Past P 2 Flashcards
What does ADH do
Increase Aquaporin-2 channels in collecting duct
Post chemo most at risk of neutropenic sepsis which day
Day 10
Vinblastine mechanism
Binds to microtubular proteins
[causes metaphase arrest]
Adrenic receptors
a1
b1
b2
a1 - Smooth muscle contraction
-G protein-coupled actives phospholipase C
b1- Heart Kidneys
-G protein-coupled actives adenyl cyclase
b2 - Bronchioles, Visceral smooth muscle, skeletal muscle
-G protein-coupled actives adenyl cyclase
Muscles supplied by median nerve
Abductor pollis brevis
Flexor pollis longus (in forarm)
New stable mild angina for 1 year- What do you do?
Don’t need ETT as stable
Bisop (or other cardioselective bb)
/ cardioselective CCB [verapamil and diltiazem]
Latex allergy which foods
Banana, chesnut, kiwi, avocado
Suspected osteomyelitis of diabetic foot. MRI or C&S more important
MRI
MODY - most common?
What if renal cysts?
What if no symptoms and incidental finding?
HNF-alpha most common
HNF-beta if you have cysts
Glucokinase - mild form
1st line antihypertensive in preg
Labetalol
[then methyldopa / CCB]
Sildenafil which type of PDE
PDE-5 inhibitor
Threadworm Rx
Mebendazole, then second dose after 2-3 weeks
Macular oedema. Not for laser rx?
VGEF inhibitors
What is the main ketoacid in DKA
Beta-hydroxybutyrate
Rtixumab is anti-
Anti-CD20
Sickle painful crisis. Rx for pain
Opiates required
Inferior stemi -> complete HB. Rate 30 and hypotensive. Rx ?
Transcutaneous pacing on the way to PCI
Left coronary artery anatomy. Arises? Becomes?
Just above the left aortic cusp
-Then divides into Left Anterior descending and circumflex
Karnovsky score?
Marker of function pre chemo.
under 60% = poor outcomes
Travel then come back with IBS-type illness? Rx?
Giardia
Metronidazole course
[Or single dose Tinidazole]
[Campylobacter more acute gastroenteritis]
Travel then come back with IBS-type illness? Rx?
Giardia
Metronidazole course
[Or single dose Tinidazole]
[Campylobacter more acute gastroenteritis]
Cluster headache Sx but in woman and shorter duration and higher frequency of headaches? Rx?
Paroxysmal hemicrania
Indomethacin
Radio-iodine and preg ? Mother and father advice
Teratogenic
Should not get preg for 6 months after
Men shouldn’t father children for 4 months
Reactive arthritis 1st line
NSAIDS Eg Naproxen
IIH on COCP order of CT / LP / Cesation of COCP
CT
LP
Cessation
Learning difficulty, high arched palate, mitral valve prolapse, joint laxicity, big ears, obese
Fragile X
[Homocystinuria - unlikely to be obese or have big ears.]
When Abx in cat scratch disease
Immunocompromised / severe Sx
[Ciprofloxaxin]
Isoniazid mechanism
Inhibits fatty acid synthesis
[fatty acids in liver - bit tenuous good luck]
What inhibits DD transpeptidase
Penicillins
what inhibits DNA Gyrase
quinolones - eg cipro
what inhibits RNA synthesis
Macrolides
Tired, hypotensive, Raised bicarb, HypoK = defect where?
Gentleman’s
Distal convoluted tubule
[Adrenal failure would have high K, conns would be hypertensive,
Barters usually presents in childhood]
Which hormone is usually under continuous inhibition
Prolactin
Molluscum contagiosum - Ix/rx
Doesn’t need any usually
[Q should indicate need for hiv test etc.]
Pie chart needs how many groups
At least 3 for MRCP
Heart where do you find Actin, troponin, Myosin?
What structure is actin, and in who is it deficient?
