PASSMED + MISCELLANEOUS Flashcards
Which immunoglobulin is first to be secreted in response to an infection?
IgM
What type of bacteria is E. coli?
aerobic gram-negative rod
What is the mechanism of action of loop diuretics (furosemide)?
Prevents reabsorption of sodium, chloride, and potassium by inhibition of the cotransporter in the thick ascending loop of Henle. This causes significant diuresis.
What drugs exhibit zero order kinetics? What is zero order kinetics?
phenytoin, alcohol and salicylates
- drugs in which the clearance rate depends on an easily saturated enzyme system. As soon as the system is saturated, the rate of clearance plateaus, and does not vary no matter how much drug is present. This results in a constant rate of elimination predisposing to high levels of the drug and toxicity.
What are the following associated with; (i) HLA-A3 (ii) HLA-B5 (iii) HLA- DR3 (iv) HLA-DR4 (v) HLA-B27?
(i) haemochromatosis
(ii) Behcet’s disease
(iii) dermatitis herpetiformis
(iv) diabetes mellitus and rheumatoid arthritis
(v) ankylosing spondylitis
What is the investigation of choice to confirm a diagnosis of bronchiectasis?
High resolution computerised tomography
What does the interior mesenteric vein drain into?
Splenic vein
Which part of the jugular venous waveform is associated with the closure of the tricuspid valve?
c wave
Name a common Parametric test.
Students T-test
Which pathogen is responsible for the majority of cases of croup?
Parainfluenza
Where in the atrium is the atrial myxoma most likely to be attached?
fossa ovalis
What is the blood supply of the AV node in the majority of patients?
In 80% of patients, the atrioventricular node is supplied by the right coronary artery
Which cells express IgE receptors on their cell surface?
Mast cells and basophils
What is the most common type of colorectal carcinoma?
adenocarcinoma
What is the blood supply of the parathyroid gland?
the super and inferior thyroid arteries
Which nerve is responsible for the sensory innervation of the tonsillar fossa?
glossopharyngeal
What cells mediate hyperacute organ rejection?
B cells
What are the risk factors for developing active tuberculosis?
- silicosis
- chronic renal failure
- HIV positive
- solid organ transplantation with immunosuppression
- intravenous drug use
- haematological malignancy
- anti-TNF treatment
- previous gastrectomy
What does the paramesonephric (Mullerian) duct give rise to?
gives rise to the fallopian tubes, uterus and upper 1/3 of the vagina in females, whereas it regresses in males
Define (i) gravidity (ii) parity.
(i) total number of confirmed pregnancies, regardless of the outcome
(ii) number of births post 24 weeks gestation
What supplements are women advised to take during/pre-pregnancy?
vitamin D and folic acid
What is defined as (i) conception (ii) EDD?
(i) 2 weeks after the first day of LMP with a regular 28 day cycle
(ii) naegele’s rule = add 9 months + 7 days of LMP (pregnancy 38 wks from conception and 40 from LMP)
When is a trisomy 21 screen performed? What defects are associated?
At 8-14 weeks
- prevalence increases with increasing age, most are secondary to non-disjunction of chromosome 21 at meiosis
- 46% have VSD or ASD
What is the second most common kind of trisomy? Describe its features.
trisomy 18 (Edward’s syndrome)
- survival beyond 1 year is rare
- small chin, low-set ears, rocher bottom feet, VSD
What advice is given to women with pre-existing diabetes prior to conception?
- weight loss (reduce BMI less than 30)
- folic acid 5mg OD in month prior + to 13 wks
- Alcohol/smoking/exercise and diet
- Screening: retinal and nephropathy
How is shoulder dystocia managed?
- McRoberts manoeuvre
2. Episiotomy allows for better access for internal manoeuvres
What are the (i) risk factors (ii) diagnostic criteria for gestational diabetes?
(i) BMI more than 30, prev macrosomic baby (more than 4.5kg), previous GDM, family origin with high prevalnce DM (S. Asian, Black Carribean, Middle eastern)
(ii) fasting glucose more than 5.6 mmol/L
2 hr plasma glucose more than 7.8 mmol/L
What are the symptoms of pre-eclampsia?
- severe headache, especially frontal
- problems with vision; blurring and flashing
- severe pain just below ribs (epigastric, RUQ)
- vomiting and nausea
- sudden swelling of FACE, hands, or feet
What increases risk of pre-eclampsia? What are these woman advised to take?
