MRCP Word Ax COPY Flashcards
Chemo peripheral neuropathy
Vincristine Cisplatin
Chemo cardiomyopathy
Doxorubicin
Chemo pulmonary fibrosis
Methotrexate
Chemo haemorrhagic cystitis
Cyclophosamide
Anti epileptics safe in pregnancy
Levetiracetam Lamotrigine
Cereberal Toxoplasmosis Tx
Sulfadiazine, Pyrimethamine
Histology Barretts Esophagus
Columnar metaplasia
Electrolyte abnormality worsening digoxin toxicity
Hypokalaemia
Leukaemia “ Broad based projections” Dry tap TRAP +ve
Hairy Cell Leukaemia
Worse prognosis RA
Female Anaemia 3 months Gradual onset +ve IgM RF +ve CCP
Rash with one “herald patch” then spreads
Pityrisias Rosea
Lewy Body Dementia
EPSs Hallucinations Variable sx/GCS
Most common Lupus Antibodie
ANA
Translucent bands bones
Osteomalacia
Punched Out Osteolytic Lesions
Myeloma
Nephritis postive for everything high C3, C4, IgM, IgG
Lupus Nephritis
Neck + shoulder pain, weakness abductor pollicis brevis, pin and needles
Cervical Rib
Polymyositis Antibody
Anti Jo
TB Drugs peripheral neuropathy
Isoniazid
Wernickes vitamin deficiency
Thiamine B1
Feltys Syndrome
Triad : Leucopaenia + RA + Splenomegaly (lympadenopathy, leg ulcers, normocytic anaemia)
Tense blistering rash (not affecting rash)
Bullous Pemphigoid IgG
Farm, haemolytic anaemia, high billrubin, neurology
TTP
Diabetic meds causing hypos
Gliclazide
Negatively bifringent crystals joint asp Monosodium Urate Monohydrate
Gout
Weakly positive bifringent crystals joint asp Calcium pyrophosphate
Pesudogout
Tx Tourettes
Risperidone
Palmar crease xanthaoma (pathognomonic)
Broad beta disease
Subchondral cysts
OA
Periarticular osteopaenia
RA
Osteophytes
OA
Brown/blue pigmentation
Alkaptonuria Homognetistic oxidase deficiency
Cushing K+/pH
Hypokalaemia Alkalosis
Conns K+/pH
Hypokalaemia Alkalosis
Bloody diarrhoea w/ shistocytes
E coli
Main bug causing HUS
E coli
Phenylketonuria
Seizures Eczema LD Musty
Cancer type most like to cause hypercalcaemia
Squamous Cell
Waldenstroms Macroglobulinaemia Ig?
IgM kappa paraprotein
Waldenstroms Macroglobulinaemia
HYPERVISCOCITY Cryoglobulinaemia/Raynauds Hepatosplenomegaly Lymphadenopathy
Lebers Optic Neuropathy inheritance
Mitochondrial
Downs cardiology issues
ASD PDA Fallots Tetralogy Endocardial cushion defect
Downs syndrome ax illness
Duodenal Atresia Leukaemia Esophageal fistulae Hypothyroid
What is Philadephia chromosome
Due to deletion of long arm 22, usually on 9 Prognosis worse without it Also myelofiborosis, polycythaemia vubra vera
Turners syndrome cardiac issues
Coarctation aorta Bicupsid aortic valve
Turners hormones
High gonadotrophin Low estrogen
Noonans features
male turners absence testicles/crypto orchidism
Kleinfelters genetics
47 XXY XXXYY XXYY
Kleinfeltoms features
Tall, thin, gynaecomastia, infertility High urinary gonadotrophins
Women affected more than male genetics
X linked
Mitochondrial inheritance
Maternal transmission V rare Leber optic neuropathy
Li Fraumeni Syndrome
Loss of p53 cancer syndrome Breast, brain, sarcoma
FAP chromosome
Bowel cancer deletion 5q21
Colorectal carcinoma chromosome
18q deletion
Haemochromatosis HLA
HLA A3
Behcets HLA
B5
HLA B27
Ank spod Reiters Psoriatic arthritis Anterior uveitis
HLA DR2
MS Pernicious anaemia Nacrolepsy Juvenile diabetes
HLA DR3
Coeliac Sjogens Hepatitis Addisons SLE Graves, Hashimotos IDDM MG
RA HLA
HLA DR4
Coeliac HLA
HLA DR5, DR7
Gram positive rods
Bacillus Clostridium Listeria
Gram positive cocci
Strep Staph
Gram negative rods
Klebsiella Enterobacter Salmonella Shigella Legionella Campylobacter Pseudomonas
Gram negative cocci
Neisseria
Q fever bug
C burnetti
Most common transmission Hep C
Contaminated blood transfusion IVDU (also sex, vertical) NO VACCINE
Chronic complications Hep C
Cirrhosis Hepatocellular carcinoma
Dengue features
fever headache retro orbital pain back ache rash mucosal haemorrhage, shcok
HIV genetics
single stranded RNA
Immune changes in HIV
decreased CD4, CD8 hypergammaglobulinaemia decreased macrophage
Virus causing T Cell leukaemia
HTLV 1
Virus causing Kaposis sarcoma
HHV 8
HBsAg
Surface antigen = current disease (or carrier)
Anti Hbs
Immune
Anti Hbc
Current or previous infection
HIV test method
ELISA Western blot
Causes of false positive treponomal tests
Genital herpes Psoriasis RA SLE
Egg vaccines
Flu, yellow fever
Live vaccines
MMR Polio Chicken pox Yellow Fever Typhoid
Von Willebrands Rx
DDAPV, TXA
Gauchers disease
Jewish hepatosplenomegaly, anaemia, osteopaenia
Type I cryoglobulin
Waldenstroms
Type II cryoglobulin
Hep C, HIV
Type Iii cryoglobulin
Sjorgens
OD causing respiratory alkalosis
Aspirin, Theophyllines
C1 Inhibitor deficiency
Hereditary angioedema
C2, C4 deficiency (classic pathway)
