Passmed round 2 Flashcards
What newborn complication can occur if phenytoin is given in pregnancy?
Phenytoin induces vitamin K metabolism, which can cause a relative vitamin K deficiency, creating the potential for hemorrhagic disease of the newborn. The most common sites of bleeding are the umbilicus, mucous membranes, gastrointestinal tract, and venepunctures.
What is the mechanism of action of bosentan?
Bosentan is a non-selective endothelin antagonist. Endothelin causes pulmonary vasoconstriction and therefore antagonists can be used to treat pulmonary hypertension. It can be associated with abnormalities in liver function tests (LFTs) and so regular LFTs are needed during treatment.
How is cryptosporidium diagnosed?
Modified Ziehl-Neelsen stain (acid-fast stain) of the stool may reveal the characteristic red cysts of Cryptosporidium
How can Addison’s disease cause features of androgen deficiency such as loss of pubic hair and reduced libido?
Dehydroepiandrosterone is the most abundant circulating adrenal steroid. Adrenal glands are the main source of dehydroepiandrosterone in females - loss of functioning adrenal tissue as in Addison’s disease may result in symptoms secondary to androgen deficiency, such as loss of libido. Research is ongoing as to whether routine replacement of DHEA is beneficial
Patients with allergy to sulphasalazine may also be allergic to what?
Aspirin
What supplementation should occur in bariatric bypass surgeries?
The duodenum is the primary site of absorption for both iron and calcium. All gastric bypass operations bypass the duodenum. Nearly all menstruating women will therefore require iron supplementation.
What is the mechanism of action of doxazosin?
Tamsulosin is alpha-1a (mainly acts on urinary tract)
Bombesin is a tumour marker in which malignancies?
Small cell lung carcinoma, gastric cancer, neuroblastoma
S-100 is a tumour marker in which malignancies?
Melanoma, schwannomas
What are the complications of RTA type 1?
nephrocalcinosis and renal stones
Which drugs cause drug induced acne?
This patient has drug-induced acne is most commonly caused by glucocorticoids and androgens but can also be precipitated by azathioprine, phenytoin, antipsychotics, and isoniazid
This typically presents as monomorphic papules and pustules with no comedones, cysts or nodules within 2 weeks of starting medication. This subset of patients will not respond to standard acne treatment, discontinuation of offending agents typically clears up the rash.
What is the mechanism of action of ocreotide?
somatostatin analogue
directly inhibits the release of growth hormone
effective in 50-70% of patients
What tests are used to diagnose HIV during seroconversion?
antibodies to HIV may not be present
HIV PCR and p24 antigen tests can confirm diagnosis
What are the rules about driving following syncope?
simple faint: no restriction
single episode, explained and treated: 4 weeks off
single episode, unexplained: 6 months off
two or more episodes: 12 months off
What are the rules regarding driving post stroke?
stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual neurological deficit
multiple TIAs over short period of times: 3 months off driving and inform DVLA
Which HIV medication is associated with pancreatitis?
Purine nucleoside analogue and reverse transcriptase inhibitor
What is the strongest independent prognostic factor in CLL?
Deletion of 17p13 is the strongest independent prognostic factor for CLL. The disease progresses more rapidly and tends to be refractory to many conventional treatments.
What is the most common genetic aberration in CLL?
The most common genetic aberration in CLL is deletion of 13q. It is associated with a more indolent course of the disease improving the prognosis.
What is the treatment for cyanide poisoning?
sodium thiosulfate, hydroxocobalamin or dicobalt edetate
What is the treatment for myoclonic seizures?
sodium valproate
second line: clonazepam, lamotrigine
——————————
Carbamazepine may worsen myoclonic seizures
What is used for screening in latent TB
The Mantoux test is the main technique used to screen for latent tuberculosis.