Thin filaments - Actin + trop
Thick filaments - myosin
Actin is double a-helix. HOCM deficient
Acanthosis nigrans = what when malignant
Gastric tumours in 90% of cases
[adenocarcinoma usually]
Erythema nodosum, macrocytic anaemia and normal sigmoidoscopy… What other aspects of question to differentiate coeliac vs crohns
Chrons - nail ridging
Coeliac - steathorrea sometimes
Hypocalcuric hypercalcaemia usual Rx
Reassure - HyperCa levels usually very stable
Severe diarrhoea symptoms post transplant on - which drug is cause
Mycophenolate
Pseudogout acute Rx
Colchicine - same as gout
Influenza -> Acute cavitating pneumonia Rx? If pen allergic?
IV fluclox
Macrolide
ACEi when can you get first episode of angiodema
straight away or not for many years.
Ie occurring after 5 years of Rx it is still the likely cause
Where is the posterior cerebellar artery found
Next to the posterior communicating artery
COCP may cause which rash
Erythema nodosum
Polycythemia -> Stroke
Rx?
Aspirin - just like normal
Rheum - now nodule compressing radial nerve Rx?
Surgical excision
Difference between asbestos plaques and asbestosis as the answer to a question
Plaques are incidental and do not cause symptoms.
If breathlessness / cough = asbestosis
Why HyperCa in thyrotoxicosis
Thyroxine stimulates osteoclasts
P vivax / ovale have which stage of life cycle not found in falciparum
Hypnozoites
2 main DMARDs for UC
Azathioprine / 6-metacaptopurine
[Infliximab]
Liver referral in paracetamol OD before 48hrs
INR?
Cr?
BP?
2 things on blood gas?
INR >2
Cr >200
SBP <80 despite fluids
BM <4
Acidosis
How many single nucleotide polymorphisms have been mapped as part of the genome project
3.7 million
Spironolactone acts on
Distal convoluted tubule
What are the 2 types of Hb that carry sickle trait
HbS
HbC
Cryoglobulinaemia and lymphadenopathy
NHL
Thermoregulation and circadian rhythms are controlled where
Anterior hypothalamic nucleus
Who gets Levothyroxine titrated very slowly
Old people
[high risk arrythmias]
MI + stents. What factor is most associated with future cardiac events
CAD - especially if >1 vessel stent required
More important than obesity, LDL levels …
Haemochromatosis often get what joint issue
Pseudogout (often bilat)
Where is landmark for subclavian line
1cm inferior to the junction of the middle and medial section of clavicle
Monitor rivaroxaban compliance
PT time
Pathology of lithium -> DI
Reduces cAMP-mediated aquaporin-2 expression
[Less aquaporins -> less water reabsorbed]
Joint erosions of Anti-CCP worse prognosis in Rhem A
Anti CCP
[Joint erosions likely just delayed presentation]
Erythema multiform most commonly what? When would you think of the other cause?
Herpes simplex - most common
[May just have vague Sx]
Symptoms of pneumonia -> mycoplasma
Which receptor is target in therapy for B-cell NHL?
CD20
[Rituxumab]
What are the mitochondrial inherited disorders
Conveniently can remember most of them using DIDMOAD - both this syndrome and all the parts of it
-Just add an EN to make DIDMOADEN
Diabetes insipidus
Diabetes Mellitus
Optic Atrophy
Deafness
Epilepsy
Neuropathy
Parietal Left vs Right side most common issue
Right - Visual spacial navigation
Left - Not understanding or being able to speak language
Visual memory defect if stroke affects where?
Right temporal lobe
What does evolocumab do?mechanism?
PCSK9 inhibitor
-> Prevents LDL receptor degradation
How does Ezetimbine work?
Inhibits NCP1L1
-> Reduces cholesterol absorption from GI
Rx in severe hereditary spherocytosis
Splenectomy
Neutropenic spesis 1st line? If pen allergic?
