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REVISION > PASSMED 4 > Flashcards

PASSMED 4 Flashcards

1
Q

what is loefflers endocarditis?

A

a rare restrictive cardiomyopathy caused by abnormal endomyocardial infiltration of eosinophils, with subsequent tissue damage from degranulation, eventually leading to fibrosis.

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2
Q

classic causes of restrictive cardiomyopathy?

A

amyoloidos
post-radiotherapy
loefflers endocarditis

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3
Q

does paracetamol give a hepatic or cholestastic liver disease picture?

A

hepatic

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4
Q

does COCP give a hepatic or cholestastic liver disease picture?

A

cholestatic

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5
Q

does sodium valproate give a hepatic or cholestastic liver disease picture?

A

hepatic

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6
Q

does phenytoin give a hepatic or cholestastic liver disease picture?

A

hepatic

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7
Q

do antibiotics such as flucloxacillin/co-amox give a hepatic or cholestastic liver disease picture?

A

cholestatic

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8
Q

do MAOIs give a hepatic or cholestastic liver disease picture?

A

hepatic

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9
Q

do sulphonylureas give a hepatic or cholestastic liver disease picture?

A

cholestatic

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10
Q

do statins give a hepatic or cholestastic liver disease picture?

A

hepatic

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11
Q

does anti-TB drugs give a hepatic or cholestastic liver disease picture?

A

hepatic

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12
Q

do anabolic steroids give a hepatic or cholestastic liver disease picture?

A

cholestatic

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13
Q

does amiodarone give a hepatic or cholestastic liver disease picture?

A

hepatic

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14
Q

does methyldopa give a hepatic or cholestastic liver disease picture?

A

hepatic

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15
Q

do phenothiazines e.g. chlorpromazine give a hepatic or cholestastic liver disease picture?

A

cholestatic

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16
Q

does nitrofurantoin give a hepatic or cholestastic liver disease picture?

A

hepatic

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17
Q

do fibrates give a hepatic or cholestastic liver disease picture?

A

cholestatic

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18
Q

which groups of patients are at increased risk of developing hepatotoxicity following paracetamol OD?

A

patients taking liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John’s Wort)
malnourished patients (e.g. anorexia nervosa) or patients who have not eaten for a few days

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19
Q

what scoring tool is used to determine if a pt with paracetamol liver failure requires a liver transplantation?

A

kings college hospital criteria for liver transplantation

arterial ph <7.3 24 hours after ingestion

or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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20
Q

LFT results in ischaemic hepatitis?

A

ALT is >1000 or 50x the upper limit of normal

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21
Q

AST:ALT in acute alcoolic hepatitis?

A

> 2:1

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22
Q

ALP rise with normal GGT indicates….?

A

bone disease
if GGT rise too then cholestasis is more likely

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23
Q

antibodies in autoimmune hepatitis type 1? what age does it affect?

A

ANA
anti-SMA

adults & children

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24
Q

antibodies in autoimmune hepatitis type 2? what age does it affect?

A

anti-liver/kidney microsomal type 1 antibodies (LKM1)

children

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25
Q

antibodies in autoimmune hepatitis type 3? what age does it affect?

A

soluble liver-kidney antigen

middle-aged adults

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26
Q

diagnostic investigation for PSC?

A

ERCP or MRCP showing multiple biliary strictures giving a beaded appearance

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27
Q

how can carcinoid syndrome affect the heart?

A

it can affect the right side
tricuspid insuffcnecy and pulmonary stenosis

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28
Q

which Parkinson’s drugs provide the most improvement in motor symptoms?

A

levodopa

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29
Q

which Parkinson’s drugs provide the most improvement in ADLs?

A

levodopa

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30
Q

which Parkinson’s drugs causes the most motor compilations?

A

levodopa

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31
Q

which Parkinson’s drugs causes more adverse events?

A

dopamine agonists and COMTi

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32
Q

what are the main adverse effects of dopamine agonists?

A

excessive sleepiness
hallucinations
impulse control disorders
nasal congestion and postural hypotension are sometimes seen

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33
Q

inducer or inhibitor of the P450 system: AEDs?

A

inducer

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34
Q

inducer or inhibitor of the P450 system: barbiturates?

A

inducer

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35
Q

inducer or inhibitor of the P450 system: ciprofloxacin ?

A

inhibitor

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36
Q

inducer or inhibitor of the P450 system: rifampicin ?

A

inducer

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37
Q

inducer or inhibitor of the P450 system: erythromycin?

A

inhibitor

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38
Q

inducer or inhibitor of the P450 system: st johns wort?

A

inducer

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39
Q

inducer or inhibitor of the P450 system: isioniazid?

A

inhibitor

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40
Q

inducer or inhibitor of the P450 system: amiodarone?

