Passmed wrong Flashcards
Tumour lysis syndrome: electrolyte abnormalities
UKPc (↑ Urate,↑Potassium,↑Phosphate and ↓calcium(small c).
What feature can help differentiate between dementia and depression?
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia
Global memory loss -depression
Short term memory loss -dementia
Management of acne vulgaris in pregnancy?
Continue topical benzoyl peroxide and change topical clindamycin to* oral erythromycin*
Causes of hepatosplenomegaly
chronic liver disease* with portal hypertension
infections: glandular fever, malaria, hepatitis
lymphoproliferative disorders
myeloproliferative disorders e.g. CML
amyloidosis
*the latter stages of cirrhosis are associated with a small liver
Examples of mitochondrial diseases?
Leber’s optic atrophy: symptoms typically develop at around the age of 30 years
central scotoma → loss of colour vision → rapid onset of significant visual impairment
MELAS syndrome: mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes
MERRF syndrome: myoclonus epilepsy with ragged-red fibres
Kearns-Sayre syndrome: onset in patients < 20 years old, external ophthalmoplegia, retinitis pigmentosa. Ptosis may be seen
sensorineural hearing loss
T-Helper cells of the Th2 subset typically secrete:
IL-4, IL-5, IL-6, IL-10, IL-13
Th1 secretes
IL2, IL3 (1,2,3) +gamma
What is the mechanism in MM that leads to hyperCa?
Increased osteoclastic activation. In multiple myeloma, malignant plasma cells produce cytokines and other factors that stimulate osteoclasts, leading to increased bone resorption. This results in the release of calcium from the bones into the bloodstream, causing hypercalcaemia. Confusion is a common symptom of hypercalcaemia, which can also cause polyuria, polydipsia, constipation, and renal stones.
What would the CSF sample of a bacterial meningitis show?
Low glucose
high protein
high polymorphs
Most common cause of bacterial meningitis in 6 years - 60 year olds?
Neisseria meningitidis
Streptococcus pneumoniae
Most common cause of bacterial meningitis in > 60 year olds?
Streptococcus pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Most common cause of bacterial meningitis in immunosuppressed?
Listeria monocytogenes
Three mechanisms by which malignancy causes hyperCa?
- PTHrP from the tumour e.g. squamous cell lung cancer
- bone metastases
- myeloma,: due primarily to increased osteoclastic bone resorption caused by local cytokines (e.g. IL-1, tumour necrosis factor) released by the myeloma cells
causes of hyperCa
- primary hyperparathyroidism
- malignancy
- sarcoidosis
other causes of granulomas may lead to hypercalcaemia e.g. tuberculosis and histoplasmosis - vitamin D intoxication
- acromegaly
6.thyrotoxicosis - Milk-alkali syndrome
- drugs:
thiazides
calcium-containing antacids - dehydration
- Addison’s disease
Causes of respiratory acidosis
- COPD
- decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
- neuromuscular disease
- obesity hypoventilation syndrome
- sedative drugs: benzodiazepines, opiate overdose
Causes of warm AIHA
- idiopathic
- autoimmune disease: e.g. systemic lupus erythematosus*
- neoplasia
- lymphoma
- chronic lymphocytic leukaemia
- drugs: e.g. methyldopa
Causes of cold AIHA
neoplasia: e.g. lymphoma
infections: e.g. mycoplasma, EBV
Congenital rubella-characteristic features
- Sensorineural deafness
- Congenital cataracts
- Congenital heart disease (e.g. patent ductus arteriosus)
- Glaucoma
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
‘Salt and pepper’ chorioretinitis
Microphthalmia
Cerebral palsy
*
Congenital CMV-characteristic features
Low birth weight
Purpuric skin lesions
Sensorineural deafness
Microcephaly
Visual impairment
Learning disability
Encephalitis/seizures
Pneumonitis
Hepatosplenomegaly
Anaemia
Jaundice
Cerebral palsy
Congenital Toxoplasmosis-characteristic features
Cerebral calcification
Chorioretinitis
Hydrocephalus
Anaemia
Hepatosplenomegaly
Cerebral palsy
“Fundoscopy shows a moderately exudative, whitish lesion with ill-defined borders located at the superior temporal fundus adjacent to a pigmented scar. Two atrophic scars were also visualized on her right fundus. A CT head was performed due to her fundoscopy findings. This revealed multiple calcifications within the basal ganglia and periventricular regions.”
