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Passmed Flashcards

1
Q

What is schistomiasis

A

aka bilharzia - a parasitic flatwork infection

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2
Q

what are the acute symptoms of schistosomiasis

A

swimmers itch
acute schistosomiasis syndrome (katayama fever- fever, urticaria/angioedema, arthralgia/myalgia, cough, diarrhoea, eosinophillia)

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3
Q

what are the symptoms of chronic schistosomiasis

A

Schistosoma haematobium casuse chronic infection
the worms deposit egg clusters in the bladder, causing inflammation.
Calcification seen on x-ray is calcification of the egg clusters
They can cause obstructive uropathy and damage to the kidney
features: frequency, haematuria and bladder calcification

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4
Q

how is schistosomiasis diagnosed?

A

Antibodies
urine or stool microscopy looking for eggs

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5
Q

how is Schistosomiasis managed

A

single oral dose of praziquantel

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6
Q

which type of Schistosoma can cause liver cirrhosis, variceal disease and cor pulmonalse

A

Schistoma mansoni and Schistosoma japonicum

These worms mature in the liver and then travel through the portal system to inhabit the distal colon. Their presence in the portal system can lead to progressive hepatomegaly and splenomegaly due to portal vein congestion.

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7
Q

What on biopsy from OGD suggests gastric adenocarcinoma ?

A

signet ring cells

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8
Q

what are the risk factors for gastric cancer?

A

H.pylori (triggers inflammation of the mucosa which leads to atrophy and intestinal metaplasia)
Atrophic gastritis
diet (salt and salt-preserved foods, nitrates)
smoking
blood group

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9
Q

what are they symptoms of gastric cancer ?

A

abdominal pain (vague, epigastric, dyspepsia)
weight loss
N&V
dysphagia
GI bleeding
supraclavicular lymph node (Virchow’s node)
periumbilical nodule (sister Mary Joeseph’s node )

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10
Q

Investigations for gastric cancer

A

OGD + Biopsy - sinet ring cells may be seen (they contain a large vacuole of mucin which displaces the nucleus to one side) Higher number of signet ring cells are associated with a worse prognosis

Staging CT

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11
Q

management of gastric cancer

A

surgery (endoscopic mucosal resection, partial gastrectomy, total gastrectomy)
chemotherapy

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12
Q

what causes farmers lung

A

Saccharopolyspora rectivigula

Contaminated hay is the most common source of it

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13
Q

what is extrinsic allergic alveolitis?

A

AKA hypersensitivity pneumonitis
A condition caused by hypersensitivity-induced lung damage due to a variety of inhaled organic particles.
It is largely caused by immune-complex mediated tissue dame (type III hypersensitivity), although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in chronic phase)

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14
Q

what are examples of extrinsic allergic alveolitis?

A

Burd fanciers’ lung - avian proteins from bird droppings
farmers lung - spores of Saccharopolyspora rectivirgula from wet hay (formerly Micropolyspora faeni)
malt workers’ lung - aspergillus clavatus
mushroom workers’ lung - thermophilic actinomycetes

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15
Q

How does EAA present?

A

Acute (4-8 hours after exposure) dyspnoea, dry cough, fever
Chronic (occurs weeks-months after exposure)
lethargy, dyspnoea, productive cough, anorexia, weight loss

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16
Q

what are the investigations for EAA?

A

Imaging (upper/mid-zone fibrosis)
Bronchoalveolar lavage - lymphocytosis
serologic assays for specific IgG antibodies
Blood - NO oesinosphilla

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17
Q

Management of EAA

A

avoid precipitating factors
oral glucocorticoids

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18
Q

what are the features of SPB?

A

ascites, abdominal pain, gever

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19
Q

how is SPB diagnosed?

A

neutrophil count > 250 cells/ul
most common organism found is E.coli

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20
Q

what is the management of SPB?

A

IV cefotaxime

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21
Q

who gets SPB prophylaxis and what is the Abx of choice

A

patients who have previously had an episode of SPB
patients with fluid protein <15d/l and either Child-Pugh score of at least 9 or hepatorenal syndrome
Offer prophylactic oral ciprofloxacin or norfloxacin

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22
Q

what are the features that suggest primary hyperaldosteronism?

A

Hypertension
Hypokalaemia
mild alkalosis (raised bicarbonate)

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23
Q

What can excessive ACTH secretion cause?