HSP Glomerulonephritis SLE Strep Staph
C3-C9 deficiency
Recurrent bacterial infection e.g Neisseria
Ataxic Telangoectasia syndrome (inheritance, features, Ig)
autosomal recessive kids - cerebellar ataxia, oculocutaneous telangiectasia, recurrent sinus/lung infections Low IgA, IgE Possible T cell deficiency
Wiskott Aldrich syndrome
X linked recessive Eczema, thrombocytopaenia, recurrent infection Lymph tumours Low antibody, IgM high IgE B and T cell WASP
Raised IgG in liver disease
hepatitis, cryptogenic cirrhosis
Raised IgM in liver disease
biliary/alcoholic cirrhosis
Raised IgA in liver disease
alcoholic cirrhosis
Anti smooth muscle +ve
Hepatits PBS Cirrhosis Viral infection
Anti mitochondrial +ve
PBC Hepatitis Cirroshsi
Gastric parietal cell antibody +ve
Pernicious anaemia Atrophic gastrisi Autoimmune thyroid disease
Thyroid autoantibodies
Hashimotos Graves Hypothyroidism Pernicious Anaemia
ANA +ve
Sjorgens Lupus RA MG Hashimotos UC
cANCA
Wegeners granulomatosis Microscopic polangitis
pANCA
Idiopathic crescentic glomerulonephritis Microscopic polyangitis Churg Strauss
Hyperacute organ rejection presentation
Hours Complemented mediated Vascular spasm, occlusion, failed organ perfusion
Acute organ rejection
Days to weeks HLA incompatibility T cell/CD4
Chronic organ rejection
months-years T Cells
What cells mediate graft versus host disease
T cells
Causes of +ve Coombs test
haemolytic anaemia/tranfusion reactions LSE, lymphoma, leukaemia Methyldopa
Loss of forearm pronation Weak wrist flexion Thenar wasting
Median nerve palsy
Wasting hand muscles, hypothenar Claw hand Radial deviation
Ulnar nerve
Paralysis of knee flexion Foot drop Ankle jerk and plantar reflex absent
Sciatic nerve palsy
What controls motor function
Basal ganglia
Anterior Cerebral Artery Occlusion
weak, numb contralateral leg mild arm signs face spare
Middle Cerebral Artery Occlusion
Contralateral hemiplegia sensory loss face dyphasia/dyspraxia contralateral homonynmous hemianopia
Vertebrobasilar artery occlusion
Hemianopia Cortical Blindness Vertigo, nystagmus hemi/quadraplegia sensory loss, drop attacks, cerebellar sx
Lateral Medullary infarct = Posterior Inferior Cereberal Artery Infarct
vertigo, vomiting, nystagmus TOWARDS lesion ipsilateral hypotonia ataxia horners soft palate paralysis
Brocas dysphasia
Inferolateral frontal lobe non fluent speech comprehension intact
Wernickes dysphasia
posterior superior temporal lobe Fluent speech but errors Issues reading, writing, comprehension
Fanconi syndrome
cystinuria, phosphaturia, RTA 2, glycosuria, rickets/osteomalacia
What do Th1 Helper cells secrete?
Cell mediated immunity IFN gamma IL2, IL3
What do Th2 helper cells secrete?
Humoural immunity IgE IL4, IL4, IL6, IL10, IL13
Nacrolepsy HLA
HLA DR2
Nicotinic Acetylcholine what type of Receptor
Ligand gated
Whats the usual outcome measure of a cohort study?
Relative risk
Fabry disease
Angiokeratomas “corneal whirl” Proteinurias Early MI/stroke
Shistocytes in blood smears
DIC
What type of receptor is ANP
Guanylate cyclase
Chi squared test
Comparing 2 percentages/proprotions
Mechanism of doxy
Inhibits 30s unit ribosomes
Achondroplasia mutation
FGFR3 fibroplast growth receptor
Achondroplasia inheritance
autosomal dominant
Features of achondroplasia
short arms and legs, short, flat nose
Bartters syndrome
Severe hypokalaemia defective chloride absorption Na+/K/Cl cotransporter loop of henle
Tay Sachs disease
lysosomal storage cherry red spot macula no hepatospelnomegaly developmental delay
Mcardles disease
glycogen storage myalgia myoglobinuria
Homocystinuria features
fine, fair hair Marfanoid LD downwards (inferonasal) dislocation of lens VTE also malar flush, livedo reticularis
Pathophysiology of homocystinuria
cystathionine beta synthase
Tetralogy of Fallot
VSD RVH right ventricular outflow tract obstruction, pulmonary stenosis overriding aorta
Goodpasture HLA
HLA DRB1*15:01
Ank spond renal disease
AA amyloidosis - apple green +ve bifringence, enlarged kidneys, heavy proteinuria IgA nephropathy
UC Vs Crohns Transmural inflammation
Crohns
UC Vs Crohns Fissuring ulcers
Crohns
UC Vs Crohns Lymphoid/neutrophil aggregates
Crohns
UC Vs Crohns Mucosa/submucosa only
UC
UC Vs Crohns Crypt Abcesses
UC
UC Vs Crohns Skip lesions
Crohns
UC Vs Crohns Continous inflammation
UC
UC Vs Crohns Transmural/all layers inflammation
Crohns
Few polyps and fhx of cancer
HNPCC
Loads of polyps (100s-1000s) and fhx of cancer
FAP
HIV nephropathy histology
Microcystictubular dilatation Collapsing FSGS
CMV Tx
Gancliclovir
Which antibodies cross the placenta
IgG
Initial therapy for phaeochromocytoma SVT
Phenoxybenzamine
Philadelphia chromosome in ALL good/bad prognosis?
