Past paper 2013 Flashcards
Give 2 causes of confusion in a patent with multiple myeloma
Hypercalcaemia and uraemia
How do you investigate bone lesions in multiple myeloma?
Full skeletal X ray (skeletal surgery) looks for the lytic lesions
Plasma cells produce cytokines that inhibit osteoblasts and increases osteoclasts
Do patients have a right to be treated with new cancer drugs that are not recommended by NICE?
How can they be funded?
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
Give 2 methods that the patient can get funding thats not from the NHS
Individual funding through the PCT
Charity - cancer drug funding
Private funding
Give 4 classical clinical features of plaque psoriasis
Well-demarcated Silver scaly plaque Erythematous rash Hyperproliferation Extensor surfaces
Give 2 distinguishing features between psoriatic arthritis and RA
DIPs affected in psoriatic
Nail involvement in psoriatic
Which enzyme does diclofenac inhibit?
Cyclooxygenase (1+2)
Give 2 substances the diclofenace prevents from forming
Prostaglandin and thromboxane A2
Give the mechanism of action of steroids
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
2 things to warn people about while taking methotrexate?
Teratogenic - avoid getting pregnant
Folate inhibitor - take folate to avoid anaemia
Which hormone is high in Conns and which organ is it from?
Aldosterone
Adrenals
Which hormone is low in Conns and which organ is it from?
Renin
Kidneys
Give the ECG changes in hyperkalaemia
Absent p waves
Tall tented T waves
Wide QRS
Give the ECG changes in hypokalaemia
Flat inverted T waves,
U waves
Depressed ST
Long QT
What happens at the mineral corticoid receptor in the CT of kidneys when acted on by spironolactone?
Works on the Na+/K+ pump -
Inhibits the pump causing less Na+ to be reabsorbed back into the serum
Hyponatraemia and hyperkalaemia
Which channels does mineral corticoid (aldosterone) act on?
- 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
Elderly woman who drinks heavily, with confusion.
Intra-cranial causes of confusion
- SOL
- Hydrocephalus
- Encephalitis
- Subdural haematoma
Give clinical signs of Korsakoff’s syndrome
- Confabultion
- Antegrade/retrograde amnesia
- Personality changes
Give the clinical signs of Wernicke’s encephalopathy
- Ataxia
- Opthalmoplegia
- Nystagmus
Thing to look for in a mental state exam in someone with korsakoffs
Mood and affect - incongruent?
Insight?
Cognition
Behaviour
Immediate treatment and route of Korsakoff’s?
IV pabrinex (thiamine B1)
What is the 1st line treatment for delirium tremens according to NICE?
PO lorazepam –> IV lorazepam –> haloperidol
Give 2 specific readings/score to look for on spirometry that is diagnostic of COPD
FEV 1 <80%
FEV1:FVC <0.7
Give 6 signs of hypothyroidism
Hyporeflexia Bradycardia Dry skin Cold peripheries Puffy face Myxoedema HTN Hypothermia Atacia
Which drugs interact with levothyroxine absorption?
Ferrous sulpahte
Calcium
Rifampicin
Amiodarone
Give 6 RF for osteoporosis
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
What investigation can you use to diagnose a crush fracture?
Spine Xray
Give 2 drugs for osteoporosis
Bisphosphonates - alendronate
ADCAL D3
Lifestyle advice for osteoporosis
Stop smoking
Reduce alcohol
Weight bearing exercises
What is sensitivity?
The proportion of people with the disease who are correctly identified by the screening process
What is specificity?
The proportion of people without the disease who are correctly identified by the screening process
What is the positive predictive value?
The proportion of people who tested positive who actually have the disease
Give 2 investigations for suspected Crohn’s disease
Bloods: CRP
Stool: fecal calprotectin
Imaging: ileocolonoscopy or endoscopy if upper GU symptoms
- SB/rectal biopsies
2 histological features of Crohn’s
- Transmural
- Non-caseating granulomas
- Rose thorn ulcers
- Cobble stoning
- Skip lesions
What is the 1st line treatment for maintaining remission in Crohn’s?
1st = azathioprine 2nd = methotrexate
What are the general measures to help Crohn’s disease?
Stop smoking
Vaccinations
Iron tablets if anaemia
How can you induce remission in an acute flare up or Crohn’s with erythema nodosum?
IV/PO hydrocortisone
What advice/treatment can you give for erythema nodosum?
Analgesics
Leg raise
Compression
Steroids
What are the features of UC?
Non-rectal sparing, continuous inflammation, mucosal and submucosal ulcers + polyps.
Tenesmus, colicky pain, blood diarrhoea, urgency and mucus
What is the 1st line treatment for inducing remission in UC?
PO mesalazine
+ PO pred
+ PO tracroimus
What is the 1st line treatment for maintaining remission in UC?
PO mesalazine
?Azathioprine if needed
What type of drug is mesalazine?
Aminosalicylate
It is a bowel specific anti-inflammatory
If a patient has hearing loss and facial weakness, where is the acoustic neuroma located intracranially?
Cerebropontine angle
The patient asks if his acoustic neuroma is cancer. What can you tell the patient?
That is it a very slow growing tumour. Indolent
With nephrotic syndrome, what are you looking for in the urine? (numerical value)
Proteinuria 3.5g/24hrs
With nephrotic syndrome, what abnormalities would you see on biochemistry?
Hypoalbuminaemia and hypoerlipidaemia
What pathological change would you see in the glomerular BM in someone with diabetic nephropathy?
BM thickening followed by me
Give 2 drug treatments and 1 lifestyle advice for a patient with nephrotic syndrome
Dietary salt and water restriction
ACE-I
Statins
Diuretics = bendroflumethiazide