A

inhibitor

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41
Q

inducer or inhibitor of the P450 system: allopurinol?

A

inhibitor

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42
Q

inducer or inhibitor of the P450 system: SSRIs?

A

inhibitor

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43
Q

inducer or inhibitor of the P450 system: chronic alcohol intake?

A

inducer

44
Q

inducer or inhibitor of the P450 system: amiodarone?

A

inhibitor

45
Q

inducer or inhibitor of the P450 system: griseofulvin?

A

inducer

46
Q

inducer or inhibitor of the P450 system: smoking?

A

inducer

47
Q

inducer or inhibitor of the P450 system: allopurinol?

A

inhibitor

48
Q

inducer or inhibitor of the P450 system: imidazole e.g. ketoconazole?

A

inhibitor

49
Q

inducer or inhibitor of the P450 system: acute alcohol intake?

A

inhibitor

50
Q

inducer or inhibitor of the P450 system: sodium valproate?

A

inhibitor

51
Q

inducer or inhibitor of the P450 system: steroids?

A

inducers

52
Q

inducer or inhibitor of the P450 system: grapefruit?

A

inhibitor

53
Q

features of thyroid storm

A

fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test - jaundice may be seen clinically

54
Q

precipitating events of thyroid storm?

A

thyroid or non-thyroidal surgery
trauma
infection
acute iodine load e.g. CT contrast media

55
Q

features of giardiasis?

A

prolonged non-bloody diarrhoea
steatorrhoea
bloating, abdominal pain
lethargy
flatulence
weight loss
malabsorption and lactose intolerance can occur

56
Q

features of campylobacter?

A

A flu-like prodrome is usually followed by crampy abdominal pains, fever and diarrhoea which may be bloody
May mimic appendicitis

57
Q

most common cause of primary hyperparathyroidism/

A

solitary parathyroid adenoma

58
Q

blood results for Ca, phos and PTH in primary hyperparathyroidism?

A

raised Ca2+
low phos
low or normal vit D
PTH raised or inappropriately normal

59
Q

blood results for Ca, phos, vit D and PTH in secondary hyperparathyroidism?

A

Ca normal or low
Phos raised
vit D low
PTH raised

60
Q

blood results for Ca, phos, vit D and PTH in tertiary hyperparathyroidism?

A

Ca normal or high
phos low or normal
vit D normal or low
PTH raised

61
Q

urine osmolality, serum osmolality and urine sodium conc in SIADH?

A

urine osmolality high
serum osmolality low
urine sodium high

62
Q

causes of nephrogenic DI?

A

genetic
hypercalcaemia
hypokalaemia
lithium
demeclocyline
tubful-interstitial disease e.g. sickle cell or pyelonephritis

63
Q

urine osmolality, serum osmolality and water deprivation test results in nephrogenic diabetes insipidus?

A

high plasma osmolality
low urine osmolality
after water deprivation urine osmolality is still low <300

64
Q

urine osmolality, serum osmolality and water deprivation test results in cranial diabetes insipidus?

A

high plasma osmolality
low urine osmolality
after water deprivation urine osmolality increases >600

65
Q

urine osmolality, serum osmolality and water deprivation test results in psychogenic diabetes insipidus?

A

low plasma osmolality
high urine osmolality
after water deprivation urine osmolality is still high and no change really occurs

66
Q

mm for ST elevation in leads V2-3?

A

men:
if under 40 - >=2.5mm
if over 40 - >=2.0

women:
1.5mm

67
Q

mm for ST elevation in all leads except for V2-3?

A

> =1.0mm

68
Q

cause of a scrotal swelling that you cannot get above on examination?

A

inguinal herna

69
Q

scrotal swolling cause that you can get above and lies above and behind the testicle?

A

epididymal cyst

70
Q

MOA of digoxin?

A

increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump

decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter

also stimulates the vagus nerve

71
Q

features of digoxin toxicity?

A

generally unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)
gynaecomastia

72
Q

examples of class 1 antiarrhythmic drugs? MOA?

A

quinidine
procainamide
disopyramide

inhibit sodium channels

73
Q

examples of class 2 antiarrhythmic drugs? MOA?

A

propanolol and bisoprolol

act on AV node to reduce conduction and have variable selective action on beta-1 and -2 receptors

74
Q

examples of class 3 antiarrhythmic drugs? MOA?

A

amiodarone and sotalol

block K+ channels to extend the refractory period and prolong the cardiac action potential

75
Q

examples of class 4 antiarrhythmic drugs? MOA?

A

verapamil and diltiazem
non-dihydropyridine CCB which block L-type Ca2+ channels and cause spontaneous depolarisation
negative inotropes and chronotropes

76
Q

MOA of adenosine?

A

Agonism of adenosine receptors A1 and A2 = induces K+ efflux and inhibiting Ca2+ influx through channels in nerve cells =hyperpolarization = reduces conduction time in AVN

77
Q

ECG features of digoxin?

