker - alpha 1 receptor antagonist

Relaxes smooth muscle - relieve symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Describe mechanism of action of finasteride

A

BPH

5-alpha reductase inhibitor

Slowly reduces the size of the prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What type of cancer is prostate cancer

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Name the investigations of prostate cancer

A

Transrectal biopsy of prostate

DRE - asymmetrical, irregular, firm prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Describe the management of prostate cancer

A

GnRH agonist e.g. leuprolide

Androgen receptor blocker - bicalutamide

Radiotherapy

Prostatectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What type of cancer is bladder cancer

A

Transitional cell carcinoma

Aromatic dyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Name the symptom of bladder cancer

A

Painless haematuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Name the investigation for bladder cancer

A

Cystoscopy + biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Name the management of bladder cancer

A

TURBT- trans urethral removal of baldder tumour (+/-) intravesical chemo for non-muscle invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What type of cancer is testicular

A

Germ cells in the testes

Seminomas

Non-seminomas (younger)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Describe the symptom of testicular cancer

A

Lump - dull ache, pain or heaviness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Describe the investigation of testicular cancer

A

Histology after orchidectomy

AFP = non-seminoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is the GS management of testicular cancer

A

Orchidectomy +/- chemotherapy

Would result in infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Testicular torsion - Summarise

Define
Symptoms
Risk factors
Investigations
Management

A

Acute onset of severe unilateral pain - triggered by activity

Prehn’s sign - absence of cremaster reflex

Ball clapper deformity

Medical emergency. US = spiral appearance to spermatic cord or blood vessels

Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Describe Prehn’s sign

A

Absence of cremaster reflex

Positive = testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What sign is used in testicular torsion

A

Prehn’s sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Describe the management of testicular torsion

A

Nil by mouth
Analgesia
Surgical exploration
- orchiopexy
- orchiectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Epididymal cyst - summarise

Define
Symptoms
Risk factors
Investigations
Management

A

Asymptomatic/lump - soft, round lump at top of testes (head of epididymis)

Middle aged men

US Scrotal

Removal if painful
Surgery - avoided in young men - infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Hydrocele - summarise

Define
Symptoms
Risk factors
Investigations
Management

A

Collection of fluid within tunica vaginalis

Painless, soft, swelling lump - water filled balloon

Common - premature, injury, connective tissue disorder

Testicle palpable with hydrocele, transilluminated

Large/symptomatic = surgery - aspiration, sclerotherapy

Idiopathic = conservative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What are the potential causes of hydrocele

A

Idiopathic or secondary to - testicular cancer, Epididymo-orchitis, inguinal hernia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What scrotal disease may present was a painless, soft swelling like a water balloon

A

Hydrocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What scrotal disease may present as unilateral pain with a positive Prehn’s sign

A

Testicular torsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What scrotal disease may present as a soft, round lump at the top of the testes

A

Epididymal cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What scrotal disease may present as a throbbing, dragging, worse on standing, disappears when lying down

A

Varicocele

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Varicocele - summarise

Define
Symptoms
Risk factors
Investigations
Management

A

Dilated pampiniform plexus = increased resistance + incomplete valves in testicular vein

Throbbing, dragging. Worse on standing, better when laying down. Bag of worms

Tall/low BMI

Doppler ultrasound (diagnosis is usually clinical)

Conservative unless very painful - surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Left sided varicocele may by indicative of what condition

A

Renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Describe testicular appendage torsion

A

Remnant of Mullerian duct

Blue dot sign

Boys 7-12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Describe the difference between testicular torsion and appendage torsion

A

Testicular torsion = twisting of spermatic cord cutting off blood flow to testicle. Medical emergency

Appendage torsion = affects extra appendage of the testicle (not testicle itself). Pain = less severe. Resolves on own

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What scoring system is used in prostate cancer

A

Gleason’s grading score

How differentiated the cells are from ‘normal’, the amount of cell atypia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

How do you remember the typical pathogens of a UTI

A

KEEPS

Klebsiella
E.coli (most common)
Enterococcus species
Proteus species/pseudomonas
Staphylococcus aureus/staph. saprophyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What does KEEPS stand for

A

Typical bacteria causing UTI

Klebsiella
E.coli (most common)
Enterococcus species
Proteus species/pseudomonas
Staphylococcus aureus/staph. saprophyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Why are women more susceptible to cystitis

A

Shorter urethra than men
Closer proximity of urethral opening to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What age group may be non-specific for symptoms of UTI - what may the symptoms be

A

Fever
New urinary incontinence
New or worsening delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What is the GS investigation for UTI

A

MSU/CU microscopy, culture and sensitivity testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Describe antibiotics given for a UTI in pregnancy

A

NO 1st trimester - Trimethoprim - inhibits folate

NO 3rd trimester - Nitrofurantoin - risk of neonatal haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

When can trimethoprim NOT be given for a UTI in pregnancy and why

A

NOT in 1st trimester

Inhibits folate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

When can Nitrofurantoin NOT be given for a UTI in pregnancy and why

A

NOT in 3rd trimester

Risk of neonatal haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What is the triad of symptoms in pyelonephritis

A

Unilateral flank pain

N&V

Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

How is the diagnosis of pyelonephritis made

A

Loin pain +/- fever + positive urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What is urethritis caused by

A

STI - gonococcal/ non-gonococcal

Post traumatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Describe the symptoms of urethritis

A

Dysuria

Urethral discharge = main

Pruritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Define urethritis

A

Inflammation/infection of urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What is used to test for gonorrhoea or chlamydia

A

NAAT - nucleic acid amplification test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Define Epididymo- orchitis

A

Inflammation or infection in epididymis + testicles on one side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What are the causes of Epididymo - orchitis

A

E.coli
Chlamydia
Gonorrhoea
Mumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What are the symptoms of Epididymo - orchitis

A

Testicular pain
Urethral discharge
Dragging/heavy sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is an extra test that may be done for epididymo - orchitis

A

Salvia mumps - serum antibodies

IgM = acute
IgG = previous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Define prostatitis

A

Inflammation or infection of prostate with evidence of recent or ongoing infection

Common cause = e. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Name the management of prostatitis

A

Acute - 2-4 weeks oral antibiotics

Chronic = alpha blockers e.g. tamsulosin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

Define nephrolithiasis

A

Stones in the collecting ducts - deposited anywhere renal pelvis to ureter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What is the most common renal stone and name the other causes

A

Calcium oxalate

Others
Calcium phosphate
Uric acid
Struvite
Cysteine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What is a key symptom of renal colic

A

Colicky loin to groin pain in peristaltic waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

Describe the management of renal stones

A

< 5mm = pass spontaneously

> 5mm

Extracorpeal shock wave lithotripsy (ESWL) - break smaller fragments using shock waves

Percutaneous nephrolithotomy (PCNL) - percutaneous access, use nephoscope to remove stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What are the two forms of PKD

A

Autosomal dominant = more common
- PKD1 - 16 (85%)
- PKD2 - 4 (15%)

Autosomal recessive
- PKHD1 - 6
- Severe
- Often picked up on antenatal scans
- End stage renal failure before adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

How is diagnosis of PKD made

A

Renal ultrasound + genetic testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is th prognostic factor for PKD

A

Fasting lipid profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is the management of autosomal dominant PKD

A

Tolvaptan

Vasopressin receptor antagonist - can slow development of cysts + progression to renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What bacteria causes chlamydia

A

Chlamydia trichromatic bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

Name the 1st line treatment for chlamydia

A

Doxycycline for 7 days oral

CI pregnancy/breastfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Name the 2nd line treatment for chlamydia

A

Azithromycin oral for 3 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What causes gonorrhoea

A

Neisseria gonorrhoea

-ve diplococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What is the treatment for susceptibility known gonorrhoea

A

1x ciprofloxacin 500mg oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What is the treatment for susceptibility unknown gonorrhoea

A

Ceftriaxone 1g IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

What STI causes reactive arthiritis

A

Chlamydia

Gonorrhoea causes septic arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What are the stages of syphilis

A

Primary - ulcer
Secondary - symmetrical, non-itchy, maculopapular rash
Tertiary - neurological, cardiovascular, Guthmata syphilis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

What is the test for syphilis

A

Dark field microscopy + PCR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

What is the treatment for syphilis

A

1x IM penicillin

3 weeks (1x a week) if late

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Name 2 crystal arthropathy’s

A

Pseudogout
Gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

What crystals are seen in gout

A

Monosodium urate crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

What crystals are seen in pseudogout

A

Calcium pyrophosphate dihydrate crystals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What is an xray finding in pseudogout

A

Chondrocalcinosis - white line hovering in the space in the middle of the joint space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

Describe the treatment of pseudogout/gout in an acute attack

A

1st line - NSAIDs e.g. naproxen + PPI
2nd line - colchicine - run before walk - severe diarrhoea suggests toxicity
3rd line - steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Describe the prophylaxis of gout/pseudogout

