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USMLE S2CK > Medicine > Flashcards

Medicine Flashcards

1
Q

what vessel is occluded to give wallenberg syndrome?

what are the features?

A

verterbral artery/PICA

infarction of lateral medulla oblongata

  • horner syndrome
  • sensory - pain and temperature - ipsilateral face, contralateral body
  • sensory - nystagmus, vertigo (CN VIII)
  • cerebellar ataxia
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2
Q

action on CYP 450: SSRIs and omeprazole

A

inhibtor

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3
Q

which heart block has a constant PR interval with occasional missed beats?

A

Mobitz type 2

pacemaker indicated

conduction abnormalilty below the AV node

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4
Q

how do you manage an aortic dissection?

A

pain control

IV beta blockers

+/- nitroprusside if the SBP remains >120

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5
Q

what is the role of the d-xylose test?

A

d-xylose is a monosacheride that is absorbed without digestion in the small bowel

reduced levels in urine after oral challenge indicates absorption defect

those with enzymatic deficiency (pancreatic insufficiency) will have a normal d-xylose test as there is no needs for them in its digestion

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6
Q

what is the diagnostic test for CLL?

A

flow cytometry showing clonal mature B cells

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7
Q

what are the neoplasms associated with each of the MEN syndromes?

A

MEN1 - pituitary, pancreas, parathyroids

MEN2A - parathyroids, medullary thyroid, phaeochromocytoma

MEN2B - mucosal neuroma, medullary thyroid, phaeochromocytoma, marfanoid body habitus

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8
Q

beta2 microglobulin is a prognostic factor in which disease?

A

multiple myeloma

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9
Q

what are the values for Ca Phos and PTH in vitamin D deficiency?

A

low Ca, low Phos, high PTH

found in low sunlight, malabsorption, poor dietary intake

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10
Q

what are the indications for IE antibacterial prophylaxis during dental/surgical procedures?

A

only with particularly high risk heart conditions such as:

  • previous IE
  • metalic heart valve
  • unrepaired CHD/CHD repair with tissue or residual defect
  • valvular lesion in a transplanted heart
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11
Q

what do you have to replace in pituitary insufficiency?

A

cortisone (hydrocortisone)

thyroxine

testosterone/oestrogen

recombinant human growth hormone

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12
Q

what is the adverse effect of aromataze inhibitors used in breast cancer treatment that has to be monitored before and during therapy?

A

osteoporosis

DEXA scanning

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13
Q

what are the medical treatment options for hepatorenal syndrome?

A

midodrine, octreotide, norepinepherine

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14
Q

what is the target of autoantibodies in guillan-barre syndrome?

A

myelin on peripheral nerve fibres

don’t be fooled by high CSF protein!

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15
Q

what disease are the following all risk factors for?

  • famle, caucasian
  • HLA-DRB1
  • cold climate, living in the West (Europe/USA)
  • low vitamin D levels
  • smoking
A

multiple sclerosis

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16
Q

which medication lead to increase in creatinine without any damage to the kidney?

A

trimethoprim, cimetidine, febuxostat

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17
Q

what are the complications of quincy?

A

airway obstruction

spread of abscess into the parapharyngeal space and involvement of the carotid sheath

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18
Q

what is the management of carpel tunnel syndrome?

A

nocturnal wrist splinting

steroid injections as a temporary measure

surgical decompression

NSAIDs will not provide relief

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19
Q

what is the important serum:ascites albumin gradient number?

what are the causes of a high SAAG?

A

>= 1.1

high = portal hypertension

  • budd-chiari syndrome
  • cardiac failure
  • cirrhosis
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20
Q

what is the medical therapy for virilization in women?

A

OCP

spironolactone/finasteride (anti-androgen)

metformin (only in PCOS)

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21
Q

what must you pay attention to when prescribing hydroxyurea?

A

do not prescribe when WBC is low

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22
Q

what is the adverse effect of platin-based chemotherapy that has to be monitoring during therapy?

A

ototoxicity

baseline and interval audiometry

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23
Q

what is the mechanism by which epilepsy leads to brain damage?

what is the hallmark pathological pattern of brain damage secondary to prolonged SE?