In recent years the interferon-gamma blood test has also been introduced. It is used in a number of specific situations such as:
- The Mantoux test is positive or equivocal
- People where a tuberculin test may be falsely negative
- -miliary TB
- -sarcoidosis
- -HIV
- -lymphoma
- -very young age (e.g. < 6 months)
What factors increase the risk of pulmonary haemorrhage in Goodpastures syndrome (anti-GBM disease)?
smoking lower respiratory tract infection pulmonary oedema inhalation of hydrocarbons young males ----------------------------- In contrast dehydration actually reduces risk of pulmonary haemorrhage
What are the features of villous adenoma?
Villous adenomas are colonic polyps with the potential for malignant transformation. They characteristically secrete large amounts of mucous, potentially resulting in electrolyte disturbances.
The vast majority are asymptomatic. Possible features:
- non-specific lower gastrointestinal symptoms
- secretory diarrhoea may occur
- microcytic anaemia
- hypokalaemia
CA15-3 is a tumour marker in which malignancy?
breast
How do you differentiate lymphogranuloma venereum?
The presence of ulcers and significant rectal symptoms in a sexually active man raises the question of lymphogranuloma venereum, which is caused by a type of Chlamydia trachomatis.
Rectal infection with gonorrhoea could cause similar symptoms but would not be expected to cause ulcers.
Which valvular abnormality is associated with pulmonary hypertension?
Functional tricuspid regurgitation ---------------------------- Signs are -pan-systolic murmur -prominent/giant V waves in JVP -pulsatile hepatomegaly -left parasternal heave
What test can be used to test pancreatic function in suspected chronic pancreatitis?
Secreted by S cells in upper small intestine
Stimulated by Acidic chyme, fatty acids
What is fanconi syndrome?
Fanconi syndrome describes a generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule resulting in:
- type 2 (proximal) renal tubular acidosis
- polyuria
- aminoaciduria
- glycosuria
- phosphaturia
- osteomalacia
What is the mechanism of action of sitagliptin?
Sitagliptin is an inhibitor of the enzyme dipeptidyl-peptidase 4 (DPP-4). As such, it prevents DPP-4 from catalysing the breakdown of naturally occurring incretins, potentiating their ability to stimulate insulin release.
What is the mechanism of pioglitazone?
A type of thiazolidinediones.
Activate peroxisome proliferator-activated receptor gamma (PPAR-γ) to increase insulin sensitivity
What is the mechanism of action of dapagliflozin?
Decrease blood glucose by inhibiting renal glucose re-uptake via sodium-glucose co-transporter 2 (SGLT2)
What is the mechanism of action of exanatide?
Mimic incretins by binding to GLP-1 receptors and stimulating insulin release
What is the treatment for face, flexural and genital psoriasis?
NICE recommend offering a mild or moderate potency corticosteroid applied once or twice daily for a maximum of 2 weeks
What is the mechanism of action of ondansetron?
5-HT3 antagonist
What is the treatment for invasive amoebiasis?
Treatment for invasive amoebiasis should be followed by a luminal amoebicide to eradicate the cystic stage which is resistant to metronidazole and tinidazole (which are used against the invasive stage)
e.g. 7 days of metronidazole followed by 10 days of diloxanide furoate
What investigation is useful in clinically unstable suspected aortic dissection?
Transoesophageal echocardiography (TOE) may be a useful investigation in clinically unstable patients with a suspected aortic dissection
When is dexamethasone used in meningitis?
Intravenous dexamethasone should be given prior to or with the first dose of antibiotic to reduce the risk of neurological sequelae by reducing cerebrospinal inflammation.
If pneumococcal meningitis is suspected or confirmed from clinical features, cerebrospinal fluid parameters or culture results, then dexamethasone should be continued for 4 days. It should be stopped if another causative organism is strongly suspected or confirmed
What is the management of hypertension in pheochromocytoma?
Phenoxybenzamine is a non-selective alpha-adrenoceptor antagonist and should be started before a beta-blocker is introduced
There is ongoing debate about the optimal medical management of phaeochromocytoma, with the suggestion that antihypertensive treatment regimes other than non specific alpha-blockade are just as effective and safe. There are however no trials to provide an answer to this question yet
What is Wellen’s Syndrome?