Bad
Weber syndrome
Midbrain stroke THIRD NERVE PALSY SAME SIDE Contralateral hemiparesis and hemiparkinsonism
Wallenberg syndrome
Lateral medullary syndrome Ipsilateral pharyngeal/ palatal palsy Ipsi horner syndrome Ipsi pain/temp loss face Contra pain/temp loss body
MOA/enzyme glitazone
CYP2C8
SVT in pregnancy tx
Beta blocker
Hyperlipoproteinaemia IB mutation
Apolipoprotein CII (APO CII)
Red spots with bluish white centre
Koplik spots Measles
Sheep, lymphadenopathy Fever Sweats Weight loss
Brucellosis
Tx for cholera
Doxy
Which immunoglobulins are responsible for haemolytic blood transfusion reactions?
IgM
Homocystinuria pathophysiology
deficiency of cystathionine beta synthase
Homocystinuria features
fine, fair hair Marfanoid LD downwards (inferonasal) dislocation of lens VTE also malar flush, livedo reticularis
Homocystinuria tx
B6 supplementation
Conditions ax with turners
Cystic hygroma Lymphedema Hypothyroidism Horseshoe kidney Crohns
Features CF
short stature diabetes mellitus delayed puberty rectal prolapse nasal polyps male infertility, female subfertility
Main constituent of pulmonary surfactant
dipalmitoyl phosphatidylcholine (DPPC)
Lesch-Nyhan syndrome
X recessive juvenile gout absence HGPRT orange sand stools
Liddles syndrome
Hypokalaemia HTN
Wilcoxon signed-rank test -
compares two sets of observations on a single sample eg before/after
DiGeorge Mnemonic
‘CATCH22 C - Cardiac abnormalities A - Abnormal facies T - Thymic aplasia C - Cleft palate H - Hypocalcaemia/ hypoparathyroidism 22 - Caused by chromosome 22 deletion
Kearns-Sayre syndrome
mitochondrial inheritance onset < 20-years-old external ophthalmoplegia retinitis pigmentosa
Beckwith-Wiedemann syndrome
organomegaly, macroglossia, abdominal wall defects, Wilm’s tumour neonatal hypoglycaemia.
Complement Leiner disease
C5
Norepinephrine receptor
G protein coupled receptor
Dermatitis herpetiformis HLA
HLA D3
Ligand gated ion receptors
Nicotinic acetylcholine Gaba glutamate
Tyrosine kinase receptors
insulin-like growth factor (IGF), epidermal growth factor (EGF) PIGG(L)ET: Prolactin, Immunomodulators GH, G-CSF, Erythropoietin Thromobopoietin
Guanylate cyclase receptors
ANP/BNP
HLA Psoriasis
HLA CW6
T1 RTA Anion gap
Normal
Lactic Acidosis Anion Gap
Raised
T1 RTA presentation
hyperchloraemic hypokalaemic metabollic acidosis
Linear IgG desposits
anti glomerular basement membrane disease
MOA sitagliptin
DPP-IV inhibitor
Tx cluster headaches
verapamil
Lip smacking seizure - which area of brain
Temporal lobe
CXR “mass surrounded by rim of air”
Aspergilloma
MODY presentation
diabetes without ketones antibody negative autosomal dominant family hx
Latent Autoimmune Diabetes Adult LADA Presentation
Treated as Type 2 for few years High BMS Ketonuria Hx of auto immune
Warm AIHA features
Happens at body temp Anaemia + jaundice +splenomegaly Coombs test +ve
Cold AIHA features
Worse cold temp Raynauds/purplish discoloration (acronyansosis) Coombs test +ve
White turbid fluid joint
Acute Gouty Arthritis
1st step tx aortic dissection
Labetalol
Haemochromatosis inheritance
Autosomal recessive
Haemochromatosis pathophysiology
mutation of HFE on chromosome 6 C282Y (80%) AND H63D (20%) cause decreased hepcidin
Heinz bodies
GP6D deficiency
Howell Jolly bodie
Hyposplenism/splenctomy
Rouleax (blood film)
Waldenstroms, myeloma
Warm AIHA features
Happens at body temp Anaemia + jaundice +splenomegaly
Cold AIHA features
Worse cold temp Raynauds/purplish discoloration (acronyansosis)
Warm AIHA Ig
IgG
Cold AIHA Ig
IgM
What infections does Sickle Cell predispose to ?
encapsulated eg strep pneumoniae, salmonella
What organism causes aplastic sickle cell crisis?
Parvovirus (Causes sudden drop in Hb)
“Pulmonary infiltrates” in sickle cell
Acute chest syndrome
Acute chest syndrome sickle cell presentation
SOB, chest pain, pulmonary infiltrates, hypoxia
Long term tx sickle cell
hydroxyurea
Carcinoid tumour features
tachycardia flushing bronchoconstriction haemodynamic instability diarrhoea
“lambda light chain” in kidney
myeloma amyloidosis
Tramline spine
Ank spond bamboo spine
Rugger Jersey spine
Renal osteodystrophy
Trophozites/cysts in stool culture
Giardia
Type II RTA
Hypokalaemic hyperchloraemic acidosis with low bicarb (high in urine) and high urine pH
Cisplatin side effects
Ototoxicity nephrotoxicity - hypokal, mag, calc
Tx for Hep C
Daclatasvir, sofosbuvir +_ ribavirin
Ciclosporin mechanism
IL2 inhibitor
Small testes, delayed puberty, loss of smell
Klamanns syndrome
Retinal protein responsible for light perception
rhodopsin
Boney lumps DIP
Heberdens nodes OA
Boney lumps PIP
Bouchards node RA
Von Hippel Lindau
Cysts tumours everywhere Chromosome 3 RCC common
Scheuermanns disease
irregular endplates loss of disc space height teenage girls thoracic smooth lump
Hormone change at ovulation
LH surge
Net like rash
Cholesterol emboli
Sickle cell treatment
Hydroxyurea
McArdle disease
Repeated cramping and myoglubinuria (dark drown urine) after exercise
Illness where prophylaxis causing haemolytic anaemia
G6PD deficiency
Hypersegmented neutrophils
Megaloblastic anaemia
Left shift of myeloid cells
Pregnancy, severe infection, CML
Blast cells
AML/ALL
Auer rods
AML
Smear/smudge cells
lymphocytosis usually CLL
Primary thrombocytopaenia features
Bleeds/clots splenic infarcts/atrophy raised megakaryoctyes
Primary thrombocytopaenia tx
hydroxycarbamide, alpha interferon, anagrelide aspirin
Polycythaemia rubra vera features
Clots - headaches, dizziness, VTE, stroke, hepatosplenomegaly
Tear drop poikilocytes
Myelobfibrosis
What condition often turns into myelofibrosis?
