MRCP part 1 (2) Flashcards
Mitochondrial diseases
Inherited from maternal genes.
MELAS syndrome - Mitochondrial encephalomyelopathy, lactic acidosis and stroke like episodes
MERRF syndrome - Myoclonic epilepsy with ragged red fibres
Sensorineural hearing loss
Kearnes sayre syndrome - <20, external opthalmoplegia, retinitis pigmentosa, ptosis
Leber’s optic atrophy - central scotoma with rapid loss of vision
Treatment of Diarrhea following ileal resection for crohn’s disease
Oral cholestyramine
MOA of 5 ASA drugs
eg - Sulphasalazin, Mesalazin
act to inhibit local inflammation
Side effects
Sulphasalzine - Oligospermia, rash, headache, megaloblastic anaemia
Mesalazine - Agranulocytosis, Acute pancreatits, GI upset
MOA of Azathioprine
Inhibition of purine synthesis -
It is broken down to mecarptopurine which enters DNA to prevent purine synthesis thus inhibiting rapid proliferation of cells.
MOA of Mycophenolate Mofetil
Inhibition of Inosine monophosphate dehydrogenase thus inhibiting purine synthesis
Management of Ulcerative colitis
INDUCING REMISSION
Mild/moderate disease:
Proctitis - rectal aminosalicylate
Right sided coitis - rectal aminosalicylate
Extensive - rectal aminosalicylate + Oral aminosalicylate
Severe disease
IV steroids / IV ciclosporin
MAINTANING REMISSION
Mild-moderate disease:
Proctits - Topical and/or Oral aminosalicylate
Extensive: - Oral aminosalicylate
Severe disease - Azathioprine/mercaptopurine
Surgery
Management of crohn’s disease
Induction of remission
First line - Steroids or 5ASA
2nd line - 5 ASA
Isolated perianal disease - Metronidazole
Associated Fistula - Infliximab
MAINTAINING INDUCTION
Azathiprine / Mecarptopurine
Surgery
Juice and drug interactions
Grapefruit juice interacts with Statins
Cranberry juice interacts with Warfarin
Risk factors of steroid induced myopathy
Female sex
multisystem disease - DM
Low BMI
Advanced age
Interpretation of DEXA scan
T score
> -1 - Normal
-1 to -2.5 - Osteopenia
< -2.5 - Osteoporosis
Commencing Bone protection for steroid induced osteoporosis
> 65 years or previous fragility fracture - Start bone protection
If<65yrs - Do a bone density scan
If T score:
0 to -1.5 - repeat scan in 1-3yrs
< -1.5 - Start bone protection
Drug-induced impaired glucose tolerance
thiazides, furosemide (less common)
steroids
tacrolimus, ciclosporin
interferon-alpha
nicotinic acid
antipsychotics
Dabigatran reversal agent
Idarucizumab
What are the major complications of ignoring subclinical hyperthyroidism
Atrial Fibrillation
Osteoporosis
Typical xray finding in Lung diseases
Egg shell calcifications of lymph nodes - Silicosis
Bilateral hilar lymphadenopathy - Sarcoidosis, Beryllosis
Mediastinal involvvment - Histoplasmosis
How do you determine the causes of Ascites
Use Serum ascites albumin gradient = Serum albumin - Ascitic albumin
If >11g/dl - Ascites is due to portal hypertension
If <11g/dl - due to protein loss, Cancer, TB, Pancreatitis
How do you classify pleural effusion into exudates and transudates
If pleural fluid protein is
>30g/L - Exudate
<30g/L - Transudates
Causes of false positive non-treponemal (cardiolipin) tests:
pregnancy
SLE, anti-phospholipid syndrome
tuberculosis
leprosy
malaria
HIV
bilateral hilar lymphadenopathy (BHL) + erythema nodosum + fever + polyarthralgia.
Lofgren’s syndrome - form of sarcoidosis
Heertford syndrome
A form of Uveoparotid sarcoidosis
parotid enlargement + fever + uveitis
fever, deranged transaminases, leukopenia and thrombocytopenia in a post-transplant patient
Cytomegalovirus infection
Causes of false negative Tuberculin test
miliary TB
sarcoidosis
HIV
lymphoma
very young age (e.g. < 6 months)
All Immunosuppressive states
Warfarin induced skin necrosis
Seen in Protein deficiency. Prevented by having a bridging course of heparin
