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1
Q

Hyperparathyroidism in CKD?

A

Part of Vitamin D dysfunction
Secondary Hyperparathyroidism from low Ca due to CKD
Treat this with Alfacaldiol

X ray shows destruction due to Calcium Resorbtion

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2
Q

Bowel Cancer with Liver Met?

A

Surgical resection

Don’t biopsy the liver lesion as can cause spread

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3
Q

Watery Diarrhoea in Immunocomprimised? Cysts on Acid Fast Staining?

A

Cryptosporidium parvum
Transient in healthy but can be very severe if immunocomprimised
Acid Fast Staining on Faeces shows Cysts

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4
Q

Cresenteric Glomerulonephritis

A

Rapid Deterioration
Nephritic Syndrome
Caused by Good Pastures and ANCA positive Vasculitis

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5
Q

Livedo Reticularis and PE/DVT in Woman

A

Antiphospholipid syndrome
Could be SLE as well with Antiphospholipid syndrome
If ANA positive then think SLE
Complement normal - not SLE

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6
Q

IgG only rasied and no CRAB present?

A

MGUS`

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7
Q

What classes someone taking steroids as immuno comprimised?

A

40mg of Pred for 7 days

20mg of Pred for 14 days

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8
Q

Anti Cardiolipin IgM / igG Antibodies

A

Seen in Antiphospholipid syndrome

These are raised in 10 % of the population

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9
Q

Pyoderma Gangrenosum

A

Treat with Steroids - Oral Pred

Classically around the stoma site in Crohn’s

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10
Q

Hypothyroidism effect on Muscles

A

Can be a cause of Muscle Weakness and Tenderness
Mildly raised CK (1000)
Causes a macrocytic anaemia
Anti Thyroid Peroxidase Antibodies

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11
Q

PAF and Heart Pauses?

A

PAF has to be AF for over 30 seconds to be significant

Heart Pauses have to be over 3 seconds to be significant without symptoms
If less but symptomatic then still needs pacemaker

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12
Q

Hepatitis B vs Hepatitis C transmission risk factors?

A

Hep B = Homosexual

Hep C = IVDU

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13
Q

Cryptogenic organising pneumonia

A

Inflammation of the alveoli and Bronchioles

Basically leads to pneumonia just from inflammation without infection
Seen in RA, but also secondary to drugs like
Amiodarone
Nitrofuarntoin
Bleomycin

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14
Q

Keratoderma Blenorrhagica

A

Seen in Reiters syndrome

Bottom of the feet get scaley

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15
Q

Diabetic Amyotrophy

A

Painful
Proximal
Diabetic Neuropathy
With Weakness at Pelvis

Painful Proximal Pelvis Weakness

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16
Q

Small vessel Vasculitis

A

Vasculitis
Fever, Joint pain, Weight loss, Rash, Raised inflammatory markers

Granulomatosis with Polyangitis
Granuloma formation after vasculitis in the upper airway, lower airway and kidney
Causes sinusitis, epistaxis, haematuria, haemoptysis, saddel nose
cANCA positive

Microscopic polyangitis
Like GPA without Sinusitis / Upper Airway
this is pANCA positive

Churg Straus
Like GPA but + some other symptoms
Gut, Lung and Heart involvement
pANCA positive
Eosinophilia high
Has a asthmatic/Allergic phase at the start
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17
Q

facioscapulohumeral

A

facioscapulohumeral is symmetrical – facial and biceps weakness

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18
Q

spinal muscular atrophy

A

spinal muscular atrophy – distal wasting and weakness, e.g. in the hands;

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19
Q

Spinobulbar muscular atrophy

A

spinobulbar muscular atrophy – bulbar weakness

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20
Q

anti PR3 = ?

A

c Anca Antibodies

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21
Q

Anti MPO=?

A

p Anca Antibodies

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22
Q

Psoriasis Triggers?

A

alcohol
Trauma
Beta Blockers
Lithium

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23
Q

Mitral Regurgitation Acutely?

A

Severe MR causes Left Heart failure

  • Oedema
  • SOB
  • Distended Neck Veins
Chest pain
Usually caused by MI causing:
chordal rupture
flail leaflet
papillary muscle rupture
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24
Q

Rupture of Valsalva

A

Valsalva anyeurysm is by the aortic valve
Can get anyeurysms that are then asymptomatic mainly
Can impact on the coronary artery supply

If they rupture, get chest pain and heart failure
Usually a young person
Then get a constant murmur

