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Pastest Flashcards

1
Q

How long after eating food contaminated with s.aureus until symptoms of food poisoning start?

A

1-6 hours

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2
Q

What are the side effects of sulfasalazine?

A

Myelosuppression
Stomatitis
Parotitis
Periorbital oedema

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3
Q

What are the general causes of prolonged APTT?

A

Factor VIII deficiency
Factor VIII inhibitor
Anti-phospholipid syndrome

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4
Q

How can factor VIII deficiency be differentiated from factor VIII inhibitor?

A

50:50 mixing study

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5
Q

Which drugs inhibit VIII (by producing autoantibodies)?

A

Phenytoin
Penicillin
Sulfa drugs

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6
Q

What are acquired causes of factor VIII deficiency?

A 
Pregnancy
Diabetes
Psoriasis
MS
SLE
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7
Q

How do bile acids cause diarrhoea post ileocaecal resection?

A

Decrease transit time
Increase motility
Deconjugated by bacteria to produce end products that stimulate water and electrolyte secretion

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8
Q

Name 5 causes of a transudative ascites?

A 
Budd-Chiari syndrome
Hepatic cirrhosis
Right sided heart failure
Nephrotic syndrome
Acute nephritis
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9
Q

Name 3 causes of exudative ascites.

A

Infection
Inflammation
Malignancy

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10
Q

Why is flexible sigmoidoscopy indicated in diagnosing severe flare of ulcerative colitis?

A

To exclude CMV colitis, which is associated with a poor response to treatment and high relapse rate

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11
Q

What are the features of intrahepatic cholestasis of pregnancy?

A

Pruritus
Jaundice
Raised ALT, bilirubin, bile acids

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12
Q

What is the treatment of intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid

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13
Q

What are the features of acute fatty liver of pregnancy?

A

Liver failure - inc coagulopathy and encephalopathy

High foetal and maternal mortalities

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14
Q

How do villous adenoma present?

A

Hypokalaemic hypochloraemic metabolic alkalosis

Copious diarrhoea

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15
Q

What is the cause of hydatid disease and where is it found?

A

Propagating cysts formed by echinococcus granulosis

Found in sheep farming areas

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16
Q

What is the most sensitive test for acute/ongoing Hep B infection?

A

HBV DNA

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17
Q

What is a consequence of giardia infection?

A

Lactose intolerance

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18
Q

What is the cause of jaundice in pernicious anaemia?

A

High bilirubin secondary to increased turnover of immature RBCs

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19
Q

What is seen on biopsy of sarcoid granulomas?

A

Asteroid bodies

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20
Q

What is neuralgic amytrophy AKA brachial plexitis?

A

Autoimmune, post vaccine/infection/surgery/childbirth

Severe pain followed by weakness, winging of the scapula

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21
Q

What is teraparatide?

A

A PTH analogue which increases osteoblastic activity

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22
Q

What is the cause of prolonged PR interval in hyperkalaemia?

A

Progressive paralysis of the atria

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23
Q

What does the right coronary artery continue as, after supplying the right atrium and right ventricle?

A

Posterior descending artery

Supplies posterior LV wall and posterior IV septum

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24
Q

What are the consequences of selective IgA deficiency?

A

Patients more likely to have a IgG2 deficiency which leads to recurrent bacterial infection
Increased risk of pernicious anaemia, allergy, and coeliac disease
Increased risk of anaphylactic response to blood products

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25
Q

What is the best way to determine the 3D structure of a protein?

A

X-Ray crystallography

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26
Q

What is the role of dual polarisation interferometry?

A

Provides information about how the conformation of a protein changes over time

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27
Q

What techniques identify DNA and RNA sequences?

A

RNA sequences - Northern blotting

DNA sequences - Southern blotting

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28
Q

What is the cause of acute intermittent porphyria?

A

Absence of porphobilinogen (PBG) deaminase

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29
Q

What are the molecular features of shock?

A

Cellular swelling
Depletion of ATP and cyclic AMP
Increase in sodium/potassium ATPase activity
Precipitation of calcium in the mitochondria
Reduced insulin mediated uptake of glucose to muscles

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30
Q

What is the mode of inheritance of the majority of complement deficiencies?

A

Autosomal recessive

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31
Q

What complement deficiency is associated with development of SLE?

A

C1 and C4

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32
Q

What is the direct precursor of cortisol?

