MRCP Flashcards
1
Q
yellow nail syndrome Associations
A
Congenital lymphedema
Bronchiectasis
Chronic sinus infection
Pleural effusion
2
Q
Koebner phenomenon Conditions
A
Vitiligo
Molluscum Contagiousum
Lichen planus
Lichen sclerosus
Warts
Psoriasis
3
Q
How is C. diff infection classified
A
Mild - No WBC rise
Moderate - WBC rise, Diarrhea
Severe - Raised WBC / raised Creatinine / Colitis on abdo imaging / Pyrexia
Life threatening - Hypotension / Toxic mega-colon / Ileus
4
Q
Treatment of C.diff
A
1st line - Oral Vancomycin
2nd line - Oral Fidaxomicin
3rd line - Oral Vancomycin +/- IV metronidazole
If recurrent, within 12 week resolution - Oral fidaxomicin
after 12 week of resolution - Oral vancomycin or Fidaxomicin
Lifethreatening - Oral Vancomycin + IV metronidazole
Monoclional antibody - Bezlotoxumab (for Toxin B)
5
Q
What is the mechanism of action of Furosemide
A
Blocks the Na-k-Cl Co-transpoter (NKCC2) thus preventing reabsorption and increasing excretion of NaCl at the THICK ASCENDING LOOP OF HENLE.
6
Q
How do you manage Psittacosis
A
Organism - Chlamydia Psittacci.
Suspect with Hx of bird contact, fever, flulike symptoms, cough, dyspnea
Treatment - Doxycycine (1st line), Macrolide eg Erythromycin (2nd line).
7
Q
Characteristic investigation finding in Osteomalacia
A
Low Calcium
Low Phosphate
High ALP.
Xray - Transluscent bands (Loosers zones and pseudo-fractures)
Treatment - Vit D and calcium supplementation
8
Q
Organism associated with animal bite
A
Pasturella Multocida
Treatment - Co-amoxiclav
Doxycycline + Metronidazole (Penicilllin allergic)
9
Q
Organism associated with Human bite
A
Streptocci spp
Staphylococcus aereus
Prevotella
Eikenella
Fusobacterium
Treatment - Co-amoxiclav
10
Q
What condition is most associated with anti-ccp?
A
Rheumatoid arthritis
11
Q
Conditions associated with Rheumatoid factor
A
Rheumatoid arthritis
SLE
Systemic sclerosis
Sdjogren’s disease
Felty syndrome
Infective endocarditis
Normal population
12
Q
What are the types of colon cancer and their associated genetics
A
Sporadic (95%) - usually loss of APC gene. other mutations like KRAS activation, p53 supression may follow
Hereditary non polyposis colorectal Ca (5%) - AUTOSOMAL DOMINANT inheritance. Multiple mutations eg: MSH2 and MLH1. usually progresses to colorectal Ca , mostly of the proximal colon
Familial adenomatous polyposis (<1%) - AUTOSOMAL DOMINANT inheritance. Mutation to APC gene. always progresses to Colorectal Ca in early years requiring early proctocolectomy.
13
Q
Treatment guideline for osteoarthritis
A
Weight loss and strengthening exercise
1st line - TOPICAL NSAIDS
2nd Line - Oral NSAIDS + PPI
Intra-articular steroid injection
Joint replacement
Weak opioids and paracetamol can be used as adjucts
14
Q
What is the pathogenesis of Lambert-Eaton syndrome.
A
Lower motor pattern of muscle weakness caused by antibody directed against presynaptic voltage gated calcium channel in the peripheral nervous system.
60% is associated with small cell Ca.
15
Q
treatment options for Lambert eaton disease
A
Investigate for underlying cancer
Immunosuppression with steroids
Plasma exchange or IV Immunoglobulins
3,4 diaminopyridine - trial drug that can keep channels open long enough for ACh efflux from presynaptic channels
16
Q
Pathogenesis of Porphyria cutanea Tarda
A
disorder arising from sporadic mutation leading to defective Uroporphyrinogen decarboxylase and thus disordered heme synthesis
17
Q
Symptoms/exacerbation of Porphyria cutanea Tarda
A
typically photosensitive bullae with orange coloured urine, Hypertrichosis, hyperpigmentation
Exacerbated by Heb C, excess alcohol
Treated with chloroquine and venesection
18
Q
How is MODY inherited and classified?