A

Xanthine oxidase inhibitors - lower uric acid levels. 2-3 weeks after attack

  1. Allopurinol
  2. Febuxostat

+ lifestyle changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What can happen in the prophylaxis of gout/pseudogout

A

Paradoxical affect

Can trigger gout flare - offer colchicine or NSAIDs to cover

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

Define the diagnosis of osteoarthritis

A

Diagnosis + no investigation if > 45, pain associated with activity + no morning stiffness (< 30 minutes)

‘Wear and tear’

Worse at the end of the day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

Name 3 features that may be seen on the hand in osteoarthritis

A

Heberden’s nodes = DIP (Hebrides = far away)
Bouchard’s nodes = PIP
CMC joint = squaring of CMC joints

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Name 4 general signs of osteoarthritis

A

Bulky, bone enlargement of the joint
Restricted range of movement
Crepitus on movement
Effusions (fluid) around the joint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Describe the x-ray signs of osteoarthritis

A

LOSS

Loss of joint space
Osteophytes (bone spurs)
Subchondral cysts (Increase density of bone along joint line)
Subarticular sclerosis (fluid-filled holes in bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Describe the key hand changes in rheumatoid arthiritis

A

Symmetrical polyarthritis - can spare DIP

Boutonniere
Swann-neck deformity
Z-thumb deformity
Ulnar deviation of fingers
Rheumatoid nodules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

Describe the x-ray of rheumatoid arthritis

A

Periarticular osteopenia
Bony erosions
Soft tissue swelling
Joint destruction + deformity (in advanced disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What can be done in rheumatoid arthiritis to detect synovitis and help in acute flares to guide treatment

A

Ultrasound scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

Summarise the treatment of rheumatoid arthritis

A
  1. DMARDS - methotrexate, sulfalazine, leflunomide
  2. 2 of above
  3. Methotrexate + biologic - e.g. infliximab (TNF-a inhibitor)
  4. Methotrexate + rituximab (B-cell direct)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

Describe 2 tests which can monitor the success of treatment in rheumatoid arthiritis

A

C-reactive protein
DAS28

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

Describe Felty’s syndrome as a complication of rheumatoid arthiritis

A

Triad of

Rheumatoid arthiritis
Neutropenia
Splenomegaly

Do an abdominal ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Describe fibromyalgia - what points does it affect

A

Characterised by widespread pain + tender points

At

Occiput - connect brain to spine
Low cervical regions
Trapezius
Second rib
Greater trochanter
Gluteal region

Often co-occurs with many rheumatology diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

Describe the diagnosis of fibromyalgia

A

31 point questionnaire - widespread pain index

> 3 months

Not have a condition which could explain the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

Describe the treatment of fibromyalgia

A

1st line - physical therapy, graded exercise therapy

Severe pain - duloxetine, pregabalin, amitriptyline

Pain related depression - CBT, antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

What are the antibodies for rheumatoid arthritis

A

Anti cyclic citrullinated peptide (anti-CCP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

What are the antibodies for vasculitis

A

c-ANCA - Granulomatosis with polyangiitis

p-ANCA - Eosinophilic granulomatosis with polyangiitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Name the antibodies for SLE

A

Main= ds-DNA

ANA

Anti-smith

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Name the antibody for scleroderma

A

Anti-centromere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

Name the antibody for antiphospholipid syndrome

A

Anticardiolipin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

Name the antibodies for Sjogren’s

A

Anti-Ro
Anti-La

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

What would be seen in a joint aspiration of septic arthritis

A

Yellow, cloudy, WCC > 50,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Describe the treatment of septic arthiritis

A

IV antibiotics 2 weeks + 4 weeks oral

1st = flucloxacillin

MRSA = vancomycin

Neisseria = ceftriaxone

Surgery = laparoscopic washout or surgical debridement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

Name 2 complications of septic arthritis

A

Osteomyelitis
Permanent joint destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Describe the difference between osteomyelitis and septic arthiritis

A

Osteomyelitis - inflammation of bone and bone marrow

Septic arthiritis = inflammation of the joint (is not inside the bone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

What is the common cause of osteomyelitis

A

S. aureus

Salmonella infection is associated with sickle cell disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Describe the management of osteomyelitis

A

6 week IV antibiotics (12 week if chronic) - flucloxacillin

Surgical debridement of bone

May require prosthetic joint revision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

Describe polymyalgia rheumatica

A

Bilateral shoulder +/- pelvic girdle pain

Stiffness over 45 minutes after walking

Low grade fever

Decrease weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

Describe the diagnosis of polymyalgia rheumatica

A

ESR/CRP = increased

Diagnosis of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

Name a complication of polymyalgia rheumatica

A

Giant cell arteritis

Long term steroid use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Define Giant cell arteritis

A

Inflammation in the walls of large size arteries

Sore when brushing hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

What is a key risk factor of giant cell arteritis

A

History of polymyalgia rheumatica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

What is seen on a USS temporal artery of giant cell arteritis

A

Halo sign + stenosis of temporal artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

Describe the treatment of giant cell arteritis

A

Steroids

No visual symptoms = oral prednisolone

Visual symptoms = methylprednisolone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

Describe the features of long term steroid use

A

Don’t STOP

Don’t - steroid dependence - occurs after 3 weeks. Risk of adrenal crisis. Wean down

S - Sick day rules - steroid doses need to be increased if unwell e.g. surgery, infection, mental stress

T - Treatment card - steroid treatment card alert

O - Osteoporosis prevention. Bisphosphonates + calcium/vitamin D score. Calculate FRAX score. DEXA scan

P - PPI required. Risk of reflex, ulcers, bleeding. Give omeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

What is the mnemonic for long term steroid use

A

Don’t STOP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Name the 2 key features of long term steroid use

A

Use PPIs

Risk of osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

Define osteoporosis

A

Decrease in trabecular mass/density + disruption of bone architecture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Define FRAX tool

A

Predicts risk of major osteoporotic fracture and hip fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

What are the two sections of the DEXA scan

A

Dual energy x-ray absorptiometry

Z-score = their age

T-score = healthy a young adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

Define Z-score

A

Number of standard deviations patient’s bone density falls below the mean for their age

Think z = later in alphabet = older

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

Define T-score

A

Number of standard deviations patient’s bone density falls below the mean for a health young adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

Classify the T-scores at hip

A

Normal > -1

Osteopenia = -1 to -2.5

Osteoporosis = < -2.5

Severe osteoporosis = < -2.5 + fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

Describe the treatment for osteoporosis

A

1st line = bisphosphonates (alendronic acid or zoledronic acid)

2nd line
Denosumab = 6 months sub cut - blocks osteoclasts
Raloxifene = oestrogen stimulator
Teriparatide = increases osteoblast activity, PTH analogue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

What are the 4 spondyloarthropathy

A

Ankylosing spondylitis
Reactive arthiritis
Psoriatic arthritis
Enteropathic arthiritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

What antibodies are linked to ankylosing spondylitis

A

HLA B27 serotype positive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

What is the features of ankylosing spondylitis

A

Young man + back pain + stiffness worse at night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

Describe what the features of HLA B27 serotype causes

A

Attacks entheses - causes inflammation, bone erosion + syndesmophyte formation - body growth inside a ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

What test is used for ankylosing spondylitis

A

Schober’s test

Marks L5 - 2nd line 10cam above 1st line

Touch toes and see difference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

What is the mnemonic for spondyloarthropathy

A

SPINEACHE

Sausage digit
Psoriasis
Inflammatory back pain
NSAID good response
Enthesitis
Arthritis
Chron’s/colitis/high CRP
HLA B27
Eye - Uveitis

242
Q

What is the medical treatment of ankylosing spondylitis

A

Medical

1st line - NSAIDs
2nd line - anti-TNF biologics
3rd line - IL-7 biologics

NO DMARDS

243
Q

Describe the x-ray findings of ankylosing spondylitis

A

‘Bamboo findings’

Squaring of vertebral
Ossification
Subchondral

244
Q

Define SPINEACHE

A

For spondyloarthropathy

Sausage digit
Psoriasis
Inflammatory back pain
NSAID good response
Enthesitis
Arthritis
Chron’s/colitis/high CRP
HLA B27
Eye - Uveitis

245
Q

Define psoriatic arthiritis and a key presentation

A

Autoimmune joint disease due to activation of CD8+ T cells

Dactylitis = inflammation of a digit that causes pain and swelling

246
Q

Name the appearance of psoriatic arthiritis on xray

A

Periostitis
Ankylosis
Osteolysis
Pencil cup appearance - telescoping appearance of digits (most severe form)

247
Q

Describe the treatment of psoriatic arthiritis

A

NSAID, physio, intra-articular injections

DMARDS
- 1st = methotrexate
- 2nd = sulfalazine

TNF a-inhibitor
- Etanercept/ustekinumab

248
Q

Describe reactive arthiritis

A

Monoarthritis

Due dysregulated immune response to an infective trigger = joint inflammation.

