Past paper tit bits Flashcards
Which vitamin deficiency linked to colorectal Ca
Vit D
5cm plaque with inflamed border
Progress from thickened ->atrophic
May become hyperpigmented / ivory white over time
Morphoea
What dictates when to use Telapravir in HepC
HepC genotype
Genotype 1 has poor clearance and so use new agents such as Telapravir
STEMI going for PCI give what? If on oral anticoag?
Aspirin and prasugrel
Aspirin and clopidogrel
Woman (asymptomatic) who’s brother has haemophilia. What is risk of her son getting it?
25%
1 in 2 risk she has it
1 in 2 risk she passes on her dodge one
How does ticagrelor work
Platelet ADP receptor blocker
Aspirin mechanism
Cox-1 inhibitor
Cerebral toxoplasmosis rx = Pyrimethamine +
Sulfadiazine + folic acid
Biggest risk factor for suicide
Previous attempt
Cerebellar pontine tumour +calcification with no hearing loss / tinitus?
Meningioma
(if hearing loss = acousic neuroma)
Rheum A
Fever, dyspnea and multifocal consolidation =
Organising pneumonia
Usual time frame for MTX pneumonitis in Rheum A
4 months after starting MTX
CT shows pulm infiltrates
Alcoholic with urinary incontinence, peripheral neuropathy + reduced knee jerk =
B12 deficient
[B1 is just wernikes for exam]
How to screen for risk of steven johnsons syndrome
Eg if starting carbamazepine
HLA testing
HLA-B1502
Gram -ve bacilli causing cavitating pneumonia in big boozer
Klebsiella
Raised white/flesh colored lumps ? usually seen in? Cause?
Molluscum contagiosum
immunocompromised/
Children
Poxvirus
48 hour lag -> bloody diarrhoea
Campylobacter
70s when is loss of high frequency sounds presbycusis? Loss of cochlear hair cells?
Presbycusis - age related
Loss of cochlear hair cells - due to load noises Eg Gamekeeper, factory, war…
Key side effect of pethedine? When does it happen and why?
pethidine is metabolised to norpethedine
If renal impairment -> accumulates
->Seizures
What accumulates in renal failure and morphine administration
Morphine 6 - glucaronide
mid 20s with hereditary peripheral neuro symptoms -> ataxia? Inheritance?
Most common presentation?
Friedriecks ataxia
GAA repeat in frataxin gene
Unstable gait is usual presentation
Rheum A, now pancytopenic. What has happened
Felty syndrome (hypersplenism)
Haemarthrosis, factor VIII lower end of NORMAL and mild elevated APTT. Prev surgery with no issues =
Von Wilebrand
Karposi’s sarcoma virus
HHV 8
Rx of SVC obstruction
Stenting followed by consideration of radiotherapy
Bone and muscle pain, weakness, lethargy. Proximal myopathy
Low Ca, raised ALP =?
Osteomalacia
Needs calcium + vit D
Positively birefringent rhomboids =
Caclium pyrophosphate
[pseudogout / CPPD]
MRSA UTI rx
Doxy (or other tetracycline) if mild
IV vanc if severe
Why CLL get recurrent infections?
Hypogamaglobulinaemia
Diarrhoeal illness and acute hepatitis. Which Hep viruses in differentials?
A or E
Consider HepE if south east asia
Corneal reflex - explain and nerves involved
Touch cornea -> stimulates sensory branch of CN V (trigeminal)
Spinal trigeminal nucleus stimulates CN 7 facial nerve to cause both eyes to blink
How can you exclude adrenal insufficiency with synacthen test?
Cortisol rise of >200nmol/L
and 30 min level >600nmol/L
Who gets neuropathy with isonazid?
-NAT-2 deficient
-Slow aceytlators
2 mechanisms of nicorandil
Nitrate
Potassium channel agonist
Both lead to smooth muslce relaxation
2 drugs which can be used for myeloma
Thalidomide
Bortezomib
Blast cells and aeur rods on blood film and acute leukaemia (especially if young) which chromosomal thing?
What if CML?
t (15:17)
CML - philadelphia t (9:22)
Post partum, hyperthyroid. Postive TPO antibodies whats the cause
Post partum thyroiditis
Which 2 leukaemias does philadelphia chromosome cause
ALL
CML
3 poor prognostic factors in ALL ?
Males
WCC >50
Philadelphia chromosome
Active SLE with thrombocytopenia. What rx>?
DMARD
Eg hydroxycloroquine
Active SLE with thrombocytopenia. What rx>?
DMARD
Eg hydroxycloroquine
Which CD and which MHC class on
T helper
Cytotoxic T
T helper - CD4, MHC class 2
Cytotoxic - CD8, MHC class 1
Multiply toget to 8
Which IL in acute phase response. Drug to target each?
