Misc 5 Flashcards
Liver biopsy contraindications
deranged clotting (e.g. INR > 1.4)
low platelets (e.g. < 60 * 109/l)
anaemia
extrahepatic biliary obstruction
hydatid cyst
haemoangioma
uncooperative patient
ascites
Fabry disease
Overview
X-linked recessive
deficiency of alpha-galactosidase A
Features
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
Causative pathogen
SBP vs peritoneal dialysis infection
- SBP - E. Coli
- PD infection - Staph Epididermidis
Causative pathogen for bronchiectasis
Haemophilus influenzae is correct. This is the most common organism found in bronchiectasis.
Malaria treatment
Non-falciparum malaria
Chloroquine sensitive area
* ACT or chloroquine
Chloroquine resistant area
* Artemisin based combination therapy like artemther-lumefantrine
Malaria treatment
Ovale, vivax
Describe the features distinguishing between vivax/ovale & malariae
Give chloroquine after initial treatment to destroy liver hypnozoites and prevent relapse
Features
* general features of malaria: fever, headache, splenomegaly
* Plasmodium vivax/ovale: cyclical fever every 48 hours.
* Plasmodium malariae: cyclical fever every 72 hours, is associated with nephrotic syndrome.
Malaria treatment
When is IV artesunate indicated?
IV artesunate - parasite count >2%
Give ACT for uncomplicated falciparum malaria
>10% artesunate - exchange transfusion
Antibodies involved in
Pemphigus vulgaris vs Bullous pemphigoid
Pemphigus vulgaris
* Desmoglein 3
Bullous pemphigoid
* Hemidesmosomal BP antigens
Nuclear Scintigraphy
What thyroid problem shows:
patchy uptake
diffuse and increased activity
absent or trace uptake
Nuclear scintigraphy uses very small, tracer amounts of radioactive molecules to diagnose diseases involving bone, soft tissues and vessels.
Patchy uptake is seen with toxic multinodular goitre.
Diffusely and increased activity with a decreased background is seen in Graves disease.
Trace or absent uptake may indicate the presence of thyroiditis resulting in inflammation or destruction of thyroid tissue.
7 layers of the skin
Why is HBA1C falsely low in sickle cell anaemia?
HbA1c (glycated haemoglobin) is a measure of the average blood glucose levels over the past 2-3 months. In sickle-cell anaemia, red blood cells have an abnormally short lifespan due to their sickle shape, leading to a faster turnover of red blood cells. This means that there is less time for glucose to bind to haemoglobin, resulting in lower HbA1c levels despite elevated fasting glucose levels.
What is the difference between HSP, IgA nephropathy and Minimal change disease?
IgA nephropathy
* Most common nephritic syndrome, comes 1-2 days after viral URTI, young males
* Macroscopic haematuria
Henoch Schonlein Purpura
* Child with palpable purpuric rash over buttocks and ext surface arms and legs
* Abdo pain, polyarthralgia
* Features of IgA - haematuria, renal failure
* Prognosis - 2/3 have full recovery, supportive tx.
Minimal change disease - nephrotic syndrome 75% children, 25% adults, steroid responsive, 30% prognosis rule
What is the difference between
Haemolytic uraemic syndrome
Henoch schonlein purpura
HUS
* Caused by ECOLI 0157 (typical)
* Triad of AKI, microangiopathic haemolytic anaemia, thrombocytopenia
HSP
* Rash
* Features of IgA nephropathy
* Abdo pain, arthralgia
ADPDK Chromosomal defect
Chromosome 4
Sickle cell crises
Thrombotic
Sequestration
Thrombotic
* Painful crises precipitated by infection, dehydration, high altitude
* Infarct in bone, lung, spleen, brain.
Sequestration
* Sickling within spleen/lungs cause pooling of blood (gets stuck)
* Anaemia falls with increased reticulocyte count
Aplastic crises
* Parvovirus infection > sudden fall in Hb causing reduced reticulocyte
* Low reticulocytosis must be in proportion to anaemia, if retic 3% (slightly above normal)
What is the difference between Amiodarone induced thyrotoxicosis Type 1 and Type 2?