Not an active infection (not infective)

249
Q

Name the causes of reactive arthiritis

A

Gastroenteritis - shigella or salmonella

STI - chlamydia

250
Q

What STI causes reactive arthiritis

A

Chlamydia

251
Q

How do you remember the symptoms of reactive arthiritis

A

Can’t pee, can’t see, can’t climb a tree

Urethritis, conjunctivitis, arthiritis

252
Q

Summarise enteric arthiritis

A

Circulating immune complexes are deposited in the joint - causing inflammation

Associated with IBD - will be in remission with remission of IBD

1 in 5 get

Most common = limb joints and spine

253
Q

Describe systemic lupus erythematous

A

Inflammatory autoimmune connective tissue disorder

Anti-nuclear antibodies (ANA) - attack cell body

Type III hypersensitivity reaction

254
Q

Describe some key symptoms of systemic lupus erythematous

A

Proteinuria = throthy urine
Red rash on face - butterfly malar rash, photosensitive
Mouth ulcers
Raynaud’s phenomenon

255
Q

If you are carrier of what puts you at a risk factor of systemic lupus erythematous

A

HLLA-DR2/3

256
Q

Describe the management of systemic lupus erythematous

A

Limit inflammation - methotrexate/hydrocholoroquine
NSAIDs
More severe disease = steroids

257
Q

What are 3 complications of systemic lupus erythematous that could result in mortality

A

End stage renal disease
Atherosclerosis - cardiovascular disease
Steroid use - immunosuppression = infection

258
Q

Define Sjogren’s syndrome

A

Autoimmune destruction + fibrosis of the epithelial exocrine glands especially lacrimal and salivary glands

259
Q

What is Sjogren’s syndrome linked to and what are its antibodies

A

Can be isolated or linked to SLE or rheumatoid arthiritis

ANA - SLE

Anti-Ro and Anti-La

260
Q

What condition is anti-Ro linked to

A

Sjogren’s syndrome

261
Q

What condition is anti-La linked to

A

Sjogren’s syndrome

262
Q

What conditions is ANA (anti-nuclear antibodies) linked to

A

SLE

Can be present in Sjogren’s, scleroderma, dermatomyositis

263
Q

Define anti-phospholipid syndrome

A

Increase risk of blood clots due to immune system creating antibodies to make blood more likely to clot = hyper-coagulable state

Autoimmune or idiopathic

264
Q

What are the antibodies linked to anti-phospholipid syndrome

A

Main = anticardiolipin antibodies

Other
- Lupus anticoagulant
- Anti-beta-2 glycoprotein 1 antibodies

265
Q

What condition is anticardiolipin antibodies seen in

A

Anti-phospholipid syndrome

266
Q

How is antiphospholipid syndrome diagnosed

A

History of thrombosis (e.g. MI, stroke) or pregnancy complications + present antibodies

Other symptoms = thrombocytopenia

267
Q

Describe the treatment of antiphospholipid syndrome

A

Long term = warfarin

Pregnant = LMWH + aspirin

268
Q

What can be used to treat Raynaud’s phenomenon

A

CCB = nifedipine

269
Q

Define scleroderma

A

Fibroblast activation = hardened + sclerotic skin

Can be limited systemic sclerosis or diffuse systemic sclerosis

270
Q

Name the symptoms of limited systemic sclerosis

A

CREST

Calcinosis
Raynaud’s phenomenon
E - Oesophageal dysfunction
Sclerodactyly - tightening of skin on fingers
Telangiectasis - dilation of capillaries causing red marks on fingers

Diffuse = them +
- Beaked nose
- Interstitial lung disease
- Renal crisis
- Pulmonary hypertension

271
Q

What antibodies are present in limited systemic sclerosis (scleroderma)

A

Anti-centromere

272
Q

What are anti-centromere present in

A

Limited systemic sclerosis (scleroderma)

273
Q

What are anti-scl70 present in

A

Diffuse systemic sclerosis (scleroderma)

274
Q

What is the mnemonic to remember the symptoms of scleroderma

A

CREST

275
Q

What does CREST stand for

A

Symptoms of scleroderma

Calcinosis
Raynaud’s phenomenon
E - Oesophageal dysfunction
Sclerodactyly - tightening of skin on fingers
Telangiectasis - dilation of capillaries causing red marks on fingers

276
Q

What is the mnemonic to remember the x-ray changes in rheumatoid arthiritis

A

LESS

Loss of joint space
Erosions
Soft tissue swelling
Soft bones - osteopenia

277
Q

What does LESS stand for

A

X ray changes of rheumatoid arthiritis

Loss of joint space
Erosions
Soft tissue swelling
Soft bones - osteopenia

278
Q

Describe Ehlers Danlos

A

Mutation in collagen - COL5A1 or COL5A2

Hypermobile - main subtype

279
Q

Describe Marfan’s

A

Mutation in EBN1 gene - chromosome 15

Less fibrin 1 = reduced functional microfibrils

280
Q

Name 2 connective tissue disorders

A

Ehlers Danlos
Marfan’s

281
Q

What is the inheritance pattern of the connective tissue disorders

A

Autosomal dominant

282
Q

Name some of the features of Ehlers’s Danlos

A

Recurrent dislocation/hypermobile
Aortic dissection
AAA
Subarachnoid haemorrhage

283
Q

Name some features of Marfan’s

A

Tall stature, long arms, long body, spider fingers

284
Q

If some was hypermobile or had an aortic dissection what connective tissue disorder do they have

A

Ehlers’s Danlos

285
Q

If someone was tall stature with long arms and legs what connective tissue disorder would they have

A

Marfan’s

286
Q

Describe the diagnosis of Ehlers’s Danlos

A

Clinical diagnosis

287
Q

Describe the diagnosis of Marfan’s

A

> 2 features

Lens dislocation
Flat feet (pes plantus)
Dural ectasia
Skeletal fractures
Inward growing of breast bone (pectus deformity)

288
Q

Describe granulomatosis with polyangiitis

A

Small/medium vessel vasculitis (multisystem)

B cells produce cANCA against neutrophils which bind to proteinase 3 in the neutrophil

Neutrophil release oxygen free radicals

= Indirect damage to endothelial cells + inflammation

289
Q

What is the antibody of granulomatosis with polyangiitis

A

cANCA - antineutrophil cytoplasmic antibodies

290
Q

What is antineutrophil cytoplasmic antibodies present in (cANCA)

A

Granulomatosis with polyangiitis

291
Q

What is the full name of cANCA

A

Antineutrophil cytoplasmic antibodies

292
Q

Name a key presentation in granulomatosis with polyangiitis

A

Saddle nose deformity

293
Q

Describe the management of granulomatosis with polyangiitis

A

Short term = steroids + cyclophosphamide

Maintanace = methotrexate + azathioprine

Severe renal disease = plasma exchange

294
Q

Describe dermatomyositis

A

Complement mediated attack of the muscle capillaries and endothelium of arterioles.

Inflammation and atrophy leads to necrosis

Genetic + environment

295
Q

Name the signs of dermatomyositis

A

Shawl sign
Heliotrope rash
Gottron’s papules

296
Q

Define shawl sign

A

Red rash over shoulders, arms and upper back and v shape chest

297
Q

Define heliotrope rash

A

Darky red rash on hands and face

298
Q

Define Gottron’s papules

A

Red/purple hardened/eroded areas of the skin on upper surface of the finger joints, elbows or knees

299
Q

Describe the diagnosis of dermatomyositis

A

At least 1 dermatological condition and one of at least 4 of the extra category

300
Q

What is the treatment of dermatomyositis

A
  1. exercise, physio, steroids - avoid sun
  2. Immunosuppressants - methotrexate and azathioprine
301
Q

Describe the mechanism of action of azathioprine

A

Immunosuppressant

Incorporates itself into replicating DNA and RNA to interrupt the replication process

302
Q

What antibodies are present in dermatomyositis

A

ANA

Anti-Jo1 and anti Mi2

303
Q

What condition is Anti-Jo1 and anti Mi2 seen in

A

Dermatomyositis

304
Q

Define Osteomalacia

A

Defective bone mineralisation = soft bones as a result of insufficient vitamin D

305
Q

Describe the pathophysiology of Osteomalacia

A

Vitamin D = essential for calcium and phosphate absorption

Low = low serum calcium + phosphate

Low calcium = increased PTH - reabsorbs calcium from bones

306
Q

Where are you likely to see Osteomalacia pathological fractures

A

Top of femurs

307
Q

What is the investigation for Osteomalacia

A

Serum 25-dihydoxyvitamin D

< 25 nmol/L = deficiency
25 - 50 nmol/L = insufficiency

308
Q

What is the treatment of Osteomalacia

A

Cholecalciferol (vitamin D3)

Recheck calcium levels 1 month after loading regime

309
Q

Define polyarteritis nodosa

A

Medium sized vessels - arteries

310
Q

What is polyarteritis nodosa associated with

A

Hep B (Also C and HIV)