Wellens’ syndrome is an ECG manifestation of critical proximal left anterior descending (LAD) coronary artery stenosis in patients with unstable angina. It is characterized by symmetrical, often deep (>2 mm), T wave inversions in the anterior precordial leads.
When do patients with aortic stenosis warrant aortic valve replacement?
Aortic valve replacement if symptomatic, otherwise cut-off is gradient of 40 mmHg mean
Also consider if AS and reduced LVEF
What is Fabry Disease?
Fabry disease is a rare genetic disorder that prevents the body from making an enzyme called alpha-galactosidase A. Alpha-galactosidase A normally breaks down a fatty substance called globotriaosylceramide. As a result, this fatty substance builds up in the cells of your body particularly cells lining blood vessels in the skin and cells in the kidneys, heart, and nervous system.
Characteristic features of Fabry disease include episodes of pain in the hands and feet (acroparesthesia); clusters of small, dark red spots on the skin called angiokeratomas; a decreased ability to sweat (hypohidrosis); cloudiness or streaks in the front part of the eye (corneal opacity or corneal verticillata); problems with the gastrointestinal system; ringing in the ears (tinnitus) and hearing loss.
X-linked recessive
What is the advantage of capecitabine over flurouracil?
Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)
Adverse effects: Myelosuppression, mucositis, dermatitis
What rheumatoid arthritis drugs are proven to be safe in pregnancy?
There is some evidence that TNF-a inhibitors may be afe but studies are poor
Which drug is contraindicated in ventricular tachycardia?
Verapamil is contraindicated in VT as intravenous administration of a calcium channel blocker can precipitate cardiac arrest.
What receptor type does insulin bind to?
Insulin binds to tyrosine kinase, a type of enzyme receptor in the cell membrane, resulting in a signal transduction cascade, activating enzymes and transcription factors within the cell that mediates the intracellular effects of insulin.
Other tyrosine kinase receptors include insulin-like growth factor (IGF) and epidermal growth factor (EGF).
How do you differentiate systemic mastocytosis and carcinoid syndrome?
Given the history of diarrhoea and flushing a diagnosis of carcinoid syndrome should be considered, which would be investigated with urinary 5-HIAA levels. This would not however explain the urticarial skin lesions. In a young person a diagnosis of systemic mastocytosis should be considered. Another factor against carcinoid syndrome is the age of the patient - the average age of a patient with a carcinoid tumour is 61 years
What is the mechanism of action of memantine?
NMDA antagonist
What is the strongest risk factor for cervical cancer and why?
Having multiple sexual partners is the strongest risk factor for the development of cervical carcinoma. This is because having multiple sexual partners greatly increases the chance of being infected with the human papilloma virus.
The 16 and 18 viral strain then triggers the carcinogenesis by inhibiting the tumor suppressor gene p53 and RB.
Why should allopurinol and rasburicase not be given together in tumour lysis syndrome?
Rasburicase is the preferred treatment choice for patients at high risk of tumour lysis syndrome.
Rasburicase is a recombinant form of urate oxidase which catalyzes the oxidation of existing uric acid to allantoin. Allantoin is more soluble than uric acid and is therefore excreted in the kidneys.
Allopurinol stops new uric acid being made by blocking the conversion of xanthines to uric acid. If less uric acid is made, this will reduce the substrate available for rasburicase to work. They should not be given together.
What is the mechanism of action of macrolides?
Erythromycin is a macrolide, which works by inhibiting the 50S subunit of ribosomes. This prevents the production of proteins from bacteria.
Macrolides are commonly confused with tetracyclines, which inhibit the 30S subunit of ribosomes
What are the causes of onycholysis?
idiopathic
trauma e.g. Excessive manicuring
infection: especially fungal
skin disease: psoriasis, dermatitis
impaired peripheral circulation e.g. Raynaud’s
systemic disease: hyper- and hypothyroidism
What are the contraindications to liver biopsy?
deranged clotting (e.g. INR > 1.4) low platelets (e.g. < 60 * 109/l) anaemia extrahepatic biliary obstruction hydatid cyst haemoangioma uncooperative patient ascites
CCK is released by which cells?