A
All types are of autosomal dominant inheritance.
Classified as MODY1, MODY2, MODY3, MODY4, MODY5, MODYX etc.
Most common types are MODY2 (20%) and MODY3 (60%).
MODY2 - Glucokinase gene mutation
MODY3 - HFN1 alpha gene mutation
19
Q
Typical representation of MODY
A
A patient frequently presenting with non ketotic hyperglycemia, asymptomatic, diagnosed before 25%
MODY3 responds to low dose sulphonylurea
20
Q
Causes of hypokalemia with hypertension
A
Conn’s syndrome
Cushing syndrome
Liddle syndrome(excessive Na reabsorption in collecting ducts)
11 beta hydroxylase deficiency
Liquorice use
Carbenoxolone use
21
Q
Causes of hypokalemia with hypotension
A
Batters syndrome (similar to long term furosemide use)
Diarrhea
Type 1/2 renal tubular acidosis
Diuretics
Gitleman syndrome(similar to long term
22
Q
How do you estimate average plasma glucose from HbA1c
A
(2 x HbA1c %) - 4.5
23
Q
causes of abnormally low HbA1C
A
Sicklecell anaemia
G6PD deficiency
Hereditary spherocytosis
24
Q
causes of abnormally high HbA1C
A
B12 and folate deficiency
Splenectomy
Iron deficiency anaemia
25
Conditions associated with complement deficiencies
C1 (INH) - Hereditary angioedema
C1,C2,C4 - SLE, Henoch schnolein purpura
C3 - Recurrent encapsulated bacterial infection
C5 - Leniers disease
C5-C9 - Predisposed to menigococcal meningitis
26
How do you differentiate leukamoid reaction from CML
in leukamoid reaction, leukocyte alkaline phosphatase is high
27
CXR finding in aspergilloma
A partially filled cavity with crescent sign
28
Renal biopsy finding in Diabetic nephropathy
Kimmelstein-wilson bodies (nodular glomerulosclerosis) and hyaline artherosclerosis
29
When to suspect Bechets disease
Painful Oral and genital ulcers in middle eastern patient
30
When should Levothyroxine be take
Normally, 30mins before breakfast/other meals.
However take it 4 hours before Calcium or Iron supplements as these directly reduce its absorption
31
HLA associated conditions
All encoded by chromosome 6
HLA A3 - Haemochromatosis
HLA B51 - Bechet's disease
HLA B27 - Ankylosing spondylitis, reactive arthritis, Acute anterior uveatis, Psoriatic arthritis
HLA DR4 - Type 1 DM, Rheumatoid arthritis
HLA DR3 - Sjodgren disease, dermatitis herpetiformis, Primary biliary cirrhosis
HLA DR2 - Narcolepsy, Good pasture disease
HLA DQ2 and DQ8 - Celiac disease
32
Describe the mechanism of the hormaonal treatment options for prostate cancer
Steroidal anti androgen - Cyproterone acetate
Non steroidal androgen blocker - Bicalutamide
GNRH Agonist - Goserelin
GNRH Antagonist - Degarelix
Inhibits androgen Synthesis - Abirateron
33
Types and associated gene defect for Autosomal dominant polycystic kidney disease
ADPKD 1 - PKD 1 gene - Chromosome 16
ADPKD 2 - PKD2 gene - Chromosome 4
34
Classification and Prevalence of Thrombophilia
INHERITED
Factor v leiden (heterozygous) - 5%
Factor v leiden (homozygous) - 0.05%
Prothrombin gene mutation - 1.5%
Factor C deficiency - 0.3%
Factor S deficiency - 0.1%
Antithrombin III deficiency - 0.02%
ACQUIRED
Antiphospholipid syndrome
35
Causes of Infective endocarditis
Staphylococcus aereus (most common, IVDU)
Streptococci viridans - S. mitis and S. sangunis (Poor dental hygiene)
Staphlococcus epidermidis (Peri-operative, indwelling lines)
Streptococcus bovis - S. gallalyticus (Colorectal Cancer
Noninfective - SLE, Malignancy
36
Culture negative causes of infective endocarditis
Prior antibiotic therapy
HACEK - Haemophilus, actinobacillus, cardiobacterium, eikinella, kingella
Bartonella
Coxiella
Brucella
37
Hematological cancers and associated translocations
CML - Philadelphia chromosome t(9,22)
Burkitt lymphoma - t(2,8), t(8,14), t(14,22)
Mantle cell lymphoma - t(11,14)
Acute promyelocytic leukaemia - t(15,17)
Follicular lymphoma - t(14,18)
38
Mechanism of action of NAC in paracetamol overdose
serves as a precursor for gluthatione production thus increasing glutathione store which react with NAPQI (Toxic component) to form a safer metabolite.