PRV
What condition does myleofibrosis often turn into?
AML
Most common leukaemia adults
AML
Philadelphia chromosome in ALL ?prognosis
Poor prognosis
CLL presentation
painless lymphadenopathy + anaemia Smear cells
Reed Sternberg cells “owls eye” appearance
Hodgkins lymphoma
Most common type of Hodgkins
Nodular sclerosing women good prognosis
High number Reed Sternbergs ?Hodgkins type
Mixed cellularity
Best prognosis Hodgkins
Lymphocyte predominant
Worst prognosis Hodgkins
Lymphocyte depleted
Poor prognostic factors in AML
>60 >20% blasts after 1st chemo deletion chromosome 5 or 7
Acute promyelocytic leukaemia genetics and cells
t15:17 fusion of PML and RAR alpha Auer rods
“Increased granulocytes at different stages of maturation +- thrombocytosis”
CML
CML genetics
t9:22 q34:11 BCR-ACL
CML treatment
imatinib - tyrosine kinase inhibitors
Leukaemia presenting with DIC
APML
Good prognostic factors ALL
FAB L1 type common ALL Pre-B phenotype low initial WCC del 9p
Poor prognostic factors ALL
FAB L3 type T or B cell markers Philadelphia <2 or 10< male CNS involvement high WCC not white Hypodiploidy
“monoclonal proliferation well differentiated B lymphocytes”
CLL
Ann Arbor Stage I
single region lymph nodes
Ann Arbor Stage II
2 sites same side of diaphragm
Ann Arbor Stage III
several sites both sides of diaphragm
Ann Arbor Stage IV
extralymphatic structures
Tumour lysis syndrome
High phos, potassium, uric acid Low Ca2+
Mantle cell lymphoma genetics
CD5+, CD19+, CD22+, CD23-, CD10- t11:!4
Follicular lymphoma genetics
t 14:18 BCL 2
TTP antibody
ADAMTS 13
What clotting factor does Von Willebrand process
Factor VIII carrier protein
What factors doe Haemophilla A affect
Factor VIII
What factors doe Haemophilla B affect
IX
DIC blood features
prolonged PT, APTT, thrombin clotting WCC, platelet, fibrinogen low
Chemo agent causing low Mg
cisplatin
Causes of intravascular haemolysis
Blood transfusion G6PD TTP DIC HUS PNH Cold AIHA
Causes of extravascular haemolysis
Sickle cell, thalasaemia Hereditary sphereocytosis Haemolytic of newborn Warm AIHA
Haemophilia PT/APTT
PT normal APPT prolonged
Antiphospholipid pregnancy tx
Aspirin and LMWH
Prognostic marker for myeloma
B2 microglobulin
MOA cisplatin
cross linking DNA
Haem issue causing headache, blurred vision
Waldenstroms
Causes warm AIHA
SLE methyldopa
Causes cold AIHA
Mycoplasma, EBV
Surgical prophylaxis Von Willebrands
Desmo
Leukaemiod reaction (rather than leukaemia)
high leucocyte alkaline phosphatase score Dohle bodies white cells Left shit neutrophils
Von Williebrand PT/APTT
Mildly prolonged APTT
CLL poor prognostic markers
male >70 lymphocyte >50 lymphocyte doubling <12 months raised LDH CD38 TP53 del 17
CLL good prognosis
del 13
Hereditary spherocytosis features
Fhx, gallstones, anaemia splenomegaly FTT EMA binding test
Glutide main side effects
Hypos plus pancreatitis, renal imp, nausea and vomiting
Ca 125
Ovarian Peritoneal
ECOG 0
Normal
ECOG 1
Can’t do strenuous stuff, but ok with work
ECOG 2
Ambulatory and ADLs but not capable of work
ECOG 3
Limited self care, confined to be more than 50% waking
Dapaglifozin SGLT2 risks
DKA Increased cholesterol
Med to reduce risk of tumour lysis
rasbicurase
JAK 2
Thrombocythaemia
Sickle cell HbSC
Mild disease
Hereditary spherocytosis tx
Fluids, high dose folic acid
Diabetes meds contraindicated in CCF
Pioglitazone
G6PD triggers meds
primaquine cipro sulphs
Test for anaphylaxis post reaction
tryptase
Hodgkins poor prognostic markers
weight loss >10% 6 months fever >38 night sweats
Acute intermittent porphyria enzyme defect
Uroporphyrinogen decarboxylase
Factor V Leiden mechanism
resistance to activated protein C
Common cancer tumour lysis syndrome
Burkitts lymphoma
Necrosis following warfarin
Protein C deficiency
What does polycythaemia vubra vera progress to?
