Pastest Flashcards
Harder, slower, scarier
1
Q
How do you distinguish anteriolateral vs high lateral infarction?
A
Antero-lateral V4-6, I, and aVL.
High lateral V5-6, I, and aVL
2
Q
How does metformin increase ovulation in PCOS?
A
Increases insulin sensitivity within the ovary to improve ovulation.
3
Q
Explain the immunopathological process of SLE
A
Activation of the classical complement pathway occurs owing to the large number of double stranded DNA and other immune complexes that form and fix complement.
These immune complexes deposit in the kidneys and other organs where they attract other components of the immune system that cause tissue damage.
4
Q
What does over warfarinization affect on the clotting screen?
A
INR - determined by PT (but can also increase APTT as well)
5
Q
When do you consider prophylaxis in cluster headaches?
A
If headaches are frequent or last more than 3 weeks.
Normally verapamil or lithium is used
6
Q
What are the benefits of Meptazinol as analgesia?
A
Meptazinol is a partial mu opioid receptor agonist; as such, it is an effective opioid analgesic associated with a lower risk of constipation.
7
Q
What does an ABG demonstrate in Grave’s Disease?
A
Compared with normal subjects, hyperthyroid patients show significantly lower resting arterial CO2 tension, tidal volume and significantly higher mean inspiratory flow and PaO2. This can, of course, lead to misdiagnosis of patients with hyperthyroidism as having hyperventilation syndrome.
Patients with hyperthyroidism also show a greater ventilatory response to hypoxia than normal patients. These ventilatory changes are significantly correlated with T3 levels.
8
Q
How does HIV enter cells?
A
Two envelope proteins on the surface of the HIV virus are involved in initial binding to human cells. GP120 binds to the primary receptor (the CD4 moleculre) and then to a co-receptor (CXCR4 (T cell) or CCR5 (macrophage)); GP41 then mediates movement through the cell membrane.
9
Q
Damage to what structure causes hemiballism?
A
Subthalmic nucleus
10
Q
What are the causes of protein losing enteropathy?
A
Sarcoidosis Inflammatory bowel disease Pseudomembranous colitis CMV colitis Tuberculosis Connective tissue diseases
11
Q
What is the appropriate follow up for adenomatous colonic polyps?
A
5 year interval for low risk patients
-one to two adenomas both <1cm
3 year follow up for medium risk
-3-4 adenomas or 1-2 where one >/=1cm
1 year follow up high risk
-5 or more small adenomas or more than 3 with at least 1 at or above 1cm.
12
Q
Which cranial nerves arise from the midbrain?
A
Midbrain – the trochlear nerve (IV) comes from the posterior side of the midbrain. It has the longest intracranial length of all the cranial nerves.
13
Q
Which cranial nerves arise from the pons?
A
Trigeminal (V)
14
Q
Which cranial nerves arise from the medulla?
A
Medulla oblongata – posterior to the olive: glossopharyngeal, vagus, accessory (IX-XI). Anterior to the olive: hypoglossal (XII).
15
Q
Which cranial nerve arises from the midbrain-pontine junction?
A
Oculomotor (III)
16
Q
Which cranial nerves arise from the pontine-medulla junction?
A
Pontine-medulla junction – abducens, facial, vestibulocochlear (VI-VIII).
17
Q
How does glucose cause diabetic retinopathy?
A
Polyol pathway. Glucose converted to sorbitol which accumulates damaging retinal cells via osmotic effects.
Also increased thickness of capillary basement membrane, leukocyte stasis and adhesion to vascular endothelium.
Glucose also persistently activates protein kinase C ad MAPK causing programmed cell death
18
Q
What conditions are associated with fragile X?
A
Epilepsy (25%), strabismus, otitis media, sinusitis, joint dislocation, orthopaedic problems, apnoea
19
Q
Causes of clubbing?
A
Suppurative disease, long standings bronchiectasis, acute lung abscess, empyema, malignant disease (esp carcinoma bronchus and pleural malignancy), fibrosing alveolitis, asbestosis.
20
Q
What is the mechanism of action of terlipressin in hepatorenal syndrome?
A
Terlipressin = synthetic ADH analogue
(non significant ADH effect (only 3% compared to real ADH))
Increases vascular and extravascular tone and therefore increased arterial vascular resistance. Decreases splanchnic hypervolaemia. This decreases renin activity due to decreased afferent and efferent flow.
Useful as a bridge to transplantation. May have mortality benefit.
21
Q
What are the 3 cardinal features of lewy body dementia to help differentiate from alzheimers?
A
Fluctuating cognitive function
Varying alert level
Significant daytime somnolence
22
Q
What is the worst antimalarial in G6PD?
A
Primiquine
23
Q
What is the gold standard test for syphilis?
A
Swab and PCR is now the best
not serology
24
Q
How does syphilis serology alter before and after treatement?
A
Non-treponeme specific (VDRL, RPR) +ve in active disease but -ve after treatment or in late disease
-Can be +ve in pregnancy, SLE, TB etc
Treponeme-specific (TPHA, FTA) +ve in active disease and remains +ve following treatment.
-Also +ve in other related treponeme disease (e.g. yaws)
25
What are the advantages and disadvantages of clindamycin use in cellulitis?
Used if patient is pen allergic
Switches off bacterial toxin production
Does increase risk of C. Diff so used second line
26
Why may CXR and sputum be -ve in TB reactivation post TNF-a initiation?
60% is extrapulmonary so you must have very high index of suspicion.
27
What are the 2 important causes of shock following an inferior MI and how do you differentiate?
RIGHT VENTRICULAR INFARCTION
1/3 of inferior wall MI. Acute loss of RV function causes pooling of blood in right ventricle with consequent decreased preload in left ventricle resulting in hypovolaemic shock. NO MURMURS OR PULM OEDEMA. On Swann Ganz catheter high right atrium pressure but low left. Aggressive IVF to increase venous return to RV and preload LV
PAPILLARY MUSCLE RUPTURE (particularly if circumflex involved)
Torrential acute mitral regurgitation causing rapid pulmonary oedema
LOUD PAN SYSTOLIC MURMUR AND CHEST CREPITATIONS
28
How can you differentiate Bartter and Gitlleman Syndrome?
Both hypokalaemic metabolic alkalosis with NORMAL BP
Gittleman = LOW urinary calcium (low calcium secretion) secondary to abnormal NaCl transporter
Bartter = NORMAL calcium.
-More likely to present in childhood with failure to thrive
29
What is the endemic typhus vector?
Endemic typhus = Rickettsia Prowazekii = Human body louse, pediculus humonis humonis
30
What is the scrub typhus vector?
Scrub typhus = Orientia tsutsugamushi = Trombiculid Mite
31
What are the clinical features of Carney Complex?