Taz + gent
Vanc, cipro + single dose gent
CN 3 palsy if Posterior communicating / vertebral isn’t an option
Internal carotid
Who classically get de Quervain’s tendosynovitis
Rx?
Mums of babies 6-12 months
->due to repeated picking them up
Splint / steroid injection
calcium carbonate reduces the absorption of what?
Levothyroxine
Levofloxacin (+ quinilones)
[Iron, zinc, strontium]
Aspirin in preg with antiphospholipid. When would you add in prophylactic LMWH ?
> 2 miscarriages
Or any fetal loss after 10 weeks gestation
Why hypoNa in thiazide diuretics
Distal tubule Na loss
Suspected pneumococcal meningitis what might be added to Ceftriaxone
Vanc + cef
Kleinfelters genetics
XXY
[Not XYY. Remember they have normal XY with some feminism Eg breast development so must have an extra X]
Heyde with normal OGD / colonoscopy what next?
Capsule endoscopy
Parkinsonism and urinary incontinence Ix?
MRI / CT first
Then LP
Lupus membranous nephropathy Rx?
Mycophenolate
Cyclophosphamide second line
Benzbromarone used in? How does it work? Commonly used in combination with?
Gout - prevents uric acid resorption in the kidney
-URAT-1 inhibitor
Often used with allopurinol (xanthine oxidase inhibitor
-Inhibits uric acid formation
What inflammatory cytokine key in gout? Drug targeting it?
IL-1
Canakinumab
Gastroparesis Sx in long-term diabetic. Rx?
Domperidone
Chinese patient is given carbamazepine. what happens next and why?
SJS
Probably HLA-B1502
Severe COPD and is already on salbutamol. What inhaler to add?
Inhaled steroid (high dose Eg 500mcgBD) and LAMA
Eg
Fluticasone/Salmeterol 500/50mcg BD
Varenicline used for? mechanism?
Smoking cessation
Partial nicotinic agonist
MgSO4 mechanism in acute asthma
Decreased histamine
Inhibits smooth muscle contraction
Inhibit Ach
Which pneumonia if have cold sore?
Strep pneumo
[Reactivates herpes simplex-1 for some reason]
1st line rescue therapy UC
Ciclosporin
Then Infliximab
Death of parter is massive risk for suicide
IDK cba thinking to to make that a flash card
Metformin mechanism
Indirect AMP kinase activator
Gliclazide mechanism
ATP sensitive potassium channel activator
Nintedanib used for? Mechanism
Pulm fibrosis
Tyrosine kinase inhibitor
Long QT due to which ion channel
Potassium
The senescence of cells is what
Cessation of mitosis - due to telomere shortening to critical point
Eosin-5-maleimide binding test used for
Hereditary spherocytosis
[Basically looks at the fragility]
First line long QT? When ICD?
What is option if people don’t respond to b blockers and don’t want an ICD
Beta blockers
ICD if collapse secondary to VT or unsuccessful b blockers
Stellate ganglionectomy
ACEi, BB and frusemide in heart failure, but worsening - what’s next step?
Change ACEi to sacubitril valsartan
[Entresto]
When ivabradine in HF
Pulse >75 and reduced EF
Young person with recurrent bacterial sinusitis and pneumonias with normal Ig’s in question has which Ig deficiency?
IgG subclass deficiency
How long after significant blood transfusions can you re-check HbA1c?
12 weeks
Primary PTX 3cm rx?
Aspirate 1st line
[Drain if unsucsessful]
Haemochromatosis in Q with raised transferrin sats. What is the next step for Dx?
Genetic testing
[Liver biopsy later]
Medical epicondylitis usually affects which nerve?
Ulnar
72 slow visual loss
Blind spot in the middle of vision of one eye.
Pigment deposition in retina with sub-retinal haemorrhage + pigment deposition in other eye =?
Rx?
Wet macular degeneration
VGEF inhibitors
Eg Bevacizumab
[Bev and her old eyes]
Why delayed hypos with alcohol consumption
Reduced glucogenesis
[Often delayed slighly]
Bitemporal inferior quadranopia - where is lesion?
