Random Flashcards

Question

Inactive Prep Vaccines

Answer 1

Hep A, Influezna and Rabies

Answer 2

Pertusis, Diptheria and Tetanus

Answer 3

Slow Rising Intraoccular Pressure - picked up on pressures or cupping of disk Tunnel Vision is symptom

Answer 4

Eye Drops to decrease Intraoccular pressure First line- Prostaglandins Second line - Beta Blocker, Carbonic Anhydrase inhibitor or sympthomimetic (bromidine or Alpha 2)

Answer 5

Prostaglandin first line increase uveoscleral outflow | Brown pigmentation of iris and increase eyelash length

Answer 6

Reduces aqueous production (2nd Line)

Answer 7

carbonic Anhydrase inhibitor- Reduces Aqueous PRoduction (2nd line)

Answer 8

Reduces Aqueous production and increase uveoscleral outflow

Answer 9

Increases Uveoscleral outflow

Answer 10

T Score > - 1.0 Normal < -1.0 Osteopenia >-1.5 = treat with Bisphosphonates, Vit D, and Ca to prevent Osteoperosis > -2.5 = Osteoperosis

Answer 11

Predicts Ten year risk of osteoperotic fracture

Answer 12

Haemoglobin oxidised from Fe2+ to Fe3+ Fe3+ Can't bind oxygen - leads to tissue hypoxia Congenital causes: Hb strains NADH methaemoglobin reducase deficiency Aquired: Drugs- sulphonamides, Dapsone and Nitrates Ailine Dyes

Answer 13

'chocolate' cyanosis dyspnoea, anxiety, headache severe: acidosis, arrhythmias, seizures, coma normal pO2 but decreased oxygen saturation Treat with NADH Methaemoglobin reducase or Methylene Blue Ascorbic Acid

Answer 14

6 Months ( no structural abnormality or Epileptic EEG or is 12 Months)

Answer 15

12 Months seizure free 5 years = normal license weaning meds- no siezures after last dose 6 months ago

Answer 16

Age, Females Steroids, Smokers, FH, Alcohol Abuse, RA, Low BMI ``` Hyperthyroidism hypogonadism (e.g. Turner's, testosterone deficiency), growth hormone deficiency hyperparathyroidism diabetes mellitus multiple myeloma lymphoma IBD malabsorption (e.g. Coeliac's/ gastrectomy, liver disease chronic kidney disease osteogenesis imperfecta homocystinuria ```

Answer 17

``` SSRIs antiepileptics proton pump inhibitors glitazones long term heparin therapy aromatase inhibitors e.g. anastrozole ```

Answer 18

Bloods - All | DEXA

Answer 19

Eosinophilia Variable FEV1/ Peak Expiratory Flow Asthma/Atopy

Answer 20

SABA/ SAMA If failing - ? Steroid responsive If STEROID Responsive 1 LABA + ICS 2 LABA + ICS + LAMA (SABA PRN) If Not LAMA, LABA and SABA Stop Smoking, Consider Mucolytics, Antibiotics (azithromycin - Check QRS) and monitor for Core Pulmonale If HF- Diuretics and Home O2

Answer 21

Chlorpromazine | Haloperidol

Answer 22

Low Risk Give Vaccine and complete course if not covered No action if 5 tetanus vaccines previously High risk : Compound Fracture / Devitalised Tissue Give IVIG even if fully vaccinated

Answer 23

Glucose-6-phosphate dehydrogenase (G6PD) deficiency X Link Recessive Egyptian/Mediterranean Features: neonatal jaundice is often seen intravascular haemolysis (triggered by food or drugs) gallstones are common splenomegaly may be present Heinz bodies on blood films. Bite and blister cells may also be seen Drugs: primaquine ciprofloxacin sulph drugs sulphonamides sulphasalazine, sulfonylureas

Answer 24

HOT Stool- Cool and you can't tell? | 15 min sample to local lab

Answer 25

``` Can be chronic asymptomatic Ranges for Watery Diarrhoea to Bloody ++ Long Incubation period Can cause abscess in colon Metronidazole tx ``` Can cause liver abscess- serology 90% positive

Answer 26

Tamoxifen if Eostrogen Positive Trastuzumab (Herceptin) for HER 2 Positive - Flu like symptoms - ECHO pre as Cardiotoxic

Answer 27

ECHO if strucutral abnormality- Long term If not 4 Weeks Warfarin

Answer 28

``` Calcium Pyrophosphate crystals in synovium Associated with Haemochromatosis Acromegaly Wilsons Hyperparathyroidism Low Mg ```

Answer 29

Wrist or knee Bifringent RHOMBOID Crystals Chondrocalcinosis

Answer 30

C 5- 9 Deficiency | Encodes for MAC Membrane attack Complex

Answer 31

C2 - 4 C1q, C1rs, C2, C4 deficiency (classical pathway components) predisposes to immune complex disease e.g. SLE, Henoch-Schonlein Purpura

Answer 32

C1 ``` C1 inhibitor (C1-INH) protein deficiency causes hereditary angioedema ``` uncontrolled release of bradykinin

Answer 33

C3 C3 deficiency causes recurrent bacterial infections

Answer 34

Pulmonary Hypertension Hypertension ASD w/o Pulmonary Hypetension

Answer 35

Aortic Stenosis

Answer 36

Pulmonary Stenosis INspiration RBBB

Answer 37

``` the Pill Coamox Fluclox Erythromycin Anabolic Steroids and testosterone Chlorpromazine prochlorperazine Sulphonylureas Fibrates ```

Answer 38

Methotrexate Levo Dopa Amiodarone

Answer 39

``` S4 Slow Rising Pulse Narrow Pulse Pressure Soft S2 Thrill Duration of Murmur LV failure ```

Answer 40

Senile Calcification Bicuspid Valve Williams syndrome HOCM Rheumatic Valve disease

Answer 41

Asymptomatic- monitor Symptomatic Replace Valve Asymptomatic with Gradient > 40 + LV Failure- ? Surgery Check angiogram for IHD Valvuloplasty for too unwell for surgery

Answer 42

Serial measurements of peak expiratory flow are recommended at work and away from work.

Answer 43

Larva migrans: there are two disease entities: cutaneous (caused by Ancylostoma) and visceral (cause by toxocara). Both NEMATODES: cutaneous larva migrans: IVERMECTIN or THIABENDAZOLE. - visceral larva migrants: self limited. steroids if severe. ALEBENDAZOLE for eradication

Answer 44

Ancylostoma - Cutaneous Larva Migrans Toxocara - Visceral Larva Migrans Strongyloides - Similar appearance to Larva MIgrans but faster movement. Can give Gram -ive sepsis, Eosinophilia and Abdopain, pneumonitis and diarrhoea Thiabendazoel or Alebendazole is main treatment

Answer 45

Short Synacthen Test: Plasma Cortisol Before and 30 mins after Synacthen 250 micrograms If not available 9 am Cortisol: > 500 normal 100-500 - Needs Short Synacthen <100 - Addisons

Answer 46

Hyperkalaemia Hyponatraemia Hypoglycaemia Metabolic Acidosis

Answer 47

``` Gullian Barre Myathsenia Gravis Kawasaki Idiopathic Thrombocytopenic Purpura (NOT TTP) Immune Deficiency Dermatomyositis ```

Answer 48

Immune (or idiopathic) thrombocytopenic purpura (ITP) is an immune-mediated reduction in the platelet count. Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex after an infection or vaccine. Acute- Children Chronic- Young females Evans syndrome = ITP in association with autoimmune haemolytic anaemia (AIHA)

Answer 49

Large Von Willibrand Factors cause Platelets to clump within vessels. Causes Thrombocytopenia and Purpura. Rare seen in women and can cause microemboli- fluctuant neurology. Caused by SLE, PRegnancy HIV, Drugs (Ciclosporin)

Answer 50

Splenic Flexure

Answer 51

Churg Struss + Others: SLE, RA, IBD, Autoimmune Hepatitis

Answer 52

Wegners or Granulomatosis with polyangitis

Answer 53

``` B3 Niacin Deficiency Ds: Dermatitis Dementia (Depression) Diarrhoea ``` Can be caused by Isoniazid

Answer 54

Gastric Parietal Cell - 90% Intrinsic Factor - 50 %

Answer 55

Radiolabelled b12 given, first alone, second with IF Measure Urinary B12 §

Answer 56

Aspirin Penicilin NSAIDs Opiates

Answer 57

1-2% AR and AS in later life Associated with Turners and Coarction of Aorta Associated with Left Dominant Supply

Answer 58

Gram Positive Bacillus Grows at low temp- therefore food contamination Cauess Diarrhoea, Flu, Pneumonia and Ataxia/ Seizures Ampicillin or Amoxicillin Treatment Increased Likelyhood in Pregnancy

Answer 59

Increase Anti Thrombin III action on Xa Long acting SC

Answer 60

Inhibits IXa, Xa, XIa, XIIa Short IV Thrombocytopenia!! APTT to monitor Used in Renal Failure

Answer 61

Thrombocytopenia Osteoperosis Hyperkalaemia

Answer 62

Protease Inhibitor produced by the liver | Leads to Emphysema in deficiency

Answer 63