A

excitatory cytotoxicity

cerebral cortical laminar necrosis

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24
Q

low C3/4, RhF, hepatitis C or lymphoproliferative disorders are consistent with…

A

mixed cryoglobulinaemia

small vessel leukocytoclastic vasculitis, immune complex deposition and palpable purpura

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25
Q

what are the treatment options for latent TB ?

A
  • isoniazid and rifapentine q1 week for 12 weeks
  • rifampin daily for 4 months
  • isoniazid daily for 9 months daily or twice weekly
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26
Q

knowing the relative risk attributable to a given factor, how do you calculate the attributable risk percentage?

A

ARP = (RR - 1.0)/RR

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27
Q

what are the FSH/LH levels in Klienfelter syndrome and Kallman syndrome?

A

Kleinfelter (XXY, tall) - high FSH and LH but androgen insufficiency due to insensitivity to gonadotrophs

Kallman syndrome (KAL-1 mutation, anosmia, renal agenesis in 50% of patients) - low FSH and LH due to deficiency in GnRH

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28
Q

what is the mechanism of pruritis following a warm shower in polycythemia vera?

A

increased number of basophils release histamine

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29
Q

when are fibrates recommended as therapy for hypertriglyceridaemia?

A

in the prevention of acute pancreatitis

serum trig > 1000 mg/dL

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30
Q

what do thalidomide and lenalidomide increase the risk of that must be prevented during therapy?

A

thrombosis

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31
Q

what is Beck’s triad?

A

hypotension, muffled heard sounds and elevated JVP

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32
Q

what do dysmorphic red cells indicate on urinalysis?

A

glomerular haematuria

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33
Q

above what size thyroid nodule must FNA be performed?

A

1.5 cm as long as TSH/T4 are normal

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34
Q

how do you treat vasospastic angina?

A

CCB (preventive)

nitrates (abortive)

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35
Q

what is an important contraindication to 5-HT receptor antagonist anti-emetics?

A

long QT syndrome

use neurokinin-1 (NK) receptor antagonists instead in chemotherapy nausea

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36
Q

how high does BUN have to be usually to precipitate uraemic pericarditis?

what is the treatment?

A

>60

haemodialysis

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37
Q

what does ruxolitinib do?

A

inhibitor of JAK2 and can be used in polycythemia vera if hydroxyurea fails to control haematocrit

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38
Q

likely cause of large volume pleural effusion with:

  • high protein (>4 g/dL)
  • lymphocytes
  • low glucose (<60 mg/dL)
A

tuberculosis

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39
Q

along with systemic chemotherapy, what should be added spicifically in ALL to prevent recurrence?

A

intrathecal methotrexate stops CNS recurrence of the cancer

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40
Q

in a healthy individual, what are the pathogens likely to cause a brain abscess?

A
  • strep viridans*
  • staph aureus*
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41
Q

what is the best test for parvovirus B19 infection?

treatment?

A

PCR for viral DNA

IV Ig

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42
Q

contralateral loss of sensation and parasthaesias resolving into allodynia/episodic pain

what is the name of this stroke syndrome and where is the lesion?

A

Dejerine-Roussy syndrome

sensory thalamic nuclei

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43
Q

if cushing’s syndrome cannot be adequately cured with surgery (inoperable, metastases) what are the medical therapies that can be used?

A

mitotane - cytotoxic to adrenal tissue, inhibits steroidogenesis, metastatic disease

pasireotide (SSA analog) - inhibits release of ACTH if the pitutary adenoma cannot be resected

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44
Q

non-anion gap metabolic acidosis with mild hyperkalaemia and only mild CKD

A

type 4 renal tubular acidosis

JGA failure and low renin/adosterone leads to reduced excretion of H and K from the collecting duct

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45
Q

when are pembrolizumab and nivolumab useful in the treatment of lung cancer?

A

in cases with elevated programmed death (PD) biomarker

more effective and better tolerated than platinum-based therapy in NSCLC

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46
Q

pronator drift is a sign of disease in which system?

why is it a sensitive test?

A

pyramidal/corticospinal tracts

UMN lesions affect the supinator muscles > pronators

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47
Q

lung cancer screening

A

low-dose CT chest

adults 55-80 who have a 30 pack-year history and quit within the last 15 years. stop scanning when they have not smoked for at least 15 years.

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48
Q

what can be given to prevent the recurrence of uric acid stones? how does this work?