39
How do you treat pulmonary hypertension
1) Do an acute vasodilatory test
a) If significant vasodilation occurs, treat with calcium channel blockers
b) If negative, Treat with Prostacyclin analogues (Iloprost), then endothelin receptor antagonist (Bosetan, Ambrisetan), then phosphodiesterase inhibitors (sildenafil).
40
Drugs causing Cholestasis-drug induced liver damage
COCP
Steroids
Testosterone
Antibiotics - Co-amoxiclav, flucloxacillin, erythromycin
Phenothiazines - Chlopromazine
Sulphonylureas
41
Drugs causing Hepatitis-drug induced liver damage
Amiodarone
Methyldopa
paracetamol
Anti TB drugs
Sodium valproate, phenytoin
Nitrofurantoin
MAOI
Alcohol
Statins
42
Drugs causing Fibrosis
-drug induced liver damage
Methotrexate
Amiodarone
Methyldopa
43
What is the most common ocular presentation in Rheumatoid arthritis
Keratoconjuctivitis Sicca - Autoimmune mediated inflammation of the lacrimal glands
44
What is atypical HUS
HUS occurring in absence of shiga toxin +/- diarrhea. More common HUS seen in adults
45
Management of Meniers disease
Diagnosis is made by ENT.
Acute attacks - Prochloperazine
Prevention - Betahistine, Vestibular rehabilitation
Inform DVLA - No driving till symptom control is achieved.
46
Mechanism of action of sulphonylurea
Increase Insulin secretion
It binds to ATP dependent potassium channels and causes depolarization which then causes voltage gated calcium channels to open and release insulin.
47
What is the relationship between Hypokalemia and digoxin toxicity
Hypokalemia can precipitate digoxin toxicity due to increase binding of digoxin to ATPase pump at the same point as potassium.
48
What form of valvular abnormality and anaemia is associated with angiodysplasia
Aortic stenosis and Iron deficiency anaemia
Treated with cautery, Tranexemic acid or Oestrogen
49
Management of SLE
Basic: NSAIDS and Sunblock
1st Choice - Hydroxychloroquine
If there is internal organ involvment: Prednisolone or cyclophosphomide
50
Investigation of hyperparathyroidism
Bone profile - Raised Calcium and low phosphate
PTH - High or Normal
Features of hypercalcemia - Polydipsia, polyuria, confusion, irritability, constipation
Most common cause - Parathyroid adenoma
51
What is the mechanism of action of Ticagrelor
P2Y12 receptor antagonist to inhibit binding of ADP thus inhibiting platelet activation and aggregation.
Side effect is Dyspnea due to accumulation of adenosine.
52
Causes of ST elevation on ECG
Myocardial Infarction
Takotsubo cardiomyopathy
Prinzmetal angina
Normal variant - high take off
Myocarditis/Pericarditis
Left ventricular aneurysm
53
Smoking Cessation
Options include
NRT
Varenicline - Nicotine partial agonist. dont use in patients with suicide ideation or hx of self harm
Bupropione - Norepinephrine and dopamine reuptake inhibitor and nicotine antagonist. Has a small risk of seizures
54
What is Brugada syndrome
Autosomal dominant inherited cause of sudden cardiac death. Occurs due to mutation of SCN5A gene that codes for myocardial Na ion channel protein.
More common in Asians
ECG finding - Convex ST elevation in V1/V2/V3 and right bundle branch block
Investigation - Administration of Flecanide.
Treatment - Implantable cardioinverter -- Defibrillator
55
What is cardiac X syndrome?