Standard error of the mean
standard deviation / square root (number of patients)
Levels of evidence: What is meta-analysis evidence?
Ia - evidence from meta-analysis of randomised controlled trials
Levels of evidence, what is 1b
Ib - evidence from at least one randomised controlled trial
Levels of evidence: what is II/III?
IIa - evidence from at least one well-designed controlled trial which is not randomised
IIb - evidence from at least one well-designed experimental trial
III - evidence from case, correlation and comparative studies
IV - evidence from a panel of experts
Levels of evidence what is IV?
IV - evidence from a panel of experts
What kind of disorder is Gaucher’s disease and what is the defect in?
Lysosomal storage disorder:
Beta-glucocerebrosidase
Clinical features of Gaucher’s disease?
Most common lipid storage disorder resulting in accumulation of glucocerebrosidase in the brain, liver and spleen.
Key features include
hepatosplenomegaly
aseptic necrosis of the femur
Causes of metabolic alkalosis
vomiting / aspiration
diuretics
liquorice, carbenoxolone
hypokalaemia
primary hyperaldosteronism
Cushing’s syndrome
Bartter’s syndrome
(e.g. peptic ulcer leading to pyloric stenos, nasogastric suction)
vomiting may also lead to hypokalaemia
Causes of respiratory alkalosis
anxiety leading to hyperventilation
pulmonary embolism
salicylate poisoning*
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
Causes of respiratory acidosis
COPD
decompensation in other respiratory conditions e.g. life-threatening asthma / pulmonary oedema
neuromuscular disease
obesity hypoventilation syndrome
sedative drugs: benzodiazepines, opiate overdose
Most common cause of bronchiectasis exacerbations
Haemophilus influenzae
Causes of decreased lung compliance
pulmonary oedema
pulmonary fibrosis
pneumonectomy
kyphosis
MoA of montelukast
leukotriene receptor antagonist (LTRA)
inhibits leukotrienes, which are inflammatory mediators that contribute to bronchoconstriction, mucus production, and airway inflammation.
Causes of massive splenomegaly
myelofibrosis
chronic myeloid leukaemia
visceral leishmaniasis (kala-azar)
malaria
Gaucher’s syndrome
Other causes of splenomegaly
portal hypertension e.g. secondary to cirrhosis
lymphoproliferative disease e.g. CLL, Hodgkin’s
haemolytic anaemia
infection: hepatitis, glandular fever
infective endocarditis
sickle-cell*, thalassaemia
rheumatoid arthritis (Felty’s syndrome
the majority of adults patients with sickle-cell will have an atrophied spleen due to repeated infarction
Causes of hepatosplenomegaly
chronic liver disease* with portal hypertension
infections: glandular fever, malaria, hepatitis
lymphoproliferative disorders
myeloproliferative disorders e.g. CML
amyloidosis
S1 lesion features
Sensory loss of posterolateral aspect of leg and lateral aspect of foot
weakness in plantar flexion of foot
reduced ankle reflex
positive sciatic nerve stretch test
mostly H and M
Autosomal dominant conditions
Achondroplasia
Acute intermittent porphyria
Adult polycystic disease
Antithrombin III deficiency
Ehlers-Danlos syndrome
Familial adenomatous polyposis
Hereditary haemorrhagic telangiectasia
Hereditary spherocytosis
Hereditary non-polyposis colorectal carcinoma
Huntington’s disease
Hyperlipidaemia type II
Hypokalaemic periodic paralysis
Malignant hyperthermia
Marfan’s syndromes
Myotonic dystrophy
Neurofibromatosis
Noonan syndrome
Osteogenesis imperfecta
Peutz-Jeghers syndrome
Retinoblastoma
Romano-Ward syndrome
tuberous sclerosis
Von Hippel-Lindau syndrome
Von Willebrand’s disease*
What is raised in aip?
urinary porphobilinogen
Treatment in acute attack of AIP
IV haematin/haem arginate
IV glucose should be used if haematin/haem arginate is not immediately available
Basis of poryphrias
abnormality in enzymes responsible for the biosynthesis of haem
results in overproduction of intermediate compounds (porphyrins)
When would you see ischaemic colitis in young people
cocaine
Features of msa
parkinsonism
autonomic disturbance
erectile dysfunction: often an early feature
postural hypotension
atonic bladder
cerebellar signs