A

potassium citrate

alkalinises the urine, citrate directly blocks stone formation

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49
Q

what effect do loop diuretics have on acid-base balance? How does this mechanism work?

A

will make the patient slightly alkalotic

increased delivery of Na to the DCT leads to exchange of K+ and H+ ions into the urine and promotes more acid being lost

volume contraction leads to aldosterone secretion which contributes to more Na exchange in the DCT as well

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50
Q

what conditions/electrolyte abnormalitis increase the risk of calciphylaxis?

A

hyperphosphataemia

hyperPTH

end-stage renal disease (haemodialysis)

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51
Q

AAA screening

A

one time US abdomen for men who have ever smoked >100 cigarettes

selective screening for men 55-65 who have never smoked

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52
Q

what is the sequence of pathophysiologic events in diabetic nephropathy?

A

glomerular hyperfiltration

thickening of the basement membrane (first finding that can be quantified)

mesangial swelling/expansion

nodular sclerosis

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53
Q

what is the diagnostic test for paget’s disease of the bone?

A

NM technetium scan with high uptake in the bone

symptomatic? treat with bisphosphonates, NSAIDs

2nd line - calcitonin

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54
Q

what is the ulnar nerve paradox

A

ulnar nerve innervates flexor digitorum profundus

proximal lesion - paralysis of FDP - fingers held in neutral paralysis

distal lesion - healthy FDP, not antagonised - flexion deformity clinically worse at the fingers

closer to the Paw, worse the Claw

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55
Q

what are the preferred treatment options for cancer-associated cachexia?

A

progesterone analogs and steroids

if the patient has a longer life expectancy then go for progesterone as they have fewer side effects

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56
Q

what is the treatment for symptomatic hyperthyroidism in the first instance?

when are anti-thyroid drugs recommended over RAI/thyroidectomy?

A

if symptoms are severe then always beta blockade and anti-thyroid drugs in advance of definitive treatment with RAI/thyroidectomy

ATDs alone in older patients with limited life expectancy or pregnancy (only PTU in the 1st trimester)

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57
Q

which immunodeficiency is associated with anaphylaxis when given blood transfusions?

A

IgA deficiency

develop IgE against IgA and can have fatal anaphylaxis
should wear medic alert bracelets and be given IgA-deficient blood products

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58
Q

what are the findings associated with lobar haemorrhage in the following sites:

  • frontal lobe
  • parietal lobe
  • occipital lobe?
A
  • frontal = contralateral hemiparesis
  • parietal = contralateral hemisensory loss
  • occipital = homonymous hemianopsia
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59
Q

what is the most accurate test for CML?

What is the treatment for it in the first instance?

What is the treatment for leukostasis reaction?

A

start with BCR-ABL PCR or FISH

Tyr Kinase inhibitors imatinib (Gleevec), dasatinib, nilotinib

leukapheresis

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60
Q

what are the lipid abnormalities commonly seen in hypothyroidism?

what are some other common biochemical abnormalities seen with hypothyroidism that are usually asymptomatic (3)?

A

elevated LDL (decreased surface LDL receptors)

less commonly, elevated triglycerides (decreased lipoprotein lipase activity)

hyponatraemia, elevated CK, transaminitis

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61
Q

other than NSAIDs, what do you use to treat pericarditis?

what is the added value of this medication?

A

cochicine

decreases the rate of recurrence

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62
Q

tuberculosis screening

A

screen in at-risk populations.

  • ethnic origin: china, vietnam, mexico, india, phillipines
  • people who live in high-risk congregate settings (homeless shelters)
  • healthcare workers

tests available are:

  • tuberculin skin test
  • inteferon-gamma release assay (T-SPOT, QuantiFERON)
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63
Q

what is the most effective intervention in slowing the progression of diabetic nephropathy?

A

tight blood pressure control <140/90

aim for 120/80

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64
Q

what are the unfavourable metabolic side effects of thiazide diuretics?

A

hyperglycaemia, increased LDL cholesterol, hypocalcaemia, hyperuricaemia (gout)

65
Q

what is the treatment for acute kidney rejection days after transplant?

A

IV steroids

66
Q

how do you treat acromegaly?

A
  1. transphenoidal recection of adenoma (70% cure)
  2. cabergoline (DA agonist), octreotide, pegvisomant
  3. radiation therapy
67
Q

what are the distinct features of uric acid stones?

what are the conditions that would increase the risk of these forming?