Also called Microvascular angina
Presence of Cardiac chest pain + Normal ECG and Normal troponin at rest + ECG changes eg ST depression on stress test (Despite Normal coronaries)
Treated with Nitrates
56
What is arrythmogenic right ventricular cardiomyopathy
2nd most common cause of cardiac death after HOCM
Autosomal dominant inherited disease due to mutation of genes encoding components of Desmosome. Causes replacement of right ventricular myocardium with fibro-fatty tissue.
presents as syncope,, palpitations or sudden cardiac death
ECG - Epsilon wave (QRS notch) + T wave inversion in V1-3
ECHO - Hypokinetic right ventricle
Treatment -
Sotalol
Ablation
Implantable cardioinverter-defibrillator.
Naxos disease is it's autosomal recessive variant
57
Parkinson disease triad
Bradykinesia
Tremor (rest)
Rigidity
Drug induced parkinsonism - Symptoms are acute and bilateral.
Rigidity and tremor are uncommon
58
Sterotypical features of Legionnella infection
Dry cough, hyponatremia, Lymphopenia and association with air-conditioning/travel history
59
Gram positive rods bacteria
ABCDL
-Actinomyces
-Bacillus anthracis
-Clostridium
-Diptheria - Corynebacterium diphteria
-Listeria
60
Key Points for Visual field defects
- Chiasmal lesions cause bitemporal defects
- Post-chiasmal lesions cause homonymous defects
- The more posterior the lesion, the more congruous the defect
61
Relationship between Lithium and antidiuretic hormone
Lithium desensitizes the kidney to ADH at the collecting ducts which causes a form of drug-induced Nephrogenic diabetes insipidus
62
Wolfram Syndrome
also called DIDMOAD
Diabetes Insipidus
Diabetes Mellitus
Optic atrophy
Deafness
63
Treatment of diabetes Insipidus
Cranial - Desmopressin
Nephrogenic - Thiazides, Low salt/protein diet
64
Complication and treatment of Pneumocystis jirovecci pneumonia
Complication is Pneumothorax.
Treatment
- Co-trimoxazol
- IV/Aerolized Penthamidine
- Steroids if Hypoxic
65
Gerstmann Syndrome and Kluver bucy syndrome
Gerstmann Syndrome - Lesion to Dominant parietal Lobe
- Acalculia, Alexia, Right left disorientation, Finger agnosia
Kluver bucy syndrome - Lesion to Amygdala
Hyperorality, Hypersexuality, Hyperphagia, Visual Agnosia
66
Charles-Bonnet syndrome
Hallucinations on background of Visual impairment in absence of neuro-psychiatric symptoms.
The patient is usually unbothered by the Hallucinations
67
Progressive supranuclear palsy
Steele-Richardson-Olszewski syndrome
- Postural instability/falls
- Vertical gaze palsy
- Parkinsonism
- Cognitive impairment
68
Features of Multiple system atrophy
An example is Shy drager disease.
Types: MSA-P and MSA-C (Prevalent parkinsonism vs cerebellar signs
Features:
- Parkinsonism
- Autonomic dysfunction
- Cerebellar signs
- Poor response to levo dopa
69
Characteristic complications of mycoplasma pneumonie
- Cold agglutination and hemolytic anaemia
- Erythema multiforme
- Gastrointestinal - Hepatitis, pancreatitis
- Neuro - Meningoencephalitis, GBS
- Renal - Acute glomerulonephritis
- Cardiac - Pericarditis/Myocarditis
- ENT - Bullous Myringitis
Treatment - Doxycycline/
70
Japanese encephalitis
caused by flavivirus transmitted by culex mosquito. risk factor is working in rice paddy. common in Asia. Reservoir is aquatic birds +/- Pigs
Presents with Confusion, Fever, headache, seizure. May have signs of acute flaccid paralysis. May also have parkinsonism features.
Investigation is by serology/PCR
Treatment is Supportive
71
Granulomatosis with Polyangitis
Also known as Wegener's granulomatosis. causes destructive necrotizing granulomatous vasculitis.