``` Cause of Emphysema in Young non smokers Autosomal Recessive Chromosome 14 PiZZ Genotype most commonly Emphysema Liver Cirrhosis Obstructive Spirometry ```

Answer 64

Angiodysplasia is a vascular deformity of the gastrointestinal tract which predisposes to bleeding and iron deficiency anaemia. Elderly patients on colonoscopy

Answer 65

Aortic Stenosis

Answer 66

Photosensitive rash on head back and shoulders Heliotrope Rash perio orbitally Gottron's patches on extors surfaces of fingers

Answer 67

``` Proximal Mm Weakness/Tenderness Respiratory MM weakness Raynauds Interstitial Lung Disease- Organising PNeumonia or Fibrosing alveolitis Dysphagia/odynophagia ```

Answer 68

ANA positive Jo-1 Screen for malignancy - breast, ovarian, Lung

Answer 69

Becks Triad - Muffled Heart sounds - Raised JVP - Hypotension Clinical distinguishing signs: an absent Y descent on the JVP - this is due to the limited right ventricular filling pulsus paradoxus - an abnormally large drop in BP during inspiration

Answer 70

``` Bromocriptine, cabergoline, Pergolide Amiodarone Bleomycin / Bulsulphan (Chemo) Methotrexate and Sulfasalazine (RA) Nitrofurantoin ```

Answer 71

CML - 95% have this Philadelphia gene

Answer 72

Mantel Cell Lymphoma

Answer 73

Follicular Cell Lymphoma

Answer 74

Burkitss Lymphoma

Answer 75

Promyelocytic Lymphoma

Answer 76

Sensory (Uraemia)

Answer 77

Sensory subacute combined degeneration of spinal cord dorsal column usually affected first (joint position, vibration) prior to distal paraesthesia Exacerbated by giving Folate replacement before B12

Answer 78

Pseudoxanthoma elasticum is an inherited condition (usually autosomal recessive*) characterised by an abnormality in elastic fibres Retinal Angiod Streaks Plucked Chicken Skin IHD Mitral Prolapse GI bleeds

Answer 79

Potassium Channel Activator Treatment for Angina

Answer 80

Headache, Flushing, Anal Ulceration

Answer 81

Direct Thrombin Inhibitor

Answer 82

Activates Anti Thrombin III

Answer 83

P2Y12 Inhibitor

Answer 84

Direct Factor X inhibitor

Answer 85

Alfentanyl Buprinorphine Fentanyl

Answer 86

NAAT | Nucleic Acid Amplification Test

Answer 87

Doxy 7 days Azithromycin 1 dose Azithromycin in Pregnancy

Answer 88

Anticholinesterase inhibitor for Dementia - Caution in Bradycardia Causes insomnia Causes Alternatives are galantamine and rivastigmine

Answer 89

NMDA recetpor antagonist 2nd line For SEVERE diseaes or Add on with Donepezil in mod- severe

Answer 90

Staph Aureus | Staph Epidermis if < 2months since valve replacement

Answer 91

Coxielle Burneti

Answer 92

Coxielle Burneti Fever and coryzal prodrome Can cause negatvie culture Endocarditis Tics from animals or inhaled dust

Answer 93

Reversal of a left to right shunt Acyanotic defect becomes CYANOTIC ASD, VSD or PDA ``` Due to pulmonary hypertension and remodelling Clubbing Cyanosis Loss of murmur Heart Failure ``` Heart Lung Bypass is treatment

Answer 94

Ebsteins anomaly is a congenital defect of the Triscuspid valve This leads to Tricuspid Regurgitation and Enlargement of rthe Right atrium. Associated PDA or PFO and Left to right shunt Leads to signs of heart failure Cause of Giant V waves

Answer 95

Ballooning for the Dural Sac athe Lumbosacral level Causes HEadaches, Back pain, and intermittent incontinence or bowel and bladder Very Common in Marfans

Answer 96

Autosomal Dominant

Answer 97

Chromosome 15, FBN1 gene which encodes for Protein Firbrin 1

Answer 98

``` Arm span to Height Ratio > 1.05 High arch palate Arachnodactyle Cardiac Issues Tall Thin stature Pneumothorax Pectus Excavatum Pes Planus Scoliosis Aortic Sinus Dilation (90%) - Aortic Aneurysm - Aortic Dissection - Aortic Regurgitation - Mitral Valve Prolapse (75%) ``` Lens Dyslocation DURAL ECTASIA - Headache, Pain, Numbness, Incontinence.

Answer 99

``` Heparin NSAIDs Quinine Carbomazepine Valproate Sulphononamides Rifampicin Furosemide Penicillins ```

Answer 100

Abnormally LArge Stick Von willibrand factors cause Platelets CLUMPING in VESSELS DEFICIENCY OF ADAMTS13 Overlaps with HUS

Answer 101

Rare- Typically adult females Fever Confusion/New Neurology - microinfarcts Renal Failure Haemolytic Anaemia

Answer 102

``` Post INfective Pregnancy Drugs (New) HIV SLE Tumours ```

Answer 103

Rare cause of Hypothyroidism Hard fixed painless goitre felt on palpation Fibrosis of the thyroid Can by Euothyroid or Hypo on presentation LEADS TO RETROPERITONEAL FIBROSIS

Answer 104

6-12 hours - symptoms of withdrawal 36 hours - Seizures 72 Hours - Delerium Tremens

Answer 105

``` Arrythmia Short Term Memory Loss ? Long Term Memory Loss Nausea Headache ```

Answer 106

Inherited Neurodevelopmental disorder due to micro deletion of chromosome 7 ``` Elfish Look Characteristically v friendly LD Short Stature Neonatal hypercalacmia Supravalvular Aortic Stenosis ```

Answer 107

Pyrimethamine and Sulphadiazine

Answer 108

``` schizonts on a blood film parasitaemia > 2% hypoglycaemia acidosis temperature > 39 °C severe anaemia ``` ``` Organ Failure: Coma/ Seizure AKI / Black Water Fever ARDS DIC ```

Answer 109

``` Severe Valve Failure Aortic Abscess Resistant Infections Recurrent Emboli Cardiac Failure ```

Answer 110

Sensitivity / 1- specificity

Answer 111

Common Opurtunistic FUNGAL infection at a CD4 count lower than < 200 in HIV <200 - should have prophylaxis

Answer 112

SOB, Fever and dry cough Very few chest signs clinically CXR- bilateral interstitial infiltrates, can be lobar or normal. BAL - Silver Stain

Answer 113

Cotrimoxazole IV PEntamidine Steroids Prone to Pneumothorax

Answer 114

Constricting chest pain Worsened by Exercise Relieved by Rest or GTN ALL NEED CT ANGIOGRAM in Negative ECG / Trop

Answer 115

Most Common inherited Thrombophilia | Works by Active Factor V is inactivated slower by Protein C

Answer 116

``` Type A (2/3) - IV labetalol and surgical repair Type B (1/3) - IV labetalol only ``` Aim BP Systolic of <110

Answer 117

Blepharitis and otitis externa

Answer 118

Tunnel Vision Night Blindness Black spiculate in peripheral retina Alports syndrome

Answer 119

Wilsons disease

Answer 120

Haemochromatosis

Answer 121

Polycythemia Ruba Vera

Answer 122

TTP- Large Von willi brands as not cleaved

Answer 123

Oral Metronidazole

Answer 124

Autoimmune necrotizing vasculitis of upper and lower airways as well as nephrons Upper respiratory tract: epistaxis, sinusitis, nasal crusting lower respiratory tract: dyspnoea, haemoptysis rapidly progressive glomerulonephritis ('pauci-immune', 80% of patients) saddle-shape nose deformity Vasculitis cANCA > 90% Steroids, Cyclophosphamides and Plasma Exchange

Answer 125

Small cell

Answer 126

Small Cell

Answer 127

Adenocarcinoma

Answer 128

Small Cell

Answer 129

Pavovirus B19

Answer 130

Horse SHoe kidney

Answer 131

FLUSHING TENLANGECTASIA Papulopustle rash Associated Blepharitis or keratitis

Answer 132

Dupyutrons contracture | Parotid Swellings

Answer 133

Vasodilation

Answer 134

