Misc 3 Flashcards
What antibodies is myasthenia gravis associated with?
ACh receptor Ab
What is the most common symptom of myasthenia gravis?
Ocular = ptosis
What antibodies are associated with dermatomyositis?
Anti-Mi-2
What antibodies are associated with Lambert Eaton myasthenic syndrome?
Voltage gated calcium channel ab
What is Whipple’s disease?
Bacterial infection caused by tropheryma whipplei
Causes malabsorption
Weight loss, abdo pain, diarrhea, arthritis
Common in farmers
Describe hereditary spherocytosis
Genetic condition causing sphere shaped RBCs
Causes hemolytic anemia
S+S: anemia, jaundice, splenomegaly, fatigue
Can cause pigmented gallstones
Howell Jolly bodies on blood smear
Describe acromegaly
Excess growth hormone - usually due to pituitary adenoma
Large hands + feet, forehead + jaw
Joint pain, thick skin, headaches, visual problems
What is the most common pathogen in cat bites?
Pasteurella multocida
What abx should be given post animal bite?
Co-amox or doxycycline + metronidazole
Describe DiGeorge syndrome
CATCH 22 Congenital heart abnormalities Abnormal facies Thymic aplasia cleft palate Hypocalcaemia + hypoparathyroidism
Ch22 deletion
Caused by dysmorphogenesis of 3rd + 4th pharyngeal pouches
RF for osteosarcoma
African 5-20 y/o (growing) or >65 (Paget's disease) Li-Fraumeni Males Metaphysis region stress
X ray findings for osteosarcoma
Moth eaten appearance
New bone formation = Codman’s triangle
Sunburst appearance
What does an onion skin, and soap bubble, appearance on x ray suggest?
Onion skin = Ewings sarcoma
Soap bubble = giant cell tumor (osteoclastoma)
What are the endocrine effects of a pituitary tumor?
Infertility Amenorrhea Galactorrhea Decreased libido Cushings disease Acromegly Hyperpigmentation Hypothyroidism Hypoadrenalism Hypogonadism Diabetes insipidus
What hormones are made in the pituitary?
GH LH FSH TSH ACTH Prolactin
What cranial nerves are affected by pituitary tumors?
3, 4, 5
Management of FB in eye
Topical abx
Topical cycloplegic for pain + photophobia
Eye shield
Describe Sheehans syndrome
Anterior hypopituitarism
Failure to lactate, amenorrhea, breast atrophy, hypothyroidism, adrenal cortical insufficiency
What surgeries can be performed to help in cerebral palsy?
Selective dorsal rhizotomy (cutting 1a sensory fibres)
Intrathecal baclofen pump insertion
What is an endocardial cushion defect?
congenital heart defect common in Downs
What is the leading cause of death in patients with multiple myeloma?
Bacterial infection (with encapsulated organisms eg strep pneumonia + Hib)
Describe haemachromatosis
Skin hyperpigmentation Polyuria, polydipsia Hepatomegaly Fatigue Impotence Athralgia Cardiomyopathy
Autosomal recessive disease causing accumulation of iron in organs
Describe primary biliary cholangitis (what is it, diagnostic test, LFT results, treatment, best prognostic indicator)
Inflammatory disease leading to fibrous obliteration of bile ducts
Diagnosed with AMA test
High ALP + GGT
Ursodiol is used to treat
Serum bilirubin is best prognostic factor
Describe DiGeorge syndrome
Failure of thymus, parathyroid + other facial structures to form properly
Reduced T cells + reduced immunity (poor thymus)
Primary hypoparathyroidism
What is autonomic hyperreflexia?
Sudden onset headache + HTN in pt with lesion above T6 level
Bradycardia, sweating, dilated pupils, blurred vision, flushing
Occurs months after injury
Due to bowel or bladder distension
What can be used to reverse steatohepatitis in obese kids?
Vitamin E
What is the female athlete triad?
Disordered eating
Amenorrhea
Osteoporosis
When do you see a pale optic disc + boxcar segmentation of vessels in the eye?
central retinal artery occlusion
What do you see Hollenhorst plaques?
Cholesterol bodies on fundoscopy
Associated with TIA or amaurosis fugax
What is amaurosis fugax?
Painless temporary vision loss due to loss of blood supply
What is a corkscrew sign?
Lumen-obliterating, non-peristaltic contractions in oesophagus
What is the stack of coins sign?
Indicates presence of small bowel haematoma
Seen on AXR
Seen frequently in people on anti-coagulants
What is a bull’s eye lesion on AXR?