Autosomal dominant inactivation of Protein Kinase A on Chromosome 17
Criteria (2 of the following or 1 feature and affected first degree relative):
- Spotty skin pigmentation
- Myxoma
- Endocrine tumours
- Psammomatous melanocytic schwannoma (PMS)
32
What are the CYP450 Inhibitors?
STICKFACES.COM
```
Sodium valproate
Ticlodipine
Isoniasid
Cimetidine
Ketoconazole
Fluconazole
Alcohol binge
Ciprofloxacin/ Chloramphenicol
Erythromycin
Sulphonamides
Cranberry juice/ Grapefruit juice
Omeprazole
Metronidazole
```
33
What are the CYP450 inducers?
BS CRAP GPS ("BS CRAP GPS induce rage")
```
Barbituates
St John's Wort
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
Griseofulvin
Phenobarbital
Sulphonylureas
```
34
What is the mechanism of action of aminophylline?
Phosphodiesterase inhibitor
Phosphodiesterase catalyses conversion of cAMP to 5' adenosine monophosphate. Blockage increases cAMP intracellularly causing bronchodilatation.
35
Pain and temperature is carried via which spinal tract?
Spinothalamic tract near anterior horn on OPPOSITE side to dorsal root (desicates early)
36
Proprioception is carried via which spinal tract?
Dorsal column
37
What spinal tract carries motor signals?
corticospinal tract
38
The femoral nerve supplies which muscles?
Iliacus, Iliopsoas, Quadriceps
39
The obturator nerve supplies which muscles?
Adductor longus, adductor magnus, gracillus
| Weakness of adduction and sensory loss of medial thigh
Damage common during childbirth
40
What are the 2 divisions of the sciatic nerve?
Common peroneal nerve
| Tibial nerve
41
What are the muscles supplied by the common peroneal nerve?
```
Tibialis anterior (dorsiflexion)
Extensor Hallucis Longus (flexion toe)
Peronei longus and brevis (eversion of foot)
```
42
What are the muscles supplied by the tibial nerve?
Gastrocnemius (plantarflexion)
Soleus
Tibialis Posterior (inversion)
43
How do you differentiate lambert eaton vs myasthenia beyond the onset of weakness?
Lambert eaton -> hyporeflexia is classic
-Autonomic involvement (Light-headedness, dry mouth etc)
Myasthenia you DONT get autonomic features
-You do get ocular features
44
How do you differentiate multifocal motor neuropathy?
Sounds like MND but nerve conduction studies will show demyelination and conduction block.
MND will have normal nerve conduction studies
PURE MOTOR SYNDROMES NO SENSORY
45
What are the pure motor syndromes?
NMJ disorders (myasthenia and lambert eaton)
Myopathies
Multifocal motor neuropathy (demyelination and conduction block on NCS)
Motor neurone disease (both upper and lower signs)
46
What does prolonged F-wave latency on nerve conduction studies indicate?
Strictly it means demyelination but very classic of early GBS
47
Fasciculation potential or active and chronic denervation on nerve conduction studies indicates what?
motor neurone disease
48
How do you differentiate familial hypocalciuric hypercalcaemia and hyperparathyroidism?
Hypercalcaemia with commonly high PTH (therefore often misdiagnosed as hyperparathyroidism)
In familial hypocalciuric hypercalcaemia urinary calcium excretion is LOW.
This is an autosomal dominant condition which usually presents with renal stones (rarely acute pancreatitis)
49
What are the radiological changes seen in ank spond?
```
Blurred joint margins
Subchondral erosions
Sclerosis or fusion of sacroiliac joints
Loss of lumbar lordosis
Bamboo spine (tramtrack appearance)
```
50
What are the T stages for lung cancer?
T1 = <3cm
T2 = 3-7cm (T2a = 3-5cm; T2b = 5-7cm)
- Atelectasis (part of lung)
- Invasion: visceral pleura, main bronchus >2cm from carina
T3 = >7cm
- Atelectasis (whole lung)
- Invasion: phrenic N, Diaphragm, Chest wall, Mediastinal pleura, Main bronchus <2cm, parietal pericardium
T4
-Invasion: Mediastinal organs, vertebral bodies, carina, tumour nodules in different ipsilateral lobe
51
What are the lymph node stages in lung cancer?
N1 = Ipsilateral bronchopulmonary/ Hilar
N2 = Ipsilateral mediastinal/ subcarinal
N3 = Contralateral side
52
What is the difference between FAP and Gardener syndrome?
Both are APC gene mutations
FAP:
- Multiple small and large bowel adenomas
- Colorectal Ca risk 90-100% (Colectomy at 16)
- 5% risk of duodenal Ca (endoscopic surveillance mandatory, 2nd commonest cause of death)
Gardener is FAP phenotype PLUS osteomas jaw, skull and long bone
53
What is enteric hyperoxaluria?
Oxalate stone risk in small bowel surgery/ Crohns
Treatment with calcium to bind oxalate and decrease absorption.
Should also decrease oxalate intake (Beetroot and Rhubarb)
54
What clinical signs should you look for prior to starting activated charcoal?
Decreased bowel sounds
Paralytic ileus common after overdose.
Associated with increased risk of charcoal aspiration and pneumonitis
55
How do you treat gout in HIV?
Colchicine is best
Allopurinol increases plasma levels of didanosine >100%
56
What is the best lipid lowering drug when on warfarin?
Atorvastatin and pravastatin (don't interfere)
Rosuvastatin increases effects along with bezafibrate and simvastatin
Cholestyramine decreases effects of warfarin
57
What are the adverse effects of carbimazole?
Nausea, rash, pruritis, arthralgia, alopecia, agranulocytosis, jaundice
58
How do you diagnose visceral leishmaniasis?
Serological usually used
Microscopy and culture is gold standard
-Either a lymph node aspirate, splenic biopsy (commonly done in 3rd world) or bone marrow
Skin biopsy can be used in cutaneous but not visceral leishmaniasis
59
What are the types of autoimmune hepatitis and their respective antibodies?
Type 1
-ANA and/or SMA (affects both adults and children)
Type 2
-LKM1 (children only)
Type 3
-Soluble liver kidney antigen (adults in middle age)
60
What are the autoimmune hepatitis associations?
Ammenorrhoea common
Associations:
- Hypergammaglobulinaemia
- HLA B8, DR3
61
What factors affect MDRD eGFR?
Pregnancy
Muscle mass
Eating red meat 12hrs before
62
What are the types of melanoma?
Superficial spreading
-Most common, irregularly pigmented macule or plaque, May have irregular edge and colour variation
Nodular
-Pigmented nodule, often rapidly growing and aggressive, usually on legs or trunk
Lentigo maligna melanoma
- Older patients with long standing lentigo maligna
- Slowly expanding, irregular pigmented macule
Acral lentiginous melanoma
- Palms, SOLES, and toenails
- Flat and discoloured
- Most common type in chinese and japanese
63
How does ileostomy cause hypocalcaemia?
