Random Flashcards
what is type 1 hypersensitivity?
short onset
ige
allergy etc
what is type 2 hypersensitivity?
igG/igM
hours - days
haemolytic anaemia
what is type 3 hypersensitivity?
weeks
immune complex
SLE
what is type 4 hypersensitivity?
T cells
weeks
rash
stevens johnson
how does ADH affect portal blood pressure?
decreases portal blood flow
blood supply to foregut eg stomach is provided by ___
coeliac artery
Humeral neck fracture = damage to what?
axillary nerve / artery / vein
midshaft humeral neck fracture = damage to what?
radial nerve
suprachondular humeral fracture = damage to what?
median nerve
brachial artery
maybe ulnar
what is odansetron?
5HT3 antagonist
antiemetic
what is cyclizine?
H1 antagonist
antiemetic
what is metoclopramide?
D2 antagonist
anti emetic
metaplasia vs dyspasia?
metaplasia = transformation into another cell type dysplasia = dodgy change
what biomarker for ovarian cancer?
ca125
what is cea a biomarker for?
colon/bowel
what is epithelium in oesophagus made from?
stratified squamous
non keratinised
where is transitional epithelium?
bladder
called transitional because it looks different when bladder is bigger
what is the most important IMMEDIATE treatment for sepsis?
fluids
what does hyperparathyroidism look like on ECG?
high PTH = high calcium
tall T and short QT
drugs ending in -azole are?
antifungals
definition of sensitivity and specificity?
sensitivity = number of true positives specificity = number of true negatives
define prevalence and incidence?
prevalence = number of cases today incidence = number of new cases today
how to calculate the amount of units in alcohol?
% x ml / 1000
autonomy is..
allowing patients with capacity to have an input in their care
(must have capacity to have autonomy)
diadepesis is?
when neutrophils attract other inflammatory cells
treatment for hypercalcaemia?
fluids
if severe / symptoms you can use bisphosphonates & calcitonin
(calcitonin is released from C cells in the thyroid and lowers blood calcium)
cold peripheries are associated with what thyroid pathology?
hypothyroid (cold intolerance)
the MRC score is for..
breathlessness
1 is fine, 5 is cannot leave house
what is Felty’s syndrome?
rheumatoid arthritis
splenomegaly
neutropenia
what does a claw hand / unable to cross fingers / forearm flexor wasting / poor grip indicate damage to?
ulnar nerve
what does unable to open jam jar / poor grip / thenar muscle wasting indicate damage to?
median nerve
what is the usual 1st line SSRI for depression?
& a side effect?
fluoxetine
sleep disturbance / random dreams / ulcers
what is citalopram? what is a side effect?
SSRI for depression/anxiety
arrythmias
what are venlafaxine and duloxetine?
SNRI - serotonin noradrenaline reuptake inhibitors
primarily use for depression
raised BP
what class is amytriptilline?
TCA - tricyclic antidepressant
which antidepressants cannot be taken with lots of cheese etc?
MAOI - monoamine oxidase inhibitors eg phenelzine
what should you do before prescribing antidepressants?
- warn the patient they can cause increased anxiety/suicide for first few weeks
- warn patient they take 3-4 weeks to work
- make sure pt knows where to find help if they suicidal
- consider other treatment eg CBT
- tell patient not to stop them abruptly, they need to be tapered
what is sertraline?
SSRI
presentation of depression?
Low mood Anhedonia, a lack of pleasure in activities Low energy Anxiety and worry Irritability Avoiding social situations Hopelessness about the future Poor sleep, particularly early morning waking Poor appetite or over eating Poor concentration Physical symptoms such as abdominal pain
risk factors for depression?
stressful life events eg loss of a partner
family history
living alone
chronic disease
parental drug/alcohol abuse / childhood neglect
alcohol
Cushing’s / overuse of steroids
what 2 questionnaires can be used to assess depression?
PHQ 9
GAD 7
what 2 questionnaires can be used to assess depression?