Myelofibrosis, AML
Bilobed mononuclear cells
AML
Liver transplant criteria paracetamol OD
pH <7.3 or INR >6.5 + grade 3/4 encephalopathy + Cr >300
Hypovolaemia shock post MI
RV infarct
Most common thyroid cancer
Papillary, great prognosis
Type and MOA pioglitazone, rosiglitazone
PPAR gamma agonist, increase insulin signalling/sensitivity
Conns triad
HTN + hypokalaemia + alkalosis
Conns causes
RAS CAH CCF Corrhosis Nephritic syndrome
Waterhouse Fredichsen
Septicaemia causing adrenal haemorrhage causing addisons
Primary hyperparathyroid
Tumour producing PTH High PTH HIgh Ca2
Secondary hyperparathyroid
Vit d deficiency Low/normal ca High PTH
Tertiary hyperparathyroidism
Secondary hyperparathyroidism goes on for ages causing high PTH, causing high Ca2
Hyperaemic membranes
TSS
Where do SGLT 2 inhibitors glifozins work
Early PCT
Glutide main side effects
Hypos
Indications for surgery in HPTH
<50 CA >0.25 upper lmit eGFR <60 renal stones/nephrocalcinosis osteoporosis sx
Mst common cause primary hyperaldoteronism
Adreanl hyperplasia
Pendred syndrome
Deafness and hypothyroid
MOA gliptins
DPP 4 inhibitors
Dapaglifozin SGLT2 MOA
Stops reabsorption glucose proximal renal tubule
Dapaglifozin SGLT2 risks
DKA
Normal fasting glucose
<6.1
Post glucose /random glucose
<7.8
Kallmans syndrome
Like kleinfelters but low LH, FSH and crypto orchidism
Sulfonylureas MOA
increase insulin secretion B cells and decrease hepatic clearance
MODY 3
most common ax with HNF alpha inc risk HCC
MODY 2 gene
glucokinase
MODY 5
rare cysts HNF 1 beta
Gitelmans syndrome
Defect in Na Cl transporter DCT Normotension Hypokalaemia Hypocalciruia Hypomagnesaemia Met alk
Target HbA1c T1DM
48
Estrogen only HRT risk
Endometrial ca
Supressed by high but low dose dex suppresion test
Cushings disease
Diabetic meds that dont cause hypos
Metformin Glitazones Gliptins
Diabetic meds that do cause hypos
Gliclazides Exanatides
Type and MOA gliclazide, glimperide
Sulfonylureas, inhibit K ATPase
Type and MOA exanatide, lirglutide
GLP 1 stimulates GLP1 receptor, Ca2+ influx, inc insulin
Type and MOA sitagliptin, linagliptin
DDP4 inhibitors Stops breakdown of GLP1
Type and MOA pioglitazone, rosiglitazone
PPAR, increase insulin signalling/sensitivity
Type and MOA empagliflozin, dapagliflozin
SGLT 2 inhibitors inhibit kidney reabsorption of glucose, excretes more in urine
Type and MOA acarbose
alpha glucosidase inhibitor inhibits gut absorption of glucose
What are insulin stress tests used for
Cushings vs pseudo cushings
Addisons electrolyes/ph
Low Na High K Acidotic
Hookworm presentation
itchy rash then resp asthma/allergy sx, the GI upset +- anaemia India
Pseudohypoparathyroidism bloods
PTH: high calcium: low phosphate: high
Pseudohypoparathyroidism features
short fourth and fifth metacarpals short stature cognitive impairment obesity round face
Pseudohypoparathyroidism genetics
G protein mutation auto dom
Well done!
.
Impaired glucose tolerance
7.8-11.1
How to test for Zollinger Ellison
Serum gastrin Ocreotide scan
Impaired fasting glucose
6.1-7
Impaired glucose tolerance
7.8-11.1
Tx Listeria meningitis
aciclovir, cef, ampicillin
Painless solitary genital ulcer
Syphillis
Painless genital ulcer painful lymphadenopathy
Lymphogranuloma verenum
Painful ulcer Painful lymphadenopathy
Chancroid (Haemophilis ducrei)
What does ezetimibe do
redcues intestinal cholesterol absoprtion
CSF TB Meningitis
very low glucose
Enterovirus meningitis
cold, diarrhoea preceding resp/faeco-oral spread creche
Necrotising pneumonia predeing viral illness empyema/abcess
Staph aureus
Adult Stills Disease
Fluctuating salmon Pink rash Arhtralgia Hepatosplenomegaly Fever
Azothiaprine eznyme
TPMT thiopurine methyltranferase
Intracranial bleed with cranial nerves, hyponatraemia, hypokalaemia
Pituitary apoplexy
Cholestrymine on INR
Lower
Abx worsening SE of statin
clarithromycin
SHBG in PCOS
Low
Intoxicated, high BP, high HR, low K+
amphetamines
Muscle weakness in medial epicondylitis/ulnar nerve palsy
adductor pollicis
Hookworm presentation
Rash then resp asthma/allergy sx, the GI upset +- anaemia India
definitive test myotonic dystrophy
Genetic testing
APML tx
all trans retinotic acid ATRA
Reasons to stop stress test
>250/115 2mm ST depression lateral leads
What age to continue HRT to in early menopause
51
Exogenous insulin on C peptide
supresses
How to test for Zollinger Ellison
Serum gastrin
Tx for chlamydia pneumonia
Erythromycin
physiological pred dose for 75kg man
7.5mg
1st line tx OCD
CBT, ERP
Thrombolysis window stroke
4.5 hours
Vitamin supplement in CF
Vitamin A
Hormone pattern PCOS
High LH, normal FSH, normal estradiol, high testosterone
Right sided stroke, DVT ?cause
PFO
Choroid neovascularisation Dye stain leaking at macula ?diagnosis
Age related macular degeneration Tx anti VEGF
SE/caution of tevinor/truvada (HIV med)
renal impairment
Painless transient visual loss Curtain descending ?diagnosis
amaurosis fugax
Amaurosis fugax tx
Clopidogrel
Ulcers ax with RA
Pyoderma gangrenosum
Photosensitive blistering rash Ax with alcohol, HIV, hep, estrogen
Porphyrea cutanea tarda
Intestinal Bacterial Overgrowth
E coli/bacteroides Presents diarrhoea, B12 deficiency tx with metro
Prolactinoma medical management
Cabergoline (dopamine agonist)
Which anti malarials are contra indicated in epilepsy
mefloquine chloroquine
Malaria prophylaxis in pregnancy