311
Q

Name the key symptoms of polyarteritis nodosa

A

Cutaneous/subcutaneous nodules - hallmark

Unilateral orchitis
Livedo reticulitis - mottled, purplish, lace like rash

312
Q

Name the investigations of polyarteritis nodosa

A

HBsAg

Biopsy - transmural fibrinoid necrosis

313
Q

What is the serological marker for hepatitis B

A

HBsAg

314
Q

What is the treatment of polyarteritis nodosa if there is not hepatitis B

A

Corticosteroids + cyclophosphamide

315
Q

What is the treatment of polyarteritis nodosa if there is hepatitis B

A

Antiviral agent, plasma exchange + corticosteroids

316
Q

Define Paget’s disease of bone

A

Excessive bone turnover (formation and reabsorption) due to excessive osteoblast and osteoclast activity

317
Q

Describe the x-ray of Paget’s disease of bone

A

Bone enlargement + deformity
Well defined osteolytic lesions - osteoporosis circumscription
Cotton wool appearance - poorly defined areas of sclerosis and lysis
V-shaped defects in long bone

318
Q

Describe the management

A

Biphosphates + calcium + vitamin D
NSAIDs - bone pain
Surgery - bone deformities

319
Q

Name 2 complications of Paget’s disease

A

Osteosarcoma
Spinal stenosis + cord compression = neurological symptoms

320
Q

How do you remember the roles of bone cells

A

Osteoblasts = bone builders

Osteoclasts = bone bulldozers

Osteocytes = bone remodellers

321
Q

What mnemonic can be used to remember the risk factors of osteoporosis

A

SHATTERED

Steroid use
Hyperthyroidism, hyperparathyroidism, hypercalcaemia
Alcohol + tobacco use
Thin (BMI < 18.5)
Testosterone (low) - women
Early menopause - oestrogen protective
Renal or liver failure
Erosive/inflammatory bone disease e.g. myeloma or RA
Dietary low calcium/malabsorption or DM1

322
Q

What tool is used to assess back pain and summarise it

A

STarT back screening tool

9 questions for function and pain

Helps guide intensity of initial treatment

323
Q

Describe vertebral disc degeneration

A

Osteoarthritis of the spine, which includes spontaneous degeneration of either disc or facet joints

324
Q

Name 5 causes of acute liver failure

A

Viral (A/B/EBV)
Drugs
Alcohol (acute overdose)
Vascular
Obstruction

325
Q

Name 4 causes of chronic liver failure

A

Alcohol (long term)
Viral (B/C)
Autoimmune
Metabolic

326
Q

Name 5 signs of chronic liver failure

A

Dupuytren’s contractures - deformity in flexion of fingers
Clubbing
Xanthelasma - yellow deposition of cholesterol under skin
Spider naevi
Hepatomegaly

327
Q

What would be seen on blood tests of liver failure

A

Increased ALT, AST, PT

328
Q

In liver failure what should be done with ascites

A

Peritoneal tap with microscopy + culture

329
Q

What is the medical management of encephalopathy due to liver failure

A

Lactulose

330
Q

What is the medical management of ascites

A

Diuretics

331
Q

What is the medical management of bleeding due to liver failure

A

Vitamin K

332
Q

Name possible causes of prehepatic jaundice

A

Due to increased production of bilirubin

Intravascular haemolysis
- TTP
- HUS

Extravascular
- Sickle cell disease
- Malaria
- Autoimmune haemolytic anaemia
- G6PD deficiency

333
Q

What form of jaundice does decreased clearance of bilirubin cause

A

Intrahepatic or post hepatic

334
Q

Name conditions which can cause intrahepatic jaundice

A

Decreased clearance of bilirubin

Gilbert syndrome
Hepatitis
Heart failure
Cirrhosis
Primary biliary cirrhosis
Lymphoma
TB

335
Q

Name conditions which can cause post hepatic jaundice

A

Decreased clearance of bilirubin

Cholangiocarcinoma
Pancreatic cancer
Chronic pancreatitis
Parasitic infections

336
Q

Summarise pathophysiology of jaundice

A

Unconjugated bilirubin (not soluble) transported to liver by albumin

Conjugated in liver by adding glucuronic acid by glucuronyl transferase (water soluble)

80% - oxidised create stercobilin = excreted by faeces
20% - transported to liver for bile production

337
Q

What is the key blood finding in alcoholic liver disease

A

AST: ALT > 2

Other findings
- Increased - bilirubin, PT, GGT
- Decreased albumin

Macrocytic anaemia

338
Q

What would be seen on an FBC of alcoholic liver disease

A

Macrocytic anaemia

339
Q

Name the symptoms of Wernicke-Korsakoff syndrome

A

Nystagmus, ataxia, encephalopathy

Due to B1 deficiency and alcohol withdrawal

Treatment = IV thiamine

340
Q

What marker on a liver function test will be raised in chronic liver damage but not acute liver damage

A

Albumin

Enzyme made by the liver and has a long half life

341
Q

What do AST/ALT on a liver function test represent

A

Enzymes made in the liver - released when there is injury to hepatocytes.

342
Q

What is the definition of binge drinking

A

6 or more units for women and 8 or more or men in a single session

343
Q

What are the two questionnaires that can be used to assess for harmful alcohol use

A

CAGE
- cut down? annoyed? guilty? eye opener?

AUDIT questionnaire
- 10 questions, > 8 = harmful use

344
Q

What two questionnaires can be used to assess fibrosis in liver disease

A

NAFLD
Fibrosis 4

345
Q

What treatment can be used in non-alcoholic fatty liver disease and what does it improve

A

Vitamin E

Improves histological steatosis/fibrotic appearance

346
Q

What imaging techniques can be used in liver cirrhosis

A

Transient elastography = used to assess stiffness

Ultrasound
- Nodularity on surface of liver
- Corkscrew appearance
- Enlarged portal vein
- Splenomegaly

Liver biopsy

347
Q

What two scoring systems can be used in liver cirrhosis

A

MELD score

Child-Pugh score

348
Q

Describe the MELD score

A

Every 6 months in patients with compensated liver cirrhosis

349
Q

Describe child-Pugh score

A

Assess severity of cirrhosis and prognosis

Score 1-5

ABCDE

Ascites
Bilirubin
Clotting - INR
Dilation (ascites)
Encephalopathy

350
Q

When is a liver transplant considered

A

When there are features of decompensated liver disease

A - ascites
H - hepatic encephalopathy
O - Oesophageal varices bleeding
Y - yellow (jaundice)

351
Q

Name complications of liver cirrhosis

A

Portal hypertension
Malnutrition
Oesophageal varices
Hepatocellular carcinoma

352
Q

In hepatitis what does IgM mean

A

Acute infection

353
Q

In hepatitis what does IgG mean

A

Chronic infection or immunity after infection

354
Q

If someone has been travelling and exhibits hepatitis symptoms what hepatitis is it likely to be

A

A

HAV IgM ab = active
Anti HAV IgG ab = post infection/vaccination

Self limiting

355
Q

If there is an anti- before one of the hepatitis serology what does that mean

A

If with a none anti marker as well = chronic infection active

If without another marker or with another anti = chronic inactive, vaccinated or immune

Vaccinated only has one anti, immune has 2 antis

356
Q

If someone has a hepatitis D infection what other condition must they have

A

Hepatitis B

357
Q

If a person shows hepatitis symptoms and has recently eaten uncooked pork what hepatitis will they have