PHQ 9
GAD 7
how are BRCA 1 and BRCA 2 inherited?
autosomal dominant
BRCA1 and BRCA 2 increase the risk of which cancers?
breast ovarian prostate skin digestive tract
what is the function of BRCA 1 and BRCA2 proteins?
repair double stranded breaks in DNA
a ‘triple negative’ breast cancer does not express receptors for:
progesterone
oestrogen
her 2
triple neg usually BRCA 1
5 risk factors for breast cancer?
alcohol smoking obesity BRCA1/2, TP53 etc family history radiation (eg several CXR) chemotherapy eg for Hodgkins diabetes female dense/glandular breasts gynaecomastia ashkenazi jew
what are the signs of breast cancer?
nipple inversion dimples palpable lump nipple/areolar exczema unilateral nipple discharge axillary lump change in breast size
T classification for breast cancer?
1 - less than 2cm
2 - 2-5cm
3 - 5cm +
4 - metastasised
treatment for oestrogen receptor positive breast cancer?
tamoxifen - for pre menopausal (selective oestrogen receptor antagonist/SERT)
letrozole/aromatase inhibitor for post menopausal (after menopause aromatase is the main source of oestrogen)
treatment of HER-2 receptor positive breast cancer?
herceptin (trastuzumab)
side affect - affects heart function
what is goosrhelin?
GnRH agonist
can be used in oestrogen receptor pos breast cancer
what 4 main things do they look for at the 8 week baby check?
hip dysplasia
congenital cataract
undescended testes
congenital heart disease eg VSD
what contraception can you use immediately after giving birth?
implant
injection
progesterone only pill
condoms
what contraception can you not use in the weeks following giving birth?
vaginal ring combined pill patch diaphragm/cap coil - unless you put it in within 48hrs
what are caspases?
enzymes that destroy the organelles in apoptosis
what type of necrosis is there in MI and tubular necrosis?
coagulative
denatured
what happens in caseous necrosis?
eg TB
macrophage form giant mutlinucleated cells
define ‘neoplasm’?
autonomous abnormal growth of cells
persists when stimulus removed
benign or malignant
what is the stroma around a neoplasm?
supportive tissue
eg fibroblasts, blood vessels
what is the difference between the way benign and malignant tumours grow on mucosa?
benign - exophytic - grow up and out
malignant - endophytic - grow down into and ulcerate
what is a papilloma?
benign
not glandular
carcinogenesis vs oncogenesis?
carcin - only for malignant
onco - benign or malignant
what specifically increases the risk of seminoma?
undescended testes
how do sulphamethoxazole and trimethoprim work?
stop the production of folic acid
how does metronidazole work?
stops the production of nucleic acid
only works in anaerobes
how do macrolides such as erythromycin, clarithromycin, azithromycin work?
target ribosome - inhibit protein synthesis
what kind of drug is doxycycline and what does it do?
tetracycline
targets the ribosome to stop protein synthesis
what abx do you need to be careful of in penicillin allergy?
cephalosporin
carbopenems
amoxicillin covers __
gram pos
strep
listeria
enterococcus
by changing from amoxicllin – co amoxiclav what are you now covering for?
staph
haemophilus
e coli
what kind of bacteria does doxycycline cover?
very broad spec
gram pos and neg and atypical
define sepsis?
body launches a large immune response against a pathogen
= systemic vasodilation
affects organ function
what makes up the triad of haemolytic uraemic syndrome?
haemolytic anaemia
AKI
thrombocytopenia
how does haemolytic uraemic syndrome develop?
following infection with ecoli 0157 or shigella
– caused by the shiga toxin
more likely if they have abx or loperamide, this is why gastroenteritis not routinely treated like that
presentation of haemolytic uraemic syndrome?
oliguria Haematuria Abdominal pain Lethargy Confusion Hypertension Bruising following a period of blood diarrhoea
what is the treatment for haemolytic uraemic syndrome?
antihypertensives
blood products (to combat haemolysis)
dialysis
what blood product would you give in anaemia?
packed red cells
used to restore the oxygen carrying capacity
what is cryoprecipitate for?
anticoagulation reversal
when is whole blood usually given?
generally only in acute/prehospital
causes of erectile dysfunction?
antidepressants trauma eg pelvis fracture MI hypertension diabetes prostatectomy alcohol
what is the investigation for thyroid cancer?
fine needle aspiration for cytology
this is sensitive for all thyroid cancers except follicular
what happens in hyperthyroid crisis?
tachycardia extreme pyrexia abdo symptoms confusion/agitation associated with graves immediate treatment is carbimazole
immediate treatment for type II heart block?
atropine
Graves is associated with pretibial myxoedema but what is that?
discoloured, non-pitting swelling of the lower legs, usually found bilaterally and can be sore or itchy
8 risk factors for angina?
biologically male
fam history
genetic hyperlipidaemia
age
HTN type 2 diabetes mellitus smoking cholesterol obesity
Systemic features of ankylosing spondylitis?