Seen in gastric mets from melanoma or lymphoma, Kaposi’s sarcoma or carcinoid tumors
What is a whirlpool sign?
Midgut volvulus - represents superior mesenteric artery wrapping around gut + vein
What is the management of ASCUS?
HPV negative = routine screening in 3 years
Positive = colposcopy
What is octreotide used for in scleroderma?
Improves intestinal dysmotility
What is the management of Reye’s syndrome?
Dextrose, Vit K, Mannitol
Describe petrous apicitis
Triad of retro-orbital pain, lacteral rectus palsy (CN6), otorrhea
Manifestation of Gradenigo syndrome
What is a likely liver infection in an hispanic individual?
Entamoaba histolytica
When is adenosine contraindicated in SVT + what would be used instead?
CI in asthma
Cardiovert or CCB
How long do you wait while a pt is in asystole after giving adenosine before commencing CPR?
20 seconds (half life of 15 seconds)
Describe a craniopharyngoma
Benign tumour arising from Rathke’s pouch
Can cause diabetes insipidus
Describe diabetes insipidus
Low ADH
Increased serum Na
Normal extracellular fluid
Decreased arginine vasopressin
What is Freidrich’s ataxia (genetics, symptoms, treatment)
Most common autosomal recessive ataxia Onset during puberty Progressive ataxia with loss of deep tendon reflexes Presence of Babinski's sign Fam hx
treat with 5-hydroxytryptophan
Describe periodic paralysis
Multiple types, most common is hypokalaemia
Weakness of hips + shoulders in young people
Diagnosed with long exercise EMG
What is the management of Tourette’s?
clonidine or AP ie pimozide
What is the organism responsible for B12 deficiency causing megaloblastic anemia, and what is its management?
Fish tapeworm = diphyllobothrium
Treat with praziquantel
What symptoms does a clonorchis sinensis infection produce?
obstruction of biliary tract
Describe an infection with echinococcus granulosus
Produce unilocular cysts on liver
Prevalent in areas with dogs raising livestock
Describe an infection with taenia saginata
Beef tapeworm - diarrhea
Describe an infection with taenia solium
Pork tapeworm - causes cysticercosis
Describe Bruton agammaglobulinemia
Immunodeficiency disease
Suspected when male infant becomes unwell with repeated URTIs
Absence of plasma cells
Small tonsils
Describe Wiskott-Aldrich syndrome
X linked recessive disease
Eczema, thrombocytopenia, immune deficiency + bloody diarrhea
Presents with bleeding
Describe Chediak-Higashi syndrome
Recessive immunodeficiency Decreased phagocytosis Hypopigmentation of skin, eyes + hair Prolonged bleeding times Recurrent infection Peripheral neuropathy
Describe chronic granulomatous disease
X linked condition
Deficiency of NADPH oxidase
Pneumonia, infectious dermatitis, subcutaneous abscess formation
High prevalence of colitis, enteritis + gastric outlet obstruction
What is Whipple’s triad?
Symptoms known to be caused by hypoglycaemia
Low plasma glucose
Relief of symptoms when blood glucose is raised
What is Cushings triad?
Bradycardia, bradynpnea, HTN
Associated with head injuries
What is Samter’s triad?
Seen in aspirin induced asthma
Aspirin sensitivity, nasal polyps, asthma
What is Beck’s triad?
Muffled heart sounds, distended neck veins + hypotension
Diagnostic of cardiac tamponade
What is the management of recurrent kidney stones?
Thiazide diuretic + potassium to counter-act the hypokalaemia caused by thiazides
Fluids + potassium to alkalinise the urine
What is Job’s syndrome?
Hyperimmunoglobulin E syndrome
recurrent staph infections, eczema rashes + severe lung infections
What is the grooved pegboard test?
Test of frontal lobe deficits, evaluates manipulative dexterity
What is the stroop test?
Used to measure person’s attention capacity + processing speed
Name colour of word - not what the word says
What is the digit span test?
Repeating a phone number - used for working memory
What is the Rey auditory verbal learning test?
Evaluates verbal memory
Reads list of 15 words, pt has to repeat back words that they remember
How does renal artery supply affect HTN?
Decreased renal artery blood supply = stimulates RAT system
Causes vasoconstriction + increased sodium retention = HTN
What is Zenker’s diverticulum?
High pressure in lower part of pharynx causing outpouch
Causes dysphagia, lump in neck, halitosis
What part of the brain is associated with gender dysphoria?