A

down-sloping ST depression (‘reverse tick’, ‘scooped out’)
flattened/inverted T waves
short QT interval
arrhythmias e.g. AV block, bradycardia

78
Q

features of organophosphate insecticide poisoning?

A

SLUD:
Salivation
Lacrimation
Urination increased
Diarroea and diaphoresis

hypotension, bardcardia, miosis and muscle fasciculations

79
Q

blood film findings in G6PD deficiency?

A

Heinz bodies
bite cells
blister cells

80
Q

what drugs can cause haemolysis in G6PD deficiency?

A

anti-malarials: primaquine
ciprofloxacin
sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

81
Q

inheritance pattern of G6PD deficiency?

A

x-linked recessive

82
Q

typical ethnicity of G6P deficiency?

A

african
mediterranean

83
Q

inheritance pattern of hereditary spherocytosis?

A

AD

84
Q

typical ethnicity of hereditary sperocytosis?

A

northern european

85
Q

in BV there is an overgrowth of….

A

Grdnerella vaginalis (this leads to a fall in lactic acid producing aerobic lactobacilli resulting in raised vaginal PH)

86
Q

what criteria is used for BV diagnosis?

A

Amsel’s criteria

3 of the following 4 points should be present:
thin, white homogenous discharge
clue cells on microscopy: stippled vaginal epithelial cells
vaginal pH > 4.5
positive whiff test (addition of potassium hydroxide results in fishy odour)

87
Q

is low or high calcium a poor prognostic sign for pancreatitis?

A

low

88
Q

difference between Glasgow-Imrie and Ranson score for pancreatitis?

A

Ranson score uses a smaller range of clinical and biochemical markers; first at admission then again at 48 hours, to generate a predictive score of mortality.

Glasgow-Imrie score assesses the severity

89
Q

pre-renal, intra-renal and post-renal urinary Na+ findings?

A

pre-renal <20
intra and post-renal >40

90
Q

metabolic abnormalities in refeeding syndrome?

A

low phosphate, magnesium and potassium

91
Q

microscopic findings in crohns?

A

increased goblet cells
granulomas
rose-thorn ulcers

92
Q

microscopic findings in UC?

A

crypt abscess
decreased goblet cells
pseudopolyps

93
Q

how does H.pylori affect risk of barretts oesophagus and why?

A

decreases the risk as the gastric atrophy leads to decreased secretion of gastric acid, reducing reflux

94
Q

outline Duke’s staging for bowel cancer?

A

A - limited to the mucos
B - in bowel wall
C - lymph node mets +/- through bowel wall
D - distant mets

95
Q

inducing remission and maintenance Tx in crohns?

A

steroids
azathioprine or mercaptopurine

96
Q

inducing remission and maintenance Tx in UC?

A

topical aminosalicylates (unless severe then steroids)
aminosalicylates for maintenance too

97
Q

how common are DVTs associated with PICC lines?

A

incidence is about 5%

98
Q

consequences of prolonged PPI use?

A

osteoporosis
hypomagnesium
hyponatraemia
microscopic colitis
increased risk of c.diff

99
Q

why may allopurinol given with azathioprine in some cases of IBD?

A

allopurinol inhivits xanthine oxidase
xanthine oxidase usually cleaves 6MP which is azathioprine’s metabolite. reducing xanthine oxidase means more 6MP is converted to azathioprine’s active metabolite of 6TGNs. this can be useful for patients who are non-responders!
however increased plasma concentrations of the active metabolites may lead to life-threatening leukopenia, thrombocytopenia or pancytopenia!!

100
Q

what is budd-chiari syndrome? what is it associated with?

A

hepatic vein thrombosis - obstruction to the outflow of blood from the liver
associated with hpercoagulable states e.g. plycythemia, thrombophilia, pregnancy and COCP

101
Q

triad of budd-chiari syndrome?

A

abdominal pain
tender hepatomegaly
ascites

102
Q

diagnostic investigation for budd-chiari syndrome?

A

doppler USS

103
Q

what is mirizzi syndrome?

A

when a gallstone is located I Hartmanns pouch of the gallbladder, or in the cystic duct and causes compression on the adjacent common hepatic duct resting in obstructive jaundice
its one of the rare times when acute cholecystitis can present with jaundice

104
Q

what does this barium swallow show?

A

oesophageal cancer

105
Q

what does this barium swallow show?

A

achalasia - birds beak appearance

106
Q

what does this barium swallow show?

A

pharyngeal pouch - out pouching of posterior hypo pharyngeal wall at C5-C6

107
Q

what’s the most sensitive test for hiatus hernia?

A

barium swallow (although most pt will have endoscopy and find hiatus hernia incidentally)

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