- hypertensive disease in previous pregnancy, CKD, autoimmune, DM, chronic HTN
- take 75 mg aspirin daily from 12 wks gestation until delivery
What should pregnant females with chronic hypertension have their BP medication switched to? Should they also add anything else?
- switch to labetolol and/or methyldopa
- add 75mg aspirin from 12 wks gestation
How is pregnancy induced hypertension managed?
Methyldopa or nifedipine (NOT labetolol)
What is eclampsia? How is it managed?
tonic-clonic seizure + pre-eclampsia
- an obstetric emergency
IV magnesium sulphate to treat and prevent seizures
- stop if RR less than 12 or tendon reflex lost or urine output less than 20ml/hr
- if develop toxicity give calcium glucoronate infusion
What are 3 dangerous causes of antepartum haemorrhage?
- abruption
- placenta praevia
- vasa paevia
What is primary sclerosing cholangitis strongly associated with? What is the initial diagnostic investigation?
Ulcerative colitis
- MRCP and shows a beaded appearance of the bile duct
What 3 histological features suggest carcinoma in all sites of the body?
Nuclear enlargement
Hyperchromasia
Pleomorphism
What is the first line treatment for an overactive bladder with urge incontinence?
Immediate release anticholinergics (oral oxybutynin)
What is the initial treatment for a paralytic ileus?
making patient nil by mouth and inserting a nasogastric tube
What vessel may be a major source of haemorrhage in peptic ulcer disease?
Gastroduodenal artery as it runs posterior to 1st and 2nd parts of duodenum
What does polycystic ovarian syndrome cause?
Increased ratio of LH:FSH, plus oligomenorrhoea and often overweight BMI
- sometimes pts have a mild elevation in prolactin
What is the use of anti tissue transglutaminase?
to diagnose coeliacs
What are the different symptomatic presentations between and duodenal ulcer and a gastric ulcer?
Duodenal tend to be made worse with stress and pain is worse at night, radiating into the back. It is relieved by eating and so patients tend to put weight on
- gastric is made worse with eating and so patients often lose weight
Describe the symptoms of inflammatory back pain (IBP).
Normally improves with activity and not relieved by rest, mechanical pain is the opposite
IBP can wake pt in early hours of the morning + sacroilieitis can radiate to the thigh
- morning stiffness is specific for IBP but not persistent daytime stiffness
How should terminal restlessness be managed?
midazolam
- either PRN subcut injections or continuous subcut infusions via syringe driver
In early Alzheimers, where are brain changes most likely to be found?
temporal lobes
What is the treatment of choice in pts with broad QRS complexes following tricyclic antidepressant overdose?
IV sodium bicarbonate
What drug can cause pulmonary fibrosis? What symptoms arise?
Amiodarone
- doesn’t cause clubbing. Patients present with cough and dyspnoea, fever and raised WCC and raised ESR not uncommon
What is the MoA of ADH?
stimulates AQP-2 in apical membrane of collecting duct which promotes water reabsorption
- leading to dilutional hyponatraemia
What is autosomal dominant polycystic kidney disease associated with?
Subarachnoid haemorrhage
Define (i) postmyalgia rheumatica (ii) osteomalacia
(I) pain and stiffness in shoulder muscles in pts over 65. Inflammation of bones and joints, treat with steroids
(ii) “soft bones” weak, more likely to bend and break. Low vit D and low calcium
What drug do antacid reduce the absorption of?
ACE-I
What is the inguinal ligament formed by?
external oblique aponeurosis
Describe what the findings of Rinnes and Webers test indicate? (in terms of sensorineural or conductive deafness)
WEBERS: (tuning fork on forehead)
- unilateral conductive hearing loss = louder in deaf (affected ear)
- unilateral sensorineural = sound louder in normal ear
RINNE if louder in air than bone = positive test
- negative rinne = conductive hearing loss
What are the features of a hyatidiform mole?
- bleeding in the first and early second trimester
- exaggerated symptoms of pregnancy
- uterus large for dates
- very high serum levels hCG
- hypertension and hyperthyroid
What is calcitonin clinically used to screen for?
medullary cancer recurrence
What is the most common cause of travellers diarrhoea?
E.coli
How much B12 does the body store? How long does it last for?