A

radiolucent, small, rhomboid yellow/brown crystals

diabetes, gout, myeloproliferative disorders

68
Q

if you add amiodarone for a patient on digoxin, what adjustment should you make?

A

25-50% reduction

69
Q

what is the rank order of non-pharmacologic intervention for reducing blood pressure?

A

weight loss

DASH diet

exercise

dietary sodium

smoking

70
Q

how does oral oestrogen affect circulating thyroid levels?

A

oral tablets affect the liver and increase thyroid binding globulin levels leading to higher doses of levothyroxine required to maintain the patient euthyroid

71
Q

which electrolyte abnormality is assoicated with difficulty in correcting hypokalaemia?

what is the mechanism?

A

hypomagnesaemia

failure of the collecting tubule ROMK channels leading to excessive urinary potassium loss

72
Q

what is first-line treatment of trigeminal neuralgia?

A

carbemazepine, oxcarbazepine

73
Q

what are the treatments for restless leg syndrome?

A

pramipexole (dopamine agonist)

2nd line: gabapentin

74
Q

which area of the brain is affected by Wilson syndrome?

A

basal ganglia

75
Q

what are the clinical findings on examination of tabes dorsalis?

which areas of the cord are responsible for which findings?

A

posterior columns - sensory ataxia, positive romberg test, decrease proprioception/vibration

nerve roots - decreased pain/temperature, sensation and diminished reflexes

76
Q

Kimmelstiel-Wilson nodules in the glomerulus identifies which disease?

A

diabetic nephropathy

77
Q

what is the epidemiology of otosclerosis?

A

young adults aged 20-30

female > male (?autoimmune)

78
Q

REM sleep disorder is associated with which neurodegenerative condition(s)?

A

Parkinson’s disease/LBD

multisystem atrophy

79
Q

what electrolyte abnormalities precipitate diabetes insipidus?

A

hypokalaemia and hypercalcaemia

80
Q

what are the dietary recommendations for patients with recurrent calcium oxalate kidney stones?

A

increase fluid intake

decrease dietary sodium

normal dietary calcium

81
Q

what are the sequence of acid-base disturbances following salicylate toxicity?

A

respiratory alkalosis - tachypnoea, stimulation of the medulla

metabolic acidosis - uncoupling of oxidative phosphorylation

near normal pH after a few hours

82
Q

what is the number of neutrophils in ascitic tap that indicates SBP?

A

>250 cells/mm3

83
Q

what side effect is most commonly associated with the NNRTI efavirenz?

A

delerium, lucid dreams, insomnia, depression/anxiety

can be experienced in up to 50% patients

use cautiously in those with a histroy of psychiatric disturbance

84
Q

what is the presentation of chagas disease?

what is the pathogen responsible?

A

megacolon/megaoesophagus and cardiac disease

trypanosoma cruzi, a protozoan

85
Q

what is Winter’s formula for the expected PaCO2 in metabolic acidosis?

A

PaCO2 = 1.5 x (HCO3-) + 8 +/- 2

86
Q

what is the difference in work up between pupil-sparing and non pupil-sparing CN III palsy?

A

non pupil-sparing = mass effect requiring CT head and CT/MR angiography

pupil-sparing = diabetic requiring HbA1c

87
Q

what is common to find between Glanzman thrombasthenia and Bernard-Soulier syndrome?

A

normal plts, normal vWF assay

BS syndrome has giant platelets

88
Q

what is the reference range for aldosterone/renin ratio?

A

<20

89
Q

what does electrical alternans refer to?

A

the beat-to-beat variation in QRS complex amplitude seen in pericardial effusion thought to result from the swining of the heart within the pericardium

90
Q

CRC screening in patients with inflammatory bowel disease

A

8-10 years after the onset of the disease

can start 12-15 years if only the left side of the colon is affected

repeat every 1-3 years

91
Q

what are the most common adverse effects of these chemotherapeutic agents:

  • doxorubicin
  • vincristine
  • bleomycin
  • cyclophosphamide
  • cisplatin
A
  • doxo - cardiotoxic
  • vincristine - neuropathy
  • bleomycin - pulmonary fibrosis
  • cyclophosphamide - haemorrhagic cystitis
  • cisplatin - nephrotoxic, ototoxic, neurotoxic
92
Q

what is the new definition of status epilepticus?