IL-1 - Anakinra
IL-6 - Toculizumab
Both used in Rheum A
IL-2 does what? Drugs targetting it?
Drives T cell proliferation Eg in tranplant rejection
Calceneurin inhibitors Eg Ciclosporin and tacrolimus
IL-2 in transplant rejection as 2 peoples organs there
Which IL is ANTI-inflamatory
IL-10
10/10 well done bud calming things down
Which IL is ANTI-inflamatory
IL-10
10/10 well done bud calming things down
Severe allergic asthma may get what -mab therapry
Anti-IgE
Omazilumab
Which Ig deficiency gets autoimmune disease
IgA
Which T helper cell in
Agressive inflam response?
Tollerant response eg preg?
Autoimmune disease?
TH -1
TH - 2
TH - 17 (secretes IL-17)
Why gynaecomastia in liver disease
Decreased steroid hormon catabolism
[specifically androstenedione -> increased substrate converted into oestrogens]
Why feminism in someone who is fat and drinks lots
increases aromatase activity
FVC in COPD
Inspiratory loop?
FVC often slightly low (due to gas trapping)
Normal inspiratory loop
Coeliac and then small bowel obstruction =
T cell lymphoma
Bacterial overgrowth would not lead to obstruction
Coeliac and then small bowel obstruction =
T cell lymphoma
Bacterial overgrowth would not lead to obstruction
Hayflick limit is?
Number of times a cell can divide
2 most common rescue therapies in IBD
Ciclosporin
Infliximab
Both have quick acting properties
Other immunosupressive Eg Azathioprine, 6-metacarporine take weeks
Throat infetion then couple weeks later - salmon pink patches with scales
Guttate psoriasis
Gastrocnemius nerve root?
S1/2 (tibial nerve)
Common drug which seems to reduce the risk of colon cancer
Aspirin
[and maybe NSAIDs]
Azathioprine / ciclosporin / methotrexate in preg?
Aza / ciclo can be continued
Stop methotrexate
Azathioprine / ciclosporin / methotrexate / sulphasalazine in preg?
Aza / ciclo can be continued
Stop methotrexate / sulphasalazine
Key risk of suphasalzine in preg
Baby born with haemolytic anaemia
Pulm / renal involvement only. 2 week course and really sick?
Goodpastures
GPA usually a bit slower with some sinus / upper stuff
Pulm / renal involvement only. 2 week course and really sick?
Goodpastures
GPA usually a bit slower with some sinus / upper stuff
Fomepazil mechanism ? Why do toxic alcohol peeps go blind?
Inhibits alcohol dehydrogenase
->prevents formation of formaldehyde -> formic acid -> acidosis and ocular toxicity
Dilsufiram mechanism
Inhibits aldehyde dehydrogenase
not alcohol dehydrogenase
Can you have DI with a normal serum osmolality ?
No
IT WILL BE HIGH
Can you have DI with a normal serum osmolality ?
No
IT WILL BE HIGH
Trip to africa
Now 6-12 weeks later
Fever and massive urticaria and rasied eosinophils?
What if after just a couple weeks?
Shitosomiasis -> eggs -> big reaction (Katayama fever)
Ascaris ssp (if soon after return)
How long Rx in schitz for symptoms to resolve
About 4-6 weeks
How long Rx in schitz for symptoms to resolve
About 4-6 weeks
Monozygotic twin with SLE whats risk?
Dizygotic?
25%
3%
Monozygotic twin with SLE whats risk?
Dizygotic?
25%
3%
Fatty with slightly low FEV1 and FVC with progressive SOB. What test to differentiate multiple small PEs and obesity hypoventilation.
Transfer coeeficient
Eg Kco 55% will be PEs
You dont get chest pain with small PEs
How does ATG work
Depletes T cells
[inhibits monocyte-derived dendritic cells maturation]
Anti La found in which 2 conditons most commonly
SLE
Sjorgrens
Repaired Aortic aneurysm. Which class of drug most important for long term?
B blockers
Keep the BP low and minimise vessle stress
Speaking in sentences but it is meaningless - Damage to? Where is this located?
Wernike’s
Superior temporal gyrus
Unable to say sentences = damage to? Where is it found?
Brocas
Inferior frontal gyrus
What is nephritic factor actually called?
Anti-C3bBb
Causes alternative complement pathway to be constantly stimulated
What is most common non traumatic cause of a chylothorax
Lymphoma
1st line Primary pulm HTN after a CCB? Mechanism ?
Bosentan
Endothelien A receptor antagonist
Klebsiella osteomyelitis Abx
Tazocin
Endocarditis with Strep Sanguinis blood culutres. What Ix for source?