A

hyperaldosteronism
elevated glucocorticoid activity

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24
Q

what is the most common cause of primary hyperaldosteronism?

A

Bilateral adrenal hyperplasia

It used to be thought that an adrenal adenoma (Conn’s)

Differentiating between the two is important as this determines the treatment.

Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism

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25
Q

what are the investigations for primary hyperaldosteronism?

A

a plasma aldosterone/renin ratio is the first line investigation (should show high aldosterone levels alongside low renin levels - negative feedback due to sodium retention from aldosterone)
Following this a a CT abdo and adrenal vein sampling used to differentiate unilateral and bilateral sources of aldosterone

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26
Q

how is primary hyperaldosteronsism managed?

A

adrenal adenoma: surgery

bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

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27
Q

Autosomal recessive conditions ve autosomal dominant conditions

A

Autosomal recessive conditions are ‘metabolic’ - exceptions: inherited ataxias

Autosomal dominant conditions are ‘structural’ - exceptions: Gilbert’s, hyperlipidaemia type II

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28
Q

what should be used to treat eclampsia whilst the delivery plan is made
what needs to be monitored whilst giving this treatment

A

magnesium sulphate
monitor respiratory rate
also urine output, reflexes and oxygen saturation

** calcium gluconate is the first-line treatment for magnesium sulphate-induced respiratory depression

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29
Q

what are the causes of riased prolactin

A

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

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30
Q

what are the features of raised prolactin

A

men: impotence, loss of libido, galactorrhoea
women: amenorrhoea, galactorrhoea

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31
Q

what skin disorder is associated with gastric cancer?

A

Acanthosis nigricans

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32
Q

what skin condition is associated with lymphoma?

A

Acquired ichthyosis
erythroderma

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33
Q

what skin condition is associated with gastrointestinal and lung cancer?

A

Acquired hypertrichosis lanuginosa

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34
Q

what skin condition is associated with ovarian and lung cancer?

A

Dermatomyositis

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35
Q

what is erythema gyratum rapens associated with?

A

lung cancer

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36
Q

what malignancy is associated with migratory thrombophlebitis?

A

pancreatic cancer

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37
Q

what malignancy is associated with glucagonoma?

A

Necrolytic migratory erythema

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38
Q

what is pyoderma gangrenosum associated with?

A

myeloproloferative disorders

39
Q

what is sweet’s syndrome associated with?

A

Haematological malignancy e.g. Myelodysplasia - tender, purple plaques

40
Q

what is tylosis associated with?

A

oesophageal cancer

41
Q

what are the features of SVC obstruction?

A

dyspnoea is the most common symptom
swelling of the face, neck and arms - conjunctival and periorbital oedema may be seen
headache: often worse in the mornings
visual disturbance
pulseless jugular venous distension

42
Q

what are the causes of SVC obstruction?

A

common malignancies: small cell lung cancer, lymphoma
other malignancies: metastatic seminoma, Kaposi’s sarcoma, breast cancer
aortic aneurysm
mediastinal fibrosis
goitre
SVC thrombosis

43
Q

what is the treatment of cluster headache?

A

100% oxygen and SC triptan
prophylaxis - verapamil

44
Q

what is PCI

A

Percutaneous coronary intervention (PCI) is a technique used to restore myocardial perfusion in patients with ischaemic heart disease, both in patients with stable angina and acute coronary syndromes. Stents are implanted in around 95% of patients - it is now rare for just balloon angioplasty to be performed

45
Q

what are the different typyes of stent used in PCI

A

bare-metal stent (BMS)
drug-eluting stents (DES): stent coated with paclitaxel or rapamycin which inhibit local tissue growth. Whilst this reduces restenosis rates the stent thrombosis rates are increased as the process of stent endothelisation is slowed

46
Q

what medication should be given post PCI stent insertion?

A

he most important factor in preventing stent thrombosis is antiplatelet therapy. Aspirin should be continued indefinitely.

47
Q

complications of PCI

A

bleeding
retroperitoneal haematoma
femoral pseudoaneurysm
cholesterol embolisation (occurs due to embolisation of cholesterol released from atherosclerotic plaques, purpura, livedo reticularis, renal impairment, blue toes

Long term complications - restenosis, stent thrombosis

48
Q

what HLA is haemochromatosis associated with

A

HLA-A3

49
Q

What HLA is bechet’s disease associated with

A

HLA-B51

50
Q

What conditions is HLA B27 associated with?