Lose large amounts of magnesium.
Hypomagnesaemia impairs PTH secretion. This causes hypocalcaemia which is resistant to increased provision of calcium. Must replace Mg2+
64
What are the 2 pathways for triggering apoptosis?
Extrinsic - initiated by death receptors on the cell surface of the target cell
Intrinsic - pathway triggered at the mitochondrial level
65
What are the causes of fixed splitting of the second heart sound?
Atrial septal defect
Right heart failure
Pulmonary hypertension
66
What do B2 adrenoreceptors do?
Arteriolar dilatation, Bronchodilatation, decreased bronchial secretion, decreased gut motility, relaxation of pregnant uterus
Metabolic effects: lipolysis, glycogenolysis and gluconeogenesis
(B blockers do the opposite)
67
Explain the current mechanisms underlying the treatment of pulmonary oedema
High catecholamine levels and activation of RAAS drive peripheral vasoconstriction, which increases myocardial O2 demand.
Conventionally treatment has been with diuretics (no evidence of mortality benefit) and effects probably due to vasodilatory action.
More powerful vasodilators (IV diamorphine and GTN) are more attractive now
ACEi and B-blockers early have morbidity and mortality benefit.
68
What is the mechanism of metthaemoglobinuria?
Iron in Haem is Fe2+
| Oxidising agents convert to Fe3+ (inactive ferric form)
69
What are the antibodies involved in paraneoplastic pemphigus?
Envoplakin, periplakin, bullous pemphigoid antigen I, desmoplakin, desmoplakin II, plectin and alpha 2- macroglobulin-like-1
70
Where are chancroid ulcers usually found?
Prepuce and frenulum in men
Vaginal entrance and perineum in women
-----------------------------
Treatment is single dose azithromycin, IM ceftriazone or 7 days erythromycin.
71
How does liver cirrhosis result in metabolic alkalosis?
Low albumin associated with severe disease drives relative intravascular volume depletion.
-Aldosterone release increases as a result.
Steroid hormone metabolism decreased by liver impairment.
Additionally albumin behaves as a weak acid therefore hypoalbuminaemia itself adds to metabolic alkalosis.
Production of urea (would be one way to compensate) is also impaired.
72
What is Tolosa-Hunt Syndrome?
Granulomatous inflammatory process that involves the anterior cavernous sinus/ superior orbital fissure region.
This causes progressive syndrome over several weeks vs quicker like cavernous sinus thrombosis.
73
What parkinsons drug causes haematuria?
L-dopa
74
Describe the nomenclature of pacemaker
First letter = chamber to be paced (A = atrium, V = ventricle, D = Duel
Second letter = chamber that is sensed ( A, V or D)
Third letter = response to a sensed beat beat by pacemaker (I = inhibits, T = trigger, D = both)
VOO = Fixed output setting
Fourth letter refers to whether or not the pacemaker has rate-adaptive properties (R)
75
What is MacLeod Syndrome?
Unilateral emphysema following childhood bronchiolytis
76
What is the mechanism of action of LMWH?
Binds antithrombin III
77
What part of Vitamin A contributes to vision?
Vitamin A is a collective term for several related biologically active molecules.
Retinaldehyde is a form of vitamin a derived from oxidation of retinol (also vit a). The cis form is found in the opsin proteins in the rods (rhodopsin) of the retina.
Exposure to light results in change to trans isomer and resulting changes in membrane potentials. This causes signals to brain.
78
What are the 3 features that demonstrate a "true" koebner phenomenon?
Lichen planus
Psoriasis
Vitiligo
79
Vigatriban is a treatment for epilepsy. What is its classic side effect?
Visual field defects.
Onset from 1 month to several years
In most cases it persists despite stopping treatment
Visual field assessment should be carried out before treatment and at 6 monthly intervals.
80
What are the risk factors for gastric cancer?
```
H. Pylori
Low dietary vitamin C
Family history
High salt diet
Race (Japan> UK > Sweden)
Gastric surgery
Pernicious anaemia
Smoking
```
81
What food items interfere with warfarin?
Cranberry juice and pomegranate juice - Inhibitors of 2C9 (main P450 responsible for warfarin metabolism)
Brussel sprouts and liver - Contain large amounts of vitamin K and so decrease effects.
82
What food should be avoided in statin therapy?
Grapefruit juice
Powerful inhibition of 3A4
May cause toxicity to simvastatin, ciclosporin and other drugs.
83
What is Alkaptonuria and what HLA is it associated with?
Homogentisic acid oxidase deficiency that leads to a defect in tyrosine metabolism (amino acid metabolism) and accumulation of homogentisic acid.
Increased incidence in those who are HLA-DR7 positive
Treatment involves dietary reduction in tyrosine and phenylalanine
84
What lab test is used to evaluate the genetics of trinucleotide repeat disorders?
TP-PCR
85
What is ornithine aminotransferase deficiency?
Causes atrophy of choroid and retina.
Begins as small yellowish spot and increasing to a circular lesion edged with pigment.
Children present with myopia and decreased night vision which progresses from tunnel vision to blindness in middle life. Cataracts also develop.
Some patients have proximal muscle weakness
Deficiency results in massive rise in plasma ornithine with particularly high concentration in CSF and aqueous humour.
86
What is Darier's disease?
Autosomal with classic cutaneous features
Warty papules and plaques in seborrhoeic areas (central chest and back, scalp, flexures), palmar pits and nail dystrophy.
Secondary infection of the lesions can lead to crusting and malodour.
Retinoid acitretin used to treat symptomatic cases.
87
Anaemia and gallstones can indicate what disease?
Hereditary spherocytosis.
88
What is the mechanism of action of nucleoside reverse transcriptase inhibitors?
These are a nucleoside which lack a 3'- hydroxyl group.
Insert into reverse transcriptase and prevents formation of 3'-5' phosphodiester bond.
Can inhibit formation of either +ve or negative strand of DNA
------------------------------
NRTIs are pro-drugs taken into host cell and phosphorylated to active form (i.e. have to be phosphorylated to work)
89
What are the adverse effects common to nucleoside reverse transcriptase inhibitors?
Peripheral neuropathy
Bone marrow suppression (Tx with GCSF)
Lactic acidosis
90
What adverse effect is most associated with didanosine?
Pancreatitis
"PancreaDIDis = DIDanosine"
91
What adverse effect is most associated with zidovudine?
Anaemia
"Zidovudine gets ZID of the haemoglobin"
92
Give some examples of nucleoside reverse transcriptase inhibitors
```
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir (Nucleotide not nucleoside)
Zidavudine
```
93
What is the mechanism of action of non-nucleoside reverse transcriptase inhibitors?
Binds to different site of reverse transcriptase to NRTIs and creates a hydrophobic pocket which slows DNA synthesis.