``` In response to increased volume From the R Atrium > L Atrium Vasodilates Secretes Sodium Lowers BP ```

Answer 135

Left Ventricle hormone secreted in response to increased LV strain Lowers BP Diuretic and Sodium Secretion Reduces RAAS and Sympathetic

Answer 136

If <100 unlikely heart failure | BNP is PROGNOSTIC

Answer 137

> 2 years of unexplained physical symptoms | Refusal to accept reassurance

Answer 138

Indifference in unexplained symptoms | Typically sensory

Answer 139

Double Stranded DNA virus

Answer 140

Chronic (5-10%) Liver Failure (1%) HCC

Answer 141

Health workers CKD 25% are poor responders HB levels should be after 4 months post immunisation LEvels - > 100 Immune 10- 100 sub optimal- booster < 10 no response. Check for current or past infection Re do 3 x doses. If still no response, for IVIG if exposed

Answer 142

Infereron Alpha is first line Reduces viral replication through 2nd line is tenofivir, entecavir and telbivudine Telbivudine works thymidine nucleoside analogue

Answer 143

Suprvalvular Aortic Stenosis

Answer 144

malignancy of lymphoid progenitor cells of B and T lineage. Leads to Increased levels of immature cells (lymphoblasts) and leads to bone marrow and tissue infiltration

Answer 145

Most common childhood cancer 2-5 years old 80% of Child hood Leukaemia

Answer 146

``` FAB (French American British) L 1 Type Common ALL pre B phenotype low initial WBC del(9)p ```

Answer 147

``` Age < 2 or > 10 FAB L 3 Type Philledelphia Gene Translocation 9:22 Non Caucasian High White Cell Male T or B cell Surface Marker CNS involvement ```

Answer 148

``` NEPHROTIC Most common in children and young adults Biopsy - usion of podocytes and effacement of foot processes 80% steroid responsive Cyclophosphamide ``` ``` 1/3 = 1 episode 1/3 = infrequent relapse 1/3 = frequent relapse ```

Answer 149

Similar effect to SSRI Shouldn't be prescribed Inducer of cytochrome P450

Answer 150

Staph Aureus

Answer 151

Staph Aureus, Prosthetic Valve, Low Complement, Culture negative

Answer 152

Low/Normal TSH, Low T3 and Thyroxine Is a response to critical illness that leads to reduced thyroid hormone.

Answer 153

is a tumour suppressor gene. Commonly mutated in breast, colon and lung ca slows s phase for DNA checks Li-Fraumeni syndrome is a rare autosomal dominant disorder characterised by the early onset of a variety of cancers such as sarcomas and breast cancer. It is caused by mutation in the p53 gene

Answer 154

Lentigo maligna Lentigo maligna is a type of melanoma in-situ. It typically progresses slowly but may at some stage become invasive causing lentigo maligna melanoma. Irregular Borders different shades

Answer 155

Similar to lentigo malignant but symmetrical. Common over 40s

Answer 156

Gram negative Diplococcus Nisseria Gonorrhea Males: Discharge and Dysuria Females: Cervicitis - causing discharge Rectal and Pharyngeal infection is usually asymptomatic Epidydimitis and PID may occur - can lead to infertility

Answer 157

Increasing Cipro resistance Current: IM Ceftriaxone If known sensitivites- can have cipro 500mg single dose If needle phobic can have: cefixime and azithromycin single dose

Answer 158

Triad of tenosynovitis, migrating poly arthritis and dermatitis Other complications are septic arthritis (most common organism in young people) Endocarditis and Periheptitis (Fitz- Hugh- Curtis Syndrome)

Answer 159

Perihepatitis from Gonorrhea infection

Answer 160

N. Gonorrhea

Answer 161

Inducer of Cytochrom P 450 | Binds to Sodium Channels

Answer 162

Most Common Hepatic Porphyria Caused by in uroporphyrinogen decarboxylase May be triggered by hepatocyte damage (alcohol) Photosenstive bullae rash on hands and face with fragility Pink fluorescence under woods lamp Leads to elevated urine uroporphyrinogen TREATMENT Chloroquine

Answer 163

Haem break down malfunction leading to build up of intermittent molecules- porphyrins

Answer 164

``` Classically presents with Abdominal pain and new onset confusion / Neurology Autosomal Dominant inheritance Females of 20-40 HTN and Tachy cardia Urine turns red on standing. ``` Defect in Porphobillogen deaminase enzyme ``` Trigerred by drugs: Alcohol Benzos Sulphonamides Barbituates COCP Halothanes ```

Answer 165

Autosomal Dominant, common in south africans defect in protoporphyrinogen oxidase Photosensitive blistering rash + abdominal and Neurology symptoms

Answer 166

Inherited Myopathy of skeletal, smooth and cardiac muscle. Develop in 20-30s Autosomal Dominant Trinucleartide repeat DM1 - More distal weakness Chrom 19, CTG repeat on DMPK gene DM2 - More proximal weakness, no severe congenital Chrom 3, Expansion of ZNF9 gene

Answer 167

``` General features myotonic facies (long, 'haggard' appearance) frontal balding bilateral ptosis cataracts dysarthria ``` ``` Others: Mild mental impairment Testicular Atrophy DM Cardiac - hearblock/myopathy Dysphagia ```

Answer 168

Somatostatin analogue

Answer 169

ATP Dependent K + Channels causing increased insulin secretion ERRATIC LIFESTYLES Weight gain and hypos repaglinide, nateglinide

Answer 170

Most common primary cardiac tumour 75% in LA systemic: dyspnoea, fatigue, weight loss, pyrexia of unknown origin, clubbing emboli atrial fibrillation mid-diastolic murmur, 'tumour plop'

Answer 171

Seen in Hypothermia

Answer 172

Mixed UMN and LMN signs ``` Causes: Acute degeneration of the cord Motor Neurone Disease Fredricks ataxia Syringomyelia Taboparesis (syphillis) ```

Answer 173

A cyst starting centrally growing outwards and longitudinally in the spinal cord. Leads to a cape like spinothalamic sensory loss and burning of hands. MRI to confirm and surgery to treat

Answer 174

``` spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride gonadorelin analogues e.g. Goserelin, buserelin oestrogens, anabolic steroids ```

Answer 175

``` Puberty Klinefelters Kallmans (androgen deficiency) Liver disease Testicular failure- mumps Haemodialiysis Test cancer Other Cancer hyperthyroidism ```

Answer 176

Primary Cilliary Dyskinesia Dextrocardia Sinusitis Bronchiectasis / Chest infection Sub fertility

Answer 177

Caused by C1 Inhibitor protein deficiency Low c2 - c4 too Autosomal Dominant Leads to: prodrome of painful macular facial rash Then painless, non itchy swelling FFP or C1 inhibitor protein for acute tx Danazol (anabolic steroid for prophylaxis)

Answer 178

Bergers disease Commonest cause of Glomerulonephritis Macroscopic haematuria in young person following URTI Post Strep Glom vs Bergers: High Complement Levels - Bergers Haematuria > Proteinuria - Bergers Time after URTI > 2 weeks - Post Strep Good prognosis - frank haematuria Bad prognosis - Male, Smoking, Proteinuria ++++ and HTN IgA seen on in membrane

Answer 179

Good Pastures | Narcolepsy

Answer 180

Coeliac Disease

Answer 181

Rheumatoid Arthritis | DM 1

Answer 182

Haemachromatosis

Answer 183

Ank Spond Reiters syndrome Anterior Uveitis

Answer 184

dermatitis herpetiformis Sjogren's syndrome primary biliary cirrhosis

Answer 185

Meglitinides, Repaglinide and Nateglinide Activate Secretion of insulin via K Channels

Answer 186

Increases HCL, IF, pepsinogen, gastric motility. In response to stomach filling Secreted by G cells of the Antrum of Stomach

Answer 187

Secretion of enzymes from pancreas, contraction of gall bladder and relax sphincter of oddi Satiety In response to digested proteins and fatty acids I cells in upper small intestine

Answer 188

Secretes Bicarb rich fluid from pancreas and hepatic duct cells. Stops HCL production In response to acidic chyme From the S Cells upper small intestine

Answer 189

Stimulates secretion from pancreas and stops HCL From small intestines and pancreas

Answer 190

Stops all secretion | D Cells pancreas and stomach

Answer 191

dipyridamole

Answer 192

Aminophylline

Answer 193