chloroquine folate supplements
Causes of raised transfer factor
Asthma Pulmonary haemorrhage Weg/goodp L to R shunt polycythaemia hyperkinetic male exercise age
Causes of low TLCO
Pulmonary fiborsis pneumonoa PE pulmonary edema emphysema anaemia Low cardiac output
Primary Sclerosing cholangitis features
Cholestatis pANCA male jaundice, pruritis, fatigue
PMR symptoms
raised ESR, CRP Weight loss/anorexia Normal CK
Anastrazole mechanism
blocks peripheral tissue conversion of androgen to estrogen
Pneumonectomy eligibility criteria
FEV >2L FEV >50% of FVC Normal PaC02 at rest
When do you use CEA for colorectal ca
post op surveilance
Rhomboid shaped crystals on joint aspiration
pseudogout - pyrophosphate arthritis/chondrocalcinosis
Rash “concentric rings varying colours”
Erythema multiforme
Hep E endemic region
North Africa
Trauma -> muscle wasting of whole hand
T1 nerve root damage
Other antibodies ax with anti phospholipid
anti b2 glycoprotein anti cardiolipin
Dig toxicity
Complete heart block Nausea/vom Yellow vision Brady/hypo
Complete heart block post MI ?which vessel
Posterior interventricular artery
1st line for acne and hirstutism in PCOS
Dianette Co-cyprindol
What causes in renal impairment in rhadomyolysis
Myoglobin
Botulin vs tetanus
Tetanus is rigid paralysis, botulin is flaccid
VTE and nephrotic syndrome
Anti thrombin III deficiency
PPAR drugs
fenofibrate
Immunoglobulin well person, allergic reaction blood
IgA
Familial primary pulmonary HTN sx
SOB, faitgue, angina raised JVP Left parasternal heave pansystolic mrumur S4 peripheral edema
Acanthosis nigricans ax illness
gastric adenocarcinoma, endometrial carcinoma
Cyanotic but not hypoxic
methaemoglobinaemia sulfonamide exposure tx methylene blue
Pneumonia: Young person out of keeping radiology muscle ache cold agglutins
Mycoplasma
Pontine haemorrhage stroke ?Vessel
Basilar artery
Malignant otitis externa
Otitis externa spreading to temporal bone/skull Facial nerve involvement Caused by pseudomonas aeruginosa
Trigeminal neuralgia sx with sensory loss
Tumour
Tx for recurrent renal stones with hypercalciruia
Thiazide diruetic
Indications for pacemaker
persistent symptomatic bradycardia Trifasicular block mobitz type 2 AV block sinus pause >3s
Anterior MI v1-v6
LAD
Septal M1 V1-V4
LAD septal branches
Lateral MI I, aVL, V5, V6
Left circumflex
Inferior MI II, III aVF
Right coronary artery (80%) or Right circumflex (20%)
Posterior MI V7, V8, V9
RCA
Right ventricle MI VI, V4R
RCA
Thoracic Outlet Syndrome
Pulse disappears when arm raised above head pain, parathesia, numb arm Ix doppler
Lipaemic sample pancreatitis
Triglycerides/chylomicrons
Power of study definition
probability of rejecting null hypothesis when its false
Cancer PSC progresses to
cholangiocarcinoma
Digital ischaemia tx
phentolamine
Gabapentin mechanism
binds to alpha 2 delta on voltage gated calcium
Skin plaques and acid fast bacilli
Leprosy
Pramaquine MOA
Removes hypnozites from liver
Somatostatin effect
Reduces gastrin secretion Reduces gastric motility
Modified glasgow pancreatitis criteria
Age O2 WCC Ca ALT LDH Glucose Urea Albumin
2nd line for animal bite
doxy and metro
T2DM med to avoid in gastroparesis
GLPT 1 glutides
Visual change with benign ICH
Enlarged blind spot Constriction visual field
Yellow fever
Flavivirus flu, epigastric pain, bruising, bleeding gums, fever
Doxasoin SE
worsens CCF peripheral edema palpitations
Pseudohypoparathryoidism mechanism
loss of function G protein linked to PTH receptor
Sx constrictive pericarditis
Raised JVP steep Y descent pusatile liver Right heart failure
Kidney disease ax with syphilis
Rapidly porgressive glomerulonephritis
Worst alpha 1 anti trypsin phenotype
PIZZ
Best alpha 1 anti trypsin phenotype
PISS
CYsticerosis
tapeworm lump + seizure
Headache better lying flat
Intracranial hypotension
Tx PHT with multi focal atrial tachcardia
verapamil
MOA propylthiouracil
inhibits conversion thyroxine to tri iodothyonine
Acute pain Small irregular oval pupil photophobia red eye, lacrimation CILLARY FLUSH, hypopyon
Anterior uveitis
Anterior uveitis tx
atropine, cyclopentolate steroid eye drops
Hutchinsons sign HZO
Rash on tip or side of nose nasocillary involvement, strong risk factor ocular involvement
HZO tx
PO anti virals 7-10 days can use topical steroids for any inflammation
Severe pain Decreased visual acuity semi dilated pupil Hazy cornea, halos
Acute angle closure glaucoma
Acute onset pain blurred vision photophobia small, fixed, oval pupil, ciliary flush
Anterior uveitis
Visual loss following surgery Red eye pain
Endopthalmitis
Pathophysiology thyroid eye disease
glycosaminoglycan and collagen deposition in the muscles
Management thyroid eye disease
Lubricants Steroids radiotherapy surgery
Red flags thyroid eye disease
deterioration in vision change in color eye pops out corneal opacity cornea visible when eyes closed disc swelling
Bilateral gritty/discomfort sticky eyes in morning red eyelid margins +- swollen eyelids, styles, chalazions
Blepharitis
Blepharitis tx
Hot compress Lid hygiene artificial tears
Reduced vision faded colour glare halos defect in red reflex
Cataracts
Cataracts risk factors
smoking, DM, alcohol, trauma long term steroids radiation myotonic dystrophy hypocalcaemia
Complications of cataract surgery
posterior capsule opacification retinal detachment endophthalmitis
