Pastest Learnings Flashcards
Autosomal dominant, chromosome 4, triple repeat
Huntingtons
Decreased crown pubis/crown heel ratio. Infertility, gynacomastia, learning disability. Normal lifespan
Klinefelter
47 XXY or 48XXXY
Klinefelters
Digoxin toxicity features on ECG
- premature ventricular beats
- bradycardia
Reverse tick sign
First and second line tx for heart failure?
1st: Beta blockers and ACEIs
2nd: aldosterone antagonists eg spiro
Side effects of which drug?
Acne, gum hypertrophy, paraesthesia, peripheral neuropathy
Phenytoin
Side effects of which anti epileptic drug?
HypoNa, thrombocytopaenia, haemolytic anaemia, dry mouth, fatigue
Carbamazepine
Lead poisoning symptoms in children?
GI symptoms and raised ICP (papillodema)
Iron toxicity symptoms in children?
Vomiting, GI bleeding, drowsiness, CVD compromise
Autosomal dominant condition leading to 80% increase in risk of bowel cancer
Lynch syndrome : increases risk of bowel, endometrial, stomach, ovarian, prostate, Urinary cancers
Von Hippel Lindau
Multiple cysts in brain, eyes, spinal cord, adrenals, kidneys, pancreas. Increases risk of kidney and pancreatic Ca
Psoriasis tx?
- Betnovate + vitamin D OD
- Vitamin D BD
- Steroid BD or coal tar
Common cause and presentation of interstitial nephritis
NSAIDs, arthralgia, eosinophilia
Anti-dsDNA, anti-Ro, ANA
SLE
SLE Presenting features
- vasculitic lesions
- mouth ulcers
- butterfly rash
- small joint arthralgia
- ophthalmological involvement
- Neuro involvement
Cranial nerve palsy, neck pain, headache, ptosis, miosis
Carotid artery dissection
Role of proximal and distal convoluted tubule?
Proximal: Sodium and glucose re absorption
Distal: urine concentration
Mechanism of action of acarbose
Inhibits alpha-glucosidase
Mechanism of action of metformin
decrease hepatic gluconeogenesis
Increase insulin sensitivity
May reduce GI carb absorption
COPD spirometry
FEV1<80%, FEV1:FVC <0.7 or 70%
Contraindications to sildenafil
ISMN - potent vasodilatory effects, hypoT
AFP, CEA, LDH cancer markers
Alpha fetoprotein - hepatocellular carcinoma
CEA-colon cancer
LDH - testicular cancer
Anti cholinergic symptoms
Mydriasis, reduced secretions, dry skin, fever, altered mental state
Drugs that exacerbate psoriasis
Lithium and beta blockers
Congenital adrenal hyperplasia at birth?
Large penis and pigmented (++testosterone), hyperK and hypoNa (low aldosterone), hypoglycaemia and hypotension (low cortisol). 21 hydroxylase deficiency
HOCM presentation?
Syncope after exercise, systolic murmur, worsens with valsalva, better with squatting. Jerky pulse
Ace inhibitor cough caused by?
Bradykinin breakdown
Infection predisposes to guttate psoriasis
Streptococcus infection
Ichthyosis
Dry scaly skin on abdomen, fingertips, fish scale appearance
Psoriasis on hands and soles of feet
Pustular psoriasis
Hepatitis B recent immunisation?
HBsAg antigen - HBS antibodies produced
Acute or recent infection of Hep B antibodies?
IgM anti-hepatitis B core (HbC)
Less common side effects of nicorandil
Mouth ulcers and stomatitis
Most common bugs in IECOPD
Moraxella, haemophilus, strep pneumoniae
Pulmonary HTN features
Raised JVP, SOB, left parasternal heave, peripheral oedema, pansystolic murmur (tricuspid regurgitation)
Cluster headaches treatment
Nasal sumitriptan or short burst oxygen therapy. Verapamil prophylactic.