A

11-deoxycortisol

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33
Q

Which HLA code is associated with psoriasis?

A

HLA-cw6

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34
Q

Overdose with which drugs is associated with a respiratory alkalosis?

A

Salicylates
Theophylline

Both respiratory stimulants

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35
Q

What is the biggest cause of death in Turner’s syndrome?

A

Rupture of thoracic AAA

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36
Q

How does the influenza virus avoid recognition?

A

Continuous changes in its surface proteins

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37
Q

Which part of the immune system is first to respond to infection?

A

Innate (including NK cells) before adaptive (including T cells)

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38
Q

What is the genetic cause of sickle cell anaemia?

A

Autosomal recessive

Replacement of valine with glutamic acid on position 6

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39
Q

What is the cause of hypercalcaemia in sarcoidosis?

A

Elevated Vitamin D, produced by alveolar macrophages

Causes increased efficiency of calcium absorption in small intestine

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40
Q

What occurs in the extrinsic apoptosis pathway?

A

Death domains attract intracellular adaptor proteins e.g. CD95/FADD, which attracts procaspase 8.

Procaspase 8 is modified to caspase 8, which activates caspase 3, an executioner caspase.

Then, the cell undergoes apoptotic changes such as chromatin condensation and cell fragmentation

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41
Q

Where are the intrinsic and extrinsic apoptosis pathways initiated?

A

Intrinsic - mitochondria

Extrinsic - death receptors on the cell surface

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42
Q

What is the mechanism of desmopressin in haemophilia?

A

Release of stored VWF and factor VIII

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43
Q

Why is bleeding time normal in haemophilia?

A

Normal adhesion of platelets to the endothelium

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44
Q

Which type of von Willebrand disease is the most severe?

A

Type 3

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45
Q

What is the management of auto-immune neutropenia?

A

G-CSF

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46
Q

Which drug can reverse alteplase and how?

A

Tranexamic acid

Inhibitor of the activation of plasminogen to plasmin, and inhibits plasmin at high concentrations

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47
Q

What is aplastic anaemia?

A

Pancytopenia with hypocellular bone marrow in the absence of abnormal infiltrate or marrow fibrosis

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48
Q

What is the most common congenital cause of aplastic anaemia?

A

Fanconi anaemia

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49
Q

How does ATRA work in treatment of acute promyelocytic leukaemia?

A

Promotes the differentiation of APML cells into mature granulocytes which then apoptose

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50
Q

What is the cause of band keratopathy?

A

Degenerative phase of chronic eye disease
Hypercalcaemia

From calcium deposition in Bowman’s layer of the cornea

51
Q

What do Roth’s spots look like?

A

White centred haemorrhages - perivascular collections of lymphocytes

52
Q

What is the drug class and mechanism of action of dorzolamide?

A

Carbonic anhydrase inhibitor

Reduced aqueous humour production

53
Q

What is the earliest lesion to appear in diabetic retinopathy?

A

Microaneurysm

54
Q

What are the features of pseudoxanthoma elasticum?

A

Loose skin folds and puckering

Angioid streaks from breaks in Bruch’s membrane

55
Q

Which muscle is affected in Wernicke’s encephalopathy?

A

Lateral rectus

56
Q

Why do patients with Ehlers-Danlos syndrome have increased risk of retinal detachment?

A

Short sighted - myopia

57
Q

What type of uveitis is seen in sarcoidosis?

A

Bilateral

Granulomatous

58
Q

How do you differentiate between insulin abuse and insulinoma?

A

Insulinoma - elevated both insulin and c-peptide

Insulin abuse - C-peptide normal

59
Q

What osmolalities are seen in psychogenic polydipsia?

A

Urine - low

Plasma - low

60
Q

What is the treatment of thyroid lymphoma?

A

R-CHOP and external beam radiotherapy

61
Q

Why is alpha blockade indicated before beta blockade in treatment of phaechromocytoma?

A

Potential for hypertensive crisis because of unopposed stimulation of alpha-adrenergic receptors

62
Q

Which drugs exacerbate or unmask the symptoms of phaeochromocytoma?

A

TCAs
Cocaine

Inhibit catecholamine reuptake

63
Q

What should be done in the 7-14 days pre phaeochromocytoma removal?