A

single seizure lasting more than 5 minutes

>= 2 seizures without fully regaining consciousness

93
Q

action on CYP 450: antibiotics and antifungals (metronidazole)

A

inhibitor

94
Q

what is the mechanism by while malapsorbative disease leads to renal stone formation?

A

increased fatty acids in the gut, binding of calcium to the fat, decreased calcium available to bind oxalate, hyperoxaliuria

oxalte stone formation

95
Q

other than vision loss, what is the most common complication of temporal arteritis?

A

10-20% develop aortic aneurysm

96
Q

where are the abberant signals initiated in

atrial fibrillation

atrial flutter

A

pulmonary veins

tricuspid annulus/cavotricuspid isthmus

97
Q

what happens to the aldosterone level in panhypopituitarism?

A

remains normal as it is controlled by the RAAS system

98
Q

what are the complications of radioiodine ablation therapy in Graves disease?

A

permanent hypothyroidism

worsening of thyroid eye disease

99
Q

how does magnesium affect circulating calcium levels?

A

Mg is needed for the release of PTH

hypomagnesaemia results in hypoPTH and low Ca

hypomagnesaemia also reduces the reabsorption of Ca in the kindey leading to increased renal losses

100
Q

CRC screening for patients with HNPCC

A

colonoscopy at age 20-25 and repeat every 1-2 years

101
Q

how do you treat TTP?

A

plasma exchange

glucocorticoids

rituximab

102
Q

how do you treat hepatin-induced thrombocytopenia?

do you give platelet transfusion?

A

stop heparin

factor Xa inhibitors - agatroban, bivalirudin, fondaparinux

remember, this is a thrombophilia and thromosis is more likely. adding platelets will increase the risk/severity of clots

103
Q

what is the referral criteria for carotid end-arterectomy?

A

70-99% stenosis of the carotid

symptomatic (TIA or ischaemic stroke)

life expectancy > 5 years

104
Q

what is the fasting glucose level minimum for diagnosis of diabetes?

HbA1c?

A

125

>6.5 %

105
Q

haemolytic anaemia, cytopenia and venous thromboses in weird places - what is the diagnosis?

what is the test for this?

A

paroxysmal nocturnal dyspnoea

test with flow cytometry for the absence of CD55 and CD59

106
Q

what is the ristocetin cofactor assay used for?

A

test of vWF dysfunction

to test for von Willebrand disease

aka vWF activity assay

107
Q

damage to which structure leads to subdural haematoma

A

shearing of low pressure cortical bridging veins

108
Q

what is the treatment for WPW syndrome with rapid ventricular response?

A

assess haemodynamic stability?

yes - procainamide or ibutilide

no - cardioversion

109
Q

what is the acid base disturbance associated with asipirin toxicity?

what are the other features of salicylate poisoning?

A

respiratory alkalosis and metabolic acidosis

tinnitus, fever and tachypnoea

110
Q

what is the adverse effect of bleomycin that requires monitoring before and during therapy?

A

pulmonary fibrosis - monitor with PFTs

111
Q

what is abiraterone?

A

a 17-hydroxylase inhibitor that halts all androgen production in the adrenals used to decrease mortality (risk -30%) and progression of metastatic prostate cancer

112
Q

how do you treat HOCM medically?

A

avoidance of volume overload

beta-blockers or calcium-channel blockers

113
Q

screening for BRCA mutations?

A

women with a family history of breast, ovarian, tubal or peritoneal cancer should be offered genetic screening for harmful BRCA mutations. if positive, they should receive genetic counceling

114
Q

between pap smear, colonoscopy and mammography, which has the lowest proven mortality benefit?

A

pap smear

115
Q

NSAIDs and ACE-I, which one constricts which arteriole to/from the glomerulus?

A

NSAIDs - afferent

ACE-I efferent

116
Q

what is medical therapy for patient with intermittent claudication who have failed aspirin and exercise therapy?

A

cilostazol (antiplatelet and vasodilator)

117
Q

what is the upper limit of normal for total protein in 24 hour urine sample?

how does P/Cr ratio equate to total protein in 24 horus?