Unlike NRTIs they do not require phosphorylation to be active.
NOT effective against HIV-2-reverse transcriptase as non competitive
94
What are the universal adverse effects of non-nucleoside reverse transcriptase inhibitors?
Hepatotoxicity and skin rash
95
What adverse effect is most associated with Efavirenz?
Vivid dreams
"EfaVIVIDs = VIVID dreams"
96
Give some examples of NNRTIs
Delaviridine
Efavirenz
Nevirapine
97
What is the mechanism of action of protease inhibitors?
Block HIV-1 protease ability to cleave protein precursors effectively blocking viral maturation
98
What are the generic adverse effects of protease inhibitors?
Hyperglycaemia
GI effects
Lipodystrophy
(liPROdystrophy, hyPROglycaemia, PROfuse diarrhoea)
99
What adverse effect is most associated with indinavir?
Nephropathy
"Indinavir = IN DA KIDNEY"
100
What adverse effect is ritonavir most associated with?
P450 inhibition
"ritONavir turns ON drugs by inhibiting P450"
101
What are some examples of protease inhibitors?
Atazanavir
Indincavir
Ritonavir
102
What is the mechanism of action of integrase inhibitors?
Blocks ability to incorporate into host genome
103
What are the adverse effects of integrase inhbitors?
Elevated creatine kinase
104
Give some examples of integrase inhibitors
Dolutegravir
Elvitegravir
Raltegravir
105
What are the two types of fusion inhibitors?
Enfuviritide
-Binds GP41 to prevent penetration (GP41 on envelope)
Miraviroc
- Binds CCR5 preventing attachment
- CCR5 is on T cells/ monocytes
106
What are the steps in Crohn's exacerbation management?
Corticosteroids used to induce remission
Immunosuppressant drugs
- Examples: Thiopurines (azathioprine, mercaptopurine) or methotrexate
- Used as adjunct in acute exacerbations, also used to maintain remission
- Can be used post "macroscopic resection" to maintain remission (unlike biologics)
Biologics
- Induce remission in severe disease not responding.
- Also effective at maintaining remission (not post surgery)
107
What are the steps in UC exacerbation management?
Steroids
Ciclosporin
Infliximab if not tolerating above
108
How can you systematically localise heart blocks?
Autonomic manoeuvres (carotid/ valsalva) worsen AV nodal block but not infranodal.
Atropine improves AV node block (increases HR) but worsens block in His-Perkinje system.
109
What is the trinucleotide repeat for Huntington's disease?
CAG
110
What is the trinucleotide repeat for myotonic Dystrophy?
CTG
myoTonic = cTg
111
What is the trinucleotide repeat in Fragile X syndrome?
CGG
fraGile = cGG
112
What is the trinucleotide repeat in oculopharyngeal muscular dystrophy?
GCG
C to SEE
113
What is the trinucleotide repeat in Freidreich's ataxia?
GAA
AAAtaxia
114
What are the most to least common valve sites for infective endocarditis?
```
Mitral valve
Aortic valve
Both aortic and mitral
Tricuspid
Rarely pulmonary
```
115
In hepatitis endemic areas what is the most common cause of acute viral liver failure?
In endemic areas, virtually everyone is infected with Hep A in childhood and immune as adults.
This means outbreaks are usually Hep E.
116
How should you test for Hep C in immunocompromised?
In the immunocompromised or those on dialysis may have Hep C but -ve Hep C antibodies
Requires virology testing by PCR
117
What are the CKD stages G and A?
```
G1 >90
G2 89-60
G3a 59-45
G3b 45-30
G4 29-15
G5 <15
```
A1 ACR <3 mg/mmol
A2 3-30 mg/mmol
A3 >30 mg/mmol
118
How should you manage HIV in pregnancy?
Oral zidovudine from 28 weeks gestation decreases risk of transmission
Optimal regimen is to commence zidovudine as an IV infusion at onset of labour AND continue treatment in neonate up to 6 weeks of age.
119
How do you diagnose CJD?
LP and perform RT-Qu1C peptide assay
| -Has a 95-98% diagnostic sensitivity and 100% specificity for sporadic CJD.
120
How do you determine prognosis in myeloma?
International scoring system (ISS) uses combination of serum B2 microglobulin and albumin
121
Neurofibromatosis type 1 diagnostic criteria?
At least 6 cafe au lait spots (5mm diameter in prepubertal patients and 1.5cm in post pubertal patients) typically on trunk.
Axillary freckling and/or inguinal freckling
At least 2 Lisch nodules (iris hamartomas)
Neurofibromas (more than one cutaneous neurofibroma or one plexiform neurofibroma)
Characteristic bone abnormalities
Optic nerve glioma
Diagnosis of NF1 in a first degree relative
122
What is the Truelove and Witt's criteria for a severe attack of acute collitis?
```
At least 6 stools per day
Visible blood and at least 1 feature of systemic upset:
1. Temp above 37.8
2. Pulse >90
Anaemia
ESR >30mm/1st hour
```
123
What are the features of a rheumatoid pleural effusion?
Up to 5% of patients with RA develop pleural effusion at some stage.
Exudates
Typically pH <7.2
High LDH
Low glucose level
RA is unlikely to be the cause of the effusion if glucose fluid level is over 1.6mmol/l.
Large amounts of cholesterol can accumulate in long standing rheumatoid pleural effusions
124
How does tetanus toxin interferre with acetylcholine-mediated transmission at the motor endplate?
Tetanus toxin cleaves specific sites of synaptobrevin (VAMP)
-------------------------
The specific fusion complex is made up of synaptobrevin, syntaxin and synaptosome associated protein (SNAP-25). The fusion complex serves to join the membranes of an acetylcholine vesicle and a nerve cell.
Botulinum toxin types BoNT/B, D, F, G and tetanus toxin (TeNT) cleave specific sites of synaptobrevin (VAMP)
125
How does bolutinum toxin type C affect acetylcholine mediated transmission at the motor endplate?
Cleaves syntaxin
---------------------------
This is different to tetanus and the other botulinum toxins which cleave specific sites of synaptobrevin (VAMP)
126
When are patients most at risk of getting Kaposi sarcoma in HIV nowadays?
In general incidence has fallen due to HIV treatment. However there is a high incidence in the immediate 6 months after starting ART.
2 theories:
- IRIS activates dormant HHV-8
- Second is just that you are most immunosuppressed prior to starting treatment so likely to develop kaposi around this time and less likely later.
127
What is the escalation of treatments for acne?
Topical treatments like antibiotics
Oral antibiotic trial for 3 months
Further antibiotic trial for 3 months with different agent
Referral to dermatology for oral isotretinoin.
128
How do you grow Nocardia spp?
Nocardia use paraffin as a source of carbon for growth.
