MSRA Flashcards
what are the features of Crohns verse UC?
Crohns:
Diarrhoea usually non-bloody
Weight loss more prominent
Upper gastrointestinal symptoms, mouth ulcers, perianal disease
Abdominal mass palpable in the right iliac fossa
UC:
Bloody diarrhoea more common
Abdominal pain in the left lower quadrant
Tenesmus
What are the extra-intenstinal features of Crohns verse UC?
Crohns:
Gallstones are more common secondary to reduced bile acid reabsorption
Oxalate renal stone
UC:
Primary sclerosing cholangitis more common
What are the complications and the pathology of crohns verse UC?
Complications of Crohns:
Obstruction, fistula, colorectal cancer
UC complications:
Risk of colorectal cancer high in UC than CD
Pathology of Crohns:
Lesions may be seen anywhere from the mouth to anus
Skip lesions may be present
Pathology of UC:
Inflammation always starts at rectum and never spreads beyond ileocaecal valve
Continuous disease
What are the histological features of Crohns verse UC?
Histology in Crohns: Inflammation in all layers from mucosa to serosa
- increased goblet cells
- granulomas
Histology in UC:
No inflammation beyond submucosa (unless fulminant disease) - inflammatory cell infiltrate in lamina propria
-neutrophils migrate through the walls of glands to form crypt abscesses
-depletion of goblet cells and mucin from gland epithelium
-granulomas are infrequent
What are the endoscopical features of UC verse Crohns?
UC:
Deep ulcers, skip lesions - ‘cobble-stone’ appearance
Crohns:
(‘pseudopolyps’)
what are the radiological signs seen for crohns and UC?
Crohns disease:
Small bowel:
-high sensitivity and specificity for examination of the terminal ileum
-strictures: ‘Kantor’s string sign’
-proximal bowel dilation
-‘rose thorn’ ulcers
-fistulae
UC:
Barium enema
loss of haustrations
superficial ulceration, ‘pseudopolyps’
long standing disease: colon is narrow and short -‘drainpipe colon’
Using the Bamford Classification, which three criteria’s should be assessed?
The following criteria should be assessed:
1. unilateral hemiparesis and/or hemisensory loss of the face, arm & leg
2. homonymous hemianopia
3. higher cognitive dysfunction e.g. dysphasia
What is the diagnostic criteria for DIC?
- low platelets
- low fibrinogen
- high PT and APTT
- high fibrin degradation products
- schistocytes due to MAHA.
Using Bamford Classification, what would a TACI )total anterior circulation infarcts) involve?
Total anterior circulation infarcts (TACI, c. 15%)
involves middle and anterior cerebral arteries
all 3 of the above criteria are present
Using Bamford Classification, how would a Partial Anterior circulation infarct present (PACI?)
-involves smaller arteries of anterior circulation e.g. upper or lower division of middle cerebral artery
- 2 of the above criteria are present
How do Lacunar infarcts present?
involves perforating arteries around the internal capsule, thalamus and basal ganglia
presents with 1 of the following:
1. unilateral weakness (and/or sensory deficit) of face and arm, arm and leg or all three.
2. pure sensory stroke.
3. ataxic hemiparesis
How does POCI (posterior circulation infarcts present?)
involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia
How does Laternal medullary syndrome (PICA- posterior inferior cerebellar artery) present?
aka Wallenberg’s syndrome
ipsilateral: ataxia, nystagmus, dysphagia, facial numbness, cranial nerve palsy e.g. Horner’s
contralateral: limb sensory loss
How does Webers syndrome present?
Weber’s syndrome
-ipsilateral III palsy
-contralateral weakness
where is the stroke localised if referred to by amaurosis fungax? & locked in syndrome.
amaurosis fungax: retinal/opthalmic artery
locked in syndrome: basilar artery
what is the MOA of nicorandil and what are the adverse and contraindications of this drug?
MOA of nicorandil: K activator with vasodilation by activation of guanylyl cylase increasing in cGMP.
adverse effects: headache, flushing, GI and anal ulcers.
contraindications: LV failure
What is the triad of infectious mononucleouss/ glandular fever caused by EBV? & how is it diagnosed?
- sore throat
-pyrexia
-lymphandenopathy : may be present in the anterior and posterior triangles of the neck, in contrast to tonsillitis which typically only results in the upper anterior cervical chain being enlarged.
FBC & Monospot test in the 2nd week of illness.
What are the features of temporal arteritis?
Typically patient > 60 years old
Usually rapid onset (e.g. < 1 month) of unilateral headache
Jaw claudication (65%)
Tender, palpable temporal artery
Raised ESR
What are the features of a cluster headache?
Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks
Intense pain around one eye (recurrent attacks ‘always’ affect same side)
Patient is restless during an attack
Accompanied by redness, lacrimation, lid swelling
More common in men and smokers
Which conditions require 1 week off driving within regulations of DVLA?
- 1 week if ACS treated with angioplastu
- PPM insertion
What is the diagnosis of PBC?
Primary biliary cholangitis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
When do we see on blood film:
1. Heinz Bodies
2. Howell- Jolly
3. Roleau formation
4.increased reticulocytes
5. Schiscocytes
- Heinz bodies is associated with G6PD deficiency. They are caused by damage to haemoglobin from oxidative stress,
- Howell-Jolly bodies is the wrong answer. These are usually present in hyposplenic or asplenic disorders, including megaloblastic anaemia and post-splenectomy patients.
- Rouleaux formation appear as stacks of red blood cells (RBC) on a blood film. This occurs due to an increase in acute-phase proteins, which are positively charged. - seen in various inflammatory conditions and is not exclusive to lymphoproliferative disorders, such as myeloma.
- Reticulocytes are immature RBCs which are typically raised when RBC turnover is increased. can be due to haemolysis (acute haemolytic anaemia) or significant blood loss.
- Schistocytes are fragmented and irregularly-shaped red blood cells which occur in patients with metallic heart valves or haemolytic anaemia.
Side effects of phenytoin?
Phenytoin, an antiepileptic drug, can cause peripheral neuropathy, a condition that results in numbness and tingling in the extremities
Lamatrogine side effects?
skin reactions (including potentially serious ones like Stevens-Johnson syndrome), dizziness, ataxia, and blurred vision.
Sodium valproate side effects?
gastrointestinal disturbances (nausea, vomiting), tremor, weight gain and hair loss. In rare cases, it can cause serious conditions like liver toxicity and pancreatitis.
Levitacetam side effects?
psychiatric symptoms including mood swings and aggression as well as somnolence
which drugs contribute to long QT syndrome?
amiodarone,
sotalol, class 1a antiarrhythmic drugs
tricyclic antidepressants,
selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron
what is the the features of Addisonions? And how is it diagnosed?
Addison’s disease given the clinical features including hypotension, hyperpigmentation, vitiligo (an associated autoimmune condition) combined with electrolyte abnormalities of hyperkalaemia and hyponatraemia. The patient requires treatment with intravenous fluids and intravenous glucocorticoids immediately. After stabilisation, his condition could be diagnosed with a short synacthen test which measures cortisol after a stimulating hormone (synacthen) is given.
What does CRAB stand for when speaking about MM?
‘CRAB’ features of multiple myeloma = hyperCalcaemia, Renal failure, Anaemia (and thrombocytopenia) and Bone fractures/lytic lesions
rouleaux formation is commonly observed due to increased serum protein levels (such as immunoglobulins), resulting in the characteristic stacking of red blood cells resembling a stack of coins.