A

E

Self limiting

358
Q

What is a complication of hepatitis B and C

A

Hepatocellular carcinoma

359
Q

What condition is this
Positive

HcRNA positive

A

Active infection of hepatitis C

360
Q

What condition is this
Positive

Anti Hc ab
HcRNA

A

Active infection (chronic/acute) hepatitis C

361
Q

What condition is this

HcRNA negative
Anti Hc Ab positive

A

Resolved infection of hepatitis C

362
Q

What condition is this
Positive

HBsAg
HBeAg
IgM

A

Acute infection hepatitis B

363
Q

What condition is this
Positive

HBsAg
HBeAg
IgG

A

Active chronic infection hepatitis B

364
Q

What condition is this
Positive

HBsAg
Anti-HBe

A

Chronic inactive hepatitis B

365
Q

How can you tell chronic infections of hepatitis B apart based on HBV DNA

A

Active = high
Inactive = low

366
Q

What condition is this
Positive

Anti-HBS
Anti-HBe
IgG

A

Immunity from a hepatitis B infection

367
Q

What condition is this
Positive

Anti-HBS

A

Immunity from a hepatitis B vaccination

368
Q

What hepatitis can you get from dialysis

A

Hepatitis B

369
Q

What deposits are seen in autoimmune hepatitis

A

IgG

370
Q

Describe the two types of autoimmune hepatitis

A

Type 1 - affects women around menopause

Type 2 - children/young girls, rapid onset

371
Q

What antibodies are seen in type 1 autoimmune hepatitis

A

ANA
anti-actin
anti-SLA/LP

372
Q

What antibodies are seen in type 2 autoimmune hepatitis

A

Anti-LKM1
Anti-LC1

373
Q

What is the treatment for autoimmune hepatitis

A

Prednisolone + azathioprine

374
Q

If the pain is triggered after a fatty meal what condition would it be

A

Biliary colic

375
Q

What are the symptoms of cholecystitis and define it

A

Inflammation of the gallbladder

Referred pain to r. shoulder (phrenic nerve) + ve murphy sign

376
Q

Define murphy sign

A

Pressure in RUQ, inspiration halts due to pain

377
Q

What are the symptoms of ascending cholangitis and define it

A

Inflammation of bile duct

Charcot triad
Reynold pentad

378
Q

Name Charcot triad

A

RUQ pain, fever, jaundice

379
Q

Name Reynold pentad

A

Charcot triad + altered mental state + hypotension

380
Q

In biliary tract disease what are the investigations

A

1st line = AUSS

GS = MRCP

381
Q

What is the treatment of biliary colic

A

Laparoscopic cholecystectomy within 72 hours

382
Q

What is the treatment of cholecystitis

A

Laparoscopic cholecystectomy within 1 week

+ Iv fluids, antibiotics, analgesia

383
Q

What is the treatment of ascending cholangitis

A

ERCP - bile duct clearance

Once stable = cholecystectomy

+ Iv fluids, antibiotics, analgesia

384
Q

Describe the differences between primary biliary cholangitis and primary sclerosing cholangitis

A

Primary biliary cholangitis
- intralobular bile ducts
- female, smoking

Primary sclerosing cholangitis
- intralobular and extralobular
- Male, UC

385
Q

What are the antibodies of primary biliary cholangitis

A

AMA

386
Q

What would be seen on a liver biopsy of primary biliary cholangitis

A

Inflamed bile ducts with intraepithelial lymphocytes, epithelioid granuloma and fibrosis

387
Q

What are the antibodies and GS investigation for primary biliary cholangitis

A

pANCA

MRCP

388
Q

What is 1st line management in primary biliary cholangitis

A

Ursodeoxycholic acid

389
Q

How do you remember the causes for acute pancreatitis

A

I GET SMASHED

Idiopathic
Gallstones - acute
Ethanol - chronic
Trauma
Steroid use
Mumps
Autoimmune
Scorpion stings
Hypercalcaemia/hypertriglyceridemia
ERCP
Drugs/medications

390
Q

What are the two signs seen in acute pancreatitis

A

Grey turner’s
Cullen’s sign

391
Q

Describe grey turner’s sign

A

Flank bleeding

(acute pancreatitis)

392
Q

Describe cullens sign

A

Periumbilical bleeding

(acute pancreatitis)

393
Q

Name the key investigation for acute pancreatitis

A

Increased lipase and amylase

394
Q

Name the scoring systems for acute pancreatitis

A

Glasgow and Ranson’s score
APPACHE II score - within 24 hours

395
Q

What is the diagnostic investigation for chronic pancreatitis

A

Abdo USS + CT

396
Q

What are gallstones made from

A

Cholesterol

397
Q

Define ascites and a medical treatment

A

Pathological accumulation of fluid in peritoneal cavity

Abdominal dissention and shifting dullness

Spirolactone

398
Q

Why is oesophageal varices a complication of portal hypertension

A

Shunting of blood to gastroesophageal vein

399
Q

Define oesophageal varices

A

Dilated submucosal distal oespheageal vein connecting portal and systemic circulations

Presents as haematemesis

400
Q

What is GS investigation for oesophageal varices

A

Upper GI OGD (oesophageal-gastro duodenoscopy)

401
Q

Name what can be given in bleeding management of oesophageal varices

A

IV terlipressin

Variceal band ligation

TIPPS - trans jugular intrahepatic portosystemic shunt = diverts pressure to other veins to lower the pressure

402
Q

In spontaneous bacterial peritonitis shows a gram positive organism what is it

A

Staph aureus

403
Q

In spontaneous bacterial peritonitis shows a gram negative organism what is it

A

E.coli
Klebsiella

404
Q

A 30 year old male non-smoker presents with COPD symptoms what is the cause

A

Alpha 1 antitrypsin deficiency

405
Q

Name 3 metabolic disease and there inheritance pattern

A

Haemochromatosis
Wilsons disease
Alpha-1 antitrypsin

Autosomal recessive

406
Q

Summarise haemochromatosis

A

Excess uptake of iron

Tris
- bronze skin
- hepatomegaly
- T2DM

407
Q

Summarise Wilsons disease

A

Copper accumulates in the liver and spills out into the blood

Fleischer ring - green brown ring around cornea

408
Q

What does alpha 1 antitrypsin deficiency result in

A

Neutrophil elastase increase

Affects the lungs and liver

No treatment

409
Q

Describe the pathophysiology of a paracetamol overdose

A

5% is metabolised in the liver by cytochrome P450 enzymes

Form toxic metabolite N-acetyl-p-benzoquinone imine (NAPQ1)

Binds to glutathione (finite amount) become non toxic and excreted in urine

Excess NAPQ1 binds to hepatocytes in the liver causing mitochondrial injury

410
Q

Describe the treatment of paracetamol overdose

A

< 8 hours from digestion

Wait 4 hours from last injection + take bloods

If over threshold start acetylcysteine treatment

411
Q

Summarise pancreatic cancer

Type
Key symptoms
GS/monitoring
Treatment

A

Adenocarcinoma of head

Courvoisier’s sign - palpable gallbladder + jaundice

GS = CT pancreas
Monitor CA19-9

Whipple procedure - pancreaticoduodenectomy

412
Q

Describe Courvoisier’s sign and when is it seen

A

Palpable gallbladder + jaundice

Pancreatic cancer (and cholangiocarcinoma)

413
Q

Summarise hepatocellular carcinoma

Type
Key symptoms
GS/monitoring
Treatment

A

Liver cirrhosis - arises from parenchyma + metastases

Liver symptoms + non specific

1st line = AUSS
GS = CT abdomen
Tumour marker - serum-alpha fetoprotein

Poor prognosis
Resection

414
Q

Summarise cholangiocarcinoma

Type
Key symptoms
GS/monitoring
Treatment

A

Adenomas - arises from biliary tree

Signs of cholestasis + Courvoisier sign

1st line - abdominal CT/US
GS = ERCP
Tumour marker = CA19-9
Increased bilirubin/ALP

Surgical resection
ERCP - used to plant stent in blocked duct = relieves symptoms

415
Q

Describe Gilberts syndrome

A

Liver ability to metabolise bilirubin in affected

Autosomal recessive inheritance of UGT1A1 gene

416
Q

Name the symptom of gilberts syndrome

A

Painless jaundice - especially at times of stress

417
Q

Name 2 treatments in hepatic encephalopathy

A

1st line = lactulose

Other - rifaximin - decrease number of ammonia producing intestinal bacteria

418
Q

Describe the pathophysiology of Wernicke-Korsakoff syndrome and the treatment

A

Alcohol prevents the absorption of thiamine (B1) by blocking thiamine pyrophosphate synthesise = thiamine deficiency

Treatment = IV thiamine

419
Q

What are the symptoms of Wernicke encephalopathy

A

Ataxia, confusion, ophthalmalgia

420
Q

What are the symptoms of Korsakoff syndrome

A

Wernicke’s encephalopathy + short term memory loss + hallucinations

421
Q

How do you remember the features of IBS

A

ABC

Abdominal pain
Bloating
Change in bowel habits

422
Q

Describe the diagnosis of IBS

A

Clinical diagnosis

Recurrent abdominal pain - 1 day per week for 3 months. Plus 2 or more of the following

Related to defecation
Change in frequency
Change in stool form

423
Q

What type of reaction is coeliac disease

A

Type 4

424
Q

What markers are associated with coeliac disease

A

HLA DQ2
HLA DQ8
IgA deficiency

Anti-transglutaminase antibodies (anti-TTG)

425
Q

What is anti-TTG associated with and give its full name

A

Coeliac disease

Anti-transglutaminase antibodies

426
Q

What is the GS investigation for coeliac disease

A

Endoscopy + duodenal biopsy

427
Q

What would be seen on a biopsy of coeliac disease

A

Complete villous atrophy
Crypt hyperplasia
Intraepithelial lymphocytes

428
Q

What is the 1st line investigation in coeliac disease

A

IgA anti-TTG increased

Total serum IgA

429
Q

Describe the pathophysiology of coeliac disease

A

Gluten (glandin) binds to IgA = taken up by macrophages = activates CD 4+ T helped cells = release proinflammatory cytokines = autoantibodies destroy epithelial cells of villi (enterocytes)