``` Chronic Liver Disease with Port HTN Lymphoproliferative Disorders CML Amyloidosis Glandular Fever, Malaria, Hepatitis ```

Answer 194

Collagen III | Rarely Collagen V

Answer 195

Collagen IV

Answer 196

Collagen I

Answer 197

Turner's syndrome bicuspid aortic valve berry aneurysms neurofibromatosis

Answer 198

TEN is a life threatening skin reaction normally as a result to a drug Bullae rash/ Blistering Nikolsky's sign- skin breaks at mild lateral pressure Systemically unwell Tachy, Pyrexia Causes: Phenytoin, sulphonamides, Allopurinol, penicillins, NSAIDs Tx- stop drug, Support and IVIG

Answer 199

Caused by Chlamydia Starts with a painless lesion that then ulcerates associated with local lymphadenopathy 'Groove Sign' hard, painful lymphadenopathy below the inguinal ligament Then Rectoproctatitis is final stage Treatment with Doxycycline

Answer 200

Syphillis (painless and goes away and months after are ill) Chlamydia (LGV - painless, ulcerates then painful lymphadenopathy) Bechets - Associated with oral ulcers Herpes - Multiple painful ulcers Chancroid - Haemophilus ducreyi. Chancroid has ragged undefined borders and is painful lymphadenopathy

Answer 201

Sodium Valproate for all seizures apart from focal | Carbemazepine first line for focal

Answer 202

Emolients Topical Steroid + Vit D ( 4 weeks) No improvement Vit D BD (8 weeks) No improvement - High dose steroids or Coal Tar Pep for 4 weeks

Answer 203

Inhibitis formation of microtubules | Leads to Peripheral Neuropathy

Answer 204

Hardened skin and other connective tisues Unknown origin 3 types of pattern of disease

Answer 205

Raynauds Fingers and Face distribution of scleraderma Anti Centromere Antibodies Subtype = CREST Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyl and Tenalngectasia

Answer 206

Trunk and proximal limbs Scl- 70 antibodies Respiratory disesae- ILD and PAH Cause of death - Resp Poor Prognosis

Answer 207

ANA - 90 % RF - 30% Anti Centromere - Limited Cutaneous Scl 70 Antibodies - Diffuse

Answer 208

Diffuse Sclera Derma

Answer 209

Limited Cutaneous Sclera Derma

Answer 210

elastic, fragile skin joint hypermobility: recurrent joint dislocation easy bruising aortic regurgitation, mitral valve prolapse and aortic dissection subarachnoid haemorrhage angioid retinal streaks

Answer 211

Hypokalaemia

Answer 212

Epicanthic Folds medial eyelid ridge, Up Slanting Palpebral fissure (lateral eyelid corner), Flat occipital, Round Face, Protruding Tongue

Answer 213

Sandal Gap toe, Single Palma Crease, Duodenal atresia, Hishprungs and Cardiac Defects

Answer 214

``` Endocardial Cushion (40%) VSD (30%) ASD (10%) TOF (5%) Isolated PDA (5%) ```

Answer 215

``` Alzhiemers Hypothyroidism Learning Diffculties Short Stature Respiratory infections ALL Subfertility ```

Answer 216

Fasting >7 Random > 11.1 (or after OGTT)

Answer 217

Fasting glucose 6-7

Answer 218

OGTT 7.8-11.1 AND Fasting Glucose < 7

Answer 219

5-HT3 Antagonist (seretonin)

Answer 220

5-HT2 Antagonist used in migraine prophylaxis

Answer 221

5-HT2 Antagonist in diarrhoea control of carcinoid pts

Answer 222

5-HT1D antagonist used in acute migraine

Answer 223

Mantoux Test

Answer 224

HIV, < 6months, Sarcoidosis, Milliary TB, Lymphoma Interferon Gamma Blood Test not Mantoux should be performed

Answer 225

Mantoux test 0.1 ml of 1:1,000 purified protein derivative (PPD) injected intradermally result read 2-3 days later

Answer 226

<5mm- negative Unvaccinated Give BCG 6-15mm Positive Shouldn't be given BCG ? Previous TB or BCG Interferon Gamma Blood test should be done > 15mm Strongly Positive TB infection

Answer 227

TTG IgA is first line Patients may be IgA deficient therefore false positives Check IgA then do TTG if IgA normal If low, then do TTG IgG Duodenal Biopsy is Gold Standard Villous atrophy Crypt Hyperplasia Lymphocyte infiltration All above reverses on a gluten free diet for 6 months

Answer 228

Burkitts Lymphoma

Answer 229

Breast and Ovarian Ca

Answer 230

Amyloidosis

Answer 231

Myelofibrosis

Answer 232

Elderly patients presenting with lethargy Massive Splenomegaly Hypermetabolic state - Temps, Night Sweats and Weigh Loss Myeloproliferative disorder ``` Labs: Anaemia High WCC Dry Marrow Tap High Urate and LDH - high cell turnover ```

Answer 233

Hyposplenism (splenectomy) + Siderocytes

Answer 234

Haemolysis

Answer 235

``` Iron Def Anaemia Hyposplenism Sickle Cell Thalasaemia Liver Disease ```

Answer 236

Hyposplenism

Answer 237

Inheritted Spherocytosis | Autoimmune Haemolytic Anaemia

Answer 238

G6PD deficiency

Answer 239

Intravascular Haemolysis Mechanical Heart Valve DIC

Answer 240

Uraemia | Pyruvate Kinase Deficiency

Answer 241

Lead Poisoning Thalasaemia Sideroblastic Anaemia

Answer 242

Major Depressive Disorder | Belief one is Dead

Answer 243

Parkinsons Disease AntiMuscarinic Drug induced Parkinsons > PArkinsons Disease Helps Rigidity and Tremor

Answer 244

``` Cytotoxic Chemo Drug Causes Cross Linking in DNA Ototoxicity Peripheral Neuropathy (Like Vincristine and Phenytoin) Hypo Magnesium ```

Answer 245

10% CXR normal then have ca

Answer 246

Immunodeficiency (Primary) of T and B cell Recurrent Chest Infections Eczema Thrombocytopenia Low IgM Is X Linked From the WASP Gene

Answer 247

Wiskott-Aldrich syndrome | X Linked Recessive

Answer 248

Poly Cystic Kidney Disease | Most Commonly Dominant

Answer 249

Cystic Fibrosis | Recessive

Answer 250

Haemochromatosis | Recessive

Answer 251

MEN2 and Hirsprung's

Answer 252

``` Idiopathic - commonest Myocarditis - CoxsackieB , Pavovirus, Chagars HTN IHD Peripartum Iatrogenic - Doxyrubicin Alcohol Cocaine Haemochromatosis Sarcoidosis ```

Answer 253

1st Propylthiouracil - causes liver damage 2nd Carbimazole 3rd Carbimazole

Answer 254

Levothyroxine is safe Monitor levels post partum Breast Feeding is safe

Answer 255

Commonest inherited Bleeding Disorder Von Willibrand deficiency Leads to reduced platelet aggregation and Factor VIII Autosomal Dominant Inheritence

Answer 256

1 - commonest and 80% Reduced Von Willibrands 2 - Abnormal Von Willibrands 3- Absence of Von Willibrands

Answer 257

Increased INR LONG APTT Mx: TXA Can have Desmopressin for Procedures- leads to increased VWB factor production Factor VIII

Answer 258

Can predict RA 10 years before

Answer 259

``` Results of Allergy to Aspergillus spores Asthmatic Symptoms Bronchiectasis Eosinophillia RAST positive Raised IGE ``` Treatment is Steroids Itraconazole is second line

Answer 260

Early Menopausal symptoms in under 40 with raised gonatrophins (FSH and LH) 1% of people Flushes and night sweats Infertility Amenorrhea

Answer 261

Long Chain Fatty Acid Metabolism

Answer 262

Erythema Nodosum? Not Black Sudden Onset

Answer 263

Mechanism | antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets

Answer 264

PPI - reduces affect

Answer 265

Photography, Metal production and insectasides

Answer 266

'classical' features: brick-red skin, smell of bitter almonds acute: hypoxia, hypotension, headache, confusion chronic: ataxia, peripheral neuropathy, dermatitis

Answer 267

supportive measures: 100% oxygen definitive: hydroxocobalamin (intravenously), also combination of amyl nitrite (inhaled), sodium nitrite (intravenously), and sodium thiosulfate (intravenously)