In this technique, a paraffin wax-coated glass rod is placed in the inoculated carbon-free broth
Nocardia grow on the rod at the air-liquid interface.
129
Mouse foot-pad inoculation is used to cultivate which bacterium?
Mycobacterium leprae.
130
What are the 3 predominant ketones seen in DKA?
Which can linger the longest still contributing to mild acidosis at 36hrs?
A range of ketoacids are formed in DKA.
- Acetone (responsible for pear drop breath)
- Beta-hydroxybutyrate
- Acetoacetic acid
Acetoacetate forms acetone and beta hydroxybutyrate.
Both acetoacetate and acetone fall before the 36hr mark but beta hydroxybutyrate can linger for some time.
131
UTI relapse is defined as what?
What are the most common causes?
Recurrence of bacteriuria with the same organism within 7 days of completing antibacterial treatment.
Usually occurs in conditions in which it is difficult to eradicate the bacteria:
- Stones
- Scarred kidneys
- Polycystic kidneys
- Bacterial prostatitis.
132
How do you decide on the appropriate treatment in SLE?
Simple arthralgia and fatigue respond well to hydroxychloroquine.
Methotrexate is used if there is arthritis (synovitis) but not for arthralgia (joint pain without swelling)
Prednisolone/ azathioprine or cyclophosphamide would be more for serious internal organ involvement (renal, neurological, eye or lung)
133
How does hypocalcaemia occur in ethylene glycol poisoning?
The principle end product of metabolism of ethylene glycol that causes significant toxicity is oxalic acid. This then combines with calcium to form insoluble calcium oxalate and drives presentation with acidosis and kidney disease
134
How do you differentiate Type 1 and Type 2 Amiodarone induced thyrotoxicosis and how does the treatment differ?
Type-1 = positive antibodies and uptake on radioisotope scan
-Treated with Propylthiouracil
Type 2 = Destructive
- Absent uptake and negative antibodies
- Treated with steroids
135
What urinary troubles is risperidone associated with?
Increased daytime frequency (pollakiuria)
Enuresis
Urinary retention
Urinary incontinence
Dysuria
136
Safest anti-depressent while breastfeeding?
Sertraline
Much lower levels in breast milk
137
What peak expiratory flow is typical for a 70kg man?
520-700 l/min
138
What total lung capacity is typical for a 70 kg man?
5-6.5 litres
139
What functional residual capacity is typical for a 70 kg man?
2-3 litres
140
What tidal volume is typical for a 70 kg man?
500-700ml
141
What inspiratory reserve volume is typical for a 70kg man?
3300ml
142
What are the laboratory findings seen in Wilson's disease?
```
Raised AST
Low caeruloplasmin
Low serum copper
Raised urinary copper excretion
Low serum uric acid (increased excretion)
```
Aminoaciduria, glycosuria and calciuria also occur with poor acidification of urine
143
What indicates drug induced immune haemolytic anaemis Vs. auto-immune haemolytic anaemia or transfusion reaction?
All 3 will have positive direct coombs
Drug induced haemolytic anaemia will have no antibodies on antibody screen
144
A posterior gastric ulcer is most likely to involve which artery?
Splenic artery
Runs along the upper border of the pancreas and results in a severe haemorrhage
145
A lesser curve gastric ulcer may involve which artery?
Left gastric artery
146
A greater curve gastric ulcer may involve which vessels?
Gastroepiploic vessels
147
Why does the hypothalamic-pituitary axis get activated during an immune response?
IL-1 and TNF-a stimulate release of corticotrophin releasing hormone from the hypothalamus. This HPA activation is integral to the stress response. Results in release of cortisol; at high levels cortisol suppresses the immune response and therefore prevents a lethal overactivation of immune processes.
148
What is birch apple syndrome?
Throat and mouth may become itchy after eating apples in between 50-75% of individuals who have allergic rhinitis related to birch tree pollen.
Celery is another food known to cause mouth irritation.
149
What is the treatment of epididimo-orchitis based on age?
Under 35 more likely STI and treat as such
Over 35 more likely gram negative enteric bacteria
Ofloxacin first line
150
What is the most commonly affected channel in congenital long QT syndrome?
Long QT syndrome type 1 is the most common (30-35% all cases)
LQT1 gene is KCNQ1 which has been isolated to chromosome 11.
Codes for volted gated potassium channel KvLQT1 that is highly expressed in the heart.
This is a slow delayed rectifier potassium channel mutation
151
What is the mechanism of action of vancomycin?
Binds to D-alanyl-D-alanine residues preventing the synthesis of polymers essential to the formation of the bacterial cell wall.
Where polymers do form, vancomycin also prevents their crosslinking to form the cell wall.
152
What is the mechanism of action of adenosine?
Purine nucleoside which acts as a G protein coupled receptor agonist of the adenosine A1 receptor.
This leads to inhibition of adenylate cyclase and hence a reduction in cyclic AMP.
153
Parinaud syndrome is a failure of vertical gaze usually associated with convergent nystagmus, as well as mydriasis and impaired pupillary reflexes. Where in the brain does it occur?
Dorsal midbrain
154
3rd cranial nerve arises from where?
Ventral midbrain
155
What is the only absolute contraindication to electroconvulsive therapy?
Raised intracranial pressure.
156
Terlipressin is a prodrug of what?
Lysine vasopressin
------------------
Terlipressin can be regarded as a circulating depot of lysine vasopressin. Following IV injection 3 glycyl moieties are cleaved from the N-terminus to release lysine vasopressin which then reduced blood flow in the splanchnic circulation and reduce portal hypertension
157
What's the difference between a type 1 and type 2 error?
Type 1 (alpha) is the incorrect rejection of a true null hypothesis (i.e. false positive)
Type 2 (beta) is when the null hypothesis is incorrectly accepted (i.e. false negative)
158
How is the bleeding time affected in haemophilia A and B?
Bleeding time is NORMAL.
-This is because there is normal adhesion of platelets to the endothelium, which is the predominant factor when assessing the bleeding time.
----------------------------------------
This is vitally important for differentiating from Von Willebrands disease. Particularly type III which can present severely with haemarrthrosis and look like haemophilia. APTT will also be raised as there is a relative deficiency of factor VIII. The only clue will be that bleeding time is prolonged.
159
What is the appearance of hairy leukoplakia?
May be very similar to candida forming irregular white patches on the tongue (most commonly on the sides of the tongue), and oral mucosa.
However, oral hairy leukoplakia lesions cannot be dislodged, whereas candida can easily be scraped away.
160
How do B-cells become plasma cells?
B-cells have surface IgG and MHC class II. When a B-cell meets an antigen these receptors recognise then the B-cell can undergo somatic hypermutation (where an enzyme makes random mutations in the antibody variable region genes) and isotype switching (i.e. switching through the immunoglobulin classes).
```
If these processes result in an antibody that more strongly binds to their targets then these B-cells will survive and differentiate into plasma cells with the new specificity.