430
Q

Describe a key differential diagnosis of coeliac disease

A

Topical sprue

Presents the same + associated with travel

Incomplete (key) villous atrophy

Tetracycline 6 months + leave affected area

431
Q

What is the GS investigation for gastritis

A

Gastritis = inflammation of stomach lining

= Endoscopy

432
Q

What type of bacteria is h. pylori

A

Gram negative spiral

Breath test

433
Q

Describe the treatment for h. pylori

A

CAP

Clarithromycin, amoxicillin + PPI (omeprazole)

Allergy to penicillin = metronidazole

434
Q

What antibiotic is given instead of amoxicillin in the treatment for h. pylori for someone with a penicillin allergy

A

Metronidazole

435
Q

What is given in gastritis caused by autoimmune

A

IM vitamin B12

436
Q

How do NSAIDs cause gastritis

A

Affect prostaglandin synthesis = less mucus secretion

437
Q

What part of the stomach does autoimmune gastritis affect

A

Fundus

438
Q

What is a key symptom of a h. pylori infection

A

Stomach pain especially when empty

439
Q

Describe the investigation of GORD

A

No red flags = clinical diagnosis

Red flag =

1st line - OGD - oesophagogastroduodenoscopy

2nd line - if nothing seen - 24hr gastric monitoring pH or oesophageal manometry

440
Q

Describe the medical management of GORD

A

1st line - PPI

2nd line - H2 receptor antagonist

Surgical - laparoscopic Nissen’s fundoplication - fundus wrapped around the lower oesophageal to minimic sphincter

441
Q

What is the change seen in Barrett’s oesophageal and its investigation

A

Metaplastic - stratified squamous to simple columnar

OGD + biopsy - In z-line, 1cm above gastro-oesophageal sphincter

442
Q

Define the diverticular diseases - how are they different from each other

A

Diverticular - broad term for outpouching of colonic mucosa

Diverticulosis - asymptomatic outpouching

Diverticular disease - symptomatic outpouching

Diverticulitis - inflammation (infection) of diverticula

443
Q

Name the symptoms and treatment of diverticular disease

A

LLQ pain, constipation, haemochirazia

Surgery + bulk forming laxatives

444
Q

Name the symptoms of diverticulosis

A

Triad - pyrexia, LLQ guarding, rebound tenderness

Antibiotics (co-amoxiclav)

445
Q

What is the GS investigation for diverticular disease

A

Contrast CT abdomen and pelvis

446
Q

Where is diverticular disease most common and what due to

A

Sigmoid colon

Increased colonic pressure or decreased wall strength

447
Q

What is seen on an x-ray (1st line investigation) in small bowel and large bowel obstruction

A

3/6/9 rule

> 3cm = small bowel. Coil spring appearance

> 6cm = large bowel.
9cm = caecum
Coffee bean appearance

448
Q

A coil spring appearance on a x-ray abdomen would be what

A

Small bowel obstruction

449
Q

A coffee bean appearance on a x-ray abdomen would be what

A

Large bowel obstruction

450
Q

Describe the management of a small and large bowel obstruction

A

Drip and suck

Drip - IV cannula + nil by mouth
Suck - nasogastric tube - decompress the stomach contents

451
Q

Describe the management of pseudo bowel obstruction

A

IV neostigmine - stimulate motility

452
Q

Gastric ulcer - what artery is affected

A

Left gastric artery

(usually get gastric ulcers on the lesser curvature)

453
Q

Duodenal artery - what artery is affected

A

Gastroduodenal artery

more common

454
Q

What is the GS investigation for peptic ulcers

A

Endoscopy

455
Q

What is the GS investigation in anyone suspected of a GI bleed

A

Endoscopy

Variceal bleed - within 24 hours

456
Q

Describe the difference between Mallory-Weiss tear and oesophageal varices

A

MWT - lower oesophageal mucosa due to vomiting e.g. alcohol or bulimia

Oesophageal varices - dilation of oesophageal vein. Liver cirrhosis, chronic alcoholism

457
Q

What is the treatment of variceal bleeding

A

IV terlipressin
Endoscopic band ligation

Prevent further bleeding
Propanol, nitrates
Repeat endoscopic banding

458
Q

What is the most common cause of appendicitis

A

Fecalith = stone made up of faeces

459
Q

What signs can be seen in appendicitis

A

Rovsing’s sign
Psoas sign
Obturator sign

460
Q

Define Rovsing’s sign

A

Palpitation of the left iliac fossa = pain in right iliac fossa

461
Q

Define Psoas sign

A

Extension of the right hip in lateral position = right iliac fossa pain

462
Q

What is seen in appendicitis

A

Murphy’s triad

N&V
Low grade fever
R. iliac fossa pain

462
Q

Define obturator sign

A

Internal rotation of the flexed right thigh = pain

463
Q

Name Murphy’s triad

A

N&V
Right iliac fossa pain
Low grade fever

464
Q

What scoring system is used in appendicitis

A

Alvarado score

5-6 = CT/ultrasound
> 7 = predictive

464
Q

What is the difference between gastroenteritis and gastritis

A

Gastritis = irritation

Gastro-enteritis = infection

465
Q

What is the first line test for gastroenteritis

A

Faecal stool culture + sensitivities

466
Q

What are 2 causative agents of gastroenteritis

A

Norovirus - adults abdominal pain 1-3 days. Care homes.

Rotavirus - severe abdominal pain in children 1 week

467
Q

What two areas are more likely to get ischemic colitis

A

Sphenic flexure
Recto sigmoidal junction

468
Q

Why may odynophagia be seen in oesophageal cancer

A

Voice hoarseness

Due to mass pressing on the recurrent laryngeal nerve

469
Q

What are the two types of oesophageal cancer and where are they seen

A

Squamous cell
- developing world
- smoking
- upper 2/3

Adenocarcinoma
- developed world
- GORD
- lower 1/3

470
Q

What is the 1st line investigation for oesophageal cancer and gastric cancer

A

OGD (upper endoscopy) + biopsy

471
Q

What are the two types of gastric cancer

A

Type 1 (80%)
- intestinal
- antrum
- lesser curvature
- male

Type 2 (20%)
- diffuse
- cardia
- female

472
Q

What may be seen on a biopsy in type 2 gastric cancer

A

Signet ring cells

473
Q

Define Krukenberg tumour

A

Ovarian metastases

474
Q

What are the 2 genetic links for bowel cancer

A

Autosomal familial adenomatosis polyposis (PAP mutation) = polyp formation

Lynch syndrome/HPCC = DNA mismatch repair

475
Q

What classification is used to grade bowel cancer and what tumour marker can see how well treatment is going

A

Duke’s classification

CEA tumour marker

476
Q

What two signs can be seen in gastric cancer

A

Sister Mary Joseph sign

Troisier’s sign

477
Q

Describe sister mary joseph sign

A

Gastric cancer

Enlarged belly button nodes

478
Q

Describe troisiers sign

A

Gastric cancer

Enlarged Virchows triad

479
Q

Under 3 year old has diarrhoea what is it most likely to be

A

Rotavirus

480
Q

Adult who has recently been in hospital/restaurant/cruise ship has diarrhoea what is it most likely to be

A

Norovirus

481
Q

Someone how has come back from travelling has diarrhoea what is it most likely to be

A

Travellers diarrhoea - e. coli

482
Q

Someone has bloody diarrhoea which is caused by a bacteria, what is it

A

Shigella

483
Q

Someone has diarrhoea after recently attending a BBQ what is it

A

Campylobacter

484
Q

Someone has signs of neurological problems after diarrhoea what is the most likely causative agent

A

Guillain-Barre - Campylobacter

485
Q

Someone has oily diarrhoea which floats what do they have

A

Coeliac

Steatorrhea

486
Q

What is the most common parasitic cause of diarrhoea and what is its treatment

A

Giardia lamblia

Metronidazole

487
Q

What is the most common cause of diarrhoea

A

Virus

488
Q

What is the treatment for clostridium difficile infection

A

Stop ‘c’ antibiotics

Metronidazole or vancomycin

489
Q

Diarrhoea which needs antibiotic treatment what do you give

A

Travellers bacteria/campylobacter = self limiting

Salmonella/shigella = broad spectrum antibiotics e.g. ciprofloxacin, ceftriaxone

490
Q

What are the investigations for diarrhoea

A

Stool culture - bacteria, parasites

PCR - viruses, c. diff or campylobacter

491
Q

What is the mnemonic to remember red flag alarm symptoms

A

ALARMS

Anaemia - iron deficiency
Loss of weight - unintentional
Anorexia - loss of appetite
Recent onset of worsening symptoms
Melaena/haematemesis
Swallowing issues

492
Q

Define Meckel’s diverticulum

A

Failure of vitelline duct to obliterate during 5th week of fetal development

493
Q

What is the imaging choice and diagnostic imaging of Meckel’s diverticulum

A

Technetium-99m pertechnetate scan (Meckel’s scan)