Rathke’s pouch
[Suprasellar lesion and probably a craniopharyngioma]
FEV values for contraindication for lung ca?
<2L for pneumonectomy
<1.5L for lobectomy
Cut off karnofsky score for good / poor prognosis in AML
60% more = good
Strep Gallolyticus endocarditis is from?
Colon Ca
[Its the new name for Strep Bovis LOL]
Recurrent infections especially N meningitis has what deficiency?
C5-9
[1,2,4 is SLE
IgG subclass would be recurrent respiratory infections]
- Peripheral neuropathy.
Osteoperosis. Abdo pain. Heritability
Purple purpuric rash = ? deficiency of?
Fabry disease
Alpha-galactosidase
What is esomeprazole
S isomer of omeprazole
Quinilone resistant bacteria
2 Common reasons why?
DNA gyrase mutation
Decreased membrane Protein F
Ribosomal mutation gives bacteria resistance to
Macrolides
N acetyl transferase mutation gives bacteria resistance to
Aminoglycosides
Disseminated gonorrhoea Abx
Cef + azithro
Ulcerative colitis - develops anterior uveitis Rx?
Topical [not oral] steroids
Mycobacterium avium Rx?
If cavitating disease?
Rifampicin, ethambutol and azithromycin
Add streptomycin
Common gene FAP
APC
C-myc seen commonly in which Ca
Ovarian Ca
Back pain
Predominant distal weakness. Increased tone + hyperreflexia
Early urinary incontinence
Conus meddularis
Imatinib resistance, second line?
Dasatinib
Pazopanib and sunatinib used for
Renal Ca
Lesser curve of the stomach supplied by
Left / right gastric arteries
Blood supply for pylorus and proximal duodenum
Gastroduodenal
Fundus of stomach supplied by?
Short gastric arteries
[Branch of splenic]
Greater curve of stomach supplied by?
Left gastro omental
Prognosis in COPD
BODE [but it spells BODD….]
BMI
Obstruction - FEV1
Distance walked in 6 mins
Dyspnea
COPD with persistent AF and IHD with atrial enlargement. 1st line Rx?
Bisoprolol
Would be amiodarone if the plan was to get them back to SR but this very unlikely given atrial enlargement
Pemphigoid biopsy
IgG and C3
[IgG mostly in the roof of the blisters]
COPD on high dose corticosteroid/LABA inhaler whats next
Long-Acting Muscarinic Antagonist
Eg Tiotropium
Which alcohol makes them go blind
Methanol
[Formic acid crystals in optic nerve]
-setron antiemetics work where in brain
Nucleus tractus solitarius
Young, cessation of menses with autoimmune disease and raised FSH
Primary ovarian failure
Pancreatitis and vomiting - how to feed
NG
Microscopic or macroscopic haematuria worse prognosis in IgA nephropathy
Microscopic
Hx sounds like ulcer.. differentiate GU vs DU?
DU more commonly assoc with obstruction
-history of fullness and bloating associated with nausea + Vomiting after food
Denosumab action
RANK ligand inhibitor
Vit D main action
Increase GI absobtion of Ca
What is the functional residual capacity
Volume of air present after passive expiration
[Residual volume is air left after forced expiration]
Thromboembolic stroke BP 190/100 plan?
Observe
[No need to treat unless >220 without cv issues]
Rheum A on MTX with multiple round nodules on CXR =
Rheumatoid nodules
Stop ETT if…? Which ecg changes
Dizziness / pre syncope
ST depression by 2mm or more
Which vein drains blood from the atrium into the coronary sinus? Which from apex of ventricles
Small cardiac vein
Great cardiac vein drains from Apex of ventricles
Rash on the scrotum and inner thighs in keen cyclist
Tinea cruis
Hashimotos -> thyroid Ca WHICH TYPE
Lymphoma
Most common genetic defect in HOCM
Myosin-binding protein C [heavy chain]
Worry about which bias in meta analysis
Publication bias
[negative trials may not have been published]
MHC Class II major presenting cells ?