Meningitis treatment in primary care
IM Ben pen
Most common cause glomerulonephriits
IgA nephropathy (Bergers), lung and kidney involvement
Cast nephropathy
Myeloma
Most common form of nephrotic syndrome in children?
Minimal change disease
thin basement membranes on renal biopsy, which disease
Alport syndrome : ears, kidney, eyes
Amiodarone monitoring blood tests? How often
LFTs and TFTs 6 monthly
Body burn percentages
Head and neck - 9%
Each upper limb - 9%
Lower limbs - 18%
Trunk - 36%
EBV causes what and predisposes to?
Infectious mono. Lymphoma.
Poor prognosis in breast cancer?
Young age, progesterone/estrogen negative,
IVDU, Recent resp infection, cavitating pneumonia
Staphylococcus
Immuno compromised individual, which pneumonia
Pneumocystis jiroveci
Alcohol and elderly pneumonia
Klebsiella
Low grade fever, rigors, hypotension and tachycardia with psoriasis
Erythrodermic psoriasis - emergency
Presentation of waldenstroms macroglobinaemia
IgM paraprotein causes hyperviscosity symptoms and amyloidosis. Infiltration of bone marrow and organs.
Retinal haemorrhages, lethargy, headache, blurred vision
Amyloidosis link to which IBD? Presents how?
Crohns - hepatomegaly, oedema
Marjolins ulcer
Underlying malignancy, slow healing, shallow ulcer
Lung tumour causing weight gain, HTN, hirsutism
Bronchial carcinoid
Haemophilia A : inheritance, clotting abnormality and deficiency
X linked recessive Prolonged APTT Factor VIII (8) deficiency
Cobblestone lesions
Crohns
Varenicline side effects
Abnormal dreams, menorrhagia
Seminona vs teratoma
Seminona: 30-40, older (sergeants)
Teratoma: 20-30, younger (troops)
Screening for TB in at risk groups?
Mantoux test
MCA stroke presentation
Contra lateral hemiparesis, face and arm worse affected
ACA lesions?
Contralateral hemiparesis, leg and shoulder worse than arms and face
Behçet’s disease
More common in Turkey, Japan and Iran. Ulcers in mouth and genitalia
Mode of inheritance of duchenne muscular dystrophy
X linked recessive
Mode of inheritance vitamin d resistant rickets
X linked dominant
Which organism and which patients get malignant otitis externa
T2DM . Pseudomonas.
Erythema nodosum and proctitis
UC
Turner syndrome cardiac abnormality
Coarctation of aorta
Down syndrome CV defect
AVSD
Cyanosed child with ESM at left sterna edge
Tetralogy of fallot
Eye: Fluroscein staining shows a dendritic ulcer
Herpes simplex keratitis
Turner syndrome
45 XO: lymphodema, small chin, low hairline, webbed neck, short stature
Trisomy 18
Edwards syndrome: rocker bottom feet
22q11 disease and features
Di George ; cleft palate, Absent thymus, aortic arch abnormality, T cell dysfunction
Adverse effects of ACEIs in pregnancy
Renal function and skull abnormalities
Adverse effects of streptomycin in pregnancy
Audio and vestibular damage
Adverse effects of NSAIDS in pregnancy
Premature labour and closure of PDA
cyp450 INDUCERS
Carbamazepine, barbiturates, rifampicin and phenytoin, smoking and chronic alcohol
cyp450 inhibitors
STICK FACES COM
Sodium valproate Trimethoprim Isoniazid Cimetidine Ketoconazole Fluconazole Alcohol Chloramphenicol Erythromycin
Ciprofloxacin Omeprazole Metronidazole Grapefruit juice
Abx for C. Diff?