What does it result in?
CCK is a peptide hormone that increases the digestion of fats and proteins. It is synthesized and released from I cells in the upper small intestine in response to increased detection of partially digested proteins and fats.
CCK results in several processes including the secretion of digestion enzymes from the pancreas, contraction of the gallbladder, relaxation of the sphincter of Oddi, decreased gastric emptying, and a trophic effect on pancreatic acinar cells all of which result in fat and protein breakdown as well as hunger suppression.
What drugs should be avoided in breast feeding?
Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, Sulphonamides Psychiatric drugs: lithium, benzodiazepines Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxic drugs Amiodarone
What are the stages of CKD?
1 = Greater than 90 ml/min, with some sign of kidney damage on other tests (if all the kidney tests* are normal, there is no CKD)
2 = 60-90 ml/min with some sign of kidney damage (if kidney tests* are normal, there is no CKD)
3a = 45-59 ml/min, a moderate reduction in kidney function
3b = 30-44 ml/min, a moderate reduction in kidney function
4 = 15-29 ml/min, a severe reduction in kidney function
5 = Less than 15 ml/min, established kidney failure - dialysis or a kidney transplant may be needed
How do you calculate the Mentzer index?
Mentzer index :
The index is calculated from the results of a complete blood count. If the quotient of the mean corpuscular volume (MCV, in fL) divided by the red blood cell count (RBC, in Millions per microLiter) is less than 13, thalassemia is said to be more likely. If the result is greater than 13, then iron-deficiency anemia is said to be more likely
What is the mechanism of pilocarpine?
a direct parasympathomimetic (e.g. pilocarpine, causes contraction of the ciliary muscle → opening the trabecular meshwork → increased outflow of the aqueous humour)
What is the management of stress urinary incontinence?
pelvic floor muscle training
-NICE recommend at least 8 contractions performed 3 times per day for a minimum of 3 months
surgical procedures: e.g. retropubic mid-urethral tape procedures
duloxetine may be offered to women if they decline surgical procedures
- a combined noradrenaline and serotonin reuptake inhibitor
- mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
What is the treatment for chlamydia?
Doxycycline (7 day course) if first-line
- This is now preferred to azithromycin due to concerns about Mycoplasma genitalium.
- This infection is often coexistant in patients with Chlamydia and there is evidence of rising levels of macrolide resistance, hence why doxycycline is preferred
If doxycycline is contraindicated / not tolerated then either azithromycin (1g od for one day, then 500mg od for two days) should be used
If pregnant then azithromycin, erythromycin or amoxicillin may be used. The SIGN guidelines suggest azithromycin 1g stat is the drug of choice ‘following discussion of the balance of benefits and risks with the patient’
What is the safest TCA in overdose?
Lofepramine
What are the features of Lesch-Nyhan syndrome?
This disease, also known as juvenile gout, is characterized by hyperuricemia. It is a genetic condition with an X-linked pattern of inheritance. It is caused by a defect in the purine salvage pathway due to the absence of the hypoxanthine-guanine phosphoribosyltransferase (HGPRT) enzyme which catalyzes the conversion of hypoxanthine to inosine monophosphate (IMP) and guanine to guanosine monophosphate (GMP). The consequence is an accumulation of uric acid. The typical findings supporting this diagnosis in this patient is the aggressive behavior, self-mutilation, intellectual impairment as well as laboratory finding of hyperuricemia
What is the Simon Broome criteria for diagnosis of familial hypercholesterolaemia?
In adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l or children TC > 6.7 mmol/l and LDL-C > 4.0 mmol/l, plus:
- for definite FH: tendon xanthoma in patients or 1st or 2nd degree relatives or DNA-based evidence of FH
- for possible FH: family history of myocardial infarction below age 50 years in 2nd degree relative, below age 60 in 1st degree relative, or a family history of raised cholesterol levels
What finding is usually seen on ECG in myotonic dystrophy?
A prolonged PR interval is seen in around 20-40% of patients
How does peptic ulceration occur in primary hyperparathyroidism?
