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3B > Past paper 2013 > Flashcards

Past paper 2013 Flashcards

1
Q

Give 2 causes of confusion in a patent with multiple myeloma

A

Hypercalcaemia and uraemia

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2
Q

How do you investigate bone lesions in multiple myeloma?

A

Full skeletal X ray (skeletal surgery) looks for the lytic lesions
Plasma cells produce cytokines that inhibit osteoblasts and increases osteoclasts

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3
Q

Do patients have a right to be treated with new cancer drugs that are not recommended by NICE?
How can they be funded?

A

Yes, if the consultant feels they would benefit from treatment that has not been recommended by nice.
The Dr can apply for funding with an individual funding plan - it can be made as an exception to the original funding

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4
Q

Give 2 methods that the patient can get funding thats not from the NHS

A

Individual funding through the PCT
Charity - cancer drug funding
Private funding

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5
Q

Give 4 classical clinical features of plaque psoriasis

A 
Well-demarcated 
Silver scaly plaque 
Erythematous rash 
Hyperproliferation 
Extensor surfaces
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6
Q

Give 2 distinguishing features between psoriatic arthritis and RA

A

DIPs affected in psoriatic

Nail involvement in psoriatic

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7
Q

Which enzyme does diclofenac inhibit?

A

Cyclooxygenase (1+2)

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8
Q

Give 2 substances the diclofenace prevents from forming

A

Prostaglandin and thromboxane A2

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9
Q

Give the mechanism of action of steroids

A

The bind to glucocorticoid nuclear receptors which translates them into cells - where they bind with glucocorticoid response elements in the promotor region or target genes.
They up regulate the anti-inflammatory genes and down regulate pro-inflammatory genes

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10
Q

2 things to warn people about while taking methotrexate?

A

Teratogenic - avoid getting pregnant

Folate inhibitor - take folate to avoid anaemia

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11
Q

Which hormone is high in Conns and which organ is it from?

A

Aldosterone

Adrenals

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12
Q

Which hormone is low in Conns and which organ is it from?

A

Renin

Kidneys

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13
Q

Give the ECG changes in hyperkalaemia

A

Absent p waves
Tall tented T waves
Wide QRS

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14
Q

Give the ECG changes in hypokalaemia

A

Flat inverted T waves,
U waves
Depressed ST
Long QT

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15
Q

What happens at the mineral corticoid receptor in the CT of kidneys when acted on by spironolactone?

A

Works on the Na+/K+ pump -
Inhibits the pump causing less Na+ to be reabsorbed back into the serum
Hyponatraemia and hyperkalaemia

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16
Q

Which channels does mineral corticoid (aldosterone) act on?

A
  • Nuclear mineral corticoid receptors in the principle cells of the tubular and collecting duct - activates Na+ and k+ pumps –> reabsorption of Na and water while secreting K+ into the urine
  • Also up regulates the epithelial sodium channels in the collecting duct increasing the apical membrane permeability for Na+ and thus absorption
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17
Q

Elderly woman who drinks heavily, with confusion.

Intra-cranial causes of confusion

A
  • SOL
  • Hydrocephalus
  • Encephalitis
  • Subdural haematoma
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18
Q

Give clinical signs of Korsakoff’s syndrome

A
  • Confabultion
  • Antegrade/retrograde amnesia
  • Personality changes
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19
Q

Give the clinical signs of Wernicke’s encephalopathy

A
  • Ataxia
  • Opthalmoplegia
  • Nystagmus
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20
Q

Thing to look for in a mental state exam in someone with korsakoffs

A

Mood and affect - incongruent?
Insight?
Cognition
Behaviour

21
Q

Immediate treatment and route of Korsakoff’s?

A

IV pabrinex (thiamine B1)

22
Q

What is the 1st line treatment for delirium tremens according to NICE?

A

PO lorazepam –> IV lorazepam –> haloperidol

23
Q

Give 2 specific readings/score to look for on spirometry that is diagnostic of COPD

A

FEV 1 <80%

FEV1:FVC <0.7

24
Q

Give 6 signs of hypothyroidism

A 
Hyporeflexia 
Bradycardia 
Dry skin 
Cold peripheries 
Puffy face 
Myxoedema 
HTN 
Hypothermia 
Atacia
25
Q

Which drugs interact with levothyroxine absorption?

A

Ferrous sulpahte
Calcium
Rifampicin
Amiodarone

26
Q

Give 6 RF for osteoporosis

A 
SHATTERED 
Steroids 
Hyper PTH/ Thyroid/Ca 
Alcohol and smoking  
Testosterone low 
Thin 
Early menopause 
Renal/liver failure 
Erosive/infalm = RA, MM Mets 
Diet - ca/DM
27
Q

What investigation can you use to diagnose a crush fracture?

A

Spine Xray

28
Q

Give 2 drugs for osteoporosis

A

Bisphosphonates - alendronate

ADCAL D3

29
Q

Lifestyle advice for osteoporosis

A

Stop smoking
Reduce alcohol
Weight bearing exercises

30
Q

What is sensitivity?

A

The proportion of people with the disease who are correctly identified by the screening process

31
Q

What is specificity?

A

The proportion of people without the disease who are correctly identified by the screening process

32
Q

What is the positive predictive value?

A

The proportion of people who tested positive who actually have the disease

33
Q

Give 2 investigations for suspected Crohn’s disease

A

Bloods: CRP
Stool: fecal calprotectin
Imaging: ileocolonoscopy or endoscopy if upper GU symptoms
- SB/rectal biopsies

34
Q

2 histological features of Crohn’s

A
  • Transmural
  • Non-caseating granulomas
  • Rose thorn ulcers
  • Cobble stoning
  • Skip lesions
35
Q

What is the 1st line treatment for maintaining remission in Crohn’s?

A 
1st = azathioprine 
2nd = methotrexate
36
Q

What are the general measures to help Crohn’s disease?

A

Stop smoking
Vaccinations
Iron tablets if anaemia

37
Q

How can you induce remission in an acute flare up or Crohn’s with erythema nodosum?

A

IV/PO hydrocortisone

38
Q

What advice/treatment can you give for erythema nodosum?

A

Analgesics
Leg raise
Compression
Steroids

39
Q

What are the features of UC?

A

Non-rectal sparing, continuous inflammation, mucosal and submucosal ulcers + polyps.
Tenesmus, colicky pain, blood diarrhoea, urgency and mucus

40
Q

What is the 1st line treatment for inducing remission in UC?

A

PO mesalazine
+ PO pred
+ PO tracroimus

41
Q

What is the 1st line treatment for maintaining remission in UC?

A

PO mesalazine

?Azathioprine if needed

42
Q

What type of drug is mesalazine?

A

Aminosalicylate

It is a bowel specific anti-inflammatory

43
Q

If a patient has hearing loss and facial weakness, where is the acoustic neuroma located intracranially?

A

Cerebropontine angle

44
Q

The patient asks if his acoustic neuroma is cancer. What can you tell the patient?

A

That is it a very slow growing tumour. Indolent

45
Q

With nephrotic syndrome, what are you looking for in the urine? (numerical value)

A

Proteinuria 3.5g/24hrs

46
Q

With nephrotic syndrome, what abnormalities would you see on biochemistry?

A

Hypoalbuminaemia and hypoerlipidaemia

47
Q

What pathological change would you see in the glomerular BM in someone with diabetic nephropathy?

A

BM thickening followed by me

48
Q

Give 2 drug treatments and 1 lifestyle advice for a patient with nephrotic syndrome

A

Dietary salt and water restriction
ACE-I
Statins
Diuretics = bendroflumethiazide

3B (21 decks)

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