Affects the Lungs (Upper and Lower tract) and kidneys
Features : Sinusitis, nasal crusting, dyspnea, hemoptysis, Rapidly progressing glomerulonephritis
+/-Peripheral neuropathy and systemic inflammation
cANCA is most specific antibody
Investigation
XRAY - Cavitating mid zone lesions
Renal biopsy:
72
Risk factors of Pseudogout
Accumulation of Calcium pyrophosphate dihydrate crystals in joints
Hyperparathyroidism
Low phosphate/Magnesium
Acromegaly
Haemochromatosis
Wilson disease
Joint aspiration show weakly positive bifringent rhomboid crystals on microscopy
Treated with NSAIDS or Steroids
73
What is Waldenstrom macroglobulinemia
A malignancy occuring in older men characterized by excessive production of monoclonal IgM paraprotein.
Features include hyperviscosity syndrome, cryoglobulinemia, systemic symptoms (weight loss, lethargy), large spleen and large lymph nodes.
Investigation - Monoclonal IgM, Bone marrow biopsy
Treatment - Rituximab
74
Nephrogenic causes of Diabetes insipidus
- Genetic - Mutations affecting ADH receptor and aquaporin 2
- Drugs - Lithium, Demeclocycline
- Electrolytes - High calcium, Low potassium
- Tubulo interstitial dsease - Sickle cell, urinary obstruction, Pyelonephritis.
- Haemochromatosis
75
Causes of SIADH
Malignancy - Small cell lung Ca, Pancreatic Ca.
Drugs - SSRI, Sulphonyurea, Cabamazepine,
Infection - Pneumonia, TB
Intracranial - SAH, ICH, Encephalitis
76
Facts about Sdjogren's disease
Autoimmune disorder affecting exocrine glands. affects more females. associated with lymphoid malignancy
Features characterized by Dry mucosal surfaces
Investigation -
Schimer test - measure tear formation.
ANA(70%), Anti Ro(70%), Anti La(30%), RF (50%), reduced C4, hypergammaglobulinemia
Treatment - Pilocarpine, artificial tears and saliva
77
Important points on opioid use for palliative care
Always use MR morphine when able.
Increase doses by 30-50% per time.
Mild-moderate renal impairment - Oxycodone.
Severe renal impairment - Fentanyl/Buprenorphine.
Breakthrough pain dose is 1/6th of total daily dose.
Metastatic bone pain - Strong opioids, biphosphonate, radiotherapy.
78
Opioid conversion factors
Codeine to Oral morphine - divide by 10
Tramadol to Oral morphine - divide by 10
Morphine to Oral oxycodone - divide by 2
Morphine to subcut morphine - Divide by 2
Oral morphine to Subcut Diamorphine - Divide by 3
Oral oxycodone to Subcut Diamorphine - divide by 1.5
12microgram of fentanyl patch = 30mg of Oral morphine daily
10 microgram of Buprenorphine patch = 24mg of Oral morphine daily
79
Allergic Bronchopulmonary Aspergillosis
Caused by Allergic reaction to Aspergillus spores.
Usually has Hx of bronchiectasis
Features - Dyspnea, wheeze, symptoms similar to asthma
Investigation
- Eosinophilia
- Raised IgE
- Raised IgG
Treatment
Oral Prednisolone
Itraconazole - 2nd line
80
Troponin binding sites
Troponin C - binds to Calcium ions
Troponin I - Binds to actin to hold troponin-tropomyosin complex
Troponin T - Binds to Tropomyosin
81
What is Cystinuria
An autosomal recessive disorder characterized by recurrent cystine renal stones formation due to defect in membrane transport of COLA (Cystine, Ornithine, Lysin, arginine).
Defects affects genes on chromosome 2 and 19.
Investigation - Cyanide-nitroprusside test
Treatment -
- Hydration
- Urine alkalinization
- Penicillamine
82
Causes of Lower lobe lung fibrosis
- idiopathic pulmonary fibrosis
- most connective tissue disorders (except ankylosing spondylitis) e.g. SLE
- drug-induced: amiodarone, bleomycin, methotrexate
- asbestosis
83
Causes of Upper lobe lung fibrosis
CHARTS
C - Coal worker's pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
84
Causes of Aortic regurgitation
sec to diseased valve:
- Rheumatic fever
- Calcified Aortic valve
- Infective endocarditis
- Connective tissue disease eg SLE, RF
- Bicuspid aortic valve
Sec to Aortic valve disorder:
- Bicuspid aortic valve
- Spondyloarthropathy eg ankylosing spondylitis
- Syphilis
- HTN
- Marfan syndrome, Ehler danlos syndrome
- Aortic dissection.
