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FRACP written exam preparation > MISC > Flashcards

MISC Flashcards

1
Q

Conversion from PO morphine to hydromorphone?

A

PO hydromorphone is 5x stronger than PO morphine

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2
Q

Conversion from PO hydromorphone to SC hydromorphone

A

SC hydromorphone is 2-3x stronger than PO hydromorphone

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3
Q

4 features of pellagra?

A

Caused by niacin deficiency.
Classic features are 4 Ds:

  1. Dementia
  2. Depression
  3. Dermatitis - brown scaly rash on sun exposed sites
  4. Diarrhoea
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4
Q

Define the following:

Southern blotting
Northern blotting
Western blotting

A

Remember:

SNOW - southern, northern, western
DROP - DNA, RNA, Protein

Therefore:

Southern - Detects DNA
Northern - Detects RNA
Western - Detects protein

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5
Q

kCal per 1g for fat, carbohydrate and protein

A

carbohydrate and protein - 4 kCal

fat - 9kCal

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6
Q

Pathogenesis of bullous pemphigoid

A

Subepidermal blistering of skin secondary to development of antibodies against hemidesmosomal proteins BP180 and BP230

Immunofluorescence shows IgG and C3 at the dermoepidermal junction

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7
Q

Triad of fat embolism?

A

Hypoxemia, neurological abnormalities, petechial rash

FES is a clinical diagnosis - no diagnostic test that is sufficiently sensitive or specific to be useful for confirming or excluding FES

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8
Q

Conversion rates for following:

Morphine PO to Morphine SC
Morphine PO to hydromorphone PO
Hydromorphone PO to hydromorphone SC
Morphine PO to Oxycodone PO
Morphine PO to Fentanyl TOP
A

1: 2.5
1: 5
1: 3
1: 1.5-2
1: 3

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9
Q

Activators of:

PPAR-gamma
PPAR-alpha

A

PPAR-gamma receptor - thiazolidinediones

PPAR alpha receptor - target of fibrates which acts by lowering TGL and increasing HDL.

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10
Q

How do you plot a ROC curve?

What does the area under the ROC curve mean?

A

ROC curve is plotted by Sn on vertical axis, 1-Sp on horizontal axis. The higher the area under the ROC curve, the more accurate the test is.

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11
Q

Respiratory changes in AS

A

AS causes chest wall restriction resulting in:

  1. Chronic hypoventilation and increased pCO2
  2. Hypoxia leading to pulmonary hypertension
  3. Reduced TLC
  4. Widened A-a gradient
  5. FRC is normal or increased due to fixation of rib cage in inspiratory position.
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12
Q

Presentation of fixed drug reaction

A

Commonly associated with analgesia, antihistamines and antibiotics.
Skin lesions occurring in genitals, perianal, peripheral limbs, usually at the same site.
Lesions preceded by burning or pruritis, with vesicular or bullous lesions occurring minutes to dates of exposure to precipitant.
Lesions heal by crusting, leaving a persistent dusky colour.

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13
Q

How are oxycodone and morphine metabolized?

A

Oxycodone is metabolized by CYP P450 enzymes, whilst morphine is conjugated by glucuronic system.

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14
Q

Compare and contrast RF and anti-CCP

A

RF has high negative predictive value of about 80%.
RF is more likely to predict extra-articular manifestations compared to anti-CCP.

Anti-CCP has Sn of 50-70% and specificity of 98% making it useful in diagnosing RA when positive.

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15
Q

Mechanism of action:

Tirofiban
Abciximab

A

Tirofiban - REVERSIBLE non peptide receptor antagonist against Glycoprotein IIB/IIIA
Abciximab - IRREVERSIBLE mab against Glycoprotein IIB/IIIA

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16
Q

Pseudohypoaldosteronism II

A

Also called Gordon Syndrome
Autosomal dominant WNK4 mutation
Results in loss of inhibition of Na/Cl cotransporter in DCT and CD with increase in sodium and chloride absorption.
Inhibits secretion of potassium resulting in hyperkalaemia.
Also NAGMA, high blood pressure due to salt retention, normal renal function

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17
Q

Licorice ingestion

A

Inhibts breakdown of cortisol resulting in increased mineralocorticoid activity.

Results in hypertension, Hypokalaemia, metabolic ALKALOSIS

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18
Q

Liddle Syndrome

A

Increased number of Na channels in collecting duct, with resultant increase in sodium reabsorption and potassium excretion.

Results in hypertension, hypokalaemia, metabolic alkalosis.

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19
Q

How do you achieve immediate steady state in intermittent bolus dosing?

A

Loading dose as 2x the maintenance dose with dosing interval same as the half life.

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20
Q

Causes of warm AIHA

A
  1. Lymphoma
  2. Mixed CTD
  3. Methyldopa
  4. CLL
21
Q

4 food to avoid in peanut allergy

A
  1. Lupin flour
  2. Lentils
  3. Ice creams
  4. Green bean

Soybean are safe.

22
Q

6 Side effects of infliximab

A
  1. Worsening of multiple sclerosis
  2. Congestive heart failure
  3. Delayed hypersensitivity reaction
  4. Positive ANA response in previously ANA negative patient
  5. LFT derangements
  6. TB reactivation
23
Q

What is the role of tumour debulking eg in ovarian cancer prior to chemotherapy?

A
  1. Reduces tumour burden
  2. Stimulates cells to go from resting G0 phase to active G1 phase
  3. Improves tumour perfusion to increase chemotherapy exposure
  4. Enhances immunological response by host
  5. Reduces chance of drug resistance
24
Q

What does cryoprecipitate contain?

A

Fibrinogen, factor 8, 13, vWF.

