Miscellaneous Flashcards
What is the typical presentation of Vitamin C deficiency?
(Scurvy)
Poor wound healing
Bleeding gums
Gingivitis
HAEMATURIA
What is the typical presentation of Vitamin A deficiency?
keratomelacia = Night blindness + tunnel vision
What is the typical presentation of Vitamin B1 (thiamine) deficiency?
Beriberi syndrome:
Dry beriberi - peripheral numbness, confusion / neurological deficits
Wet beriberi - tachycardia, SOB, peripheral oedema
-> Wernicke’s = triad of ophthalmoplegia + ataxia + confusion / decreased cosnciousness
Presentation of Vit B3 (niacin) deficiency
= pellagra
Presents w/ the 3Ds!
Diarrhoea
Dementia
Dermatitis
Presentation of Vit B6 (pyroxidine) deficiency?
peripheral neuropathy
sideroblastic anaemia
Vitamin D deficiency presentation?
Proximal muscle weakness, fatigue, muscle/bone pains, depression
Which electrolyte deficiencies will cause HYPOREFLEXIA?
Hypokalaemia
Which electrolyte abnormalities will cause HYPERreflexia
Hypernatraemia
Hypocalcaemia
What is the typical presentation of vitamin B12 deficiency? (pernicious anaemia)
Beefy red sore tongue
Stomatitis / glossitis
YELLOW TINGE to the skin (Vit B12 is needed for cell DNA so ^ haemolysis = mild JAUNDICE + the pallor from the anaemia = lemon tinge)
Polyneuropathy
Dose of adrenaline in CPR for adults?
1mg (10mls of of 1:10,000 IV)
Dose of adrenaline in CPR for children?
10 micrograms / kg IV
Dose of adrenaline in anaphylaxis in adults and children?
Adults - 0.5mg of 1:1,000 IM
Child > 12 - also 0.5mg
Child 6- 12 = 0.3mg
Child 6 months to 6 = 0.15mg
Chid <6 months = 0.1-0.15mg
What is the inheritance of cystic fibrosis?
Autosomal recessive
What is the inheritance of sickle cell anaemia
Autosomal recessive
(if just get one gene = sickle cell trait)
what is the inheritance of Huntingtons disease
Autosomal dominant
Examples of autosomal dominant conditions?
Marfans
Neurofibromatsosis
Huntington’s
Achondroplasia
examples of autosomal recessive conditions?
Cystic fibrosis
sickle cell anaemia
albinism
phenylketonuria
examples of X-linked dominant conditions?
Fragile X syndrome
Alport’s syndrome (inherited cause of rapid renal failure)
Vit d resistant rickets
examples of X-linked recessive conditions
G6PD deficiency (hence mainly affects males as they only need one copy as their other chromosome is Y!)
Duchenne muscular dystrophy
Haemophilia (again hence why males mainly affected)
examples of polygenic inheritance?
Neural tube defect
Pyloric stenosis
examples of chromosomal inheritance?
Turner’s 45X0
Klinefelters 47XXY
the trisomies
Which antibody can cross the placenta?
igG -> the most prevalent antibody across the body
which antibody is involved in allergy type reactions / atopy?
IgE
IgM
only have small amounts
in blood and lymph only
INITIAL reaction to infection
IgA
found in parts of the body EXPOSED TO THE OUTSIDE WORLD -> ie eyes skins
Why is aspirin not suitable for children < 16?
Due to the risk of Reye’s syndrome = acute onset mitochondrial damage = liver failure with high serum ammonia, drop in blood glucose, cerebral oedema with ^ ICP
Linked to a recent viral infection (eg chickenpox) and ASPIRIN use
What are the 4 types of hypersensitivity reaction?
Type I = Immediate = IgE mediated = anaphylaxis + asthma + hayfever
Type II = igG/IgM monomer mediated = ABO blood group incompatability, drug-induced haemolysis, myaesthenia gravis, Goodpasture’s (INTRAVASCULAR)
Type III = immune complex / IgG/IgM multimer mediated = rhematoid arthritis, SLE
Type IV = delayed type = T cell mediated = chronic asthma, contact dermatitis
What factors make eGFR inaccurate?
- abnormal body mass (low or high BMI)
- extremes of age (<18 or > 75)
- pregnancy
- rapidly changing renal function ie AKI
- vegetarian diet
Minimal urine output / hr for adults and children?
Adults - 0.5ml/kg/hr
Child - 1ml/kg/hr
Infant - 2ml/kg/hr
Typical hormonal pattern in PCOS?
High/normal oestrogen, high tesosterone, high LH
(FSH normally normal)
What the pre-school booster injections and when are they given?
MMR + dTap/IPV (diphtheria, tetanus, pertussis and polio)
given at 3 years and 4 months
Rust-coloured sputum is associated with what chest infection
Strep pneumoniae LRTI
Typical presentation of malaria?
hepatosplenomegaly + low plts + fever + jaundice
Cause and presentation of Chagas disease?
Cause = T. cruizi = a protozoa parasite transmitted by insects found in the Americas including Brazil
Presentation - initial bite = a chagoma nodule
10 - 20 yrs later -> congestive heart failure, arrythmia, enlarged colon presenting w/ constipation and abdominal pain and enlarged oesophagus.
AIDs -defining pneumonia in HIV?
Pneumocystis pneumonia
Often have normal CXR -> need HRCT
Which antibody is present in drug-induced lupus and what drugs can cause it?
Anti-histone
Drugs - isoniazid, hydralazine and procainamide
Dermatomyositis antibodies ?
Anti-Mi2
(papules on knuckles + heliotrope rash over eyelids + weakness)
Which virus is associated with nasopharyngeal cancer?
Epstein Barr
Which antibody is associated with diffuse systemic scleroderma?
Anti-topoisomerase antibody
What is the treatment for giardia lamblia
Metronidazole
What is the vector for Bartellenosis and how does it present?
Bartellena bacilliformis
Vector = the sand fly
Get hepatosplenomegaly + neurological symptoms + fever
Tx - penicillins
What is the transmission of Shigella and how does it present?
Faeco-oral! (^ in cases amongst men who have sex with men)
Presents w/ bloody diarrhoea
Typical presentation of microscopic polyangitis and which antibody is associated with it?
RAPIDLY progressive glomerulonephritis + pulmonary haemorrhage
pANCA
Typical presentation of granulomatosis with polyangitis (Wegner’s) and antibody associated?
Initially sinus symptoms / nasal congestion
Then arthralgia, pulmonary and renal manifestations
Antibody = cANCA
typical presentation of primary biliary cirrhosis?
progressive cholestasis, cirrhosis and portal hypertension
mainly FEMALES
antibody = anti-mitochondrial antibody
Presentation, antibody and management of myaesthenia gravis?
FATIGUABLE weakness due to antibodies against the acetylcholine receptor
(Anti acetylcholine)
Must screen for thymic hyperplasia / thymoma as strong association!
Mx -> Pyridostigmine (anti-acetylcholinesterase), Steroids
Thymectomy if thymoma but can also improve symptoms even if not!
Transmission and incubation period of cholera?
Faeco-oral transmission (contaminated water and poor hygiene)
Incubation period = SHORT = 0-5 days = hence the potential for huge / rapid outbreaks
Typical presentation of ebola and it’s vector?
Vector - fruitbats and monkeys
Presentation - initially vague viral symptoms then severe renal and liver failure and coagulopathy
Which type of candida causes vaginal candidiasis?
Candida albicans
which skin yeast overgrowth is associated with sebborheic dermatitis?
malasezzia furfur
When can the rabies injection NOT be given?
Only if prev adverse reaction to!
Safe in pregnancy / HIV etc if clinical need
Organsims that cause spotted fever? (Initial fever and then widespread rash several days later)
Ricketsia Ricketsii -> Rocky Mountain Spotted Fever
Ricketsia Conorri -> Mediterranean Spotted Fever
What is the vector for trypanosomiasis?
Trypanosomiasis = sleeping sickness
Vector = Tstetse fly
What is the most common cause of a B cell deficiency and what bacteria does it leave you vulnerable to?
Selective IgA deficiency
Predisposes you to encapsulated gram positive bacteria
W hat is the organism that causes river blindness?
Onchocerciasis volvulus
DIAGNOSTIC test for coeliac disease and what does it show?
Duodenal biopsy
-> subtotal villous atrophy + crypt hyperplasia
Antibodies associated with coeliac disease?
Anti-endomysial
Anti TTG (tissue transglutaminase)
Alpha gliadin
Which antibodies are associated with Guillain Barre?
Anti ganglioside
typical presentation of pernicious anaemia + antibodies associated?
Parietal cell + Intrinsic factor antibodies
= deficiency of intrinsic factor = impaired Vit B12 absorption
= ^ risk of gastric carcinoma
typical presentation of epstein-barr / infective mononucleosis and NICE’s recommended diagnostic pathway?
suspect if BILATERAL TONSILLAR ENLARGMENT WITH WHITEWASH EXUDATE + lymphadenopathy +/- hepatosplenomegaly
If < 12 or immunosupressed -> EBV serology
If > 12 -> Monospot test (checks for heterophile antibodies) and FBC
Glandular fever likely if +ve monospot OR >20% atypical/reactive lymphocytes
If initial monospot is negative -> repeat in 5-7 days -> if remains inconclusive can do serology
Example of a potent and less potent topical steroid?
Potent = BETNOVATE
Less potent = hydrocortisone
Treatment of head lice?
Malathion or Dimeticone
what is the leading cause of death in schizophrenics?
Suicide
(followed by cardiovascular diease)
Differentiating hydrocoele from an epididymal cyst?
Epididymal cysts = more commonly bilateral, slowly increase in size and are SEPARATE (Cyst for Separate) from the testes
Hydrocoele = normally unilateral and is attached to the testes
What drug type should NOT be used in acute sinusitis?
ANTIHISTAMINES
THEY SLOW DOWN RECOVERY FROM ACUTE SINUSITIS
Differentials in a newborn with delayed passage of meconium?
Hirschsprung’s disease -> initial delay in meconium, subsequent difficulty opening bowels with progressive abdominal distention and poor feeding
Meconium ileus -> ASSOCIATED WITH CYSTIC FIBROSIS -> delay in passage of meconium because it is thicker and stickier than normal
Pyloric stenosis versus duodenal atresia?
Duodenal atresia = presents in the first few days with BILIOUS VOMITING and scaphoid abdomen
Pyloric stenosis - presents a little later ~ 6 wks with NON-BILIOUS PROJECTILE VOMITING
Aggressive transformation from a non-healing (eg diabetic ulcer) ?
= a MARJOLIN’S ULCER.
malignancy that arises from chronically inflamed / traumatised skin
Venous versus arterial ulcers?
Venous = ++ painful, MEDIAL aspect of the distal leg
Arterial = on bony prominences, lATERAL aspect of the distal leg
For what condition is the Rotterdam criteria used?
PCOS
What criteria are used for rheumatic fever?
Jones Criteria
For what condition is the Ranson criteria used ?
severity of acute pancreatitis
Which drugs are associated with causing drug-induced SLE?
Isoniazid
Hydralazine
Phenylbutazone
Procainamide
(HPP!!)
Which drugs can precipitate psoriasis?
Lithium
+
Beta blockers
can precipitate psoriasis
Alcohol, NSAIDs and anti-malarial drugs can make existent psoriasis worse
1st line diagnostic test for malaria?
Thick and thin blood film
abx for h.pylori gastritis?
Non-allergic = amoxicllin + clarithromycin
Allergic = metronidazole + clarithromycin
1st line treatment for partial/petit mal/jacksonian seizures versus 1st line for generalised / tonic clonic seizures?
Partial/petit mal/jacksonian = 1st line = LAMOTRIGINE or CARBEMAZEPINE
Generalised / tonic clonic - 1st line = sodium valproate
Drugs for use in status epilepticus?
Give benzos after seizure activity for 5 mins
Lorazepam if have IV access
if not = buccal midazolam or PR diazepam
What is Argyll Robertson pupil?
BILATERAL CONSTRICTED + IRREGULAR PUPILS THAT DO NOT REACT TO LIGHT
Seen in diabetes, neurosyphilis, MS + encephalitis
What is Markus Gunn pupil?
Failure of the affected pupil to constrict to light but when you test the normal eye both pupils constrict
Can be seen with anything that damages the optic nerve or retina eg ^ ICP/tumour, retinal detachment
Gold standard investigations for monitoring lung function in upper and lower respiratory disease?
Upper resp / airway function -> PEF or spirometry
Lower resp / alveolar function in in pulmonary fibrosis -> lung diffusion test
Next investigation if CXR shows suspicion of lung cancer?
NEED TO HAVE A CT / HRCT BEFORE ANY BIOPSY IS DONE!!
Best test to differentiate bacterial from a non-bacterial eg viral exacerbation of COPD?
PROCALCITONIN!
If procalcitonin negative this likely non-bacterial
Tx of Pelvic Inflammatory Disease ?
IM Ceftriaxone stat then 2 weeks of Doxycline + Metronidazole
Mental State Examination structure?
Appearance + Behaviour - their presentation, their facial expression, their eye contact
Mood - subjective and objective mood
Thoughts - though disturbance, delusional beliefs, obsessions
Perception - any HALLUCINATIONS or illusions
Speech - rate, rhythmn, tone
What is malignant hyperrexia?
A reaction to suzemethonium used during rapid sequence induction
-> muscle rigidity + high fever
Causes of apnoea in an intubated patient?
Displacement or obstruction of endotracheal tube
Stomach distention
Presentation of incomplete paralysis in pt under anaesthetic?
Tachycardia and generalised muscle spasms
Presentation of awareness in pt under anaesthetic?
Rise in blood pressure and twitching of fingers
Different types of breech presentation?
Footling breech - feet first
Flexed breech = feet + bottom
Extended breech = bottom
Testing the infant of a HIV positive mother?
HIV PCR testing at 48 hrs, 6 wks and 12 wks
Antibody testing at 18 months
Lights Criteria for pleural effusion?
EXUDATIVE (Extremely bad -> cancer + pneumonia) has higher protein and LDH
Lights criteria = exudative if EITHER
* pleural protein: serum protein ratio >0.5
* pleural LDH : serum LDH > 0.6
Adult Cardiac Arrest protocol ?
If witnessed VF/pVT arrest -> upto 3 stacked shocks (120-360J)
can be given before commencing the usual CPR protocol.
Compressions 30:2
Pause every 2 mins for a rhythm check
Once you have a definitive airway ie a tracheal tube -> give continuous chest compressions with asnychonous ventilations
VF/pVT -> shocks every 2 mins -> after the 3rd shock => 1mg adrenaline IV/IO + 300mg amiodarone
Repeat adrenaline every 3-5 mins
Give further 150mg amiodarone after the 5th shock then that’s it.
Asystole/PEA -> 1mg adrenaline IV/IO ASAP -> repeat every 3-5 mins
Paediatric cardiac arrest protocol?
CPR ratio = 15:2
VF/pVT (less common in children)
Shock ASAP -> 4J / kg
If AED -> use paediatric attenuator if <8 yrs, if >8 deliver adult shock
Give adrenaline 10 micrograms / kg
+ amiodarone 5mg / kg
after the 3rd shock
Repeat the adrenaline every other shock
give one further 5mg/kg amiodarone dose after the 5th shock
PEA/asystole/bradycardia <60bpm
Give adrenaline ASAP -> 10 micrograms / kg
Summary of diabetic medication
Metformin:
Pros - 1st line. Most effective. Weight neutral (may cause a slight reduction in weight). No hypos
Cons - GI upset. Vit B12 malabsorption. Must stop if eGFR <30. Theoretical risk of lactic acidosis -> must suspend during dehydrating illness.
Sulfynlureas -> end in ‘ide’
Gliclazide, Glipezide + Tolbutamide
Stimulate insulin release
Pros -> effective. RAPID response (often used initially for SYMPTOMATIC HYPERGLYCAEMIA then stepped down to something else)
Cons -> risk of hypos (self-monitoring recommended and mandatory if eGFR <30). weight gain.
SGLT-2 inhibitors (the glliflozins) (gliFLOzin = FLOws out of the kidney)
Renal Secretion
Pros -> weight loss! moderate efficacy. improve outcomes in heart failure and cardiovascular disease
Cons -> freq infection, polyuria / dehydration, can cause a euglycaemic DKA
Pioglitazone
Pros = EFFECTIVE BUT SLOW-ONSET OF ACTION. hepatic metabolism so no limitation in renal failure.
Cons = weight gain. risk of bladder cancer. ^ risk of fractures.
DPP4 inhibitors (gliptins)
Cons - not that effective! weight neutral. ^ risk of HF hospitalisations! risk of acute pancreatitis and acute allergic reactions.
Acarbose - modest effect. GI upset.
Presentation and treatment of renal osteodystrophy?
= high phosphate + low calcium and inability to convert vitamin D into it’s active form in end stage renal failure
Tx = active vit D replacement = alfacalcidol
What frequency of noise does presbyacusis normally affect?
High frequency
Hydrocoele versus epidydmal cysts?
Hydrocoele - Hugs the testes
Epididymal cysts = SEPARATE to the testes, normally just above the testicle
Hydrocoele = the testes is WITHIN the hydrocoele
Ovarian torsion risk factors?
Pregnancy - the ovarian ligament is more lax
Ovarian induction for IVF
prev pelvic surgery (provides adhesions for it to twist around)
CXR findings in CCF?
Bilateral pleural effusion
Pulmonary oedema
Kurley B lines
UPPER lobe diversion !!
Kartagener’s syndrome?
Dextrocardia + bronchiectasis (recurrent chest infections) + Deafness + infertiltiy
Most SPECIFIC diagnostic test for appendicitis?
CT of the abdomen
Biggest drug culprits for aplastic anaemia?
CHLORAMPHENICOL
Gold
Phenylbutazone
Diagnostic test for acromegaly?
ORAL GLUCOSE TOLERANCE TEST + GROWTH HORMONE LEVELS.
(in acromegaly the GH levels won’t be suppressed by the glucose challenge!)
Diagnostic test for addison’s disease ?
Short synacthen test (synacthen = synthetic ACTH -> adrenals don’t respond to it in addison’s / primary adrenal insufficiency) and morning cortisol (low)
Most common causative agent in bacterial keratitis (linked to contact lens wearing)
pseudomonas aeruginosa
Mg of uterine inversion during labour ?
Initial - MATERNAL RESUSCITATION
Then - uterine replacement either manually or with hydrostatic pressure
Blood results in aplastic anaemia?
PANCYTOPENIA - all cell lines are low!
Majority are acquired ~ 20% congenital
Antibiotic treatment of rheumatic fever?
Rheumatic fever = group A strep!!
Tx = stat of IM benzylpenicillin then oral penicillin V
Typical presentation of retroperitoneal fibrosis?
Dull abdominal pain with radiation to the back
Gradual ureteric obstruction w/ hydronephrosis and renal failure
Primary sclerolsing cholangitis versus primary biliary cirrhosis/cholangitis ?
Primary sclerosing cholangitis = affects ducts in and out of the liver, strong association with ulcerative colitis, increased risk of progression to malignancy
Primary biliary cholangitis = affects ducts in the liver only, anti mitochondrial antibody, mainly women, increased risk in smokers, no risk of progression to malignancy
Ursodeoxycholic acid can be used for both, more likely to be beneficial in primary biliary cholangitis.
Antibodies in autoimmune hepatitis?
Adults - type I - anti smooth + anti nuclear
Children - type II - anti liver kidney
INTERFERON CAN MAKE AUTOIMMUNE HEPATITIS WORSE HENCE AVOID!!!
pH suggestive of empyema?
pH < 7.2
Presentation of femoral hernia?
More common in WOMEN
inferior + lateral to pubic tubercle
IRREDUCIBLE
PAINFUL
Often contain bowel -> obstruction / ischaemia
Mx of Hodgkin’s lymphoma ?
1st line = chemotherapy + radiotherapy
IF RELAPSE = chemotherapy + bone marrow transplant
Mx of non-aggressive non-hodgkins lymphoma (eg follicular lymphoma)
if asymptomatic -> surveillance
If symptomatic -> biologic eg rituximab
Mx of aggressive non-hodgkins lymphoma?
iF YOUNGER - BEST CHANCE OF CURATIVE OUTCOME = BONE MARROW TRANSPLANT.
Otherwise = combo of chemo + radio + biologic
Presentation of Paget’s disease of the breast?
= ECZEMA CHANGES OF THE NIPPLE
UNDERLYING INTRADUCTAL BREAST CANCER