Keratitis organisms
bacterial - staph a, pseudomonas aeruginosa contact lens funga amoebic keratitis (soil/contaminated water) parasitic onchocercal river blindness HSV exposure
Red eye photophobia foreign body/gritty hypopyon
Keratitis
Management keratitis
topical abx cycloplegic for pain
Complications of keratitis
corneal scarring perforation endopthlamitis visual loss
Redness/swelling severe ocular pain visual disturbance proptosis pain/opthalmoplegia on eye movements eyelid edema/ptosis
Orbital cellulitis
Orbital cellulitis vs preseptal cellulitis
reduced visual acuity, proptosis, pain/opthalmoplegia on eye movements = orbital cellulitis
Floaters Flashers blurred vision Cobwebs across vision dark curtin descending Weiss ring
Posterior vitreous detachment
Posterior vitreous detachment tx
should self resolve if retina tear will need treatment
Risk factors for vitreous detachment
Age Myopia
Cupping of disc
glaucoma
Tx glaucoma
prostaglandin analogue eye drops 2nd line beta blocker, carbonic anhydrase / sympathomimetic
Prostaglandin analogue eye drops
increases uveoscleral outflow brown pigmentation eye, increases eye lash length
Beta block eye drops
avoid in asthmatics or heart block
Sympathomimetics e.g brimonidine
Reduces aqueous production and increased outflow Avoid if taking MAOI or TCA, causes hyperaemia
Carbonic anhydrase inhibitor eyedrops eg Dorzolamide
Reduces aqueous production, sulphonamide like reactions
Miotic eye drops e.g pilocarpine
increase outflow SE constricted pupil, headache, blurred vision
Dry macular degeneration
90% of all Drusen spots - yellow spots in bruchs membrane
Wet macular degeneration
choroidal neovascularisation eudative worst prognosis
ARMD sx
decreased visual acuity (near) poor dark vision fluctuating visual disturbance photopsia/glare distortion of ines Amsler grid red patches/drusen spots
Supplements for dry ARMD
Vit A, C, E and zinc no beta carotene for smokers
Angioid retinal streaks
dark red streaks on fundoscopy caused by breaks in bruchs membrane ax pseudoxanthoma elasticum, ehler danlos, pagets, sickle cell, acromegaly
“plucked chicken” skin
psuedoxanthoma elasticum
Treatment of acute glaucoma
acetazolamide + pilocarpine
What is a Holmes Adie pupil
Dilated and slow to react pupil little/no response to light absent/poor tendon reflexes
“Pale well demarcated disc” on fundoscopy
Optic atrophy
Acquired causes optic atrophy
MS Papilloedema raised IOP Retinal damage ischaemia toxins nutrition B1, B2, B6 , B12
Cogenital causes optic atrophy
Friedreich ataxia Mitochondrial disorders DIDMOAD (DI, DM optic neuropathy, deafness)
Most common RA eye disease
keratoconjunctivitis sicca
RA red eye painless no itch
episcleritis
RA dry, itchy
sicca
RA red painful eye
scleritis
Causes of tunnel vision
papilloedema glaucoma retinitis pigmentosa choroidoretinitis optic atrophy hysteria
Argyll Robertson pupil
accommodate but dont react tertiary syphilis
HZO tx
PO aciclovir
Ramsay hunt
HVV FACIAL nerve (HZO is TRIGEMINAL)
Sudden loss of vision + severe retinal haemorrhages on fundoscopy
Central Retinal Vein Occlusion
Cherry red spot on pale retina
Central retinal artery occlusion
Night blindness + tunnel vision
Retinitis pigmentosa
Confusion and papilloedema
Vit A toxicity
Causes of RAPD
Retina detachment Optic neuritis MS
RAPD (Marcus gunn)
light shone into affected eye both eyes dilate
Kidney disease ax retinitis pigmentosa
Alports syndrome
Visual loss - dense shadow starting peripherally moving inwards
Retinal detachment
Enlarging dark spots in vision
Vitreous haemorrhage
Stage I hypertensive retinopathy
Arteriolar narrowing, tortusoity Increased light reflex, silver wiring
Stage II hypertensive retinopathy
AV nipping
Stage III hypertensive retinopathy
Cotton wool eudates Flame blots haemorrhages
Stage IV hypertensive retinopathy
Papilloedema
Mild NPDR
1 or more microaneurysm
Moderate NPDR
Microaneurysms blot haemorrhage hard excudates cotton wool spots venous beading/lopping
Severe NPDR
blot haemorrhages and microaneurysms 4 quadrants venous beading 2 quadrants IRMA 1 quad
Diabetic Proliferative retinopathy
neovascularisation fibrous tissue ant to disc
Diabetic Maculopathy
hard exudates
Friedrichs ataxia
cerebellar sx L and UMN pes cavus normal IQ optic atrophy pale disc
intracranial bleed causing fluctuating confusion over time
subdural
Tx neuroleptic malignant sydrome
dantrolene
Cancers ax with von hippel lindau
clear cell renal hemangiomas
PD vs drug induced parkinsons
PD = rigid, resting tremor DIP = bilateral sx
Huntingtons genetics
trinucloetide repeat CAG auto dom
MS tx
beta inteferon
GBS paralysis
flaccid hyporefflexia, tachycardia
Miller Fisher syndrome
areflexia, ataxia opthalmoplegia variant of GBS
NF1
Cafe au lait Axillary/groin freckles Peripheral neurofibromas Lisch nodules scolisos phaeochromcytoma
NF2
Bilateral vestibular schwannomas meningomas ependynomas intracranial schawnommas
Tuberous sclerosis
Ash leaf spots adenoma sebaceum shagreen patches subungal fibroms epilepsy develpmental delay retinal haematomas
Migraine acute tx
triptan
Migraine prophylaxis
tompiramate, propanolol
Tx for drug induced PD
benzhexol
“slow relaxing grip”
myotonic dystrophy
Loss of corneal reflex
acoustic neuroma
Dementia and myoclonus
CJD
Autonomic dysfunction +PD/cerebellar signs
multi systems atrophy