Use in hypofibrogenaemia

25
Q

Cancer associations with high BMI

A

Men: thyroid and colon
Women: Endometrial, gall bladder

Both: oesophageal and renal cancer

26
Q

What is the effect of perioperative beta blocker use?

A

Beta blockers reduce incidence of non fatal MI but at the expense of increasing stroke, mortality, bradycardia and hypotension.

27
Q

PRV criteria - major and minor

A

Major:

  1. Hb >185 in men, >165 in women or evidence of increased red cell mass
  2. JAK 2 positive

Minor:

  1. BMB showing hypercellularity across all three cell lines
  2. Low serum EPO level
  3. Endogenous erythroid colony formation in vitro

Need 2 major or 1 major/2 minors for diagnosis

28
Q

5 features of salicylate toxicity

A

Tachypnoea, tinnitus, vomiting, hyperthermia pulmonary oedema

29
Q

What is the significance of FENO?

A

Indicates eosinophilic airway inflammation, therefore steroid responsive.

30
Q

Genetic linkage

A

Refers to two alleles being inherited together at a higher than random rate due to proximity on a chromosome. Less likely to be separated by cross over.

31
Q

Manifestations of lipoprotein lipase deficiency (type 1 hyperlipoproteinaemia)

A
  1. Pancreatitis
  2. Opalescent retinal vessels on fundoscopy (lipaemia retinalis)
  3. Eruptive xanthomatas
  4. Hepatosplenomegaly

No clear association with cardiovascular disease

32
Q

Structures contained in the cavernous sinus

A

O TOM CAt

Oculomotor
Trochlear
Ophthalmic
Maxillary
Carotid artery
Abducens

Mandibular branch of the trigeminal nerve is not included in the cavernous sinus.

33
Q

Mutation in BMPR2 leads to which condition?

A

Familial pulmonary arterial hypertension.

34
Q

5 Medications absolutely contraindicated in G6PD deficiency

A
  1. Primaquine
  2. Nitrofurantoin
  3. Dapsone
  4. Methylene blue
  5. Uricase such as rasburicase
35
Q 
Changes in lung function in morbid obesity as it relates to:
FRC
A-a gradient
Chest wall compliance
DLCO
Gas trapping
A 
FRC - reduced
A-a gradient - increased
Chest wall compliance - reduced
DLCO - normal/increased
Gas trapping - usually not present.
36
Q

Action of cinacalcet

A

Cinacalcet increases the sensitivity of the calcium sensing receptors found on chief cells of the parathyroid gland to extracellular calcium.

Chief cells are responsible for PTH production

37
Q

Greatest risk factor for ovarian cancer

Effect of smoking, early menarche, late menopause, OCP use and multiparity.

A

Nulliparity.

Effect of smoking, early menarche and late menopause only give as light overall increased risk of ovarian cancer.
OCP use and multiparity reduces the risk (reduced exposure to FSH/LH)

38
Q

Management of cerebral vasospasm post subarachnoid haemorrhage?

A

Triple H therapy - hypervolaemia, haemodilution, hypertension. ie, give fluids, noradrenaline.

39
Q

Classic tetrad of HSP

A
  1. Palpable purpura
  2. Abdominal pain
  3. Arthralgia/arthritis
  4. Renal disease.
40
Q

4 causes of hyperemesis gravidarum

A
  1. Normal pregnancy
  2. Molar pregnancy
  3. Thyrotoxicosis
  4. Twin pregnancy

Ectopic pregnancy is usually not associated with hyperemesis gravidarum due to the lower levels of beta HCG.

41
Q

MuSK antibodies

A

Antibodies to muscle specific receptor tyrosine kinase.

Found in 40% of AChR antibody negative MG.
Not present in those with well-established ocular MG.
Not associated with presence of underlying thymoma.
Less associated with thymic hyperplasia.
Variable response to cholinesterase inhibitors (may actually get worse) but excellent improvement post plasma exchange.

42
Q

What is the most accurate way of diagnosing acute flare of chronic hep B infection?

A

HBc IgM.

IgM becomes negative with seroconversion.
Other markers such as HBeAg, HBeAb, HBsAb, HBsAg can all be positive in chronic hepatitis.

43
Q

Miller fisher syndrome presentation

A
  1. Ophthalmoplegia
  2. Ataxia
  3. Areflexia.

90% have Anti-GQ1b antibodies. Positivity to this antibody is strongly associated with involvement of oculomotor nerve.

44
Q

Treatment of choice in acyclovir resistant HSV in immucocompromised patient

A

Foscarnet

45
Q

Prognostic indicators in NHL

A 
Age >60
ECOG status
LDH
Extranodal involvement
Ann arbor staging
46
Q

Why can’t you use radioactive iodine in medullary thyroid cancer?

A

They do not take up iodine so unable to be treated with RAI nor be searched with iodine scan. Follow up monitoring is with calcitonin.

47
Q

Pathognomonic sign of glucagonoma

A

Necrolytic Migratory Erythema.

Also associated with coeliac disease.

48
Q

2 forms of pneumococcal vaccine

A

Conjugate and polysaccharide vaccine.

Polysaccharide vaccine - pneumovax 23 contains 23 polysaccharide molecules from pneumococcal strain which causes 60% of infections.

Conjuvagate vaccine - PCV13, a vaccine containing polysaccharides from the seven pneumococcal serotypes that caused most pneumococcal disease in young children. The polysaccharides are covalently linked to a nontoxic protein that is nearly identical to diphtheria toxin, which renders the polysaccharides antigenic in infants and toddlers. Also beneficial in that PCV stimulates mucosal antibody and greatly suppresses nasal carriage of S. pneumoniae due to vaccine serotypes causing population herd effect.

FRACP written exam preparation (18 decks)

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