Peptic ulceration caused by hypercalcaemia which stimulate Gastrin secretion
What are the features of zinc deficiency?
perioral dermatitis: red, crusted lesions acrodermatitis alopecia short stature hypogonadism hepatosplenomegaly geophagia (ingesting clay/soil) cognitive impairment
Coarctation of the aorta is associated with which conditions?
Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis
What drugs cause drug induced lupus?
Most common causes
- procainamide
- hydralazine
Less common causes
- isoniazid
- minocycline
- phenytoin
Anti-histone antibodies are in 80-90%
How often should lithium levels be checked once established?
Lithium levels should be checked every 3 months once a stable dose has been achieved
What are the ECG features of Wolff-Parkinson White?
short PR interval
wide QRS complexes with a slurred upstroke - ‘delta wave’
left axis deviation if right-sided accessory pathway*
right axis deviation if left-sided accessory pathway*
What are the risk factors for pseudogout?
Patients who develop pseudogout at a younger age (e.g. < 60 years) usually have some underlying risk factor, such as:
- haemochromatosis
- hyperparathyroidism
- low magnesium, low phosphate
- acromegaly, Wilson’s disease
What is the treatment of discoid lupus erythematosis?
Discoid lupus erythematous - topical steroids → oral hydroxychloroquine
What is the mechanism of action of botulism?
Botulinum toxin inhibits the release of acetylcholine at synapses
What are the indications for dialysis in salicylate overdose?
serum concentration > 700mg/L metabolic acidosis resistant to treatment acute renal failure pulmonary oedema seizures coma
Why is silica a risk factor for TB?
Toxic to macrophages
What are the causes of a normal anion gap metabolic acidosis?
Normal anion gap ( = hyperchloraemic metabolic acidosis)
- gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
- renal tubular acidosis
- drugs: e.g. acetazolamide
- ammonium chloride injection
- Addison’s disease
What are the causes of a raised anion gap metabolic acidosis?
Raised anion gap
- lactate: shock, sepsis, hypoxia
- ketones: diabetic ketoacidosis, alcohol
- urate: renal failure
- acid poisoning: salicylates, methanol
What is the pathophysiology of methaemoglobinuria?
Methaemaglobinaemia is an underlying problem of EXCESSIVE oxidation of Fe2+ to Fe3+, rendering RBCs unable to bind O2.
Methaemaglobin reductase reduces methaemoglobin to haemoglobin (Fe3+ to Fe2+) by transferring electrons from NADH to methaemoglobin. Therefore congenital deficiency will cause methaemoglobinaemia.
(OIL RIG - Oxidation is loss, Reduction is gain)
What are the characteristic side effects of indinavir?
renal stones, asymptomatic hyperbilirubinaemia
t(14:18) is associated with which malignancy?
The t(14;18) translocation causes increased BCL-2 transcription and causes follicular lymphoma
What translocation occurs in Ewing’s sarcoma?
t(11;22) is a translocation which occurs in Ewing sarcoma. This is a malignant bone tumour which often occurs in individuals under 15 years of age. The disease is known to be very aggressive and is associated with the development of early metastases
t(12;15) is associated with which cancer?
t(12;15) is associated with the development of breast cancer, more specifically secretory breast carcinoma. This type of breast cancer is known to be rare and the clinical outcome following is usually good.
What is the conversion of codeine to oral morphine?
Divide by 10
What drugs should be avoided in WPW and AF?
Wpw with Afib: Avoid drugs which prolong av delay
e.g V BAD: Verapamil, B-blocker Adenosine, Digoxin
What is the mechanism of action of digoxin?
inhibits the Na+/K+ ATPase pump
How does ticagrelor cause breathlessness?
Dyspnoea is a common side effect of ticagrelor and is estimated to occur in up to 15% of patients started on this medication. It is hypothesised that the sensation of dyspnoea in ticagrelor-treated patients is triggered by adenosine, because ticagrelor inhibits its clearance (by inhibiting the enzyme adenosine deaminase), thereby increasing its concentration in the circulation. It is important to be aware of this side effect in order to avoid unnecessary treatment and/or investigation, as it is easily remedied by switching the patient to clopidogrel
What electrolyte abnormalities are seen in Addison’s disease?
hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis
What are the causes of Chorea?