- 10 days Vancomycin
- Fidaxomicin
If life threatening, add IV metronidazole
Argyll Robertson pupils - causes and presentation
Syphillus and diabetes, small and minimally reactive
Accommodation Reflex Present (ARP) but Pupillary Reflex Absent (PRA)
Acne vulgaris pregnancy
Oral erythromycin
tick causing pneumonia
Q fever - coxiella. Also presents with hepatosplenpmegaly
Brucellosis presentation
Middle Eastern disease, unpasteurised milk: fever, pneumonia, hepatosplenomegaly, epididymoorchitis
MEN1
3 p; pituitary, parathyroid, pancreas
MEN2
Parathyroid, phaeo, medullary thyroid
MEN3
Phaeo, medullary thyroid, Marfanoid
FOOSH, fat pad sign on X-RAY, elbow injury
Radial head #
Glomerulonephritis: Ig ? Precipitant
IgA nephropathy, precipitated by URTI, young males
Chest, eye and renal involvement, c-ANCA +be
Granulomatosis with polyangitis
Adult stills disease
Rheumatic disease: pink rash, arthritis, recurrent fever
Proximal muscle weakness, tenderness, raised CK
Polymyositis
Headache, fever, agitation, hydrophobia
Rabies
Presentation and diagnosis of typhus
Fever, meningism, rash. Dx with serology
Emergency contraception pill options
Ulipristal acetate: up to 5 days post intercourse
Levonelle: 72 hours post intercourse, but efficacy drops
Referral pathway following abnormal smear?
Mild dyskaryosis AND HPV +ve: colposcopy and biopsy within 6wks
Moderate/high dyskaryosis : colposcopy 2wks
Crusting of both eyelids, worse in the morning, normal acuity and pupils
Blepharitis
Test for suspected acromegaly
- First line: IGF-1
2. 2nd line: OGTT
P-ANCA IBD?
UC
discrepancy between kidney size and worsening HTN
Renal artery stenosis
How might Burkitts lymphoma present?
Child with Ascites, abdo pain, hepatosplenomegaly, B symptoms,
How does internuclear opthalmoplegia present? Where is the lesion?
Rapid saccades, lesion in the medial longitudinal fasciculus (which connects 3rd and 6th nerve nuclei)
Risk factors for sudden infant death syndrome
Male sex, winter months, young maternal age
Management of unstable VT
Synchronised cardio version up to 3x
Telogenum effluviam presentation
acute onset hair shedding in response to variety of stressed eg anorexia, childbirth, chronic illness, etc
Hair loss with tapered hairs and exclamation mark hairs, fine white hair in areas of regrowth
Alopecia
Most common diarrhoea
Campylobacter
Treatment for prolonged and unwell gastroenteritis
Ciprofloxacin
GBS risks
Previous GBS, PROM, Pre term labour
UTI drugs in pregnancy and breastfeeding
Nitro - fine until term then you can’t
Trimethoprim - never
Cefalexin at term
After birth: trimethoprim safe in breast feeding
Tests for DDH, imaging, treatment
At 6 weeks, USS if:
Barlow - dislocates
Ortolani - relocates
If >4 months: X ray
Tx: Pavlik harness
VSD murmur and ECG findings
ECG: biventricular hypertrophy
Pansystolic murmur over lower left sternal edge
Immunoflurescence findings in pemphigus vulgaris vs bullolus pemphigoid? Antibody findings?
PV: Intraepidermal circular deposits. Anti desmosome Abs
BP: Linear IgG and C3 deposits. Anti hemidesmosome Abs
Name of manoeuvre for tx of BPPV
Epsley manoeuvre
Presentation of acute glaucoma
Red, painful eye, fixed and dilated pupil with hazy cornea
Acute glaucoma treatment
Acetazolamide, topical beta blocker
Optic neuritis pupil effects?
Loss of direct pupillary reflex, preservation of consensual reflex. Due to optic nerve damage
Medical treatment options for acromegaly
Somatostatin analogues and pegvisomant (GH antagonist)
How might a basilar artery infarction present?
Quadriplegia, locked in syndrome
Law around children and sexual intercourse
Under 13, no one considered competent to consent. Always statutory rape. Gillick competence is irrelevant. Involving parents difficult as you do not know how responsible they may be or involvement in child’s life
Treatment for stage 4 renal cancer
Immunomodulatory drugs