Phase 3B 2013 Flashcards
List the potential causes of confusion in patients with myeloma
Hypercalcaemia of malignancy
Tumour lysis syndrome
Hyperviscosity syndrome
How do you investigate for bone mets in myeloma and why would you choose that means of imaging
Full skeletal survey
Technician measures osteoblastic activity and this is inhibited by IL-6 which is secreted by plasma cells
Name 4 classic features of plaque psoriatic arthritis
Well demarcated Silver scales Symmetrical Areas of hyper proliferation Auspitz sign
Out line the mechanism of action of NSAIDs
Inhibit the action of cyclooxyrgenase enzymes. These enzymes are involved in the synthesis of key biological mediators
Prostaglandins ( involved in inflammation)
Thromboxanes (involved in blood clotting)
Outline the mechanism of steroids both intranuclealy and in the cytoplasm
Nucleas: Lipid soluble molecules pass through the cell membrane, bind to the nuclear receptors in the cytoplasm, translocation to nuclear bins to nuclear DNA leading to an increase in transcription of the relevant gene products
Cytoplasm:
Bind to the steroid receptors in the cytoplasm that regulate vital cell activities
Side effects of methotrexate
Pulmonary fibrosis
Bone marrow suppression
Anaemia
Teratogenic
Features of hypokalaemia
Flat or inverted T waves
Pathological U waves
Long OT waves
Depressed ST waves
Were does spironolactone act and in what why
Collecting tubules
NA2+/K+ pump, exchanges sodium for potassium
Retains sodium and excrets potassium
Upregulated epithelial sodium channels increasing apical membrane permeability for sodium.
Intracerebal causes of confusion in the elderly
Cerebral oedema Space occupying lesion Hydrocephalus Encephalitis Meningitis
First line treatment for delirium terminus
Lorazapam
Common causing organism of infective execrations in COPD
Haemophilis influenza (Gram -ve bacilli with fastidious growth requirements) Streptococcus pneumoniae (Gram +ve cocci, alpha haemolytic)
Outline the ways in which you can assess COPD severity
Spirometry with bronchodilators
Trial of oral steroids
CXR look for any other pathology
6 signs associated with hypothyroidism
Bradycardia Reflexes relax slowly Ataxia (cerebellar) Dry thin hair Yawning, drowsy coma Cold peripheries Ascites Non pitting oedema Pericardial or pleural effusion Round puffy face Immobile Congestive cardiac failure
Outline the target tissues for T4 and the effect it has there
Cell nuclei have a high affinity for T3(TRalpha1 in muscle and fat, alpha2 in brain and also in liver and kidneys
Metabolism of all substrates vitamins and mineral
Modulations of all other hormones and the target tissue response
Stimulation of )2 consumption and generation of metabolic heat
Regulation of protein synthesis, carb and lipid metabolism
Stimulation of demand for co-enzymes and related vitamins
How does hypothyroidism result in a goitre
Thyroid stimulating hormone (TSH),this hormone stimulates the thyroid to produce thyroid hormone and to grow in size. This abnormal growth in size produces what is termed a “goiter.”
Is it hyperplasia or hypertrophy
Why might levathyroxine not be working to full effect
Malabsorption
Non compliance
Pernicious anaemia (Polyglandular syndrome 1)
Dose titration
Medication interfering (ferrous sulphate, calcium, rifampicin, amiodarone)
Risk factors for osteoporosis
Steroids Hyperparathyroidism Alcohol Testosterone low Thin Erosive bone disease (Ra/myeloma) Renal/liver disease Early menopause Dietary calcium low/malabsorption
Outline the UMN and LMN signs associated with MND
UMN - Spasticity - Increase reflexes - Upgoing plantars LMN - Wasting - Fasciculations
Symptoms of bulbar or pseudo bulbar palsy
Dysphagia Labile mood Nasal regurgitation Weak, wasted and fasiculating tongue Loss of gag reflex Jaw jerk affected
Define sensitivity
The proportion of people with the disease who are correctly identified as having the disease
True +ve/ True +ve + false -ve
Define specificity
Proportion of people without the disease who are correctly identified as not having the disease.
True -ve/ false +ve + true negative
Define PPV
Proportion of people with a +ve that truly have the disease
True +VE/ (true +ve + false +ve)
histological features of Crohn’s
Skip lesions Transmural inflammation Granulomas Cobblestone mucose Marked fibrosis Fistulae
What drugs is used to induce remission in Crohn’s
Corticosteroid
Pathological change seen on the basement membrane in the kidney in nephrotic syndrome
Advanced glycosylation end products – inflammatory response
Deposition of type IV collagen and mesangial expansion
Arterial hyalinization
Thickening of the basement membrane, glomerulosclerosis
Management of nephrotic syndrome
Dietary salt and water restriction Loop diuretics are often used in large doses Daily weights ACEi to reduce proteinuria Statin