Answer 268

``` Africa Asia India JOINT PAIN As well as pyrexia, Malaise, Fever, Rash, Headache Similar to Dengue By Mosquitos Alphavirus ```

Answer 269

Nevirapine

Answer 270

Non-nucleoside reverse transcriptase inhibitors (NNRTI) | Induces Cytochrome P450

Answer 271

Protease inhibitor | kidney stones and hyperbilirubinaemia

Answer 272

Protease inhibitor HIV | Induces Cytochrome P450

Answer 273

140/90 and above | Should decrease initially then increase from 20 weeks onwards

Answer 274

``` Every Three Months Aim 0.4-1.0 mmol/L Fine Tremor Check Us & Es and TFTs every 6 months (DI/Nephrotoxic and Hypothyroid/goitre) ```

Answer 275

Indications for steroids patients with chest x-ray stage 2 or 3 disease who are symptomatic. hypercalcaemia eye, heart or neuro involvement

Answer 276

Immunoglobulins which undergo reversible precipitation at 4 deg C, dissolve when warmed to 37 deg C. One-third of cases are idiopathic

Answer 277

I (25%) - Monoclonal II (25%) - Mixed Mono and Polyclonal (RF) III (50%) - Polyclonal (RF) I: IgM or IgG Associated with Waldenstrom macroglobulinaemia and Multiple Myeloma II: RF Assoicated with RA, Hep C, Srojrens and Lympoma III: RF Associated with RA and Srojrens

Answer 278

Tests low complement (esp. C4) high ESR Treatment immunosuppression plasmapheresis

Answer 279

Raynauds - Type 1 only vascular purpura, distal ulceration, ulceration arthralgia renal involvement (diffuse glomerulonephritis)

Answer 280

Detects RNA | SNOW DROP

Answer 281

Detects DNA | SNOW DROP

Answer 282

Detects Proteins | SNOW DROP

Answer 283

Sildenafil

Answer 284

``` penicillamine - Wilsons quinidine, procainamide beta-blockers lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines ```

Answer 285

5 (asbestosis) * 10 (smoking) = 50 x more likely

Answer 286

``` Isoniazid procainamide hydralazine dapsone sulfasalazine ```

Answer 287

Acute Tubular Necrosis Interstitial Nephritis Glomerulonephritis

Answer 288

Most Common Likely secondary to hypoperfusion injury ``` Also caused by nephrotoxic meds/ toxins Myoglobulin (Rhabdo) Uric Acid (Tumour lisis syndrome) Aminoglycosides (Gentamicin) Heavy Metal Contrast ``` Tubules blocked by dead cells leading to reduced pressure difference over glomerulus and decreased eGFR - Hyperkalaemia - High Urea - Oliguria - Lower eGFR - Acidosis - Acellular therefore no increased WCC on Dip - Minimal blood on dip - PROTEIN ON DIP

Answer 289

Inflammation of interstitium with Infiltration of the immune cells. Type 1 or Type 4 hypersensitivity reaction- Antibiotics, NSAIDs, Diuretics. - Oliguria - Eosinouria - Fever - Rash - less marked K+ and acidosis? Dip - protein ++ Minimal blood WCC ++ as is an immune response Can cause papillary necrosis leading to haematuria

Answer 290

Glomerulonephritis: commonly caused by antigen antibody complexes causing inflammation. Completment is activated, causing infiltration of immune cells, release of enzymes and damage to podocytes. Causes increased membrane permiability causing proteinuria and haematuria. - Haematuria - Proteinuria - HTN - Oliguria - Oedema Bloods: Urea and Creatinine increase Reduced eGFR Protein dip Protein ++ RBC +++ WCC +/++

Answer 291

Interferon Gamma

Answer 292

Cushings Conns 11-beta hydroxylase deficiency (CAH) Liddles Disease

Answer 293

``` Bartemanns Giltemans GI losses Diurteics Renal Tubular Acidosis ```

Answer 294

``` Valsalva Carotid MAssage 6mg 12mg 12mg Adenosine (Verapamil in asthmatics) Electircal Cardioversion ```

Answer 295

90% Germ Cells: Seminoma Non Seminoma AFP is elevated in around 60% of germ cell tumours LDH is elevated in around 40% of germ cell tumours seminomas: hCG may be elevated in around 20%

Answer 296

Caspofungin Inhibits synthesis of beta-glucan, a major fungal cell wall component Adverse: Flushing

Answer 297

Amphotericin B Binds with ergosterol forming a transmembrane channel that leads to monovalent ion (K+, Na+, H+ and Cl) leakage Adverse: Nephrotoxicity, flu-like symptoms, hypokalaemia, hypomagnaseamia Used for systemic fungal infections

Answer 298

Gram Negative (Red) Diploccoci

Answer 299

Gram Negative Rod

Answer 300

Gram Negative Diploccoci

Answer 301

Autosomal Dominant The estimated prevalence is 1 in 500. HOCM is important as it is the most common cause of sudden cardiac death in the young. C

Answer 302

β-myosin heavy chain protein or myosin-binding protein C

Answer 303

``` Asymptomatic largely Exertional Dyspnoea Syncope - exercise associated Angina Sudden Death in young jerky pulse, large 'a' waves, double apex beat ```

Answer 304

Associations Friedreich's ataxia Wolff-Parkinson White

Answer 305

Echo findings - mnemonic - MR SAM ASH mitral regurgitation (MR) systolic anterior motion (SAM) of the anterior mitral valve leaflet asymmetric hypertrophy (ASH)

Answer 306

ECG left ventricular hypertrophy non-specific ST segment and T-wave abnormalities, progressive T wave inversion may be seen deep Q waves atrial fibrillation may occasionally be seen

Answer 307

Acetazolamide Increased risk if fit Slow ascent Treatment descent

Answer 308

Treatment Oxygen Nifedipine, phosphodiesterase inhibitors, Acetazolamide, Dex DESCENT

Answer 309

Treatment Dexamethasone Descent

Answer 310

Infections: Streptococci, TB, Brucellosis Sarcoidosis IBD Bechet's Lympoma/Malignancy Drugs: Penicillins, Oral Contraceptive Pill, Sulphonamides Pregnancy

Answer 311

Dermatomyositis

Answer 312

Dermatomyositis

Answer 313

Hemiparesis Upper > Lower Sensory Loss Aphasia Homonymos Hemianopia

Answer 314

Like MCA but no Aphasia or HH | Lower> Upper

Answer 315

Contralateral homonymous hemianopia with macular sparing | Visual agnosia

Answer 316

Amorosis Fugax

Answer 317

Locked in Sydrome

Answer 318

Symptoms are similar to Wallenberg's but: | Ipsilateral: facial paralysis and deafness

Answer 319

Ipsilateral: facial pain and temperature loss dysphagia, facial numbness, cranial nerve palsy e.g. Horner's Contralateral: limb/torso pain and temperature loss Ataxia, nystagmus

Answer 320

Ipsilateral CN III palsy | Contralateral weakness of upper and lower extremity

Answer 321

Hairy cell leukaemia is a rare malignant proliferation disorder of B cells. It is more common in males (4:1)

Answer 322

pancytopenia splenomegaly skin vasculitis in 1/3 patients 'dry tap' despite bone marrow hypercellularity tartrate resistant acid phosphotase (TRAP) stain positive Management chemotherapy is first-line: cladribine, pentostatin immunotherapy is second-line: rituximab, interferon-alpha

Answer 323

``` Child Pugh Ascites Encephalopathy Bilirubin Albumin Coagulation ``` MELD uses Bilirubin, Creatinine and INR

Answer 324

``` Poor prognostic features rheumatoid factor positive poor functional status at presentation HLA DR4 X-ray: early erosions (e.g. after < 2 years) extra articular features e.g. nodules insidious onset anti-CCP antibodies ```

Answer 325

Protzoan Infection with 2 main types African - Sleeping Sickness American (South)- Chagas African has 2 types of causative organisms. Both types are spread by the tsetse fly. Sleeping Sickness: Trypanosoma chancre - painless subcutaneous nodule intermittent fever Post Cervical Lymphadenopathy CNS later: somnolence, headaches, mood changes, meningoencephalitis Chagas: 95% asymptomatic at time of infection. However, Chancre or periorbital swelling can be seen. Chronic Chagas' - Heart and GI tract Myocarditis commonly causing dilated cardiomyopathy and arrhythmias GI= megaoesophagus and megacolon causing dysphagia and constipation

Answer 326

``` Hepatorenal toxic Fluid Retention Tremor Hyperkalaemia Hyperglycaemia Hypertension Hypertrichosis Gingerval Hypertrophy Hyperlipidaemia ```

Answer 327

Melioidosis, Whitmore's disease, iinfection of gram-negative bacterium Burkholderia pseudomallei. soil and fresh surface water in Asia/North America Diabetes Strong RF Incubation period: 1-21 days Likely pneumonia but also surface/abscess disease IV ceftazidime, imipenem, or meropenem for 10–14 days

Answer 328

Autoimmune hepatitis unknown aetiology seen in young females. IgG may present with signs of chronic liver disease acute hepatitis: fever, jaundice etc (only 25% present in this way) amenorrhoea (common)

Answer 329

I: Anti-nuclear antibodies (ANA) and/or anti-smooth muscle antibodies (SMA) (adults and children) II: Anti-liver/kidney microsomal type 1 antibodies (LKM1) Affects children only III: Soluble liver-kidney antigen Affects adults in middle-age Steroids immunosuppressants Transplant

Answer 330

Think Tumour Lysis Syndrome

Answer 331

Fish Tank Granuloma

Answer 332

Staphylococcus saprophyticus is the second most common cause of UTIs in sexually active young women (E. coli is most common). It is a gram-positive coccus that grows in clusters and is coagulase-negative.