Orthopantomogram
Sanguininis is usally from a dental abscess
What causes the raised urate in tumour lysis
Neucleic acid breakdown
-> purines
->uric acid
H+ pH conversion - 2 vaulues to remeber
ph 7.4 = h+ 40
ph 7 = h+ 100
Lutembacher’s syndrome is?
a congenital atrial septal defect (ASD) complicated by acquired mitral stenosis (MS).
Why do people who’ve had a big stroke stay cold?
Damage to hypothalamus
-Leads to an impaired catecholamine response
Left Trochlear nerve palsy. How would patient tilt head when speaking to you?
Tild head to right
When do you see bilateral scotomas
Methanol posioning
Lesion in central scotoma is where
Optic nerve
Antibodies in HIT
Anti PF4
[platelet factor]
Visit Nepal/india and up to date with vaccines Acute symptoms. Which hepatitis do they have ? Incubation period?
HepE
2-9 weeks
Contact dermatitis which hypersenitivity type?
Type 4
Klebsiella pneumonia drug choice?
Tazocin
Mechanism for PTH reducing PO4 in blood
Reduces proximal tubule reabsorbtion
Septic arthritis gonorrhea Rx
Ceftriaxone
Ballistic movements - where is damaged
Sub thalamic nucleus
Ballistic movements - where is damaged
Sub thalamic nucleus
Blueish discolouration of the skin caused by?
Amiodarone
Blueish discolouration of the skin caused by?
Amiodarone
Which cardiac drug causes mouth ulceration (and GI)
Nicorandil
P Vivax initial Rx
Chloroquine
[followed by a course Primaquine]
Difference between an auditory hallucination and a second-person auditory hallucination.
Auditory - ‘He wants to…’
-Commentary
Secondary - ‘You are going to…’
-Second person talking to you
Pyoderma gangrenosum Topical/oral steroids?
Oral
Pyoderma gangrenosum Topical/oral steroids?
Oral
Worried about thyroid eye disease - what test can you do first?
Perimetry
[formal visual field testing]
Target lesions, haemolysis and pneumonia likely?
Mycoplasma
PVL staph - not responding to fluclox. What next?
Clinda
[Doxy, rifampicin other options]
Where on the ECG is the 4th heart sound ? What is it?
P wave
Caused by atria contracting forcefuly to overcome a stiff ventricle
Heart sounds
1
2
Where on ECG?
1 closure mitral/tricuspid
QRS
2 closure aortic / pulm
T
where are ketones formed in DKA
Lypolysis
DVT prophylaxis post acute stroke
Pneumatic compression boots
LMWH carries risk of bleed
CKD why raised PTH
Low vit D
-> Low Ca
Shallow painless ulcer on penis
enlarged lymph node in groin? bug? Rx?
Lymphogranuloma venereum
Chlamydia
Doxy 1 week
Unconcious house fire. Metabolic acidosis, normal O2 sats. Ischemic ECG
CO posioning
Chostochondritis - Do you need an Xray?
No
Erythema nodosum and bilateral ankle arthritis - whats high on differential
Lofgren syndrome
[sarcoidosis -> needs a CXR]
Pre menopausal woman with iron defiiency anaemia 1st line Ix?
TTG
When is ivabradine used? Class
Heart failure with pulse > 75
HCN channel blockers
[Hyperpolarization and Cyclic Nucleotide ]
It works by slowing the heart rate so the heart can pump more blood through the body each time it beats
Which class of drug is HIV most commonly resistant to?
Reverse transcriptase inhibitors
Which class of drug is HIV most commonly resistant to?
Reverse transcriptase inhibitors
Can you reduce O2 % in COPD if they have a PO2 < normal
No
Heading towards NIV
What is lactate produced from?
Anaerobic metabolism from Pyruvate via lactate dehydrogenase
Fly to Africa and bitten by Tetse fly? Months later now sleep/wake cycle becomes reversed + other general CNS / psych issues? Bug? Ix? Rx?
Trypanosoma Brucei species
[sleeping sickness]
CSF
Pentamidine
Flu -> cavitating pneumonia. Which bug?
Staph Aureus
Head injury -> persistent headaches, memory loss, lethargy. Slowly improving over several weeks
Post concussion syndrome
Pleuretic chest pain relieved while sitting forward. Best Ix?
ECG - pericarditis
[trop wont be that exiting]
Which part of antibody binds to a receptor on surface of phagocyte
Fc Portion
Which part of antibody binds to a receptor on surface of phagocyte? Which part to bugs?
Fc Portion [FagoCyte]
Fab [Think Fab fragments finding to digoxin - or faBacteria]
Travel.
Chronic fevers + weight loss + splenomegally
Pancytopenia and derranged LFTs =
Visceral leishmaniasis
Diagnosis of PMR
Clinical -> give pred
Common electrolyte abnormality in thyrotoxicosis
HyperCa
Rapid correction of hyperNa -> ? Whats happening intracellularly?