Dendritic
SLE membranous nephropathy Rx
Mycophenolate
GPA, not responding to steroids and cyclophosphamide What next?
Rituximab
MHA which section for doctors to detain for 72hrs? For 28 days assessment and Rx?
5 (2) doctors
2 for 28 days
[3for 6months]
Botulism but pen allergic?
Metronidazole
Mum had PKD how to screen 20 year old
US
HNPCC which gene mutation?
MLH1 - DNA missmatch repair
Most common moody type?
Which one with renal cysts
Which one with Glucokinase
HNF-alpha - MODY 3
HNF beta - MODY 5
Glucokinase - MODY 2
Scleroderma renal crisis after prescription with what in systemic sclerosis
Prednisolone
[It is unknown why]
Carbimazole mechanism
Converted to methimazole
which Inhibits thyroid peroxidase
MS 1st line?
2nd line?
When straight to mabs?
Interferon or glatiramer acetate
Dimethyl fumarate
[Then the mabs eg natalizumab]
Mabs if 2 disabling relapses in 1 year
When NF type 2
Bilat CN 8 tumors
Lidle syndrome affects
Distal convoluted tuble
Most common percarditis bug
Coxsackie
Simvastatin and cyclosporin in which hepatic transporter
CYP3A4
What does eplerenone do
Prevents binding of aldosterone to mineral corticoid receptors
Liquorish inhibits?
11-b-hydroxysteroid dehydrogenase
Brugada Rx
ICDefib
pyridostigmine class
cholinesterase inhibitor
Nec fasc 1st line
Clinda + metronidazole
Left posterior artery stroke leads to
Right sensory/motor loss
Right homonymous hemianopia
Phase 0-4 action potential
[N0 People CAn CLOSE]
0 - Na influx
1 - Potassium efflux (lasts until phase 3)
2 - Ca influx
3 - Ca channels close
4 - Resting action potential
What does microRNA do?
Silences messengerRNA
Rheum vs OA knee xray
Rheum - Joint erosion lateral aspect (non-weight bare part)
OA - Medial joint space narrowing and subchondral sclerosis
Omeprazole electrolyte abnormalities
HypoMg
HypoNa
Most common antibody in systemic sclerosis
ANA
HOCM on echo. No symptoms ever. Next line
Ambulatory ECG monitoring
Why combination chemo
Prevents drug resistance and kills more cells per cycle
Acute on chronic renal failure. When bicarb?
If Ph <7.2
Latent Tb rx
3 months Rifampicin and Isoniazid
Worst prognosis CLL
17p(del)
p53
Thyroid nodule palpated with thyrotoxicosis initial Ix
Thyroid isotope uptake scan
Waldenstroms - what does the Rx contain if they can hack it
Rituxumab
[+bendamustine]
What detects hypoxia Eg in high altitude
Glomus cells in the carotid body
Deadly disease eg meningitis what screening bit is most important
High sensitivity
early detection of HIV
HIV RNA
How does aspirin inhibit platelets
Reduced production of thomboxine A2
GH deficiency 1st line ix? if this is low?
IGF-1
Then Arginine GHRH test
How many lung Ca deaths due to smoking
> 90%
What type of Ig is Rheum Factor?
IgM
Long term prevention of hepatic encephalopathy
Rifaxamin
When would you hear 4th heart sound on ECG
Just after p wave
[s3 is just before p wave]
Lateral medullary most commonly occlusion where
Vertebral
[then PICA aneuryism]
Pacing wire insertion patient suddenty develops VT where has the pacing wire ended up
Coronary sinus
Lithium-induced DI. Stopped lithium several months ago and followed low salt low protein diet. Still DI. Rx?