Answer 333

MSH2 (60% of cases) MLH1 (30%) DNA mismatch Repair genes

Answer 334

Seen in HIV patients just starting ARV Treatment Is activation of a previously unkown infection Can be very severe and commonly seen with TB a few weeks after starting HIV treatment Treatment will cause CD4 to go up and viral load to go down but they will present unwell.

Answer 335

Age > 65 | IHD

Answer 336

Malignant Pleural Effusion, FEV1 < 1.5, Vocal Cord Paralysis and SVC Obstruction

Answer 337

Salt Wasting Nephropathy due to abnormality in NaCl channel of DCT Kidney Stones Metabolic alkalosis

Answer 338

Na Channel in DCT

Answer 339

Sodium Potassium Chloride pump in Loop of Henle

Answer 340

Like BV but green offensive smell and treated with metronidazole Unlike- causes dyspyrunia and cervix involvement (Strawberry Cervix). Motile on microscopy

Answer 341

Intrahepatic cholestasis of pregnancy Acute Fatty Liver of Pregnancy HELLP (Haemolysis, elevated Liver, Low Platelets

Answer 342

``` 1% of pregnancies Third Trimester Pruritis No skin rash other than excoriations High Bilirubin ``` REgular LFTs, Induction at 37 weeks. Increased still birth risk. ursodeoxycholic acid for symptom relief

Answer 343

``` Third Trimester Very Rare abdominal pain nausea & vomiting headache jaundice hypoglycaemia severe disease may result in pre-eclampsia ``` ALT very raised Supportive Treatment Stabilise and Deliver

Answer 344

> 3 is clinically important Refer to Nephrology after 1 sample if > 70 (unless DM) Refer to Nephorlogy if 30-70 + Haematuria (2 x + on dip) Refer to Nephrology if 3-29 + any other concerning issues. Haematuria, worsening renal function of IHD. Spot Albumin Creatinine Ratio should be done first thing in the morning

Answer 345

< 5 Clinical Judgement > 5 Need objective testing - FeNO - increased production by eosinophils > 35 in children, > 40 in adults is positive - Spirometry reversibility FEV1/FVC < 0.7 = obstructive Reversibility testing positive improvement in FEV1 of 12% or more (and increase in volume of 200 ml + in adults) If > 17 ask about occupational asthma - if yes then refer

Answer 346

The majority of patients with autoimmune-related diabetes present younger in life. There are however a small group of patients who develop such problems later in life. These patients are often misdiagnosed as having T2DM

Answer 347

Mainly Arabic / Turkish Decent / Armenia Autosomal Recessive 20s development ``` Features - attacks typically last 1-3 days pyrexia abdominal pain (due to peritonitis) pleurisy pericarditis arthritis erysipeloid rash on lower limbs ``` Colchicine may help

Answer 348

Radioiodine > block and replace

Answer 349

Hypopigmentation and sensory loss associated with skin lesions Caused by Mycobacterium leprae. WHO-recommended triple therapy: rifampicin, dapsone and clofazimine

Answer 350

Myeloproliferative disorder leading to increased RBC and platlets and Neutrophils ``` HTN Itching especially after a hot bath Hyperviscocity Splenomegaly Haemorrhage - abnormal platelet function Plethoric appearance ``` LOW ESR!!! HIGH Leucocyte Alkalkine Phosphate typically onset is 60s 90% have JAK 2 Mutation so diagnosis is made on this 5-15% get Myelofibrosis and or ALL as well

Answer 351

Stage 1: Bilaterally Hilar Lymphadenopathy Stage 2: BHL + infiltrates Stage 3: Infiltrates Stage 4: Fibrosis

Answer 352

Antigen binds to IgE on the MAST CELL IgE + Mast Degranulation Atopy asthma and Hayfever

Answer 353

IgG or IgM bind to the ANTIGEN on CELL SURFACE ``` Coombs test ITP Autoimmune Haemolytic anaemia Transfusion reaction Pemphigoid Good Pastures Pernicious Anaemia Rheumatic fever ```

Answer 354

FREE antigen and antibody (IgG, IgA) combine Serum sickness Systemic lupus erythematosus Post-streptococcal glomerulonephritis Extrinsic allergic alveolitis (especially acute phase)

Answer 355

Delayed T Cell Mediated ``` Tuberculosis / tuberculin skin reaction • Graft versus host disease • Allergic contact dermatitis • Scabies • Extrinsic allergic alveolitis (especially chronic phase) • Multiple sclerosis • Guillain-Barre syndrome ```

Answer 356

mutation of p53 tumour suppressor gene Leads to multiple cancers Is autosomal Dominant

Answer 357

``` p53 APC - Colorectal BRAC1 / 2 - Ovarian and Breast NF1 - Neurofibromatosis Rb- Retinoblastoma WT1 - wilms Tumour ```

Answer 358

Pancreatitis

Answer 359

Hepatocellular carcinoma

Answer 360

Colorectal

Answer 361

Small cell lung, Gastric and neuroblastoma

Answer 362

Melanoma and Schwannoma

Answer 363

abscess (Staph aureus, Klebsiella and Pseudomonas) squamous cell lung cancer tuberculosis Wegener's granulomatosis pulmonary embolism rheumatoid arthritis aspergillosis, histoplasmosis, coccidioidomycosis

Answer 364

``` Hypokalaemia with alkalosis vomiting thiazide and loop diuretics Cushing's syndrome Conn's syndrome (primary hyperaldosteronism) ```

Answer 365

``` Hypokalaemia with acidosis diarrhoea renal tubular acidosis acetazolamide partially treated diabetic ketoacidosis ```

Answer 366

``` Cause of Flash Pulmonary Oedema Hypotension Metabolic Acidosis Hypoglycaemia Tinnitus Visual Distrubances Flushing ``` Supportive treatment

Answer 367

Prophylaxis of Malaria | Leg Cramps

Answer 368

Diabetic dermopathy is characterised by red papules that progress to small, round, atrophic hyperpigmented skin lesions, usually on the shins. It is associated with increased age and longer duration of diabetes.

Answer 369

Acanthosis nigricans is hyperpigmentation and hyperkeratosis of the axilla, groin and back of the neck. IT is associated with malignancy and hyperinsulinaemia.

Answer 370

Doxycycline or Macrolide

Answer 371

Rickettsia ricketsii Headache and fever are common Rash starts on the peripheries (wrist, ankles) before spreading centrally. It is initially maculopapular before becoming vasculitic Endemic to east coast of US

Answer 372

Rickettsial infections think travel and in general : | Rash, headaches, and either single or multiple eschars.