-They now lack IgG and MHC class II and cannot undergo somatic hypermutation or isotype switching again
```
161
What are the 3 types of nephropathy seen in ankylosing spondylitis?
AA amyloidosis: when disease has been going on for many years. (apple-green birefringence seen)
NSAID induced nephropathy
IgA nephropathy: also common among young men in the absence of ank spond
162
What is the mechanism of action of sotalol?
Class III agent (predominantly K channel blocker)
-----------------------------------
Risk of Torsades, should have ECG 2-3 days after initiation to look for prolonged QT.
163
How is paracetamol metabolised?
Conjugation to glucuronic acid
| -Requires glutatione which forms conjugates with NAPQI metabolite
164
What is the pathophysiology of Hyper-IgM syndrome?
X linked condition where levels of IgG, IgA and IgE are undetectable but there are high levels IgM and IgI.
This is due to role of CD40 in B-cell maturation and isotype switching (also called CD40 ligand deficiency).
B-cell defect which presents with recurrent sinopulmonary infections and particularly susceptible to PJP. Patients can develop cryptosporidial infection, leading to sclerosing cholangitis, liver failure, and also increased risk of malignancy predominantly abdo cancers.
165
What is the narcolepsy tetrad?
Chronic daytime sleepiness,
Cataplexy
Hyperagogic/ hypopompic hallucinations
Sleep paralysis
166
How do you differentiate between hepatic adenoma and hepatic angioma?
Hepatic adenoma occur in women of childbearing age. Associated with COCP. Mainly asymptomatic
Usually right lobe of liver and can be hypervascular (look like angioma)
167
What is the most common cause of lithium induced nephrotic syndrome?
Minimal change disease
| Less commonly FSGS
168
What drugs do you use for PEP and PEPSE after exposure to HIV?
Truvada (Tenofovir and emtricitabine) + Raltegravir for 28 days.
169
What is the calculation for confidence interval?
Confidence interval = mean +/- 1.96 x (SD/Square root fo sample size)
----------------------------
For exam 1.96 is just 2
170
What is the genetics of Prader-Willi?
Non-mendelian
- 70% due to deletion or disruption of genes on proximal arm of paternal copy chromosome 15 (15q11-13).
- 28% due to maternal disomy
171
How does ciclosporin cause renal impairment?
Chronic interstitial nephritis
172
What bone disease is associated with diabetes mellitus and peritoneal dialysis?
Adynamic bone disease
- Increased incidence of hip fractures.
- Tendency towards hypercalcaemia as bone loses capacity to buffer serum calcium
173
What is the pathophysiology of liver fibrosis?
Stellate cells have similar morphology to fibroblasts but with additional fat droplets. These are located in Disse space. Essential to hepatic fibrogenesis responding to mediators released by parenchymal and Kupffer cells, and mediating their transformation to myofibroblasts.
Transforming growth factor beta (TGF-B) initiates process.
Transformed stellate cell then stimulates production of extracellular matrix products in addition to products for matrix degradation.
174
GLP-1 analogues are contraindicated in which complication of diabetes?
Suspected gastroparesis
175
How do you differentiate vitiligo and pityriasis?
Vitiligo characteristically symmetrical
Pityriasis usually confined to trunk with fine scale.
176
What are the ECG changes during the course of pericarditis?
ST elevation with concavity upward in all leads facing the epicardial surface (i.e. anterior, inferior and lateral)
Only "cavity" leads aVR, V1 and rarely V2 show ST depression
This is followed by return of ST segments to baseline and flat or inverted T waves.
THERE CAN BE NO LOSS OF R WAVES OR DEVELOPMENT OF Q WAVES
177
What are the two main locations for respiratory drive?
Peripheral chemoreceptors -> carotid bodies (and a lesser extent aortic arch).
-These detect plasma pH for metabolic changes in acid base
Central chemoreceptors -> response to plasma CO2 tension
-Control of normal respiration
178
Insulin regulates which enzymes?
Down regulation of pyruvate carboxylase (key step in gluconeogenesis)
Upregulation of pyruvate dehydrogenase, glucokinase, glycogen synthetase, G6PD
179
What antibiotic is used in meningitis prophylaxis?
Ciprofloxacin
180
What genetic mutation is most associated with pancreatic cancer?
KRAS
- Codes for GTPase
- 80-90% pancreatic adenocarcinomas have mutations in the KRAS2 gene
181
What is the most common side effect of imatinib?
Nausea
182
What are the antibody mediated antibodies?
IL-4, IL-5, IL-6, IL-10
183
What are the cell mediated cytokines?
IL-2, Interferron Gamma
184
What are the acute phase response cytokines?
IL-1, IL-6, TNF-a
185
How does adenosine interact with dipyridamole?
Adenosines effect prolonged by dipyridamole
- Effects may last for up to several minutes
- -------------------------
Adenosine contraindicated in 2nd or 3rd degree heart block, sick sinus syndrome or verapamil use.
186
Goodpasture's is associated with which HLA?
HLA DRB1*15:01
187
Psoriasis is associated with which HLA?
HLA Cw6
188
Why does digoxin have a slow onset of action and require a loading dose?
High degree of protein binding
| Half life around 30-40 hours
189
What are the 4 dyslipidaemia syndromes and their basic pathophysiology?
"1LP, 2LD, b adds V, 3 is E, 4 gets more"
Type 1 = LPL deficiency
Type 2 = LDL receptor deficiency
Type 2b = LDL receptor deficiency and VLDL
Type 3 = ApoE deficiency
Type 4 = Overproduction of VLDL
190
What are the features of type 1 dyslipidaemia?
Autosomal recessive. (very rare)
- Caused by LPL deficiency which results in triglyceride accumulation (can result in pancreatitis)
- May also be caused by ApoC2
- Chylomicrons, triglycerides and cholesterol are increased
191
What are the features of type 2 dyslipidaemia?
Familial hypercholesterolaemia
Type 2 (Autosomal dominant)
- LDL receptor deficiency causes LDL build up
- This results in classic tendon xanthoma
- May also be caused by ApoB100
- Also causes corneal arcus
- High cholesterol but triglycerides and HDL may be normal
```
Type 2b (autosomal dominant)
-All of the above but VLDL also elevated
```
192
What are the features of type 3 dyslipidaemia?
Remnant hyperlipidaemia (aka familial dysbetalipoproteinaemia, broad base disease)
ApoE deficiency. Important for the uptake of remnants (chylomicrons and VLDL) and so these build up.
Causes palmer xanthoma
Treated with fibrate
193
What are the features of type 4 dyslipidaemia?
Familial hypertryglyceridaemia
| Overproduction of VLDL -> triglycerides -> pancreatitis
194
What are the features of abetalipoproteinaemia?