Thiazide
Baclofen mechanism
BABA Agonist
How do neutrophils kill bacteria
Phagocytosis
What causes hypotension in anaphylaxis
Histamine release
What is the chance of a sibling being a HLA match
25%
Assessment of ability to perform ADLs which score system?
Barthel
Where are SLG-2 transporters found
Proximal convoluted tubule
Acute optic neuritis Ix
MRI orbits
[VER testing rarely done]
Hashimotos -> nephrotic syndrome ?Initial Rx ?
Membranous nephropathy
Furosemide initially to get ocntrol of oedema
Then steroids
Primary progressive MS Rx?
Secondary progressive?
Ocrelizumab
Siponomod
What does a reticulocyte have that an erythrocyte doesn’t
Ribosomal RNA
Most common cause of u waves
HypoK/Ca/Mg
Cause of hypoxia in early single lobe consolidation
intrapulmonary shunting
[blood directed to the area (consolidation) with poor oxygen diffusion capacity]
Ebstein anomaly? ECG?
Tricuspid regurg
[displacement of the septal and posterior tricuspid valve leaflets]
RBBB
Aqueous humour drains into
The canal of schlem
Most common bug in human bite
Strep anginosus
Fit healthy septic arthritis 1st Abx
IV fluclox
Clyclospora diarrhoea rx
Septrin
Peritoneal dialysis infection rx
Oral cipro and peritoneal vanc
Turners rx to prevent osteoperosis
HRT
[need oestrogen replaced]
MODY 3 HNFa. BM control worsening on max gliclazide. Second line?
Insulin
Cyclophosphamide mechanism
DNA alkylation
-depletes CD4>CD8 T cells
Cyclophosphamide - what causes haemorrhagic cystitis
Acrolein
Pregnant fasting bm >7
Insulin metformin and lifestyle
TIA - what are 2 parts on ABCD2 score worth 2 points
Unilateral weakness
duration > 60 mins
When lobeectomy in epilepsy
Partial complex siezures (temporal) on 2 antiepileptics with ongoing disabling seizures
how does timolol help raised IOP
Reduced aqueous humour production
Bony met pain on high dose opiates
Bisphosphonates or denosumab
Common classes of drugs causing microscopic colitis
PPI
NSAID
Global aphasia means damage to
Left parisylvian region and thalamus
Graves 1st line mab
Toculizumab
Complex partial epilepsy 1st line?
If Han Chinese ?
Oxycarbazine
Keppra (HLA B1502* in 10%-> risk of SJS)
Most common antibody T1DM
Anti GAD
HNPCC drug
Aspirin 600mg
Pancreatitis - when would you think new palapble mass is necrotic pancreatitis and when pseudocyst
Acute clinical deterioration = necrotic
Grumbling long term abdo pain = pseudo
Which soda bic in tricyclic OD
50-100mls of 8.4%
Essential thrombocytosis rx
Hydroxyurea
Bechets rx
Pred
Ectopic ACTH in which lung Ca
Small cell
Thyroid hormone receptor found
In the nucleus
C1 esterase inheritance
Hereditary angioedema …. DOMINANT
CO poisoning effect on ventilation
None
ASx bacteruria in old person
Dont treat
Recent MI now episode of VT (resolved) and some ST elevation in a couple leads
Ventricular aneurysm
When straight to evolocumab rather than ezetimibe in someone already on statins ?
LDL >4 with issues eg reccurent MI
Epley or brand daroff
Epley
Which lymphocytes in immune memory
T cells
Kallman’s inheritance
X linked recessive
Restless leg with no dopamine agonist as option rx?
Gabapentin / pregabalin
Dermatomyositis not responding to pred
Azathioprine
CKD with raised phosphate 1st line
Calcium acetate
>
- T score -3.5 or worse and prev fractures who cant tolerate bisphosphonates
Teriparatide
Antiepileptic with highest risk osteoperosis
Phenytoin
CKD what is best blood test for iron deficiency anaemia
% hypochromic blood cells