A

150 mg / 24 hrs

0.1 = 100 mg, 1 = 1 g , 2 = 2 g

118
Q

CRC screening for individuals with family history of CRC or adenomatous polyps

A

note FH positive refers to 1 family member with CRC younger than 60 or 2 family members of any age

use colonoscopy at age 40 or 10 years before the youngest age of onset of CRC in the affected family member

repeat every 5 years

119
Q

in hodgkin lymphoma, is lymphocyte predominant or depleted associated with better prognosis?

A

lymphocyte predominant - better prognosis

120
Q

what is the treatment of methaemoglobinaemia?

what are the contraindications to first line therapy and what can be used instead?

A

methylene blue

CI = G6PD deficiency; use high dose vitamin C instead

121
Q

which treatment for hyperthyroidism will worsen the thyroid eye disease?

A

radioiodine ablation

use prednisolone and anti-thyroid drugs to minimise this effect

122
Q

how long should you wait following uncomplicated MI to resume normal sexual activity?

A

at least 2 weeks

check for recurrent angina, arrhythymias or worsening ventricular function

123
Q

what is the mechanism of hepatorenal syndrome?

A

liver cirrhosis leads to splanchnic arterial dilation which leads to an overall decrease is systemic vascular resistance

subsequent RAAS activation leads to renal vasoconstriction and decreased perfusion of the glomeruli

124
Q

what is the treatment for warm AIHA and cold AIHA?

A
  • *warm** - steroids, IV Ig, splenectomy, immunomodulators
    i. e. rituximab, cyclophosphamide, cyclosporin, MMF
  • *cold** - keep the patient warm, rituximab, plasmapheresis, immunosuppression
    i. e. cyclophosphamide, cyclosporin

note that steroids and splenectomy do not work in cold AIHA

125
Q

what is the adverse effect of trastuzumab (Herceptin) that has to be monitored before and during therapy?

A

type II cardiotoxicity

myocardial stunning/hibernation

likely to be reversible

echocardiogram before and during therapy

126
Q

what is the ladder of treatment for acne?

A
  1. topical retinoids and benzoyl peroxide
  2. topical antibiotics
  3. oral antibiotics
  4. oral retinoids
127
Q

what are the aetiologies of SIADH

A
  • cerebral pathology (seizure, stroke)
  • lung (pneumonia)
  • tumour (small cell lung CA)
  • medications (carbemazepine, SSRIs, NSAIDs)
  • pain and/or nausea
128
Q

in hyperthyroidism, what does increased radioactive iodine uptake (RAIU) suggest about the mechanism/pathology?

what would decreased thyroglobulin suggest?

A

increase RAIU = increased denovo synthesis

decreased = release of pre-formed T3/4

low thyroglobulin = exogenous thyroid hormone

129
Q

what is the vitamin deficiency in carcinoid syndrome and how does this occur?

A

pellagra - niacin deficiency

tumour consumes tryptophan in the production of serotonin, which is also the substrate for B3 producion

130
Q

what is the treatment of essential thrombocytosi?

A

asymptomatic and plts < 1500 - not indicated

symptomatic or plts >1500 - hydroxyurea, anagrelide 2nd line if RBCs are suppressed with therapy

131
Q

in a patient with AIDS

solitary, weakly ring-enhancing mass in the periventricular area

what pathology does this suggest?

What is the most specific CSF test to confirm the diagnosis?

A

primary CNS lymphoma

PCR for EBV DNA

132
Q

why are beta-blockers contraindicated in cocaine-induced coronary vasospasm?

A

they will lead to unapposed alpha-adrenergic action and worsen vasoconstriction, putting the myocardium at increased risk of ischaemia

133
Q

what is aliskiren?

A

direct renin inhibitor

134
Q

abortive therapies for migraine

preventive therapies for migraine

A

abortive: triptans, NSAIDs, acetaminophen, antiemetics, ergotamines

preventive: topiramate, divalproex, TCA antidepressants, beta-blockers (propranolol)

135
Q

what is the most common type of nephrotic syndome seen in Hodgkin lymphoma?

A

minimal change disease

unlike other solid cancers in which membranous nephropathy is more common

136
Q

what is the most common genetic abnormality in myelodysplastic syndrome? how does this affect management?

what is the most distinct abnormality on blood film?