85
Most Common gene mutations associated with HOCM and pattern of inheritance
Mutation to genes coding for Beta myosin heavy chain and myosin binding protein C.
Inherited as Autosomal dominant disorder
86
Conditions associated with HOCM
Fredreich's ataxia
Wolff parkinson white
87
Clinchers for causes of Pneumonia
Cavitating lesions - Staphylococcus aereus
In alcoholics - Klebsiella pneumonie
Cold Sores - Streptococcus Pneumonie
IECOPD - Haemophilus influenza
Deranged LFTs - Legionella
88
Causes of Hypercalcemia
Hyperparathyroidism
Malignancy - Myeloma, Squamous cell Ca (PTHrP), metastasis
Addison disease
Granulomatous disease - Sarcoidois
Milk alkali syndrome
Excess Vitamin D
Acromegaly
Thyrotoxicosis
Drugs - Thiazides
Dehydration
89
Causes of Bronchiectasis
post-infective: tuberculosis, measles, pertussis, pneumonia
cystic fibrosis
bronchial obstruction e.g. lung cancer/foreign body
immune deficiency: selective IgA, hypogammaglobulinaemia
allergic bronchopulmonary aspergillosis (ABPA)
ciliary dyskinetic syndromes: Kartagener's syndrome, Young's syndrome
yellow nail syndrome
90
Causes of COPD
Smoking!
Alpha-1 antitrypsin deficiency
Other causes
cadmium (used in smelting)
coal
cotton
cement
grain
91
Criteria for surgery in primary hyperparathyroidism
Age <50
Presence of symptoms or end organ damage
Ca levels > 2.85
92
Methaemoglobinemia : clincher, causes, symptoms, treatment
Clincher - Raised or Normal pO2 despite reduced SPO2
Causes:
Congenital - NADH Methaemoglobin reductase deficiency,
Acquired - Drugs (Daspsone, sulphonamides, Lidocaine, benzocaine, Chloroquine, primaquine
Chemicals - Aniline dyes
Treatment -
- Ascorbic acid - NADH Methaemoglobin reductase deficiency
- Methylene blue
93
how to differentiate carbon monoxide poisoning and methemoglobinemia
CO poisoning - Normal SPO2
Methaemoglobinemia - Low SPO2 and normal pO2 on ABG
94
Characteristic features of congenital infections
Congenital toxoplasmosis - Cerebral calcification, hydrocephalus and chorioretinitis
Congenital CMV - Microcephaly, Low birth weight,
Sensorineural deafness, Purpuric skin lesions
Congenital Rubella - Congental heart defect, Congenital cataracts, sensorineural deafness,
95
Monoclonal antibodies for different conditions
- Trastuzumab - Breat Ca
- Infliximab/Adalimumab Crohn's disease
- Bezlotuzumab - C diff with +ve toxin B
- Rituxumab - CLL
- Cetuximab/ Panitummumab - Colorectal Ca
96
Lithium toxicity - Features and management
Lithium levels>1.5mmol/L
Coarse tremor, seizure, Coma, confusion, Hyperreflexia.
Treated with
IV fluids (Mild - moderate)
Haemodialysis (Severe)
97
Rapidly progressive glomerulonephritis
rapid deterioration of kidney function
Microscopy - Epithelial crescents in glomeruli
Causes - Wagener's granulomatosis, Ig A nephropathy, Good pasture disease, SLE, Microscopic polyarteritis
98
Distal renal tubular acidosis
Inability to acidify urine by secretion of H ions into urine.
Associated with renal stones
Causes incle Sjogren's dx, SLE, amphotericin B toxicity, analgesia nephropathy
99
Proximal renal tubular acidosis
inability in reabsorption of HCO3 in PCT.