Diagnosis - contrast CT abdo + pelvis

494
Q

What is a complication of a c. diff infection

A

Pseudomembranous colitis

Severe inflammation of the lining of the large intestine

495
Q

What is the GS investigation of pseudomembranous colitis and what is seen

A

Colonoscopy + biopsy

Owl’s eye inclusion bodies

496
Q

What condition would you see owl’s eye inclusion bodies

A

Pseudomembranous colitis

497
Q

What is the treatment of pseudomembranous colitis

A

C. diff - vancomycin

Unknown - vancomycin + fidaxomicin

498
Q

What condition would show beak like narrowing on barium swallow

A

Achalasia

Oesophageal motility disorder

499
Q

What is GS investigation for achalasia

A

Oesophageal manometry

500
Q

Which IBD causes RLQ pain

A

Chrons disease

501
Q

What is the mnemonic to remember chrons disease

A

NESTS

No blood or mucus
Entire GI tract affected from mouth to anus
Skip lesions on endoscopy
Transmural inflammation and terminal ileum most affects
Smoking is a risk factor (do not set nests on fire)

502
Q

Define NESTS

A

Chrons disease

No blood or mucus
Entire GI tract affected from mouth to anus
Skip lesions on endoscopy
Transmural inflammation and terminal ileum most affects
Smoking is a risk factor (do not set nests on fire)

503
Q

Name 4 signs which would be seen in chrons disease

A

Transmural inflammation + non-ceasing granulomas
Cobblestone appearance
String-sign = strictures
Fissures - cracks in lining

504
Q

What is the 1st line medication to maintain remission in chrons disease

A

Azathioprine

Antagonist of pure metabolism = inhibition of DNA, RNA and protein synthesis

505
Q

What antibodies/mutations are associated with chrons disease

A

NOD2/CARD15 frame shift mutation

ASCA antibodies

506
Q

What is the mnemonic to remember ulcerative colitis

A

CLOSEUP

Continuous inflammation
Limited to rectum and colon
Only superficial mucosa affected
Smoking may be protective
Excrete blood and mucus
Use aminosalicylate
Primary sclerosing cholangitis (70%)

507
Q

Define CLOSEUP

A

Ulcerative colitis

Continuous inflammation
Limited to rectum and colon
Only superficial mucosa affected
Smoking may be protective
Excrete blood and mucus
Use aminosalicylate
Primary sclerosing cholangitis (70%)

508
Q

Which IBD has LLQ pain

A

UC

509
Q

What antibodies/gene are associated with UC

A

HLA-B27

p-ANCA antibodies

510
Q

What would be seen on an xray of UC

A

Lead pipe

511
Q

What scoring systems are used in UC

A

True love and witts severity scoring

Escalation = travis criteria

512
Q

Name two risk/complications of UC

A

Increase risk of colorectal cancer

Toxic megacolon

513
Q

What is the mnemonic to remember IBD extra manifestations

A

A PIE SAC

Ankylosing spondylitis
Pyoderma gangrenosum
Iritis (anterior uveitis)
Sclerosing cholangitis
Aphthous ulcers/ amyloidosis
Clubbing

514
Q

Define A PIE SAC

A

Extra IBD manifestations

Ankylosing spondylitis
Pyoderma gangrenosum
Iritis (anterior uveitis)
Sclerosing cholangitis
Aphthous ulcers/ amyloidosis
Clubbing

515
Q

Summarise Cushing’s syndrome

Definition
Symptoms
Cause
Test
Management

A

Excess cortisol

Moon face
Purple striae
Buffalo hump

Usually by pituitary adenoma (other excess steroids)

Dexamethasone suppression test (low)
High test = excess cortisol

Trans-sphenoidal surgery

516
Q

Summarise Acromegaly

Definition
Symptoms
Cause
Test
Management

A

Excess secretion of growth hormone (GnRH)

Prognathism
Bitemporal hemianopia

Pituitary adenoma

1st line - insulin like growth factor-1
GS - oral glucose tolerance test

Trans-sphenoidal surgery

517
Q

Prolactinoma

Definition
Symptoms
Cause
Test
Management

A

Increased prolactin

Benign lactotroph adenoma (pituitary adenoma)

Male vs female (low libido, infertility etc).

Serum prolactin (elevated) + pituitary MRI

Dopamine agonist - oral cabergoline + bromocriptine

518
Q

Carcinoid tumour/syndromes

Definition
Symptoms
Cause
Test
Management

A

Serotonin + other vasoactive particles into systemic circulation

Flushing, diarrhoea, palpitations
50+ MEN-1 female

Carcinoid tumour (from GI tract)

Urinary-5-hydroxin-choleacaetic acid test (elevated)

Only cure = surgery
Somatostatin analogues e.g. octreotide

519
Q

Conn’s

Definition
Symptoms
Cause
Test
Management

A

Too much aldosterone

Often asymptomatic

By adrenal glands - adrenal adenoma (syndrome)

Selective venous sampling
Serum renin = low

Aldosterone antagonist

520
Q

Adrenal insufficiency

Definition
Symptoms
Cause
Test
Management

A

Adrenal glands do not produce enough steroid hormones - cortisol and aldosterone

Hyper-pigmentation

Primary = autoimmune (Addison’s)
Secondary = loss/damage to pituitary

Short Synacthen test (failure to double)

Hydrocortisone = cortisol
Fludrocortisone = aldosterone

521
Q

What is Na+ and K+ in adrenal insufficiency (Addison’s)

A

Na+ = low
K+ = high

Cortisol = Low
ACTH = high

Secondary - ACTH - low

522
Q

Summarise SIADH

Definition
Symptoms
Cause
Test
Management

A

Inappropriate secretion of ADH

Symptoms due to hyponatraemia e.g. seizures

Small cell lung cancer, medications (SSRI), surgery

Diagnosis of exclusion

Acute - treat underlying cause + fluid restriction

Chronic - vasopressin receptor antagonist

Complication = central pontine myelinolysis deficiency

523
Q

Summarise arginine vasopressin deficiency

Definition
Symptoms
Cause
Test
Management

A

Lack of ADH - not produced by hypothalamus

Polyuria (> 3L of urine)

Damage/dysfunction to hypothalamus or pituitary

Water deprivation/desmopressin test
Low after water, high osmolality after desmopressin

Desmopressin

524
Q

Summarise arginine vasopressin resistance

Definition
Symptoms
Cause
Test
Management

A

Lack of response by collecting ducts

Genetic, medication e.g. lithium, kidney conditions e.g. PKD

Water deprivation/desmopressin test
Low after water, low osmolality after desmopressin

High dose desmopressin

525
Q

Summarise hyperparathyroidism

Definition
Symptoms
Cause
Test
Management

A

Excess secretion of PTH by parathyroid gland

Hyper/hypocalcaemia

Primary/secondary/tertiary

PTH, calcium and phosphate levels

  1. surgical removal
  2. vitamin D/transplant

Calaminetic

526
Q

Describe primary hyperparathyroidism

A

Due to parathyroid adenoma

High PTH
High calcium
Low phosphate

527
Q

Describe secondary hyperparathyroidism

A

Insufficient vitamin D/chronic renal failure

High PTH
Low calcium
Normal phosphate

528
Q

Describe tertiary hyperparathyroidism

A

Prolonged CKD - does not respond to negative feedback

High PTH
High calcium
High phosphate

529
Q

Summarise hypoparathyroidism

Definition
Symptoms
Cause
Test
Management

A

Reduced PTH production

Hypocalcaemia - Chvostek’s sign, Trousseaus sign

Primary = autoimmune
Secondary = surgical removal or low magnesium

Bone profile - low calcium, phosphate, PTH

ECG - prolonged QT segment

IV calcium

530
Q

What is needed for PTH production

A

Magnesium

531
Q

Name two signs of low calcium

A

Chvostek’s sign
Trousseau’s sign

532
Q

Define Chvostek’s sign

A

Facial nerve induces spasm

533
Q

Define Trousseau’s sign

A

BP cuff causes wrist flexion and fingers to pull together

534
Q

Summarise pheochromocytoma

Definition
Symptoms
Cause
Test
Management

A

Excessive, unregulated amounts of catecholamines (adrenaline)

Fluctuate depending on when tumour is secreting

Tumour of chromaffin cells - adrenal glands

MEN-1

Plasma metanephrines 24-hour urine catecholamines

Surgically remove tumour - control symptoms first alpha blockers then beta blockers

535
Q

Describe metformin

Drug class
Mechanism of action
Side effect
Extra

A

Biguanide

Increased peripheral sensitivity to insulin + prevents gluconeogenesis from the liver (creating glucose from lipids)

GI upset

Risk of acute metabolic acidosis (lactic acidosis)