Pre-optic hypothalamic nucleus
What testicular tumor has the worst prognosis?
Choriocarcinoma
What is isolation as a defence mechanism?
Characteristic of OCD
Remembering fine detail but without expressing affect
What is undoing as a defence mechanism?
Dealing with emotional conflict with words/ behaviours designed to negate unacceptable thoughts
i.e. being told bad news + going home to organise the kitchen cupboards
What is displacement as a defence mechanism?
Redirecting emotions towards another object/ person
i.e. being told bad news + taking it out on the cat
What is intellectualisation as a defence mechanism?
Dealing with emotional stress by excessive use of abstract thinking to control disturbing feelings
i.e. being given a a diagnosis and researching it for hours
Describe the blood markers for hepatitis infection (HBsAg, Anti-HBs, HBeAg, Anti-HBe, Anti-HBc)
HBsAg = person is infectious (acute or chronic infection) Anti-HBs = immunity through infection or vaccine HBeAg = indicated viral replication - acute + chronic Anti-HBe = produced in recovery Anti-HBc = core ab, appears at onset of infection + persists for life IgM = recent infection IgG = long standing infection or recovery
Management of fistulizing Crohns
Anti TNF (infliximab) 1st line - check for PPD first due to risk of reactivation of TB
Azathioprine 2nd line
Surgery if unresponsive to meds
Common complications of intubation in epiglottitis
Segmental atelectasis
Pneumonia is 2nd most common complication
What is the recommended ART for HIV?
2 NRTIs + 1 INSTI/PI (boosted with ritonavir or cobicistat)
What are the NRTIs in ART?
Nuceloside reverse transcriptase inhibitors - incorporated into DNA viral chain to terminate growth
-VUDINE
What are the INSTIs in ART?
Integrase strand transfer inhibitors - inhibits integration of HIV DNA into human genome
-GRAVIR
What are the classic RF for acute glaucoma?
Asian/ first nation
Peripheral anterior synechia
Hyperopia
Presentation of acute glaucoma
Severe periorbital pain, ipsilateral headache, blurred vision, haloes, profuse tearing
Management of acute angle glaucoma
Latanoprost, bethamethasone, pilocarpine
Definitive: laser peripheral iridotomy
Describe magnesium toxicity
Due to Mg administration in eclampsia
Feel warm, flushing, vomiting, muscle weakness, respiratory depression, PPH
Stop infusion + treat with calcium gluconate
Describe an aspergilloma infection
Caused by fungus, usually involving upper lobes of lungs
Asymptomatic with tumor like opacity on CXR
Describe infection with mycoplasma pneumoniae
Erythema multiforme, low Hb + agglutination of peripheral blood smear
What is the most common cause of painless blood in stools in toddlers?
Meckel’s diverticulum + polyps
How to work out odds ratio?
Odds of exposure given disease = number cases exposed/ number not exposed (for case + control)
Then divide case odds by control odds
Describe noonan syndrome
Similar to Turners
Short height, congenital heart disease (pulmonary valve stenosis), bleeding problems, webbed neck
Can cause leukaemia
Describe Reye’s syndrome
Encephalopathy with hepatic fatty infiltration
Follows giving aspirin in a viral syndrome
Causes hypoglycaemia + altered mental state, vomiting + abdo pain + distention
What ABPI indicates PVD?
> 20 mmHg decrease in systolic blood pressure
Management of trigeminal neuralgia
Carbamazepine or phenytoin
Surgery
Describe Zollinger Ellison syndrome
Associated with MEN 1
Gastrin secreting tumor of pancreas
Causes ulcers + dyspepsia
Management of cerebral palsy
Botox - reduces spasticity
Gives examples of type 1 hypersensitivity reactions
Allergic rhinitis
Gives examples of type 2 hypersensitivity reactions
Myasthenia gravis
Goodpasture’s
Gives examples of type 3 hypersensitivity reactions
Arthus reaction
Gives examples of type 4 hypersensitivity reactions
Contact dermatitis
MS
Crohns
Transplant rejection
Diagnostic test for acute angle glaucoma
Goldmann applanation tonometry - IOP >21
2nd line is ultrasound biomicroscopy
What marker is used to test for neural tube defects in the mother + what are the results?
Elevated AFP Ach-ase activity
What ECG changes are seen with VSD?
High pulmonary blood flow = left atrial hypertrophy = broad bifid P waves
Difference between murmur in aortic stenosis vs sclerosis
Sclerosis does not radiate to clavicles/ carotid