Cerebral oedema due to gain of water
Atherosclerosis which cells in tunica intima?
Macrophages
lipid laden foam cells
DVT in preg Rx
LMWH
Long term rate control in AF with cardiac failure
Bisoprolol
Digoxin worse mortality
Lots of lifting - Carpal tunnel symptoms but also paraesthesia over palm
Pronator syndrome
carpal tunnel symptoms do not affect the palm, pronator syndrome will
Lesion is proximal to formation of sensory branch
They will also not get worsening of symptoms atnight unlike carpal tunnel
Which enzyme transports free fatty acids into cell to use as energy?
carnitine acyltransferase
Carnivors eat lots of fat
coarctation usually also have?
Bicuspid aortic valve - in 60%
Ring enhancing lesions on CT. How to confirm Dx? Rx?
CSF PCR
Pyrimethamine and sulfadiazine
Stab wound just lateral to sternum hits?
RV
LV if a couple cm lateral
Wells score DVT - If 1 or less?
2 or more?
1 or less - D-dimer
2 or more - Doppler
If doppler negative for DVT then what?
if doppler negative -> d dimer and if this is positive repeat the doppler after 6 days
No freinds and not intersted in people and does not feel lonely? What if they were lonely?
Schitzoid
Avoidant if they are lonely
Differentiate common peroneal and L5 lesion
Common peroneal has preserved foot inversion and plantar flexion
Which post-mi heart failure drug might cause pancreatitis
Furosemide
Carbamazepine mechanism
Inhibit voltage gated sodium channel
Think causes hypoNa (different mechaism but same electrolyte)
Diabetes, gall stones, weight loss, dia/steatorrhoea, HypoCl
Somatostatinoma
From D cells
BP med worsening psoriasis
B blockers
Endocarditis - which bug has better outcomes
Strep - less resistance and better response to Abx
Severe lung disease in A1AT which genotype
ZZ
[tired of trying to remeber these]
Carribean
Intermittent confusion
Nodular skin rash, distal sensory deficit, thoracic anuerysm
Syphilis
syphilitic aneurysms occur in 90% of cases on the thoracic aorta
Bar immunpsupression what other cause for poor antibody response to vaccines
HLA type
Prolactinoma - drug class for Rx
Dopamine agonist
Eg bromocriptine, ropinorole, carbegoline
Syringomyelia - where LMN signs? UMN?
LMN - upper limbs (reduced reflexes and wasting
UMN - Lower limbs - spaciticty
Thumb to touch fingertips muscle?
Opponens pollicus
Opposition of thumb
Thumb to touch fingertips muscle?
Opponens pollicus
Opposition of thumb
2 Types of BP med that worsen myasthenia
BB / CCBs
Cat scratch disease - usual Rx?
Conservative in immunocompetent
cipro/azithro if needed
Cat scratch disease - usual Rx?
Conservative in immunocompetent
cipro/azithro if needed
What causes finger drop in rheum A
Swelling of ulnar styloid
->rupture of tendon
Needs surgical repaire obvs
Dosuleptin class
Tricyclic
Recurrent myoglobinuria likely cause?
Cartinine palmitoyltransferase deficiency
Gonnorrheoa Rx
IM cef + oral azithro
Ph of normal pleural fluid?
Ph to suspect pleural fluid is malignant
7.6
under 7.3
Icidental finding of pleural plaques on XR - what next
Nothing - likely asbestos but in absence of lung disease just leave them alone
Surgical referral in endocardititis
Prolonged PR
ongoing Fevers after 5 days
Neck pain
tongue deviates right
Right sided loss of vibration and proprioception
Left sided weakness
Where is lesion
Vertebral artery
What stimulates bladder emptying? Overactive bladder drug class for Rx ?
Parasympathetic stimulation
Muscarinic antagonists
Closure of urethral sphincter is from?
Sympathetic stimulation
opposite of bladder - want bladder contraction and urethral relaxion at the same time
Malignant / asbestosis effusion 1st line Ix?
Pleural tap
Tertiary hyperPTH when cinacalcet, when parathyroidectomy
Cinacalcet if surgery inappropriate
If young deffs surg
Paracetamol OD INR for poor outcome
> 2 by 24hrs
3.5 by 72
> 6.5 is referral for liver Tx
IVDU - now extensive palapable purpuric rash and distal motor weakness over months. What has happened ?
Cryoglobulinaemia secondary to HepC
Lorazepam mechanism? When might it be used in pal care not for agitation?
GABA-A agonist
Nausea - enhances the effects of conventional antiemetics
2 things prolonging life in MND
Riluzole
NIV
Codine to morphine calculation
divide by 12
240mg codeine = 20mg morphine