Associated with osteomalacia
Causes include Fanconi syndrome, wilson disease, cystinosis, tetrcyclines, carbonic anhydrase inhibitors
100
Type 4 renal tubular acidosis
Caused by Aldosterone deficiency or resistance
Associated Hyperkalemia
Causes - diabetes, Addison's
101
Conditions associated with thymoma
SLE
SIADH
Myaesthenia gravis
Red cell aplasia
Dermatomyositis
102
Most common cause of Peritonitis in peritoneal dialysis
Coagulase negative Staphylococcus eg: Staphylococcus epidermidis,
Next cause is S aureus
Treated - Vancomycin + Ceftazidime
or Vancomycin + ciprofloxacin
103
Acute intermittent porphyria
Classical combination of abdominal symptoms and neuropsychiatric symptoms.
Caused by lack porphobilinogen deaminase
Autosomal dominant inheritance
Increased urine porphobilinogen levels
Treatment - IV Haematin/ haem arginate
IV glucose
104
Lead poisoning
caused by defective ferrochelatase and ALA dehydratase function.
classic combination of abdominal and neuropsychiatric symptoms with basophilic stippling and blue gum line
Elevated urinary coproporphyrin and delta aminolaevulinic acid
Treated with
DMSA
D-penicillamine
EDTA
Dimecarprol
105
jejunal biopsy showing deposition of macrophages containing Periodic acid-Schiff (PAS) granules is seen in what condition?
Whipple's disease
Classic presentation - Multisystemic symptoms - Athralgia, GI symptoms, weight loss, +/- opthalmoplegia
multisystem condition caused by tropheryma whipplei infection
more Common in HLA B27 positive men.
Treatment - Oral Cotrimoxazole for 1 year. often preceded by IV penicillin
106
Why do celiac disease patients need regular immunizations
Celiac disease has some degree of FUNTIONAL HYPOSPLENISM
Can cause Howell jolly bodies on blood film
107
What form of glomerulonephritis is most associated with HIV nephropathy
Focal segmental glomerulosclerosis
108
Nephritic glomerulonephritis
Rapidly progressive GN (Cresenteric) -
seen in Good pasture disease, ANCA vasculitis
Ig A nephropathy (Berger's disease/Mesangioproliferative) -
seen in Celiac disease, HSP, Post URTI
Alport syndrome
109
Nephrotic glomerulonephritis
Minimal change disease -
mostly seen in children. caused by Lymphoma, NSAIDS
Membranous GN -
most common in adults. seen in malignancy, infectons, rheumatoid drugs
Focal segmental glomerulosclerosis -
Seen in HIV nephropathy
Diabetic nephropathy
Amyloidosis
110
Mixed Nephrotic/Nephritic GN
Diffuse proliferative GN -
Most common in SLE
Post streptococcal GN
Membranoproliferative GN (Mesangiocapillary) -
Type 1 - Hep C, cryoglobulinemia
Type 2 - Partial lipodystrophy
111
MOA of flecanide in tachyarrythmia
blockage of Nav 1.5 sodium channels
side effects
Oral paresthesia
bradycardia
Proarrythmic
negative inotrope
Visual disturbance
112
Markers of poor prognosis in Acute pancreatitis
Hypocalcemia - Fatnecrosis cause use up of calcium
Hyperglycemia
Raised WBC (Neutrophilia)
Raised LDH >350
Raised CRP >150
Hypoxia
Age > 55yrs
113
Side effects of 5-Aminosalicylic acid drugs
Sulphasalazine - MEGALOBLASTIC ANEMIA, OLIGOSPERMIA, RASH, Lung fibrosis
Mesalazine -
Acute pancreatitis, interstitial nephritis, agranulocytosis, headache,
114
Smoking cesssation methods and associated side effects
NRT - Use patch with other forms
Varenicline - can cause abnormal dreams. be careful in those with hx of depression and suicide
Bupropione - be careful in hx of seizures
In pregnancy - 1st line is Psychological support then NRT.
115
Positive cyanide-nitroprusside test
Seen in CYSTINURIA
Autosomal recessive defect in membrane transport of Cystine,ornithine, lysin and arginine
Affected genes are on Chromosome 2 and 19
recurrent renal stones are seen
Treatment
Hydrate
D penicillamine
Urine alkalinization
116
Trastuzumab MOA and side-effect
Monoclonal antibody used in metastatic Breast Ca which targets HER receptors
Major side-effect is Cardiotoxicity