BPH
Management - first line, second line
First line - alpha 1 antagonist - tamsulosin
Second line - 5 alpha reductase inhibitors finasteride
Aortic dissection
Initial management
type A - ascending aorta - control BP (IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)
Myotonic dystropby
Describe genetic defect in DM1 vs DM2
Inheritance
DM1 - DPMK gene on Ch 19, distal weakness
DM2 - ANF9 gene on Ch 3, proximal weakness
Myotonic dystrophy
Features
myotonic facies (long, ‘haggard’ appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria
myotonia (tonic spasm of muscle)
weakness of arms and legs (distal initially)
mild mental impairment
diabetes mellitus
testicular atrophy
cardiac involvement: heart block, cardiomyopathy
dysphagia
Corticosteroids
For each type of corticosteroid, describe the level of glucocorticoid and mineralocorticoid activity
Fludrocortisone
Hydrocortisone
Prednisolone
Dexamethasone
Remember that usual side effects of corticosteroids are associated with classic ones but mineralocorticoids are associated with fluid retention, hypertension
What is meliodosis?
Burkholderia pseudomallei
History of diabetes with severe respiratory sepsis - endemic in tropics, SEA, percutaneous inoculation via contaminated soil/water.
What is pretibial myxoedema associated with?
Graves disease
What defines reversibility in bronchodilator testing for asthma?
The criteria for reversibility in the diagnosis of asthma is a >12% change in FEV1, which must also be an absolute increase in FEV1 of >200 ml.
Heparin-induced thrombocytopenia
- immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin
- these antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors
- usually does not develop until after 5-10 days of treatment
- despite being associated with low platelets HIT is actually a prothrombotic condition
- features include a greater than 50% reduction in platelets, thrombosis and skin allergy
Diarrhoea in traveller
What are the differences between shigella, giardia, campylobacter, entamoeba histolytica
Shigella dysenteriae
* Incubation period 1-3 days
* Bloody diarrhoea
Campylobacter jejuni
* Bloody diarrhoea - incubation period 2-4 days
Giardia lamblia
* Incubation 3-40 days
* Non bloody diarrhoea
Entamoeba histolytica
* Amoebiasis 2-4 weeks incubation
* Entamoeba - months to years
* Bloody diarrhoea
Which drug can cause Haemorrhagic disease of the newborn if mother takes it?
Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for heamorrhagic disease of the newborn
Syphilis investigations
Non-treponemal tests
Not specific for syphilis
* RPR
* VDRL
* Will become negative after treatment, will show repeat infection
Treponemal specific tests
* Qualitative results - reactive vs non-reactive
* Remain positive after the first infection
* TPHEA, TP-EIA
Intravascular vs Extravascular haemolysis
In intravascular haemolysis, free haemoglobin is released which then binds to haptoglobin. As haptoglobin becomes saturated haemoglobin binds to albumin forming methaemalbumin (detected by Schumm’s test). Free haemoglobin is excreted in the urine as haemoglobinuria, haemosiderinuria
Intravascular haemolysis: causes
mismatched blood transfusion
G6PD deficiency
red cell fragmentation: heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold autoimmune haemolytic anaemia
Extravascular haemolysis: causes
haemoglobinopathies: sickle cell, thalassaemia
hereditary spherocytosis
haemolytic disease of newborn
warm autoimmune haemolytic anaemia
Campylobacter vs Salmonella
Campylobacter
* Bloody diarrhoea
* Barbecues
Salmonella typhi
* Abdo pain
* Constipation
* Vomiting
Topical steroids
Name the moderate, potent and very potent steroid from the following
Clobetasone butyrate 0.05%
Betamethasone valerate 0.1%
Clobetasol proprionate 0.05%
moderate: Clobetasone butyrate 0.05%
potent: Betamethasone valerate 0.1%
very potent: Clobetasol propionate 0.05%
Complication of measles
otitis media: the most common complication
pneumonia: the most common cause of death
encephalitis: typically occurs 1-2 weeks following the onset of the illness)
subacute sclerosing panencephalitis: very rare, may present 5-10 years following the illness
febrile convulsions
keratoconjunctivitis, corneal ulceration
diarrhoea
increased incidence of appendicitis
myocarditis
Cardiac complications of Downs syndrome
multiple cardiac problems may be present
endocardial cushion defect (most common, 40%, also known as atrioventricular septal canal defects)
ventricular septal defect (c. 30%)
secundum atrial septal defect (c. 10%)
tetralogy of Fallot (c. 5%)
isolated patent ductus arteriosus (c. 5%)
Statistics
Statistics to determine correlation for parametric and non-parametric data
parametric (normally distributed): Pearson’s coefficient
non-parametric: Spearman’s coefficient
