PTS Reading Week 2 Flashcards
Which TLRs are intracellular?
TLR 3,7,8 and 9
What is the mechanism of action of Beta Lactams antibiotics?
Inhibit the synthesis of the peptidoglycan layer of bacterial cell walls by binding irreversibly to Penicillin Binding Proteins
Name 4 categories of beta lactam antibiotics
- Penicillins
- Cephalosporins
- Carbapenems
- Monobactams
Name some penicillins
- Penicillin
- Amoxacillin
- Flucloxacillin
Name some cephalosporins
- Cefotaxime
- Ceftriaxone
- Cefuroxime
Name some carbapenems
- Meropenem
What sorts of bacteria are more susceptible to beta lactam antibiotics?
Gram positive
Staph & Strep
What is responsible for differences in the spectrum and activity of beta lactams?
Their relative affinities for different Penicillin Binding Proteins
What can beta lactams not be used in?
Intracellular pathogens
What is the mechanism of action of glyopeptides?
Block bacterial cell wall synthesis
Name 2 glyopeptide antibiotics
- Vancomycin
- Teicoplanin
What is the mechanism of action of quinolones?
Block DNA replication by inhibiting DNA gyrase
Name some quinolones
- Ciprofloxacin
- Levofloxacin
What is the mechanism of action of Metronidazole?
Causes a loss of helical DNA structure and strand breakage, and disrupts protein synthesis
What is the mechanism of action of Rifampicin?
Inhibits RNA polymerase
What is the mechanism of action of macrolides?
Bind to the 50S subunit of the ribosome and inhibit protein transcription
Name some macrolides
- Clarithromycin
- Azithromycin
- Erythromycin
What is the mechanism of action of aminoglycosides?
Bind to the 30S subunit of the ribosome and inhibit protein transcription
Name an aminoglycoside
- Gentamicin
What is the mechanism of action of lincosamides?
Bind to the 50S subunit of the ribosome and inhibit protein transcription
Name a lincosamide
- Clindamycin
What is the mechanism of action of tetracyclines?
Bind to the 30S subunit of the ribosome and inhibit protein transcription
Name a tetracycline
Doxycycline
What is the mechanism of action of streptogramins?
Bind to the 50S subunit of the ribosome and inhibit protein transcription
Name a streptogramin
- Virginiamycin
What is the mechanism of action of sulphonamides?
Bind to the DHPS enzyme and inhibit folate synthesis
Name a sulphonamide
Sulfasalazine
What is the mechanism of Trimethoprim?
Inhibits folate synthesis
What is the purpose of clavulanic acid in Co-Amoxiclav?
Makes it harder for the bacteria to break down the amoxicillin
What is a key finding in the blood or CSF during bacterial infection?
Neutrophils!!
What is type 1 hypersensitivity?
Mass cell degranulation (basophils and mast cells) mediated by IgE linkage
What is type 2 hypersensitivity?
IgM and IgG linkage to surface cell antigens or tissue components
What is type 3 hypersensitivity?
Antibody-antigen complexes deposit into tissues
What is type 4 hypersensitivity?
T cell mediated response
What is type 5 hypersensitivity?
Stimulatory autoantibodies
Give examples of a type 1 hypersensitivity reaction
- Anaphylaxis
- Atopy
Give examples of a type 2 hypersensitivity reaction
- Goodpasture syndrome
- Autoimmune haemolytic anaemia
Give examples of a type 3 hypersensitivity reaction
- Systemic Lupus Erythematosus
Give examples of a type 4 hypersensitivity reaction
- Tuberculosis
Give examples of a type 5 hypersensitivity reaction
- Grave’s Disease
What is the test for delayed type 4 hypersensitivity reactions
Patch test
Which antibody is first released in the humoral response?
IgM
What is the most efficient and powerful antigen presenting cell?
Dendritic cells
What is the most common opportunistic infection and presentation of AIDS?
Pneumocystis Pneumonia
(caused by the pneumocystis jirovecii fungus)
What bacteria is the most common cause of UTI?
Escherichia Coli
What bacteria is the most common cause of Pyelonephritis?
Escherichia Coli
What pathogen is most commonly isolated in cases of chronic diarrhoea associated with HIV
Cryptosporidium
What is the mechanism of action of rivaroxaban (and other DOACs)
Directly inhibits activated clotting factor X to prevent conversion of prothrombin to thrombin
What is the mechanism of bisphosphonates?
Inhibit osteoclastic activity to decrease bone resorption, which reduces bone turnover and improves bone mass
What sort of drug is Diclofenac?
NSAID
What medicines can cause constipation?
Opiates! eg, Codeine
What can decrease the effects of warfarin?