Deficiency of ApoB48 and ApoB100
No VLDL, LDL or chylomicrons and so cannot process fats
Results in steatorrhoea and decreased vitamins ADEK
- Vit E deficiency -> retinitis pigmentosa and spinocerebellar degeneration
- Acanthocytes on bloods film
- Vitamin K deficiency causing increased PT
195
What area of the brain is involved in regulation of satiety?
Ventromedial nucleus (along with arcuate nucleus of hypothalamus)
196
What area of the brain is involved in regulation of blood pressure and heart rate?
Dorsomedial hypothalamic nucleus = blood pressure and heart rate
Posterior nucleus = blood pressure, shivering response and release of vasopressin
197
CYP-2D6 is involved with metabolism of which drugs?
B-blockers (esp. metoprolol)
Dihydrocodeine (metabolised to morphine via CYP-2D6
MDMA
Certain SSRIs
198
CYP-2C8 is involved with metabolism of which drugs?
```
Omeprazole
Diazepam
Barbituates
Dapsone
Pioglitazone
```
199
CYP-2C19/19 is involved with metabolism of which drugs?
Omeprazole
Diazepam
TCAs
Proguanil
200
Oncholysis (separation of nail from bed) is associated with what?
Trauma
Infection
Drugs: Tetracyclines (esp. doxy), psoralens
201
In hypoglossal (XII) nerve paralysis the tongue deviates to which side?
Affected side
202
Why is giving buprenorphine and morphine together stupid?
Buprenorphine = partial agonist at opioid receptors
| -Antagonises action of full agonist such as morphine reducing effect of both
203
What is the best treatment for rate control SVT in pregancy?
Metoprolol
204
What features of intestinal polyps are most associated with malignancy?
```
Sesile (flat) higher risk than pedunculated (stalked)
Higher number = higher risk
Polyps more than 1.5cm
Histology showing:
-Villous architecture
-Severe dysplasia
-Squamous metaplasia
```
205
What is the management of Kallman Syndrome?
Depends on the patients desires:
- If you dont want kids then no need to stimulate spermatogenesis with GnRH or gonadotrophin
- Testosterone injections, inplants or patches are more reliable than oral preparation
- If at a later stage they want kids then pulsed therapy with GnRH analogues are required
206
Which HLA is associated with Felty's syndrome?
HLA DRW4 found in 95% of patients with Felty's syndrome and 70% of patients with RA alone
HLA DR4 is in 50-75% patients with RA and correlates with poor prognosis. More likely to be found in Felty's but not as specific as DRW4
207
HLA-B8DR3 is associated with which condition?
Sjogrens
208
What are the features of a C5 nerve root palsy?
Altered sensation upper arm and shoulder
Weakness of biceps and shoulder abduction
Reduced biceps reflex
209
What are the features of a C6 nerve root palsy?
Weakness of biceps and shoulder (like C5)
| Sensory loss forearm and hand
210
What are the features of a C7 nerve root palsy?
Radial nerve supplied muscles (triceps, extensor carpi radialis)
Diminished triceps reflex but preserved biceps and bracheoradialis
211
What are the features of a C8 nerve root palsy?
Weakness of intrinsic hand muscles and sensory loss hand and forearm
212
What are the features of a T1 nerve root palsy?
Intrinsic hand muscles and sensory loss proximal forearm.
DOES NOT affect hand unlike C8
213
What are the side effects of Bosentan?
Flushing, hypotension, dyspepsia, fatigue.
Most serious:
-Hepatotoxicity (contraindicated in moderate to severe liver disease.
Contraindicated in pregnancy
214
By what process are solutes removed from the blood during haemodialysis?
Convection
215
What degree of IQ corresponds to degree of mental disability?
```
69-50 = mild
49-35 = moderate
34-20 = severe
<20 = profound
```
216
What monoclonal antibody can be used in HUS?
Eculizumab is a monoclonal antibody to complement factor C5 which blocks complement activation.
Evidence suggests Shiga toxin associated HUS is associated with complement activation, particularly C3 and C9.
Earlier intervention with eculizumab is most effective, and small studies suggest its use is associated with improved neurological outcomes.
217
Which antibiotic is classically associated with worsening of muscle weakness associated with GBS?
Ciprofloxacin
218
How do you determine B-cells on immunochemistry?
Presence of CD19
219
What is the treatment for molluscum contagiosum?
Cryotherapy is best
Podophyllotoxin also demonstrated efficacy but causes local inflammatory reaction which limits use.
Rash spontaneously resolved over the course of 18 months.
220
What cytochrome is responsible for pioglitazone metabolism?
CYP2C8
221
Rituximab puts you at risk of which particular reactivation infection?
Hep B
Pts should be screened for previous exposure to hepatitis B prior to starting rituximab.
222
What is the modified valsalva maneouvre?
Involves a strain of 40 mmHg for 15s with the patient in the semi-recumbent position, followed by supine repositioning with 15s of passive leg raise at a 45-degree angle.
-----------------------------
It is highly successful at converting paroxysmal SVT (rates of around 40% cardioversion, vs. 17% for the standard Valsalva)
223
What is the gold standard treatment of SVC obstruction?
Stenting
224
What is riboflavin used for in the body?
Riboflavin is involved in redox processes involving the hydrogen-transfer chain in the mitochondria and the production of ATP, there is no specific storage tissue.
---------------------
Dietary sources include liver, milk, cheese, eggs, some green vegetables, beer, marmite and bovril
225
In a wide split fixed S2 with ejection systolic murmur how can you differentiate between ostium primum and secondum ASD?
LBBB in ostium primum
| RBBB in ostium secundum
226
What is the treatment for gastroparesis?
Domperidone now first line
Erythromycin second line
---------------------------
Due to long term neurological side effects metoclopramide is no longer recommended
227
What is a common cause of stridor in patients with rheumatoid arthritis?
Crichoaretinoid arthritis
------------------------------
Seen in studies in up to 75% of patients with RA. It can cause sore throat, hoarse voice and stridor but is often asymptomatic. However, symptoms can rapidly worsen in the post-operative period. It is unrelated to any lung fibrosis.
Diagnosis can be with flow-volume loop, direct laryngoscopy and HRCT of the larynx.
Patients can need urgent tracheostomy and steroids, both orally and via joint injection
228
Where in the kidney is EPO produced?
Produced predominantly by interstitial fibroblasts found within the renal cortex, in response to hypoxia.
-------------------------
The main extra-renal site of production is in the perisinusoidal cells in the liver where production occurs in the fetal and perinatal period.
229
What drugs inhibit the tubular secretion of digoxin?
```
Verapamil
Nifedipine,
Quinine,
Quinidine
----------------------
```
Dose of digoxin should be decreased if co-administering
230
What is the treatment for Behcet's disease?
Corticosteroids first line
Second line: cyclophosphamide, azathioprine, etanercept
231
Calcium channel blockers mainly act on which part of the conduction system?