2-3 mg that last for 2-4 years
What is sick euthyroid?
presence of low TSH, T3 and/or T4 with a normal functioning thyroid
- seen during periods of illness but recovers when illness is over and so is treatment supportive
What is a contraindication for use of the oral contraceptive pill?
migraine with aura
What are the levels of methylmalonic acid like in B12 and folate deficiency?
raised in B12 and normal in folate
What is used to manage opioid (heroin) overdose?
naloxone
What are the features of acne rosacea? What is the treatment?
- affects nose, cheeks and forehead
- flushing is often the first symptom
- telangiectasia is common
- later develops into persistent erythema with papules and pustules
- rhinophyma
- ocular involvement (blepharitis)
treat with topical metronidazole, if severe symptoms use antibiotics (oxytetracycline)
What is the recommended treatment for asystole?
epinephrine
What is the treatment for (i) bacterial vaginosis (ii) trichomoniasis (ii) gonorrhoea?
(i) oral metronidazole
(ii) oral metronidazole
(iii) IM ceftriaxone and oral azithromycin
If a patient is on methotrexate, what drug should be avoided?
trimethoprim
What is the treatment for a post menopausal woman with a hip fracture?
biphosphonates (risedronate)
What are the 3 indications for the use of electroconvulsive therapy?
- catatonia
- prolonged/severe manic episode
- severe depression that is life threatening
What is schistosoma infection associated with?
risk of developing squamous cell carcinoma of bladder
What are the triad of symptoms in Meigs syndrome?
- benign ovarian tumour (fibroma)
- ascites
- pleural effusion
What is kaposi’s sarcoma caused by?
HHV-8
What are the risk factors for sudden infant death syndrome (SIDS)?
- prone sleeping
- parental smoking
- bed sharing
- hyperthermia and head covering
- prematurity
When is pulsus alternans present?
patients with heart failure
third heart sound is a feature of LHF
What is the most common ovarian cancer?
serous carcinoma
What is premature ovarian failure (POM) defined as?
cessation of menses for 1 year before the age of 40
What are the following tumour markers used for; (i) CA125 (ii) CA 19-9 (ii) CA 15-3 (iv) AFP (v) CEA (vi) S-100 (vii) bombesin
(i) ovarian cancer
(ii) pancreatic cancer
(iii) breast cancer
(iv) hepatocellular carcinoma
(v) colorectal cancer
(vi) melanoma, schwannomas
(vii) small cell lung carcinoma, gastric cancer, neuroblastoma
What is the SSRI of choice in children and adolescents?
fluoxetine
What are the 3 main side effects of GTN?
hypotension
tachycardia
headache
How long is the incubation period of ebola?
2-21 days
What does a painful third nerve palsy indicate?
posterior communicating artery aneurysm
What is the MoA of loperamide?
reduces gastric motility through stimulation of opioid receptors
What does any patient undergoing hip replacement require as DVT prophylaxis?
TED stockings and dalteparin sodium started at least 6 hrs post op
What is pulsus paradoxus present in?
cardiac tamponade (jerky pulse = hypertrophic obstructive cardiomyopathy)
What is a main side effect of isoniazid?
can cause B6 deficiency causing peripheral neuropathy
What is the treatment for tonsilitis?
either phenoxymethylpenicillin or erythromycin if patient is allergic to penicillin
- a 7 or 10 day course
What is the initial imaging modality of choice for suspected achilles tendon rupture?
ultrasound
What can SVC obstruction cause?
visual disturbances such as blurred vision
What bacterial organism are sickle cell patients prone to salmonella osteomyelitis?
salmonella osteomyelitis
What antibiotic used to treat UTIs should be avoided in pregnancy? And why?
Trimethoprim
- folate antagonist
What causes hyperthyroid followed by hypothyroid?
Sub acute thyroiditis
- DeQuervain’s thyroiditis
What condition would you see hypokalaemia associated with hypertension?
Primary hyperaldosteronism
What is the treatment methods for stable angina?
1st line = beta blocker or calcium channel blocker
- then use a combo of the two, when combined only use these Ca blockers (nifedipine, amlodipine, felodipine)
- if pt can’t tolerate either of these, use one of the following as monotherapy: long-acting nitrate, ivabradine, nicorandil, ranolazine
What is used for the long term prophylaxis of cluster headaches?
verapamil
What are symptoms of subarachnoid haemorrhage?
- bleeding from berry aneurysm in circle of willis
- sudden onset headache reaching maximum severity in seconds to minutes (thunderclap headache) + meningitic symptoms