Leafy green vegetables
What can increase the effects of warfarin?
Alcohol
What anti-emetic is contraindicated in Parkinson’s?
Metoclopramide - because it is a dopamine blocker
What are the diagnostic criteria for DKA?
- Blood glucose > 11mmol/L
- Plasma ketones > 3mmol/L
- Blood pH < 7.3
- Bicarbonate < 15mmol/L
What is the most common subtype of thyroid cancer?
Papillary
What is the gold standard investigation for carcinoid syndrome?
Chromagranin-A + octreoscan
What are typical EKG findings in hyperkalaemia?
- Tall tented T waves
- Wide QRS
- Prolonged PR
- Absent P waves
What are some symptoms of polycystic ovarian syndrome?
- Oligomenorrhea
- Hirsutism
- Acne
- Ovarian cysts
What is the difference between Gigantism and Acromegaly?
Gigantism is the over secretion of GH PRIOR to the fusion of the epiphyses
What is the management for diabetic ketoacidosis?
IV Fluids immediately
Then insulin and potassium (as insulin can cause hypokalaemia_
What is the epithelium of the Vas Deferens?
Pseudostratified columnar epithelium with stereocilia
Where in the female reproductive tract does fertilisation usually occur?
Ampulla
What is cardiac tamponade?
The accumulation of fluid in the pericardial cavity that compresses the heart and reduce cardiac function
What are the four main features of Tetralogy of Fallot?
- Ventricular septal defect
- Pulmonary artery stenosis
- Right ventricular hypertrophy
- Overriding aorta
What is orthopnoea?
Difficulty breathing when lying down
What is a Mobitz type 1 second degree heart block?
Increasingly long PR intervals followed by a drop in a QRS complex
What is a Mobitz type 2 second degree heart block?
Constant length PR intervals but drops in QRS complexes (eg, 2 or 3 PRs for every QRS)
What are roth spots?
Retinal haemorrhage with pale centers
What are the signs of left sided heart failure on Xray?
- Alveolar oedema
- Kerley B lines
- Cardiomegaly
- Dilated upper lobe vessels
- Pleural effusion
What are the signs of right sided heart failure?
- Increased JVP
- Hepatomegaly
- Ascites
- Pitting oedema
What is primary prevention?
Methods taken to prevent the onset of disease
What is secondary prevention?
Methods to detect and address an existing disease prior to the appearance of symptoms
What is the most appropriate 1st line test in patients with symptoms for stable angina?
CT coronary angiography
What is taken for the prevention of angina attacks?
1st line treatment is beta blocker or a cardioselective CCB (eg, Verapamil)
- After that, combine beta blockers with a non-cardioselective CCB such as Nifedipine
What is the most appropriate initial treatment for STEMI?
- Dual antiplatelets (Aspirin + Clopidogrel & Ticagrelor)
- Anticoagulation (Heparin)
- Percutaneous Coronary Intervention
What is the 1st line treatment for hypertension in people aged 55+ or Afro Caribbeans?
Calcium Channel Blocker, eg. Amlodipine
What is the 1st line treatment for hypertension in people aged < 55 or ANY AGE with T2DM?
Ace-i
What is the treatment given in atrial fibrillation to prevent strokes?
Warfarin or DOAC
When is Warfarin more effective than a DOAC?
In a patient with metal heart valves
What is the treatment for pericarditis?
NSAIDs & Colchicine
What is the mechanism of action of colchicine
Tubulin disruption which reduces inflammatory pathways
What is the 1st line treatment for iron deficiency anaemia?
Ferrous sulphate
What is G6PD deficiency?
A deficiency in Glucose-6-phosphate-dehydrogenase which causes haemolytic anaemia
What drug is contra-indicated in G6PD deficiency?
Nitrofurantoin - as it can cause a drug induced oxidative crisis
What is a diagnostic test for DVT?
Doppler ultrasound
What are some causes of thrombocytopenia?
- HIV
- Myeloma
- Heparin
- Alcohol abuse
What leukaemia is most common in children?
Acute lymphoblastic leukaemia
What is the diagnostic test for sickle cell anaemia?
Hb electrophoresis
What is the treatment for chronic myeloid leukaemia?
Chemotherapy and a tyrosine kinase inhibitor, eg. Imatinib
What is the pathology of hereditary spherocytosis?
Defects in the red cell membrane, resulting in them having increased permeability to sodium
What is the infective stage of the malaria parasite?
Sporozites
What are some hallmarks of Acute Myeloid Leukaemia?
Auer rods
What are some hallmarks of Acute Lymphoblastic Leukaemia?
Most common type in children
Blast cells
What are some hallmarks of Chronic Myeloid Leukaemia?
Association with the Philadelphia chromosome
What are some hallmarks of Chronic Lymphoblastic Leukaemia?
Smudge cells
What are some hallmarks of Multiple Myeloma?
RBCs in Rouleaux formation
Bence jones proteins
How long would a patient be initially put on a DOAC for as a result of a provoked DVT?
3 months
How long would a patient be initially put on a DOAC for as a result of an unprovoked DVT?
6 months
What indicates a poor prognosis in a diagnosis of Acute Lymphoblastic Leukaemia?
- WCC of >20 at time of diagnosis
- Age < 2 or > 10
- Being male
What are some of the long term complications of ABVD chemotherapy used to treat Hodgkin’s lymphoma?
- Infertility
- Lung damage
- Cardiomyopathy
- Peripheral neuropathy
- Hair loss
What gene is associated with a proportion of myeloma cases?
MGUS
What is sideroblastic anaemia?
A type of anaemia where the body has enough iron, but is unable to turn it into haemoglobin
What are some clinical features of sideroblastic anaemia?
Iron accumulates in the mitochondria of blood cells, causing “ringed sideroblasts”
What foods are rich in B12
Meat, dairy and eggs
What is beta-thalassaemia major?
Blood disorder that reduces the production of haemoglobin due to a lack of production of beta-globin
What are reticulocytes?
Immature red blood cells
What genetic mutation is associated with polycythaemia rubra vera?
JAK2
What are some risk factors for DVT?
- Overweight
- Long haul travel
- Oral contraceptive
- Pregnancy
- Immobility
What virus is associated with Hodgkin’s lymphoma?
Epstein-Barr virus
What is Haemolytic Uraemic Syndrome?
A potential complication of E.Coli infection - endothelial damage to blood vessels that leads to thrombocytopenia and haemolytic anaemia
What is the 1st line test for suspected coeliac?
Serology for IgA tTg antibodies
What is the appropriate 1st line management of IBS?
Dietary advice
Then, anti-motility agents to help with diarrhoea (eg. Loperamide) / mild laxatives for help with constipation (eg. Lactulose)
What is the 2nd line treatment for IBS?
Tri-cyclic antidepressant - amitriptyline
What is Zenker’s diverticulum / Pharyngeal pouch?
A herniation of the upper oesophagus. Zenker’s is posteromedial.
What are some symptoms of pharyngeal pouch?
- Dysphagia
- Chronic cough
- Bad breath
- Throat lymp that gurgles on palpatation
What is the treatment for H.pylori?
7 day of triple therapy (2 antibiotics and a PPI)
eg, Omeprazole, Amoxicillin, Clarithromycin
What is the difference between anal fissures and haemorrhoids?
- Anal fissures are associated with intense pain post defecation
- With haemorrhoids you may feel an outpouching
Where is Virchow’s node located?
The left supraclavicular area
What is a hallmark of IBS?
Symptoms improve upon opening bowels
Where is iron absorbed?
Duodenum
Where is vit B12 absorbed?
Terminal ileum
Where is folate absorbed?
Duodenum and jejunum
How do NSAIDS cause peptic ulcers?
NSAIDS inhibit COX enzymes which are needed to produce prostaglandins that stimulate mucus secretion
Less mucus > reduced mucosal defense > ulcer
How does H.pylori cause peptic ulcers?
Secretes urease which splits urea in the stomach into CO2 and ammonia.
Ammonia combines with H+ in the stomach to make ammonium.
Ammonium causes an inflammatory response and reduces the mucosal defense
How does bile regurgitation cause peptic ulcers?
Strips away the mucus layer in the stomach, reducing muscosal defense
How does ischaemia cause peptic ulcers?
Reduced blood flow means gastric cells die off and don’t produce mucin, reducing mucosal defense
Where is the most common place for colorectal cancers to develop in the large intestine?
Rectum
What are main sources of ALP in the body?
- Bone
- Liver
What is the diagnostic test for primary biliary cholangitis?
Blood test for Anti mitochondrial antibodies
In the context of GI pathology, what would a raised ALP indicate?
Cholestasis
What is the mechanism of action of N-acetyl cysteine in paracetamol overdose treatment?
Replenishes the supply of glutathione that conjugates NAPQI to non toxic compounds
What is the best investigation to confirm a suggested diagnosis of ascending cholangitis?
ERCP
What are some causes of chronic pancreatitis?
- Iatrogenic - ERCP
- Hypercalcaemia
What hepatitis virus is a DNA virus?
Hepatitis B
What are some symptoms of iron excess / haemochromatosis?
- Fatigue
- Weakness
- Abdominal problems
- Bronzing of skin
- Hepatomegaly
What is the 1st line investigation for suspected haemochromatosis
Blood test for ferritin levels
What is the 1st line antibiotic for uncomplicated UTI?
Nitrofurantoin
What drug can also be used in UTI?
Trimethoprim - but it is teratogenic
What is the gold standard investigation for kidney stones?
Non contrast CT - Kidney ureter bladder
What are some symptoms of bladder cancer?
- Painless haematuria
- Polyuria
- Increased urgency
- Nocturia
What are the treatments for chlamydia?
Doxycycline or Azithromycin
What are some risk factors for testicular torsion?
- Young age, often just before puberty
- Cryptorchidism
- Trauma or exercise
What are some signs of Wegener’s granulomatosis / granulomatosis with polyangiitis
- Nasopharynx symptoms
- Saddle nose
- Hypertension
What is Henoch-Schoenlein purpura?
A disease where capillaries become inflamed and damaged
What are the 4 main symptoms for Henoch-Schoenlein purpura?
- Non blanching purpura ash
- Abdominal pain
- Glomerulonephritis
- Arthralgia
When does Henoch-Schoenlein purpura tend to occur?
Males age 3-15 after an upper respiratory tract infection
What is Alport syndrome?
A defect in type IV collagen that causes problems in the kidneys, eyes and ears
What is the most appropriate 1st line treatment for frequency and urgency?
Oxybutynin with bladder training
What are the side effects of anticholinergics such as oxybutynin?
- Dizziness
- Dry mouth
- Constipation
What are some symptoms of acute pyelonephritis?
- Fever
- Flank pain
- Frequency and urgency
- Pain on urination
What is the 1st line antibiotic for pyelonephritis?
Ciprofloxacin
Cefalexin
Co-amoxiclav
What are most renal calculi made of?
Calcium oxalate
What is another cause of renal calculi?
Magnesium ammonium phosphate
What is Chvostek’s sign?
Associated by hypocalcaemia - elicited by tapping CN7 resulting in momentary facial contraction
What is Prehn’s sign positive?
Pain relief upon lifting the affected testicle
What does a positive Prehn’s sign indicate?
Epididymitis
What does a negative Prehn’s sign indicate?
Testicular torsion
What is the most common cause of epididymitis?
STIs
What does new onset proteinuria on a background of diabetes mellitus suggest?
Diabetic nephropathy
What is the treatment for diabetic nephropathy?
Hypertensive control - Ace-i
Where does the left testicular vein drain to?
The left renal vein
Where does the right testicular vein drain into?
The IVC
What drugs must be stopped in AKI?
- NSAIDs
- ACE-i & ARB
- Aminoglycosides
What dietary advice should be followed in patients with chronic kidney disease?
Low protein, phosphate, potassium and sodium
What genetic component is most associated with spondyloarthropathies?
HLA-B27
What would the blood profile look like in a patient with Paget’s disease of bone?
Elevated ALP
Normal PTH, phosphate, calcium, vitD
What medicines can cause gout?
Bendroflumethiazide
What nerve covers the knee jerk reflex?
L4
What STI is a common causative agent of reactive arthritis?
Chlamydia
What STI can cause septic arthritis?
Gonorrhoea
What is a risk for contracting a Pseudomonas aeruginosa infection?
IVDU
What sort of bacteria is Haemophilus Influenzae
A gram negative coccobaccilus
What forms of arthritis has distal interphalangeal joint (DIPJ) involvement?
Osteoarthritis and Psoriatic arthritis
What is the 1st line medication for osteoarthritis?
Topical NSAIDs
What is the 2nd line medication for osteoarthritis?
Oral NSAIDs & PPI
What is the 3rd line medication for osteoarthritis?
Weak opioids eg. Codeine
What is reserved for very severe osteoarthritis?
Intra articular steroid injection
What antibodies are found in Sjogrens?
Anti-Ro (SS-A) and Anti-La (SS-B)
What is the most specific antibody in Sjogrens?
Anti-La (SS-B)
What is methotrexate?
A disease modifying anti-rheumatic (DMARD)
Why must methotrexate be avoided in pregnancy?
It is a folic acid inhibitor
Folic acid is crucial in the neurodevelopment of the foetus
What is severe osteoporosis?
A score of < -2.5 and a known pathological fracture
What is the name of the descending painless loss of vision that can occur in patients with Giant Cell Arteritis?
Amaurosis Fugax
What part of the brain is most affected in complex partial seizures?
Temporal lobe
What is Wernicke encephalopathy?
Degenerative brain disorder that can present with changes in metal status, gait and oculomotor dysfunction
What is Korsakoff syndrome?
A memory disorder
What causes Wernicke encephalopathy and Korsakoff syndrome?
Vitamin B1 deficiency (associated with alcohol abuse)
What is Myasthenia Gravis?
An autoimmune disorder where autoantibodies attack post synaptic nicotinic ACh receptors at the neuromuscular junction of skeletal muscles
What is Guillain-Barre syndrome?
An autoimmune demyelination of the PNS
Early on in GBS, Schwann cells can remyelinate nerves, but what happens as the disease progresses?
The Schwann cells fail to remyelinate properly leading to irreversible damage to the PNS
What are some symptoms of Guillain Barre?
- Parasthesia
- Loss of ankle and arm reflexes
- Double vision and difficulty speaking
What tests can be done to help confirm a diagnosis of Guillain Barre?
- Lumbar puncture, increased protein in CSF but not increased leukocytes
- Nerve conduction tests
What is the treatment for Guillain Barre
Intravenous immunoglobulin
What are the complications of Guillain Barre?
Respiratory failure
Pulmonary emboli
What is Motor Neurone disease?
A neurodegenerative disease that causes destruction of the upper and lower motor neurones
What are the symptoms of MND?
- Muscle weakness (with visible wasting)
- Spasticity & Fasciculations
- Problems swallowing
What drug can be used in MND?
Riluzole
What is Cauda Equina syndrome?
Compression of the cauda equina
What are the symptoms of Cauda Equina?
- Lower back pain
- Loss of bowel or bladder control
- Pain that radiates bilaterally down the leg
What is the difference in the CSF between viral and bacterial hepatitis?
Viral: Normal glucose, higher protein, lymphocytes
Bacteria: Lower glucose, higher protein, neutrophils
What is Horner’s syndrome?
Disruption to the sympathetic nerve supply that presents with ptosis, facial anhydrosis, miosis
What can cause Horner’s syndrome?
A Pancoast tumour in the upper part of lung can interfere with the sympathetic chain
What is Brown Sequard syndrome?
Lesion to one half of the spinal cord
What are the symptoms of Brown Sequard syndrome?
- Ipsilateral loss of position, vibration, sensation and motor control at the level of the lesion
- Contralateral pain and temperature loss 2 levels below the lesion
What artery is commonly implicated in an extradural haematoma?
Middle meningeal artery
What drug can be used to lower intercranial pressure?
Mannitol
What drug should be given as soon as possible after sub arachnoid haemorrhage is confirmed?
Nimodipine
CCB to prevent vasospasm
What bacteria is the most common cause of Guillain Barre?
Campylobacter jejuni
What is the most common cause of bacterial gastroenteritis?
E.Coli
Salmonella
Campylobacter jejuni
What are some symptoms of cluster headaches?
- Unilateral around the eye
- Bad pain
What is the most appropriate 1st line investigation for suspected MS?
MRI head
What can be used with an MRI to help confirm a diagnosis of MS?
Lumbar puncture
What would a lumbar puncture show in MS?
Oligoclonal IgG bands
What characterises an extradural haematoma?
A lucid interval
If a patient is getting farily regular moderate level migraines, what treatment is appropriate?
Triptans eg. Sumatriptan
What is the mechanism of action of Triptans?
A serotonin 5-HT1 receptor agonist, causes vasoconstriction
What is Lambert Eaton Myasthenic syndrome?
A pre synaptic neuromuscular junction disorder
What is the main difference between Lambert Eaton Myasthenic syndrome and Myasthenia Gravis symptoms?
LEMS improves after exercise but Myasthenia Gravis gets worse
What are some characteristics of Frontotemporal dementia?
Can cause early personality changes, eg. aggression and disinhibition
What are some non-motor symptoms of Parkinson’s?
- Depression
- Constipation
- REM sleep disorder
- Postural hypotension
What is the only life prolonging medication in MND?
Riluzole
How does Guillain Barre tend to present?
Weakness in the toes to nose fashion
What is Charcot Marie Tooth?
Inherited condition that causes nerve damage
What are some symptoms of Charcot Marie Tooth?
- Weakness / Numbness in the legs and arms
- Usually presents in children under 10
What is 1st line treatment for tonic-clonic seizures?
Sodium Valproate
What is the 1st line treatment for women of child bearing age for tonic-clonic seizures?
Lamotrigine
What causes Alzheimer’s disease?
Beta amyloid plaques and Tau neurofibrillary tangles in the brain that disrupt the neural network and lead to memory issues
What sort of dementia is Parkinson’s linked to?
Lewy-body
What test can be used to test for Carpal Tunnel?
Phalen’s test