A

Alpha blockade before beta blockade

High sodium and fluid intake diet to reverse catecholamine induced blood volume contraction and prevent severe hypotension after removal

64
Q

What are the biochemical abnormalities seen in anorexia nervosa?

A

Low WCC
Low K, Ca, Mg
Low FSH, LH, oestradiol
Low GnRH

High fasting GH
High cortisol

65
Q

What is the cause of pre-tibial myxoedema?

A

Accumulation of glycosaminoglycans

66
Q

What do SGLT-2 inhibitors reduce the risk of?

A

Heart failure

Ischaemic heart disease

67
Q

How can branch retinal vein thrombosis be differentiated from central retinal vein thrombosis on fundoscopy?

A

Segmental flame haemorrhages

More commonly seen in systemic conditions

68
Q

Which hormone drives the development of secondary sexual characteristics in males?

A

Dihydrotestosterone as it has a higher level of affinity for the androgen receptor

69
Q

What are the 2 types of amiodarone-induced thyrotoxicosis?

A
  1. Increased uptake, positive antibodies: propylthiouracil

2. Absent uptake, negative antibodies (destructive thyroiditis): prednisolone

70
Q

What is the treatment of gastroparesis secondary to diabetes?

A

Domperidone (not metoclopramide)

71
Q

What is the gold standard diagnosis of insulinoma?

A

72 hour fast

72
Q

What is the treatment of narcolepsy?

A

Modafinil

73
Q

What is seen on CXR in simple pneumoconiosis?

A

Nodular interstitial shadowing

74
Q

How is DLCO measured?

A

Measurement of end-expiratory CO after inspiring a small amount and breath holding
Adjusted for haematocrit and alveolar volume

75
Q

What are the surgical treatment options in pulmonary hypertension?

A

Pulmonary endarterectomy
Balloon pulmonary angioplasty in CTEPH
Atrial septostomy
Heart-lung transplant

76
Q

To reduce the risk of pulmonary hypertension and right heart failure in COPD, for how many hours each day should patients have supplemental oxygen?

A

15 hours via a concentrator

77
Q

What is the treatment of multidrug resistant TB?

A

Rifampicin, ethambutol, pyrazinamide, isoniazid, streptomycin

78
Q

What is Cushing’s syndrome related to small cell lung cancer characterised by?

A 
Hypertension
Hyperglycaemia
Hypokalaemia
Alkalosis
Muscle weakness
79
Q

Which lung tumour is most common in non-smokers?

A

Adenocarcinoma

80
Q

What are the stages of eosinophilic granulomatosis with polyangiitis?

A
  1. Asthma prodrome
  2. Tissue and peripheral eosinophilia
  3. Systemic vasculitis
81
Q

What are the features of mycoplasma pneumonia?

A

Cold agglutins
Wheeze
Muscle tenderness/myringitis/pharyngitis
Disproportionate CXR features

82
Q

What kind of cell does SCLC arise from?

A

Neuroendocrine`

83
Q

What happens to the gas transfer in extrathoracic restriction?

A

Decreased gas transfer factor

Elevated gas transfer co-efficient

84
Q

In which condition does LTOT improve mortality?

A

Cor pulmonale secondary to chronic airflow obstruction

85
Q

In which cases of drug induced liver injury is it recommended to stop a drug?

A

If ALT>5x normal

86
Q

What are the functional criteria for pneumonectomy?

A
  1. FEV1> 2 litres
  2. FEV1 >50% observed FVC
  3. Normal PaCO2 at rest
87
Q

Why does orthodeoxia occur in hepatopulmonary syndrome?

A

Hepatic disease can result in R–>L shunt secondary to lower lobe intrapulmonary vasodilation
Therefore increased blood flow through lower lobes when patients moved from supine to erect position
Therefore poorly oxygenated blood from lower lobes enters left side of the heart.

88
Q

What are the features of subacute combined degeneration of the cord?

A 
Bilateral weakness
Reduced vibration and proprioception
Absent ankle reflexes
Hyper-reflexia at the knees
Plantars initially flexor --> then extensor
89
Q

What type of neuropathy is associated with amyloidosis?

A

Autonomic

90
Q

Why is vibration and proprioception spared in anterior spinal artery thrombosis?

A

The dorsal columns sits in the upper 1/3 of spinal cord therefore has a different blood supply (posterior spinal artery)

91
Q

At what level does the spinal cord end?