A

5q deletion

better prognosis, will respond well to lenalidomide

pelger-huet cells (bilobed neutrophil)

137
Q

how is measured calcium level affected by serum pH?

A

alkalosis - less H+ binding to albumin, more Ca++ bound to albumin and lower fee Ca++

acidosis - more H+ displaces Ca++ from albumin leading to higher levels of free Ca++

138
Q

what systemic condition is associated with porphyria cutanea tarda?

A

hepatitis C

139
Q

what pathologies are associated with:

  • red cell casts
  • white cell casts
  • eosinophil casts
  • broad, waxy casts
  • granular/muddy brown casts
A
  • glomerulonephritis
  • pyelonephritis
  • allergic (acute) interstitial nephritis
  • CKD
  • acute tubular necrosis
140
Q

intensive HbA1c control (6-7%) in diabetes is intended to reduce the risk of what?

A

microvascular complications (nephropathy, retinopathy)

141
Q

alternative complement pathway activation from persistent action of C3 convertase secondary to IgG binding is the mechanism of which disease?

A

type 2 membranoproliferative disease

the IgG is referred to as C3 nephritic factor

there is only complement deposition in the glomerulus, no immune complexes or immunoglobulins even though the disease is IgG-mediated

142
Q

what is the fluid treatment of choice in hypovolaemic hyponatraemia?

A

normal saline

once the patient is euvolaemic you can switch to 5% dextrose

143
Q

what are the PT and aPTT in antiphospholipid syndrome with lupus anticoagulant present?

A

PT - normal

aPTT - spuriously elevated that does not correct by mixing serum

the LA spuriously increases the aPTT by binding the phospholipids typically used in the lab assays. it is an artefact and does not reflect the prothrombotic in vivo effect

144
Q

action on CYP 450: oral contraceptives

A

inducer

145
Q

following MI, which vessel would be occluded to lead to the following complications:

LV free wall rupture

papillary muscle rupture

right heart failure

intraventricular septum rupture

A

LAD

RCA

RCA

LAD

146
Q

what are the indications for starting statin therapy?

A

clinically significant ASCVD (ACS, stable angina, revascularisation, stroke, TIAs or PAD)

LDL > 190

age 40-75 with diabetes

>7.5% 10-year risk with pooled cohort equations

147
Q

how should VQ scans be interpreted

A

Normal VQ scan - PE excluded

Low probability VQ scan, low pretest probability - PE excluded

High probability VQ scan, high pretest probability - PE confirmed

any other combination - needs further testing

148
Q

what is the vitamin deficiency that leads to wernicke encephalopthy?

A

vitamin B1 - thiamine

149
Q

which suptype of acute leukaemia is associated with DIC?

how do you treat this leukaemia?

A

M3 acute myeloid leukaemia

-promyelocytic

treat with ATRA

150
Q

what is the best initial and most specific test for sickle cell disease?

A

BI - peripheral blood smear

MS - haemoglobin electrophoresis

151
Q

action on CYP 450: carbemazepine and phenytoin

A

inducer

152
Q

what is the pattern of cardiomyopathy seen in acromegaly?

A

concentric thickening of the LV wall leading to restrictive CM and global hypokinesis

153
Q

what is the significance of eosinophils found in urine on microscopy?

A

allergic reaction

acute interstitial nephritis

NB NSAID nephropathy does not lead to eosinophils

154
Q

thrombophilia screen should be performed before starting which breast cancer chemotherapeutic agent?

A

tamoxifen

usually just test for factor V leiden

155
Q

CRC screening in a patient with classic FAP

A

start at age 10-12 and repeat annually

156
Q

action on CYP 450: paracetamol and NSAIDs

A

inhibitor

157
Q

following abrupt discontinuation of steroids, what are the levels of ACTH and cortisol likely to be?

A

low ACTH (HPA axis dysfunction) and low cortisol (adrenal atrophy)

158
Q

what are the different associations with cold AIHA and cyroglobulinaemia?

A

cold AIHA - EBV, mycoplasma, waldenstrom macroglobulinaemia

cryoglobulins - HCV, joint pain, glomerulonephritis

159
Q

parkland formula for burns

A

4ml x TBSA x weight

50% in first 8 hours

50% over next 16 hours

aim for UO > 0.5 ml/kg

USMLE S2CK (6 decks)

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