Answer 373

Q Fever No rash but causes pneumonia Headache ? Eschars etc

Answer 374

Rickettsia typhi Flea Rash starts centrally then spreads to the peripheries Rickettsia prowazekii Human Louse

Answer 375

Borrelia burgdorferi Doxy Amoxicillin if pregnant

Answer 376

Bartonella henselae

Answer 377

Metabolic Conditions Fredricks Ataxia Ataxia Telangectasia

Answer 378

Structural | Gilberts and hyperlipidaemia

Answer 379

``` Produced by adipose Increases Melanocyte Stimulating Hormone Increased in Obesity Causes satiety Role in weight management ```

Answer 380

Where as leptin induces satiety, ghrelin stimulates hunger. It is produced mainly by the P/D1 cells lining the fundus of the stomach and epsilon cells of the pancreas. Ghrelin levels increase before meals and decrease after meals

Answer 381

Staph infection Mem Gland Dysfunction Rosecea Sebhorreic Dermatitis

Answer 382

Pain like Tennis elbow 5cm from olecranon is most pain Increased with Elbow extension and pronation of arm

Answer 383

Digoxin tox

Answer 384

Sildenafil

Answer 385

Indapamide Chlortalidone Used in HTN after A and C

Answer 386

IgG Females Acute or chronic liver failure

Answer 387

Relative Risk outcome

Answer 388

Odds Ratio Outcome

Answer 389

e.g. atrial natriuretic factor, brain natriuretic peptide

Answer 390

``` Features 'bones, stones, groans and psychic moans' corneal calcification shortened QT interval on ECG hypertension ``` ST Elevation, PR prolongation, Short QT and Wide QRS

Answer 391

``` Arterial Thrombus Venous Thrombus Paradoxical Prolonged APTT Livido Reticularis Miscarriage Thrombocytopenia ``` Primary or Secondary (SLE) Warfarin is treatment 1 x VTE: INR of 2-3 for 6 months Multiple - Life Long Warfarin VTE on Warfarin INR to 3-4 arterial thromb- lifelong warfarin with target INR 2-3

Answer 392

3.5 -5 - loss of reflexes > 5 respiratory depression Can cause hypotension

Answer 393

70%, 10%, 0.2%

Answer 394

Dopamine AGONIST - Ropinorole Benzodiazepine Gabapentin

Answer 395

Following a severe relapse or >=2 exacerbations in the past year oral azathioprine or oral mercaptopurine

Answer 396

``` Hyperhidrosis: Aluminium chloride Iontophoresis Botox Surgery ```

Answer 397

``` Causes of LBBB ischaemic heart disease hypertension aortic stenosis cardiomyopathy rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia ```

Answer 398

Morphine / 2 | Diamorphine / 3

Answer 399

Gram Positive Rod first-line therapy is oral metronidazole for 10-14 days if severe or refractory- Vancomycin fidaxomicin - previous infection or refractory Systemic illness IV Vanc and Metronidazole

Answer 400

``` Ann-Arbor staging of Hodgkin's lymphoma I: single lymph node II: 2 or more lymph nodes/regions on same side of diaphragm III: nodes on both sides of diaphragm IV: spread beyond lymph nodes ```

Answer 401

Features impotence, inability to sweat, postural hypotension postural hypotension e.g. drop of 30/15 mmHg loss of decrease in heart rate following deep breathing pupils: dilates following adrenaline instillation ``` Causes diabetes Guillain-Barre syndrome multisystem atrophy (MSA), Shy-Drager syndrome Parkinson's infections: HIV, Chagas' disease, neurosyphilis drugs: antihypertensives, tricyclics craniopharyngioma ```

Answer 402

The following conditions are inherited in a X-linked recessive fashion: ``` Androgen insensitivity syndrome Becker muscular dystrophy Colour blindness Duchenne muscular dystrophy Fabry's disease G6PD deficiency Haemophilia A,B Hunter's disease Lesch-Nyhan syndrome Nephrogenic diabetes insipidus Ocular albinism Retinitis pigmentosa Wiskott-Aldrich syndrome ``` The following diseases have varying patterns of inheritance, with the majority being in an X-linked recessive fashion: Chronic granulomatous disease (in > 70%)

Answer 403

Young Females Rarely develop SLE Pathology: KERATIN PLUGS erythematous, raised rash, sometimes scaly may be photosensitive face, neck, ears and scalp Scaring Alopecia with hyperpigmentation Management topical steroid cream oral antimalarials may be used second-line e.g. hydroxychloroquine avoid sun exposure

Answer 404

Dry Macular Degeneration | Yellow spots in Bruch's Membrane

Answer 405

Bronchiectasis

Answer 406

Pagets Increased osteoclasts Therefore increased bone turnover Men of advancing age, nordic and FH Thickening of skull, Deafness, Sarcoma in 1% Bowing of tibia, Thick skull Treat with bisphosphonates

Answer 407

Silicon Silicosis has increased risk factor of TB as Silica is toxic to macrophages. ``` Occupations at risk of silicosis mining slate works foundries potteries ``` Fibrosing lung disease with EGG SHELL opacities around hilum

Answer 408

Sickle Cell G6PD Heredetory Spherocytosis Any reason why glucose can't bind to RBC as well

Answer 409

Vitamin B12/folic acid deficiency Iron-deficiency anaemia Splenectomy Any reason for Anaemia therefore less RBC

Answer 410

``` pseudoxanthoma elasticum (Chicken plucked Skin) Ehler-Danlos syndrome Paget's disease sickle-cell anaemia acromegaly ```

Answer 411

Minocycline

Answer 412

Rubbery Lymphadenopathy and B symptoms Associated with Reed Sternberg Cells Nodular Sclerosing (70%) Good prognosis Women and lacunar cells Mixed Cellularity (20%) Good Prognosis Reed Sternberg cells +++ Lymphocyte predominant 5% BEST PROGNOSIS Lymphocyte deplete RARE WORST PROGNOSIS

Answer 413

``` Increased Gastrin leading to Duodenal Ulcer Disease from a Gastrin Secreting Tumour. Commonly associated with MEN1 - Parathyroid (95%) - Pituitary (70%) - Pancreas/ Gastrin (50%) Also Adrenal ```

Answer 414

Cerbellar Vermis Lesion

Answer 415

Native valve amoxicillin, consider adding low-dose gentamicin If penicillin allergic, MRSA or severe sepsis vancomycin + low-dose gentamicin If prosthetic valve vancomycin + rifampicin + low-dose gentamicin

Answer 416

Native valve amoxicillin, consider adding low-dose gentamicin If penicillin allergic, MRSA or severe sepsis vancomycin + low-dose gentamicin If prosthetic valve vancomycin + rifampicin + low-dose gentamicin

Answer 417

Risk of Fetal Varicellar Syndrome Especially if exposure < 20 weeks Needs to be vaccinated. If not sure if vacinnated. Do bloods IgG and IgM - if 0 then need immunoglobulin

Answer 418

Risk of Fetal Varicellar Syndrome Especially if exposure < 20 weeks Needs to be vaccinated. If not sure if vacinnated. Do bloods IgG and IgM - if 0 then need immunoglobulin

Answer 419

Proliferation of bacteria in small bowel causing abdominal pain and bloating and flatulence. Investigated with h breath test Gold is small bowel aspriate Treatment is Rifaximin DM, Scleroderma, GI abnormalities etc.

Answer 420

Pagets Osteoperosis prophylaxis (with Vit D and Ca) Hypercalcaemia Bone Pain Decrease Osteoclast formation Can cause stress fractures Oesophagitis

Answer 421

Graves and Myathsenia Gravis | Antibody

Answer 422

Tricuspid regurgitation ``` Signs pan-systolic murmur prominent/giant V waves in JVP pulsatile hepatomegaly left parasternal heave ``` ``` Causes right ventricular infarction pulmonary hypertension e.g. COPD rheumatic heart disease infective endocarditis (especially intravenous drug users) Ebstein's anomaly carcinoid syndrome ```

Answer 423

Acute Apendicitis

Answer 424

Strep Throat Score and ? Antibiotics?