A

ankylosing spondylitis
reactive arthritis
acute anterior uveitis

51
Q

what HLA is coeliac disease associated with

A

HLA DQ2/DQ8

52
Q

what conditions is HLA-DR2 associated with

A

narcoplepsy
good pastures

53
Q

what conditions is HLA DR3 associated with?

A

Dermatitis herpetiformis
Sjogren’s syndrome
primary biliary cirrhosis

54
Q

what conditions is HLA-DR$ associated with ?

A

type 1 diabetes
RA (in particular the DRB1 gene)

55
Q

what chromosome is HLA antigen encoded by

A

6

56
Q

when suspecting SAH at what point can LP be done?

A

12 hours after the onset of headache

57
Q

what is the treatment for toxoplasmosis?

A

If they are immunocompetent - they don’t usually require treatment
supportive care with fluids and analgesia - most infections are self limiting.

If there is eye involvement - toxoplasma chorioretinitis and those who are immunosuprresed - a combination of pyrimethamine and sulfadiazine is usually given for several weeks.

58
Q

what kind of bacteria is toxoplasmosis?

A

protozoan

59
Q

how do you get infected with toxoplasmosis?

A

via the gastrointestinal tract, lung or broken skin. It’s oocysts release trophozoites which migrate widely around the body including to the eye, brain and muscle.

60
Q

what are the symptoms of cerebral toxoplasmosis?

A

headache
confusion
drowsiness

61
Q

what would a CT show in cerebral toxoplasmosis?

A

single or mutiple ring-enhancing lesions, mass effect may be seen

62
Q

what can congenital toxoplasmosis cause

A

neurological damage- cerebral calcification, hydrocephalus, chorioretinitis
ophthalmic damage- retinopathy, cataracts

63
Q

which type of diabetic medication cause weight gain?

A

Sulfonlyureas cause weight gain (gliclazide)

64
Q

what are the adverse effects of sulfonylureas?

A

hyponatraemia secondary to syndrome of inappropriate ADH secretion
bone marrow suppression
hepatotoxicity (typically cholestatic)
peripheral neuropathy

they should be avoided in pregnancy

65
Q

what is sideroblastic anaemia

A
66
Q

what is sideroblastic anaemia?

A

a condition where the red cells fail to completely for haem
This leads to deposits of iron in the mitochondria that form a ring around the nucleus called a ring sideroblast
it can be congenital or acquired

67
Q

what are the causes of sideroblastic anaemia?

A

Congenital cause: delta-aminolevulinate synthase-2 deficiency

Acquired causes
myelodysplasia
alcohol
lead
anti-TB medications

68
Q

how do you investigate sideroblastic anaemia?

A

full blood count - hypochromic, microcytic anaemia
iron studies - high ferritin, high iron, high transferrin saturation
blood film -basophilic strpplinf of RBC
Bone marrow - prussian blue (also known as perls stain) will show ringed sideroblasts

69
Q

what is HOCM?
How is HOCM inherited?

A

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins

70
Q

what may you see on an ECG in a person with HOCM?

A

left ventricular hypertrophy
non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen
deep Q waves
atrial fibrillation may occasionally be seen

71
Q

what are the characteristics of the heart in someone with HOCM?

A

predominantly diastolic dysfunction - left ventricular hypertrophy - decreased cmpliance - decreased cardiac output
Characterised by myofibrillar hypertrophy with chaotic and disorganised fashion myocytes

72
Q

what are the features of HOCM?

A

often asymptomatic
exerional dyspnoea
angina
syncope (typically following exercise)
sudden death
jerk pulse, large a waves, double apex beat
systolic murmurs -ejection systolic murmur: due to left ventricular outflow tract obstruction. Increases with Valsalva manoeuvre and decreases on squatting
pansystolic murmur: due to systolic anterior motion of the mitral valve → mitral regurgitation

73
Q

what arrhythmia are associated with HOCM

A

friedreich’s ataxia
wolff parkinson white

74
Q

what are the echo findings of HOCM ?

A

Echo findings - mnemonic - MR SAM ASH
mitral regurgitation (MR)
systolic anterior motion (SAM) of the anterior mitral valve leaflet
asymmetric hypertrophy (ASH)

75
Q

what are the adverse effects of levodopa?