A

L1

92
Q

Which nerve root supplies the intrinsic muscles of the hand?

A

T1

93
Q

What are the features of corticobasal degeneration?

A

Asymmetrical limb rigidity and apraxia
Alien limb phenomena
Dysphasia

94
Q

What are the 5 classic lacunar syndromes?

A
  1. Pure motor hemiparesis
  2. Pure sensory stroke
  3. Sensorimotor stroke
  4. Ataxic hemiparesis
  5. Clumsy-hand dysarthria
95
Q

What does pyoderma gangrenosum look like?

A

Multifocal
Painful and necrotic, deep
Violaceous border

96
Q

How is pseudoxanthoma diagnosed?

A

Skin biopsy - the elastic fibres of the dermis are short and fragmented
Basophilic fibres
H&E stain, granulomas
Van Kossa stain - calcium deposits

97
Q

What is the mainstay of treatment in PCT?

A

Venesection

98
Q

What is seen on the full blood count in toxic epidermal necrolysis?

A

Eosinophilia

99
Q

What is Marjolin’s ulcer?

A

SCC arising in scar/wound, or area of inflammation

100
Q

Which infection can trigger guttate psoriasis?

A

Streptococcal

101
Q

What part of the heart does the left circumflex artery supply?

A

Lateral and posterior LV walls

102
Q

Why does aortic regurgitation occur in ankylosing spondylitis?

A

Aortitis –> aortic root dilatation –> failure of leaflet coaptation

103
Q

What are the types of carotid sinus hypersensitivity?

A

Cardioinhibitory: cardiac asystole >3s
Vasodepressor: drop in systemic BP>50mmHgMixed type

104
Q

What occurs in carotid sinus hypersensitivity and what is the management?

A

AV nodal block

Ventricular pacing +/- atrial pacing

105
Q

What is a side effect of co-trimoxazole?

A

Allergic myocarditis

106
Q

What is the cause of variable intensity of the first heart sound in VT?

A

AV dissociation causing variable filling of the ventricles from the atria

107
Q

What is the pathophysiology of HfPef?

A

Ventricular stiffness causing poor cardiac filling and elevated diastolic pressures

108
Q

What is the mechanism of action of ivabradine?

A

Inhibits funny current in the sinus node to slow sinus rhythm

109
Q

What is rescue primary PCI?

A

If thrombolysis fails to reduce ST elevation by 50%

110
Q

What are 5 differentials of acute pulmonary oedema?

A 
Severe LV dysfunction
Paroxysmal arrhythmias
3 vessel of left mainstem coronary artery disease
Renal artery stenosis
Phaeochromocytoma
111
Q

What does LBBB mean?

A

The left ventricle depolarises via the right ventricle, rather than the conventional pathway

112
Q

What are the signs of LBBB on auscultation?

A

Soft S1
Reversed split S2 - (split in expiration and single in inspiration) due to delayed closure of the aortic valve due to delayed depolarisation

113
Q

What is seen on ECG in constrictive pericarditis?

A

Small complexes

114
Q

Why is S2 normally split in inspiration?

A

During inspiration there is increased venous return to the right heart, which delays the closure of the pulmonary valve, relative to the aortic valve

115
Q

In HOCM, what is most correlated with risk of sudden death?

A

Degree of septal hypertrophy

116
Q

In malignant hypertension, what is the target BP reduction and why?

A

25% reduction in MAP in first hour

Greater reductions risk organ hypoperfusion due to tissue dysregulation

117
Q

What is pulsus alternans associated with?

A

Left ventricular failure

118
Q

What is the most common type of ASD?

A

Ostium secundum

119
Q

What is the normal oxygen saturation of the pulmonary artery, right atrium, and right ventricle?

A

75%

120
Q

What is the mechanism of action of quinolones?

A

Inhibit bacterial DNA gyrase

121
Q

Why does digoxin need a loading dose?

A

High volume of distribution

122
Q

What are the functions of endothelin A and B receptors in the pulmonary vasculature?

A

A: mediate vasoconstriction and smooth muscle proliferation
B: mediate production of nitric oxide and prostacyclin

123
Q

What are the signs of digoxin toxicity?

A

Xanthopsia (yellow halos)
Complete heart block
Nausea and vomiting
Hypotension

chances increased with hypokalaemia

MRCP (17 decks)

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