5As
anterior uveitis autoimmune bowel disease apical lung fibrosis aortic fibrosis amyloidosis
what is prophylaxis for migraine?
propanolol
topiramate
amitryptilline
how is adrenaline administered in anaphylaxis?
1 in 1000 IM
3 risk factors for Crohn’s?
family history HLA b27 caucasian ashkenazi Jewish smoking NSAIDs
non malignant causes of lymphadenopathy?
infection sarcoidosis SLE phenytoin EBV associated lymphoproliferative disease
3 symptoms of leukaemia?
lymphadenopathy weight loss anorexia fatigue bleeding infections abdo pain
As well as the blood film what can you use to confirm the diagnosis of leukaemia?
immunophenotyping
3 risk factors for TB?
IVDU homeless immunosupressed close contact with infected people alcoholic from a country of high incidence
what kind of diuretic is furosemide and how does it work?
loop diuretic
inhibits the sodium potassium transporter in the ascending loop of henle
what kind of diuretic is bendroflumethiazide and how does it work?
thiazide
inhibits sodium potassium pump in the Distal convoluted tubule
what is acetazolamide and how does it work?
carbonic anhydrase inhibitor diuretic
works at proximal distal tubule
what is amiloride and how does it work?
diuretic
inhibits ENaC on apical membrane at distal tubule
what is a good antibiotic for skin infections eg cellulitis?
flucloxacillin
what is the most important part of the U&E to monitor in AKI?
potassium
what infection do owls eye bodies indicate?
CMV
what is:
paraprotein in urine, racoon eyes, macroglossia?
amyloidosis
What is the name of the test for sjorens?
dry mucous membranes
schirmers test
which of the coeliac antibodies are most specific & sensitive?
TTG - sensitive
EMA - specific
in vWF deficiency how does the clotting tests change?
Like haemophilia, high APTT as vWF deficiency affects the intrinsic pathway
a posterior duodenal ulcer can lead to bleeding from which artery?
gastroduodenal
why does isoniazid cause peripheral neuropathy?
because it depletes vit B6
at what Well’s score do you do a CTPA or USS not a D dimer?
2 or more
in tension pneumothorax where do you put your wide bore cannula?
2nd intercostal space on the midclavicular line just above the rib
(left or right is fine)
what kind of hypersensitivity is asthma?
type I
what drug for Raynauds?
nimodipine
in tertiary hyperPTH what is high/low?
high PTH
high Ca
high phosphate
caused by chronic secondary hyperPTH, usually needs surgery
how is G6PD deficiency inherited?
x linked recessive
what is the treatment for vWF deficiency?
1 - packing
2 - TXA
3 - vasopressin analogue
4 - vWF
where do you hear the aortic valve/a murmur radiating to the carotids?
2nd intercostal space
left sternal border
what mutation is most common in CF?
f508 deletion
chromosome 7
what diet should people with CF follow?
high calorie high fat
what 4 bones does pagets commonly affect?
vertebrae
pelvis
skull
femur
what investigations (3) in pagets?
X ray to see bone lesions
calcium and phosphate - normal
ALP - high
what about driving after a TIA?
you dont need to tell the DVLA, but don’t drive for 1 month
what is first and second line treatment for chlamydia?
first - doxycycline 1 week
second - azithromycin 3 days
prophylaxis for a. migraine and b. cluster headache?
migraine : amitriptyline, propanolol, topiramate (amy, poppy and tally get migraines)
cluster: verapamil, lithium and prednisolone (vere, leo and fred)
what chromosome is CF on?
7
what chromosome is wilson’s on?
13
what chromosome is alpha 1 antitrypsin on?
14
what chromosome is haemachromotosis on?