A

dyskinesia
‘on-off’ effect
postural hypotension
cardiac arrhythmias
nausea & vomiting
psychosis
reddish discolouration of urine upon standing

76
Q

what is the key pathophysiological feature of metabolic syndrome?

A

insulin resistance

77
Q

how long should you monitor someone after anaphylaxis?

A

6 hours
patients can have a biphasic reaction = this includes a recurrence of symptoms that develop after apparent resolution of the initial reaction

78
Q

management of anaphylaxis

A

IM adrenaline (in adults 500mcg)
can be given every 5 minuites if needed
the best location for the IM injection is he anterolateral aspect of the middle third of the thigh

79
Q

HLAs

A

SjogR3n’s –> HLA-DR3
D3Rmatitis Herpetiformis –> HLA-DR3
Rheumatoid 4rthritis –> HLA-DR4
hA3mochromatosis –> HLA-A3
B5hcet’s disease –> HLA-B51
coeliaQ Disease –> HLA-DQ2/DQ8 (only one with a Q)
naRcolepsy + GoodpastuRe’s –> HLA-DR2 (2 R’s)
Bones (seronegative arthritis, ankylosing spondylitis) –> HLA-B27 (letter B)

80
Q

what drugs affect acetylator status?

A

isoniazid
procainamide
hydralazine
dapsone
sulfasalazine

81
Q

what are drugs exhibiting zero-order kinetics?

A

phenytoin
salicylates (e.g. high-dose aspirin)
heparin
ethanol

82
Q

what is complex regional pain syndrome?

A

Complex regional pain syndrome (CRPS) is a condition that causes severe, persistent pain and swelling, typically affecting one of the limbs. It usually develops after an injury, surgery, or fracture.

83
Q

what in tumour necrosis factor?

A

Tumour necrosis factor (TNF) is a pro-inflammatory cytokine with multiple roles in the immune system. It is secreted mainly by macrophages

84
Q

what are the effects of tumour necrosis factor on the immune system?

A

activates macrophages and neutrophils
acts as costimulator for T cell activation
key mediator of bodies response to Gram negative septicaemia
similar properties to IL-1
anti-tumour effect (e.g. phospholipase activation)

85
Q

what are examples of TNF inhibitors?

A

Examples of TNF inhibitors
infliximab: monoclonal antibody, IV administration
etanercept: fusion protein that mimics the inhibitory effects of naturally occurring soluble TNF receptors, subcutaneous administration
adalimumab: monoclonal antibody, subcutaneous administration
golimumab: subcutaneous administration
adverse effects of TNF blockers include reactivation of latent tuberculosis and demyelination

86
Q

features of anti phospholipid syndrome

A

venous/arterial thrombosis
recurrent miscarriage
Lived reticular
pre-eclampsia, pulmonary hypertension
thrombocytopenia
prolonged APTT

Antibodies - anticardiolipin, anti-beta2 glycoprotein I (anti-bata2GPI) antibodies, lupus anticoagulant

87
Q

which type of thyroid cancer is associated with hashimoto/autoimmune thyroiditis

A

thyroid lymphoma

88
Q

what are contraindications to the TB vaccine?

A

previous BCG vaccination
a past history of tuberculosis
HIV
pregnancy
positive tuberculin test (Heaf or Mantoux)

89
Q

what is the mechanism of action of mycophenolate?

A

Mycophenolate mofetil (MMF) reduces lymphocyte production through inhibition of iosine-5’-monophosphate dehydrogenase which is needed for purine synthesis

90
Q

what is the most common cause of bladder calcification world wide?

A

Schistosomiasis

91
Q

What is schistomosoma haematobium?
how is it managed?

A

These worms deposit egg clusters (pseudopapillomas) in the bladder, causing inflammation. The calcification seen on x-ray is actually calcification of the egg clusters, not the bladder itself.
single dose of praziquantel

92
Q

what ate the adverse effects of Bisphosphonates?

A

oesophageal reactions: oesophagitis, oesophageal ulcers (especially alendronate)
osteonecrosis of the jaw
increased risk of atypical stress fractures of the proximal femoral shaft in patients taking alendronate
acute phase response - fever, myalgia and arthralgia
hypocalcaemia

93
Q

How do you council a patient to take bisphosphonates?

A

Tablets should be swallowed whole with plenty of water while sitting or standing; to be given on an empty stomach at least 30 minutes before breakfast (or another oral medication); patient should stand or sit upright for at least 30 minutes after taking tablet’

MRCP (18 decks)

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