Huntington's disease, Wilson's disease, ataxic telangiectasia SLE, anti-phospholipid syndrome rheumatic fever: Sydenham's chorea drugs: oral contraceptive pill, L-dopa, antipsychotics neuroacanthocytosis pregnancy: chorea gravidarum thyrotoxicosis polycythaemia rubra vera carbon monoxide poisoning cerebrovascular disease
What is the treatment of Thrombotic Thrombocytopenic Purpura?
no antibiotics - may worsen outcome
plasma exchange is the treatment of choice
steroids, immunosuppressants
vincristine
What is the pathogenesis of homocystinuria?
Homocystinuria is caused by a deficiency of cystathionine beta synthase
What is the most sensitive clinical sign in hypocalcaemia?
Hypocalcaemia: Trousseau’s sign is more sensitive and specific than Chvostek’s sign
What is the management of Guttate psoriasis?
Most cases resolve spontaneously within 2-3 months
(there is no firm evidence to support the use of antibiotics to eradicate streptococcal infection)
Topical agents as per psoriasis
UVB phototherapy
Tonsillectomy may be necessary with recurrent episodes
What are the British Journal of Haematology Guidelines in patients on warfarin having emergency surgery:
- If surgery can wait for 6-8 hours - give 5 mg vitamin K IV
- If surgery can’t wait - 25-50 units/kg four-factor prothrombin complex
What conditions cause a false positive VRDL/RPR?
False positive VDRL/RPR: ‘SomeTimes Mistakes Happen’ (SLE, TB, malaria, HIV)
What is the prevalence of rheumatoid arthritis in the UK?
1%
What are the causes of papillary necrosis?
chronic analgesia use sickle cell disease TB acute pyelonephritis diabetes mellitus
What are the side effects of checkpoint inhibitors?
Novel immunotherapy drugs that target checkpoint inhibitors leads to reduced checkpoint inhibition. This keeps the immune system activated and thus potentiating anti-tumour effects. However, it is important to realise, as a consequence, there is reduced self-tolerance and auto-immune side effects occur. Prominently
- Thyroiditis
- Hypophysitis
- Adrenalitis
- Brittle diabetes (T1)
What is the genetics of alport syndrome?
X-linked dominant
What antibody is a marker of development of ILD in polymyositis?
The anti-Jo-1 antibody is a predictor of the presence of ILD at diagnosis, with up to 70% of patients with the antibody having concurrent ILD. The 5-year survival rate is between 60 and 80%.
What motor neurone disease carries the worst prognosis?
Progressive bulbar palsy?
What are the features of Pseudoxanthoma elasticum?
Pseudoxanthoma elasticum is an inherited condition (usually autosomal recessive*) characterised by an abnormality in elastic fibres.
- retinal angioid streaks
- ‘plucked chicken skin’ appearance - small yellow -papules on the neck, antecubital fossa and axillae
- cardiac: mitral valve prolapse, increased risk of -ischaemic heart disease
- gastrointestinal haemorrhage
How do you determine the cause of a lesion in bitemporal hemianopia?
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a craniopharyngioma
What are the common causes of environmental asthma?
GF works at PEPSI factory and comes home every day with asthma symptoms:
-GF— Glutaraldehyede. Flour
PEPSi :
- Platinum salt
- Epoxy resins
- Proteiolytic enzymes
- Soldering flux resins
- Isocynayes
What is the treatment of hiccups in palliative care?
chlorpromazine or haloperidol
What is the difference in side effects for sulphasalazine and mesalazine?