6
what is the best imaging for bowel obstruction?
CT
What hypersensitivity is hypersensitivity pneumonitis?
3
define positive predictive value?
proportion of positive results that are true positives
who gets osteosarcoma?
young people/children
who gets ITP & when?
children get it acutely following an illness
adults with SLE etc get it chronically
presents with purpura/rash
4 typical presenting features of TTP?
purpura
fever
fluctuating cerebral function
haemolytic anaemia
what are the clotting tests like in DIC?
high PT, APTT, TT
how does aplastic anaemia present?
bleeding, especially from gums and blisters in mouth
increased susceptibility to infections
when you test for DI how is the desmopressin given?
IM
what cardiac related drugs can you not give in heart failure?
verapamil, other calcium channel blockers
amlodipine is fine
at what QFracture score or FRAX score do you need a DEXA scan?
10% or more
or over 50 with a frailty fracture
3 times when it’s appropriate to break confidentiality?
risk to public safety
patient has given consent
required by law (eg notifiable disease)
what does the ABCD2 score mean about TIA?
everyone with TIA or ?TIA needs to be seen within 7 days
score of 4 – seen within 24hrs
score of 6 – seen immediately
how is spontaneous pneumothorax managed?
needle aspiration
what is de quervains thyroiditis, when does it develop, what are the symptoms, how is it managed?
hyperthyroidism after infection large painful asymmetrical neck lump lid lag, tremour, sweating, etc supportive management - analgaesia, anti inflammatories, beta blockers
in anterior artery stroke which limbs are affected?
legs
there can also be sensory impairment
face, speech, vision etc should be fine
If there is high unconjugated bilirubin, nomal/low conjugated, what kind of jaundice is this, and what will the urine/stools be like?
pre hepatic jaundice
eg haemolytic anaemia, gibsons
urine is pale bc urine has conjugated bilirubin in it (makes it water not fat sol)
if both conjugated and unconjugated bilirubin is high what kind of jaundice is this? what might cause it?
intrahepatic
liver damage/cirrhosis/PBC
what part of the lung is affected in idiopathic pulmonary fibrosis?
lower
this is different from most other problems, eg silicon, ankylosing spondylitis, hypersensitivity affect the top
at what CD4 do you diagnose AIDS?
200 or less
what drug do you give for pneumonia, based on the CURB score?
mild (CURB of 0-1): amoxicillin
moderate (CURB 2): amoxicillin + clarithromycin
severe (CURB3): co-amoxiclav + clarithromycin
PCP: cotrimoxazole (really you only see this in AIDs)
what is ABPI?
ankle brachial pressure index
an index of vessel competency
measure ratio of systolic BP in arm vs ankle
ratio less than 0.8 indicates arterial disease
what is the lump like in testicular cancer?
hard and painless
doesnt transluminate
part of the testicle (different from a hernia)
heavy/dragging sensation
what is the most specific blood marker of acute liver damage?
ALT
albumin is best for chronic
in haemophilia what is the INR?
normal
what are the ‘irritative’ LUTs?
related to storage
nocturia, frequency, urgency, incontinence
what is mild UC?
4 or less poos a day
small amounts of blood
what is moderate UC?
4-6 poos
mild-severe blood
what is severe UC?
6+ poos ESR 30+ pyrexia tachycardia (above 90) anaemia
how is aminosalicylate given in UC?
topically in mild-moderate, and orally if no response
what are the main differences between arterial and venous ulcers?
arterial – caused by peripheral vascular disease. on the feet. dry base. ‘punched out’. painful
venous – caused by blood stasis. ragged edges, on the legs, not painful, oozing, superficial
give two points from the wilson and jungner criteria for screening tests?
- condition is an important health problem
- there is an accepted treatment for patients with the disease
- there are available facilities for the diagnosis and treatment of the disease
- there is a recognisable latent or early symptomatic stage of the disease
- there must be a suitable test or examination
- and this test must be acceptable to the public
- we should understand the natural history of the condition, including the progression from latent to declared disease
what is cullens sign?
bruising around the bellybutton
what is fox’s sign?
bruising around the inguinal ligament
what is grey-turners sign?
discolouration, eccymosis of the flank