536
Q

Name an example of an SGLT-2 inhibitor

A

Dapagliflozin

  • end flozin
537
Q

What type of medication is dapagliflozin

A

SGLT-2 inhibitor

538
Q

Describe dapagliflozin

Class of medication
Mechanism of action
Side effects
Extra

A

SGLT-2 inhibitor

Prevents reuptake of glucose by the tubules = increase glucose urinary excretion

UTI

Weight loss

1st line if Q-risk = more than 10%

539
Q

What is Qrisk(3) a measure of

A

Risk of having a heart attack or stroke in the next 10 years

540
Q

Name a DPP-4 inhibitor

A

Linagliptin

541
Q

What type of medication is linagliptin

A

DPP-4 inhibitor

End -liptin

542
Q

Describe linagliptin

Class of drug
Mechanism of action
Side effects
Extra

A

DPP-4 inhibitor

Inhibits DPP-4 enzyme = increase insulin secretion by beta cells

Upper resp infections, GI upset, skin rashes

543
Q

Name a sulfonylurea

A

Gliclazide

544
Q

What type of medication is gliclazide

A

Sulfonylurea

545
Q

Describe gliclazide

Class of drug
Mechanism of action
Side effects
Extra

A

Sulfonylurea

Stimulate release of insulin from beta cells

GI upset

Weight gain

546
Q

Describe pioglitazone

Class of drug
Mechanism of action
Side effects
Extras

A

Pioglitazone

Alters transcription of genes influencing carbohydrate and lipid metabolism

Eyes - yellowing of the eyes

Weight gain

547
Q

Why are beta blockers contraindicated in diabetes

A

Can hide hypoglycaemia

548
Q

What are the key genetics in type 1 diabetes

A

HLA-DR3-DQ2
HA-DR4-DQ8

549
Q

What can be used to measure the rate of b cell destruction

A

serum c-peptide

Type 1 diabetes = absent

550
Q

What are the antibodies in type 1 diabetes

A

Anti-GAD (antibodies to glutamic acid decarboxylase)

Islet cell antibodies (ICA)

Insulin antibodies (IAA)

Insulinoma-associaed-2 antibodies (IA-2A)

551
Q

What does a DKA cause

A

Metabolic acidosis

552
Q

Describe 4 features of an ECG of DKA

A

Tall peaking T waves
Widened QRS complex
ST elevation
Prolonged ST interval

553
Q

Describe the pathophysiology of DKA

A

Lack of insulin = uncontrolled lipolysis = breakdown of fasts = increased fatty acids converted into ketones = metabolic acidosis (pH < 7.3)

554
Q

What is the treatment for DKA

A

FIG PICK

Fluid - 3L over 1st 3 hours (risk of cerebral oedema)
Insulin - sliding scale
G - glucose (dextrose + insulin)

Potassium
Infection
Chart fluid balance
Ketone monitoring

555
Q

What is the marker for hypoglycaemia

A

< 3.9 mmol/L

556
Q

Define the markers of hyperosmolar hyperglycaemic state

A

Hyperglycaemia > 30 mmol

Serum osmolality > 320 osmole/kg

No ketonuria

557
Q

What is the treatment of hyperosmolar hyperglycaemic state

A
  1. Fluid replacement
  2. LWMH - due to increase risk of thrombolytic events = blood viscosity
  3. Restore electrolytes
558
Q

Describe the difference between Graves vs. De Quervain’s

A

Both hyperthyroidism

Graves
- Painless goitre
- Treatment (block and treat)
- autoimmune

De Quervain’s
- Painful goitre + pyrexia
- self-limiting
- viral infections

559
Q

What is the name for T4

A

Thyroxine

560
Q

What is the name for T3

A

Triiodothyronine

561
Q

Describe the role of T3 and T4 and there names

A

Thyroxine (T4) is converted into triiodothyronine (T3) in the thyroid

TSH is produced by the anterior pituitary

562
Q

What antibody is present in Grave’s disease

A

Hyperthyroidism

TSH receptor antibody (anti-TSHR)

563
Q

What antibody is present in Hashimoto thyroiditis

A

Hypothyroidism

Anti-thyroid peroxidase antibodies (anti-TPO)

564
Q

What is the treatment for Grave’s disease

A

Hyperthyroidism

Block and treat

Carbimazole + levothyroxine

565
Q

What is produced in the posterior pituitary

A

Oxytocin

Antidiuretic hormone

566
Q

What is produced in the anterior pituitary

A

Growth hormone

Prolactin

TSH

FSH/LH

567
Q

Name a symptom and the treatment of thyroid cancer

A

Palpable thyroid nodule

Thyroidectomy + radioactive iodine

568
Q

What are the symptoms of hypercalcaemia and what is seen on an ECG

A

Renal stones
Painful bones
Abdominal groans
Psychiatric moans

ECG = short QT

Cancer or hyperparathyroidism

569
Q

What are the symptoms of hypocalcaemia and what is seen on an ECG

A

CATS go Numb
Convulsions
Arrythmia
Tetany
Spasms/stridor
Numbness in fingers

ECG = prolonged QT interval

570
Q

What is a potential life threatening complication of hypocalcaemia

A

Low QT syndrome

Decreased HR and contractility

571
Q

Describe ECG of hyperkalaemia

A

Tented T waves
Small p waves
Wide QRS complex
Ventricular fibrillation
Sine wave

572
Q

Describe the management of hyperkalaemia

A

ECG changes - IV calcium gluconate/chloride - stabilise cardiac membranes

No ECG changes - insulin, dextrose, salbutamol

573
Q

Name the ECG changes in hypokalaemia and 2 causes

A

Small or inverted T waves
Prominent U waves
Long PR interval
Deep ST segments

Bulimia (vomiting), diarrhoea

574
Q

How do you calculate serum osmolality

A

2Na + Glu + Urea (all in mmol/L)

575
Q

Auer rods

A

Acute myeloid leukaemia

576
Q

Describe acute myeloid leukaemia

A

Proliferation of myeloblasts

Diagnosis > (or equal to) 20% myeloblasts in bone marrow

Blood film = Auer rods

577
Q

Philadelphia chromosome

A

Chronic myeloid leukaemia

translocation 9:22

FISH PCR

578
Q

Describe chronic myeloid leukaemia

A

Overproduction of myeloid cells

Philadelphia chromosome

Tyrosine kinase inhibitor - imatinib

579
Q

Cancer seen in children

A

Acute lymphoid leukaemia

580
Q

Describe acute lymphoid leukaemia

A

Rapid proliferation of lymphoblasts

Children

Diagnosis = > 20% lymphoblasts on bone marrow biopsy

581
Q

Smudge cells

A

Chronic lymphoid leukaemia

582
Q

Describe chronic lymphoid leukaemia

A

Failure of apoptosis

Smudge cells on blood

Complication ritcher formation

583
Q

Describe Ritcher transformation

A

CLL transforms into non-Hodgkin’s lymphoma

584
Q

Reed-Stenberg cells

A

Hodgkin’s lymphoma

585
Q

Describe Non-Hodgkin’s lymphoma

A

Failure of cell apoptosis

Aims to control - remission - incurable

Features - skin rashes, mycosis, fungicides (patches)

586
Q

Describe Hodgkin’s lymphoma

A

Failure of cell apoptosis

Reed-Stenberg cells - CD15+, CD30+

Features - skin picking

Most curable - immunosuppression

587
Q

Abnormal proliferation of single Ig - mainly IgG

A

Multiple myeloma

588
Q

Describe multiple myeloma

A

Abnormal proliferation of single Ig - mainly IgG

CRABBI
Calcium increase
Renal failure
Anaemia
Bone lytic lesions
Bleeding
Infections

Rouleaux formation

< 65 stem cell treatment

589
Q

Rouleaux transformation

A

Multiple myeloma

590
Q

Describe polycythaemia vera

A

Increased concentration of erythrocytes

Primary = abnormality of bone marrow
Secondary = disease outside bone marrow = overstimulation of bone marrow

Itching after warm water

Red cell mass > 25%

Venesection (removal of blood from body) = aspirin

591
Q

Describe thrombolytic thrombocytopenia purpura (TTP)

A

ADAM 13 deficiency cannot break down clumps of VWF

Smear = schistocytes

Plasma exchange + ADAM13 replacement

592
Q

Describe immune thrombocytopenia purpura (IPT)

A

Autoimmune destruction of IgG

Steroids + IV IG

593
Q

Monoclonal band seen on serum and urine electrophoresis

A

Myeloma

594
Q

Pain in the neck when drinking

A

Hodgkin’s lymphoma

595
Q

What’s the combs test for

A

Autoimmune haemolytic anaemia

IgM antibodies are associated

596
Q

Heinz bodies

A

G6PD haemolytic anaemia

597
Q

What is the inheritance of von Willebrand’s disease and what symptoms are seen

A

Autosomal dominant

Muscutaneous bleeding

Treat with desmopressin

Tranexamic acid - can reduce active bleeding

598
Q

What is the inheritance pattern of haemophilia A/B and symptoms seen

A

X-linked recessive

A = 8
B = 9

Soft tissue bleeding - into muscles, joints, haematoma formation

599
Q

Describe the symptoms of cardiac tamponade

A

Bucks Triad

Raised JVP
Muffled heart sounds
Low blood pressure

Phase 2a (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions