Miscellaneous Flashcards
Gestational diabetes
Diagnostic thresholds for gestational diabetes
these have recently been updated by NICE
gestational diabetes is diagnosed if either:
1. fasting glucose is >= 5.6 mmol/L
2. 2-hour glucose is >= 7.8 mmol/L
Management of GDM
f the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met insulin should be added to diet/exercise/metformin
In gestational diabetes, when should insulin be offered
at first testing, plasma glucose >7
Patient with hashimotos thyroiditis has a finding of hypo echoic mass in thyroid - cause?
Hashimoto’s thyroiditis is associated with thyroid lymphoma
Hashimoto’s thyroiditis is characterised by a chronic infiltration of the thyroid gland with B-lymphocytes, which are prone to undergo clonal proliferation. As such, the incidence of thyroid lymphoma is markedly increased amongst patients with Hashimoto’s thyroiditis compared to the general population.
Measure: Sensitivity
Formula: TP / (TP + FN)
Plain English: Proportion of patients with the condition who have a positive test result.
Measure: Specificity
Formula: TN / (TN + FP)
Plain English: Proportion of patients without the condition who have a negative test result.
Measure: Positive Predictive Value
Formula: TP / (TP + FP)
Plain English: The chance that the patient has the condition if the diagnostic test is positive.
Measure: Negative Predictive Value
Formula: TN / (TN + FN)
Plain English: The chance that the patient does not have the condition if the diagnostic test is negative.
Measure: Likelihood Ratio for a Positive Test Result
Formula: Sensitivity / (1 - Specificity)
Plain English: How much the odds of the disease increase when a test is positive.
What is the mechanism behind rapid depolarization in the cardiac action potential?
Rapid sodium influx occurs, and these channels automatically deactivate after a few milliseconds.
What characterizes the early repolarization stage in cardiac action potential?
Early repolarization is marked by the efflux of potassium.
What defines the plateau phase in the cardiac action potential?
The plateau phase involves a slow influx of calcium.
What occurs during the final repolarization stage in cardiac action potential?
Final repolarization is achieved through the efflux of potassium.
How is the restoration of ionic concentrations achieved in the cardiac action potential?
The restoration is accomplished by Na+/K+ ATPase, with slow entry of Na+ into the cell decreasing the potential difference until the threshold potential is reached, triggering a new action potential.
Drugs causing lung fibrosis
name 5
Drugs causing lung fibrosis
amiodarone
cytotoxic agents: busulphan, bleomycin
anti-rheumatoid drugs: methotrexate, sulfasalazine
nitrofurantoin
ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide)
NNT formula
Numbers needed to treat (NNT) is a measure that indicates how many patients would require an intervention to reduce the expected number of outcomes by one
It is calculated by 1/(Absolute risk reduction) and is rounded to the next highest whole number
Experimental event rate vs control event rate
How can these be used to calculate absolute risk reduction?
Experimental event rate (EER) = (Number who had particular outcome with the intervention) / (Total number who had the intervention)
Control event rate (CER) = (Number who had a particular outcome with the control/ (Total number who had the control)
The absolute risk reduction (ARR) may be calculated by finding the absolute difference between the control event rate (CER) and the experimental event rate (EER). You will often find both versions of the above listed in different sources. In some ways in doesn’t matter which you use as you will end up with the same answer but from a technical point of view:
Heparin
MOA: Activates anti-thrombin III
Clopidogrel
Abiciximab
Dabigatran
Rivaroxaban
Horner syndrome
What are central lesions that can cause Horners syndrome
What are pre-ganglionic lesions that can cause Horners syndrome
What are post-ganglionic lesions that can cause Horner syndrome
Multiple Endocrine Neoplasia (MEN)
MEN type 1
MEN type IIa
MEN type IIb
Describe the genetic mutation of each
Describe MEN type I
3 P’s
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Also: adrenal and thyroid
Most common presentation = hypercalcaemia
Describe MEN type II and MEN type IIb
CHA2DS2-VASC score