Class IV agents mainly act on the sinoatrial and atrioventricular nodes, as these structures almost exclusively depolarise by slow calcium channels.
232
What are the characteristic findings in eosinophilic fasciitis?
Swelling and tenderness of the forearms, with induction of the skin (peau d'orange)
Carpal tunnel syndrome
Flexion contractions of the fingers
Peripheral blood eosinophilia
Hypergammaglobulinaemia
-------------------------------------
Diagnosis is confirmed by deep biopsy
233
How does the progesterone only pill prevent conception?
Thickens cervical mucus, preventing the entry of sperm
234
What is the most important prognostic marker in AML?
Bone marrow karyotype.
This essentially is cytogenetic analysis of the blast cells.
Patients with certain genetic changes have a low risk of relapse, for example t(8:21) or chromosome 16 inversion. Conversely, patients with multiple cytogenetic abnormalities or changes in chromosome 5 or 7 have a higher risk of relapse.
235
What is the treatment for rate control in long QT syndrome?
B-blockers
Decrease conduction through the AV node and have negatively ionotropic and chronotropic effects.
If patients continue to have rate disturbances on B-blocker, cervical sympathectomy or ICD is persued.
Lifestyle changes, such as avoiding competitive or particularly intensive sporting activity, may also be recommended.
236
Which cancer is most associated with pemphigus?
Non-hodgkin's lymphoma makes up the majority of cases of paraneoplastic pemphigus at around 39%.
237
What are the adverse effects of Ribavirin?
Haemolytic anaemia
Nausea and vomiting
Dry mouth
Stomatitis
Cautions and contraindications:
-Should avoid during pregnancy and for 6 months after delivery. Counsel men to use barrier contraception.
- Cardiac disease
- Haemoglobinopathies
- Severe liver dysfunction
- Autoimmune disease
- Previous psych history
238
What pathological process is responsible for increased clot risk in protein C deficiency?
Reduced degradation of factors Va and VIIIa.
----------------------
Protein C acts to inactivate the active forms of the procoagulant co-factors factors Va and VIIIa.
239
What is the first virological marker detectable in the serum following Hep B infection?
HBsAg.
First becomes detectable approximately 4 weeks after exposure to the virus.
240
Describe the locations of the following glucose transporters:
```
GLUT-1
GLUT-2
GLUT-3
GLUT4
GLUT-14
```
GLUT-1:
- Erythrocytes and endothelial barrier cells (e.g. blood brain barrier)
- Low level of glucose transport to facilitate respiration
GLUT-2
-Absorption of glucose, galactose and fructose from intestinal cells into portal circulation. Also expressed by hepatocytes, renal tubular cells and pancreatic beta cells.
GLUT-3:
-High affinity transporter in neurones and placenta
GLUT-4
-Insulin mediated glucose uptake in striated muscle and adipose tissue
GLUT-14
- Testes
- GLUT-14 expression associated with poor prognosis in gastric adenocarcinoma.
241
What is the mechanism of action of nicorandil?
Activator of ATP-dependent potassium channels. Relaxes smooth muscle in veins and increased venous capacitance, which leads to reduced ventricular filling pressures and dilatation of the coronary arterioles
242
What is the treatment for Strongyloides infection?
Albendazole or ivermectin
243
Weber syndrome is caused by which vessels?
Paramedian branches of the basilar artery or branches of the posterior cerebral artery
--------------------------
244
What drugs cause Torsades and long QT syndrome?
Antiarrhythmic drugs
-Sotalol, quinidine, disopyramine, procainamide, flecainide
Certain non-sedating antihistamines
-Terfenadine and astemizole
Antibiotics
-Erythromycin, clarithromycin, azithromycin, levofloxacin, moxifloxacin, gatifloxacin, Co-trim, clindamycin, pentamidine, chloroquine
Antifungals
-Ketoconazole, itraconazole
Certain psychotropic medications
-risperidone, haloperidol, phenothiazines, thioridazine, trifluoperazine, sertindole, zimeldine, ziprasidone
TCA and tetracyclic antidepressants
Certain gastric motility agents
-cisapride
Lithium
245
What is the treatment for syphilis?
Benzylpenicillin first line
Doxycycline or cephalosporins (e.g. ceftrixone 500mg IM for 10 days) second line
246
Tertiary syphilis presentations can be split into which 3 groups?
Gummatous
-Granulomatous lesions typically involving skin and bone, though can occur anywhere
Cardiovascular
-Typically involving the ascending aorta and potentially leading to aneurysmal changes and aortic regurgitation
Neurological
- Either general paresis presenting with dementia-like symptoms, or tabes dorsalis
- --------------------------------
30% of untreated patients will go onto develop tertiary disease
247
What is the most common symptom seen in patients with Waldenstrom's macroglobulinaemia?
Generalised muscle weakness
248
What is the mechanism of action of thiazolidinediones?
Bind to specific receptors in the nucleus, "peroxisome proliferator activating receptor -y" (PPAR-y). This causes increased insulin sensitivity.
They do not cause hypoglycaemia when used alone, but can exagerate the hypoglycaemic effects of insulin or sulphonylureas.
Adverse effects include weight gain, fluid retention, and decreased bone mineral density.
249
What is the mechanism of action of quinolones such as ciprofloxacin?
Inhibit DNA gyrase which prevents DNA replication and transcription, inducing cell death and preventing cell replication.
Bactericidal antibiotics
250
What is the treatment for Clostridium tetani?
Administration of intravenous tetanus immunoglobulin, followed by debridement of the wound.
Antibiotic therapy involves the use of either penicillin or metronidazole, and is important particularly when there are generalised symptoms as seen here.
251
What acid base disorder commonly occurs in drowning?
Mixed metabolic and respiratory acidosis
-------------------------
Inhalation of fluid leads to disordered gas exchange in patients with significant fluid aspiration, precipitating respiratory acidosis. Metabolic acid results from intravascular volume depletion, hypotension and consequent tissue hypoxia.
252
What is the treatment for disseminated gonorrhea infection?
Ceftriaxone
253
What are the features of Polyglandular syndrome type 1?
```
Hypoparathyroidism (in around 90%)
Musculocutaneous candidiasis
Adrenal insufficiency (in around 60%)
Primary gonadal failure
Primary hypothyroidism
Hypopituitarism/diabetes insipidus (rarely)
----------------------------------
```
There might be associated malabsorption, pernicious anaemia, chronic active hepatitis or vitiligo.
254
What are the features of Polyglandular syndrome type 2?
```
Adrenal insufficiency (in all patients)
Hypothyroidism
Type 1 diabetes
Gonadal failure
Diabetes insipidus (rare)
---------------------------------
```
Associated conditions include vitiligo, myasthenia gravis, alopecia, immune thrombocytopenic purpura and pernicious anaemia.