Long term prophylaxis cluster headaches
Verapamil
Patchy haemoorahgic change on MRI Head
HSV encephalitis
Thrombectomy window
6 hours
Intracranial bleed - hypodense not confied to suture lines
chronic subdural
Epsilon sign
Right ventricular dysplasia
Test for acute Hep C
HCV RNA
Kussmaul sign
insp inc venous pressure, steep y jvp - perocarditis
tx broad beta
fibrate
NMS vs serotonin
serotonin = myoclonus, hyperreflexic, tremor NMS = rigid
loose bodies in joint
osteochondritis dissecans
onion peel bone
ewings sarcoma
Thailand Subcut nodule pus gram neg bacellie
meliodosis
Main clinicl sign of left ventircular dysfunction
4th heart sound
amitriptyline OD with VT tx
bicarb
Bone mets with breast ca pain relief
Bisphosphonates
Raised ALP, cortical thickening, trabceular pattern
Pagets
PD tx
interfering - levodopa not intefering - dopamine receptor agonist eg ropinrole
Ascending cholangitis
Charcot triad - jaundice, RUQ, Fever Gallstones E coli
Ascending cholangtiis vs cholecystitis
Cholan - charcot triad chole - murphys
Diethylene glycol tox/OD tx
IV ethanol haemodialysis
Tropical med, non specific sx, eosinophilia
helminth/hookworm
Biventricular hypertrophy on ECG
VSD
What type of renal disease is Churg strauss and wegeners
focal segmental glomerulonephritis
MRI: increased signal in pulvinar of thalamus
CJD
Hyperoxaluria/uric oxalate renal stones tx
calcium supplemements
Impaired memory/planning inappropriate behaviour diminishing speech
fronto temporal dementia
Etanacerpt
anti TNF alpha CI in MS. TB
MS CF
oligoclonal bans raised IgG
TB drug course length
TB meningitis 12 months everything else 6 months
Signet ring cells
adenocarcinoma
MOA bupropion
Noradrenaline dopamine reuptake inhibitor
Topiramate side effects
weight loss, renal stones, behaviour change
mechanism of pedal edema in ccf
increased renin
Bronchial carcinoma tumour marker
Chromogranin A
Recurrent infections spanish immunoglobuin deficiency
IgD deficiency
Kearn sayre syndrome
sensineural hearing loss mitochondrial atazia stroke retinitis pgimentose cardiomypathy diabetes
Usher syndrome
retinitis pigmentose, hearing loss
What des BCR ABL code for
tyrosine kinase
Meds causing torticollis or acute dystonia
Prochloperazine, metocloperamide
Nerve root - weakness of thumb, numbness first web space
Radial nerve
NMS tx
dantrolene
Tx paraneoplastic pemphigous
steroids
SE carbimazole
rash pruritis arthalgia alopecia agranucytosis jaundice
Lyme disease test
Borrelia IgG
Irregular plauqe like lesion chronic progressive indurated foreign
Lupus vulgaris
Annular rimmed lesion with punched out hypopigmented centre
Borderline leprosy
Gold standard bronchiectasis diagnosis
HRCT
ECGs sign of impending cardiac arrest hyperkalaemia
prolonged QRS
Tx Neisseria mengitis
Ceftriaxone
RF Ig?
IgM
Why do people with CLL need irradiated blood?
Depletion of donor white cells
Where does 4th heart sounds sit on ECG
After P wave
Night sweats, lethargy, penumonia sx, hypercalcaemia
pulmonary sarcoid
Tx for lupus
hydroxchloroquine life threatening: cyclophosphamide lupus nephritis: mycophenolate mofteil
Tx necrobiosis lipoidica
Topical corticosteroids
Goes into VT whilst pacemaker - where had been touched?
coronary sinus
Tx Whipples disease
IV cef
mucosa appeared yellowed externally with erythematous erosions
Whipples
Dx ank spond if active sx
MRI sacro iliac
Pericarditis ECG
Saddle shaped ST most leads
Bone issue: High ALP low phos Lowish Ca High PTH
Osteomalacia
Pagets disease bloods
isolated ALP rise
Docetaxel renal impairment toxicity
renal tubular toxicity
MOZ tocilizumab
Anti IL 6
Tx for nephrogenic DI
hydrochlorthiazide
MOA baclofen
GABA agonist
Antibodies causing neonatal heart block
Anti RO, anti La
Tx syphilis
penicillin, doxy, azithro
Diabetic med good for heart failure/ CV health
dapagliflozin
SE pyrazinamide
joint pain hepatitis fever
SE rifampicin
thrombocytopaenia, nausea, vom
Cahnce of sibling being a HLA match
25%
Best anti hypertensives if on lithium
Ca channel blockers
2st step DKA tx
fluids
Scale for assessing ALDs
Barthel
Muscle causing fixed flexion deformity
rectus femoris
Virus causing anal cancer
HPV
Tx for Crohns skin/stoma ulcers
SC infliximab
Eplenerone site kidney
Distal PCT
1st line tx urgent thryoid eye disease
IV methylpred
Toxin causing heptaocellular carcinoma
aflatoxin
Positive urine nitroprusside hexagon shaped crystals on urine analysis
cystine stones
Boil breaking down to large painful ulcers
pyoderma gangrenosum
Mechanisms of haemolysis in G6PD
Reduced NADPH
When is 3rd nerve palsy likely compressive
pupil inovolvement
Porphyrias skin AND abdo
variegate porphyria
How long after increasing phenytoin should you check levels
2 weeks
MOA etanercept
TNF alpha
headache, fever myalgia, rash with black centre
mediterrean spotted fever
Can’t sit still
Akthasia
Antidote to beta blocker overdose
IV glucagon
dehydration, sthen seizure, then focal neurology
saggital sinus thrombosis
Study type that has biggest issue with recall bias
case-control
Palm/sole melanoma
acral lentigous
Sun exposed area melanoma
Lentigo maligna
Which polyarteritis isnt ANCA +ve
polyarteritis nodosa
Tropical med + raised Right hemidiaphragmm
amoebic liver abcess
Life threatening warfarin bleed tx
Prothrmobin complex and vit K
Renal disease caused by NSAID
Interstitial nephritis
Pneumonia causing haemolytic anaemia
Mycoplasma