Sulphasalazine
- A combination of sulphapyridine (a sulphonamide) and 5-ASA
- Many side-effects are due to the sulphapyridine moiety: rashes, oligospermia, headache, Heinz body anaemia, megaloblastic anaemia, lung fibrosis
- Other side-effects are common to 5-ASA drugs (see mesalazine)
Mesalazine
-A delayed release form of 5-ASA
-Sulphapyridine side-effects seen in patients taking sulphasalazine are avoided
————————–
Common to both 5-ASA
-GI upset, headache, agranulocytosis, pancreatitis*, interstitial nephritis
*Pancreatitis is 7 times more common in patients taking mesalazine than sulfasalazine
How do you differentiate radial tunnel syndrome from lateral epicondylitis?
Radial tunnel syndrome presents similarly to lateral epicondylitis however pain is typically distal to the epicondyle and worse on elbow extension/forearm pronation
What are the criteria for gestational diabetes?
“5678”
Either:
- fasting glucose is >= 5.6 mmol/L
- 2-hour glucose is >= 7.8 mmol/L
What starting insulin regimens are recommended by NICE for type 1 and type 2 DM?
Type 1 - try basal bolus first. 2nd line twice daily ‘mixed’.
Type 2 - Start with isophane once or twice daily
What is the pathophysiology of hepatorenal syndrome?
Hepatorenal syndrome is primarily caused by splanchnic vasodilation
What are the cut-offs for bariatric surgery under NICE?
Obesity - NICE bariatric referral cut-offs
- with risk factors (T2DM, BP etc): > 35 kg/m^2
- no risk factors: > 40 kg/m^2
What is the management of methaemoglobinuria?
NADH - methaemoglobinaemia reductase deficiency: ascorbic acid
IV methylthioninium chloride (methylene blue) if acquired
In general what are the 2 causes of nephrotic syndrome in adults?
FSGS
Membranous glomerulosclerosis
What are the guidelines for controlling high INR on warfarin?
Major bleed: stop warfarin.
Give prothrombin complex . give vit k
Minor bleeding : stop warfarin
. Give vitamin k
No bleeding : manage according to INR
5:8 …..hold 2 doses &reduce dose
8:12 …. hold warfarin & give vit k 2.5 mg
More than 12 …..hold warfarin & give vitk 5 mg
Donepazil is relatively contraindicated in what?
Bradycardia
What antibiotics increase the risk of acquisition of MRSA?
Although ciprofloxacin is not a beta-lactam antibiotic, its use is strongly linked to the acquisition of MRSA as with all quinolone antibiotics.
What MRI finding can be seen in Wernicke’s encephalopathy?
The MRI finding of enhancement of the mamillary bodies due to petechial haemorrhages is specific for Wernicke’s encephalopathy, although sensitivity is only 50%.
How do you calculate the standard error of the mean?
Standard error of the mean = standard deviation / square root (number of patients)
Which anti-epileptic is contraindicated in absence seizures?
Carbamazepine is contraindicated and can worsen absence seizures (along with phenytoin, vigabatrin and gabapentin)
What drugs should be avoided in HOCM?
nitrates
ACE-inhibitors
inotropes
What test do you use to ensure eradication in H. Pylori infection?
Urea breath test is the only test recommended for H. pylori post-eradication therapy
What are the poor prognostic factors Guillain-Barre syndrome?
age > 40 years poor upper extremity muscle strength previous history of a diarrhoeal illness (specifically Campylobacter jejuni) high anti-GM1 antibody titre need for ventilatory support
What are the causes of pseudohyperkalaemia?
Haemolysis during venipuncture (excessive vacuum of Blood drawing, prolonged tourniquet use or too fine a needle gauge)
Delay in the processing of the blood specimen
Abnormally high numbers of platelets, leukocytes, or erythrocytes (such as myeloproliferative disorders)
Familial causes
What are the features of Tay-Sachs Disease?
Tay-Sachs disease typically presents with developmental delay and cherry red spot on the macula, without hepatomegaly or splenomegaly.
This can present after 3 months of age as hypotonia, muscle weakness and myoclonic jerks and then progress to psychomotor retardation and regression, muscle spasticity, recurrent seizures, dementia and eventual death in early childhood. The cherry red spot in the macular is present in 90%.