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25
Anti ENA?
Sjogren's
26
pANCA positive?
Churg Strauss Microscopic polyangitis Cresenteric Glomerulonephritis primary sclerosing cholangitis Other Causes: UC > Crohn's IBD RA, SLE and Sjogren's Autoimmune Hepatitis
27
Pacemaker Syndrome
Associated with Single chamber pacemakers People feel worse after pacemaker due to loss of synchrony There is signs of Heart failure
28
Phenytoin Toxicity?
Causes Ataxia essentially
29
Glomus tumour of the Ear?
``` Slow Growing Affecting Cranial nerve 9 mainly - Speech, Swallowing, Tounge, Palate - Conductive Hearing Loss Very Vascular ```
30
Cholesteatoma?
Hearing Loss Recurrent infections Balance problems Surgical removal needed
31
Red Cell Casts?
Granulomatosis with Polyangitis SLE Post Strep Glomerulonephtiritis Good Pastures Syndrome
32
White Cell Casts?
Interstitial Nephritis | Pyelonephritis
33
Psuedo Cushings
Essentially Cushings with milder symptoms No striae, no myopathy You then find that the suppression test leads to cortisol suppression on low dose Mildly raised Urinary Cortisol (should be 3 x in true Cushings)
34
Membranous Nephropathy SPIKE DOME
Commonest Glomerulonephritis in Adults Primary or Secondary Presents as nephrotic syndrome and can cause end stagr renal failure Primary: Antiphospholipase A2 Antibodies ``` Seondary Infection: Heb B, Malaria Ca: Lung, Leukaemia and Lymphoma Drugs: Gold, Penicillamine Autoimmune: SLE, RA ``` ACEi for Proteinuria Doesn't respond to steroids Immunosuppressant 1/3 resolve 1/3 continued proteinurea 1/3 ESRF
35
Minimal Change Fusion of the Podocytes
Nearly always Nephrotic (75% of all nephrotic syndrome in children) Idiopathic 80% Hodkins lymphoma NSAIDS EBV Normotension Nephrotic syndrome with intermediate sized proteinurea 1/3 1 episode 1/3 infrequent 1/3 Relapsing Chronic RESPONDS WELL TO STEROIDS
36
Brugada Syndrome ECG
V1 V2 ST Elevation RBBB Relieved by Flecanide Autosomal dominant cause of sudden cardiac death due to Ventricular Arrythmias
37
ASD CXR changes?
Small Aortic Knuckle L heart border straighter Due to reduced L outflow from L--> R Shunt Prominant pulmonary vessels
38
Dextra Cardia ECG
Small Volume Chest Lead QRS - this means not just user error AVR is Positive AVL and 1 is Negative Chest leads will show opposite progression too
39
HOCM ECHO and ECG
MR - Mitral Regurg SAM - Systolic Anterior Motion of ant mitral valve ASH - A Symetrical Hypertrophy ECG LVH +++ Progressive T Wave inversion in Chest Leads Deep Q Waves Family History Exertional dypnoea, syncope Ejection systolic Murmur
40
Pemphigoid Vulgaris
IgG type 2 sensitivity (autoantibodies) against Desmoglein 3 Ulcers Nikoslky positive skin ulcerations Treatment with steroids Immunoflurecence on biopsy
41
Macroprolactinoma Treatment?
Bromocriptine or Dopamine Agonists Then Surgery If Prolactin is 2-3 x usual then this is due to compression rather than secretion
42
Azothioprine
``` Causes LFT derrangement Check TPMT levels first Bone Marrow Suppression N+V Pancreatitis Non melanoma Skin Cancer increased SAFE IN PREGNANCY ```
43
Psuedodementia?
Depression
44
Dressings?
Antibacterial and silver-impregnated dressings are indicated only when there are signs of local infection Hydrocolloid- Advanced ulcers where trying to maintain tissue and need to pack the wound Alginate - exudative wounds
45
Polycythemia Vera
Overproduction of red blood cells Due to JAK 2 mutation (like in myelofibrosis) Leads to Increased Haematocrit Itching on heat Thrombosis risk Then can progress to spent phase- essentially fibrosis of BM - ie Myelofibrosis and marrow failure Treatment: Hydroxyurea (like in essential thrombocytopenia) Rituxolitinib - stops itching (JAK 2 inhibitor) Aspirin Antihistamines Phlebotomy
46
Treatment of HIT
argatroban or danaparoid
47
HIT cause
HIT is caused by the development of IgG antibodies directed against a complex of platelet factor 4 (PF4) and heparin
48
CLL
Don't treat if asymptomatic Indcations: B symptoms Marrow failure on Bloods - anaemia etc Organomegaly/lymphadenopathy
49
CLL Treatment
anti-CD20 monoclonal antibody (e.g. obinutuzumab), chlorambucil bendamustine TP53 Mutation - Ibrutinib
50
High Protein CSF?
TB | Strep Pnuemonia
51
Previous Ear ache and Meningitis
Strep Pneumonia
52
Listeria CSF changes
Causes meningitis in elderly, immunocomprimised and neonates. Has Lymphocytic changes
53
Radial Nerve Weakness>
Wrist Drop
54
Axillary Nerve Weakness
deltoid weakness and outer arm sensation loss
55
Myasthenia Gravis
Ptosis Diplopia Bulbar Symptoms Respiratory Weakness Edrophonium chloride test positive Anti Choline Receptor Antibodies / Other Antibodies in only 80% of disease Associated with Thymoma 15% or Thymic Hyperplasia (70%) Acetyl cholinesterase inhibitors - pyridostigmine Plasmapheresis Immunosuppression
56
Tensilon / Edrophonium
Test for Myasthenia Gravis
57
Miller Fisher Syndrom
Opthalmaplegia Ataxia Areflexia
58
Cluster Headache Treatment?
Acute: Oxygen Triptan Prophylaxis: Verpamil
59
Migraine Treatment
Oral Tryptan NSAIDs Paracetamol Prevention with Propranolol Tryptan
60
Treatment of Advance prostate Ca?
Use of Hormone replacement Usually Goserelin This is LHRH agonist This causes worsening of symptoms firstly in first few weeks as tumour grows due to increased LH and increased Testosterone However, after a few weeks the receptors are down regulated that causes LH and FSH production to stop Bicalutamide (androgen receptor antagonist) are used to reduce this TUMOUR FLARE in the first couple of Weeks
61
Sjogren's Antibodies
Anti Ro Anti La Anti ENA
62
Bicalutamide
Adrogen Antagonist | given with zoladex or goserelin- LH agonist

MRCP (6 decks)

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