Answer 425

Unwell with fever, malaise, Sore throat after 3weeks - 12 weeks post infection Antibodies may not be present so use p24 or HIV PCR to confirm Diagnosis

Answer 426

Unwell with fever, malaise, Sore throat after 3weeks - 12 weeks post infection Antibodies may not be present so use p24 or HIV PCR to confirm Diagnosis

Answer 427

``` Frontal lobes lesions expressive (Broca's) aphasia: located on the posterior aspect of the frontal lobe, in the inferior frontal gyrus. Speech is non-fluent, laboured, and halting disinhibition perseveration anosmia inability to generate a list ```

Answer 428

Temporal lobe lesion Wernicke's aphasia: this area 'forms' the speech before 'sending it' to Brocas area. Lesions result in word substituion, neologisms but speech remains fluent superior homonymous quadrantanopia auditory agnosia prosopagnosia (difficulty recognising faces)

Answer 429

ccipital lobe lesions homonymous hemianopia (with macula sparing) cortical blindness visual agnosia

Answer 430

``` Parietal lobe lesions sensory inattention apraxias astereognosis (tactile agnosia) inferior homonymous quadrantanopia Gerstmann's syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation ```

Answer 431

Strep Pneumoniae

Answer 432

Tunnel vision is the concentric diminution of the visual fields ``` Causes papilloedema glaucoma retinitis pigmentosa choroidoretinitis optic atrophy secondary to tabes dorsalis hysteria ```

Answer 433

Tense ITchy blisters on arms and inner thighs in the elderly Skin biopsy immunofluorescence shows IgG and C3 at the dermoepidermal junction

Answer 434

Tense ITchy blisters on arms and inner thighs in the elderly Skin biopsy immunofluorescence shows IgG and C3 at the dermoepidermal junction

Answer 435

Phenoxybenzamine

Answer 436

Mercury poisoning can cause visual field defects, hearing loss and paraesthesia. The commonest cause of mercury poisoning is ingestion via foodstuffs- in particular fish and whale. ``` paraesthesia visual field defects hearing loss irritability renal tubular acidosis ```

Answer 437

bromocriptine, cabergoline, Pergolide | Dopamine Agonists

Answer 438

Gram Positive Bacteria Corynebacterium diphtheriae releases an exotoxin encoded by a β-prophage exotoxin inhibits protein synthesis (ADP and EF2) Necrosis on tonsils and cardiac or neuro Possible presentations recent visitors to Eastern Europe/Russia/Asia sore throat with a 'diphtheric membrane' - see above bulky cervical lymphadenopathy neuritis e.g. cranial nerves heart block

Answer 439

Stop 3 months before trying to conceive

Answer 440

Features fever, headache, psychiatric symptoms, seizures, vomiting focal features e.g. aphasia peripheral lesions (e.g. cold sores) have no relation to presence of HSV encephalitis Pathophysiology HSV-1 responsible for 95% of cases in adults typically affects temporal and inferior frontal lobes Investigation CSF: lymphocytosis, elevated protein PCR for HSV CT: medial temporal and inferior frontal changes (e.g. petechial haemorrhages) - normal in one-third of patients MRI is better EEG pattern: lateralised periodic discharges at 2 Hz Treatment intravenous aciclovir The prognosis is dependent on whether aciclovir is commenced early. If treatment is started promptly the mortality is 10-20%. Left untreated the mortality approaches 80%

Answer 441

Raloxifene - selective oestrogen receptor modulator (SERM) may worsen menopausal symptoms increased risk of thromboembolic events may decrease risk of breast cancer

Answer 442

trontium ranelate 'dual action bone agent' - increases deposition of new bone by osteoblasts and reduces the resorption of bone by inhibiting osteoclasts increased risk of cardiovascular events- not for hx of CVA Not for Prev DVT - increases TVE Stevens Johnson syndrome

Answer 443

Denosumab human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts given as a single subcutaneous injection every 6 months initial trial data suggests that it is effective and well tolerated

Answer 444

Teriparatide recombinant form of parathyroid hormone very effective at increasing bone mineral density but role in the management of osteoporosis yet to be clearly defined

Answer 445

Teriparatide recombinant form of parathyroid hormone very effective at increasing bone mineral density but role in the management of osteoporosis yet to be clearly defined

Answer 446

Increased with mature WBC Reduced with imature WBC ``` Raised in myelofibrosis leukaemoid reactions polycythaemia vera infections steroids, Cushing's syndrome pregnancy, oral contraceptive pill ``` ``` Reduced in: chronic myeloid leukaemia pernicious anaemia paroxysmal nocturnal haemoglobinuria infectious mononucleosis ```

Answer 447

Monitored with viral load > 95% clearance rate currently a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir) with or without ribavirin are used ribavirin - side-effects: haemolytic anaemia, cough. Women should not become pregnant within 6 months of stopping ribavirin as it is teratogenic interferon alpha - side-effects: flu-like symptoms, depression, fatigue, leukopenia, thrombocytopenia

Answer 448

Scaly, Brown Pink Rash Examination with Wood's light reveals a coral-red fluorescence. Topical miconazole or antibacterial are usually effective. Oral erythromycin may be used for more extensive infection

Answer 449

Staph Aeurus Salmonella in Sickle Cell MRI Fluclox for 6 weeks Clindamycin if pen allergic

Answer 450

``` ECG features down-sloping ST depression ('reverse tick') flattened/inverted T waves short QT interval arrhythmias e.g. AV block, bradycardia ``` LBBB in toxicity Blocks AV Node Slows Rate Causes increased contractility

Answer 451

Complement disorder due to CD59 def - Causes platelet aggregation --> Thrombosis ``` Other Features: haemolytic anaemia Pancytopenia (CD59 def on all blood types) haemoglobinuria: dark urine @ morning thrombosis e.g. Budd-Chiari syndrome aplastic anaemia ``` Diagnosis flow cytometry of blood to detect low levels of CD59 and CD55 Ham's test: acid-induced haemolysis Management blood product replacement anticoagulation eculizumab, a monoclonal antibody directed against terminal protein C5

Answer 452

``` Complications aortic regurgitation* infective endocarditis Eisenmenger's complex right heart failure pulmonary hypertension: pregnancy is contraindicated in women with pulmonary hypertension as it carries a 30-50% risk of mortality ```

Answer 453

``` Benzodiazepines enhance the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the frequency of chloride channels. They therefore are used for a variety of purposes: sedation hypnotic anxiolytic anticonvulsant muscle relaxant ``` GABAA drugs benzodiazipines increase the frequency of chloride channels barbiturates increase the duration of chloride channel opening Barbidurates increase duration & Frendodiazepines increase frequency

Answer 454

Stage 1 - drunk and confused state Stage 2 - High Anion Gap Metabolic Acidosis. Tachycardia, HTN Stage 3- Renal Failure No visual loss in Ethylene Glycol Poisoning Ethanol is a competitive Fomipizole

Answer 455

Drunk / N + V Confusion etc Blindness / Visual loss from Formic Acid formation Ethanol / Fomipazole

Answer 456

Drunk / N + V Confusion etc Blindness / Visual loss from Formic Acid formation Ethanol / Fomipazole

Answer 457

Systemic therapy oral methotrexate is used first-line. It is particularly useful if there is associated joint disease ciclosporin systemic retinoids biological agents: infliximab, etanercept and adalimumab ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials

Answer 458

Antibiotics: bactericidal vs. bacteriostatic ``` Bactericidal antibiotics penicillins cephalosporins aminoglycosides nitrofurantoin metronidazole quinolones rifampicin isoniazid ```

Answer 459

``` Bacteriostatic antibiotics chloramphenicol macrolides tetracyclines sulphonamides trimethoprim ```

Answer 460

``` Therefore, only a small list of Gram-positive rods (bacilli) need to be memorised to categorise all bacteria - mnemonic = ABCD L Actinomyces Bacillus anthracis (anthrax) Clostridium Diphtheria: Corynebacterium diphtheriae Listeria monocytogenes ```

Answer 461

Gram-positive cocci = staphylococci + streptococci (including enterococci) Gram-negative cocci = Neisseria meningitidis + Neisseria gonorrhoeae, also Moraxella catarrhalis

Answer 462

``` Remaining organisms are Gram-negative rods, e.g.: Escherichia coli Haemophilus influenzae Pseudomonas aeruginosa Salmonella sp. Shigella sp. Campylobacter jejuni ```

Answer 463

Fibrosis predominately affecting the upper zones hypersensitivity pneumonitis (also known as extrinsic allergic alveolitis) coal worker's pneumoconiosis/progressive massive fibrosis silicosis sarcoidosis ankylosing spondylitis (rare) histiocytosis tuberculosis

Answer 464

Fibrosis predominately affecting the lower zones idiopathic pulmonary fibrosis most connective tissue disorders (except ankylosing spondylitis) e.g. SLE drug-induced: amiodarone, bleomycin, methotrexate asbestosis

Answer 465

Rare Lymphoma with IgM overproduction B Cells produce IgM (Pentomer Macroglobulin) Causes hyperviscosity Mucousal Bleeding Distensive Retinal Vessels- Causes Vision loss Headache, fatigue, Peripheral Neuropathy and weakness Lymphadenopathy, Splenomegaly and Hepatomegaly Electropheresis (M Spike) Symptomatic- electropheresis and chemo

Answer 466

``` Primary (Famililal) Secondary: high alcohol intake type 2 diabetes mellitus renal disease drugs (cyclosporin, oestrogens, corticosteroids) bulimia nervosa pregnancy ``` > 20 refer to specialist 10-20 - lifestlyle, statins and fibrates 5-9 - lifestyle and CVD RF modification

Answer 467

Start DMARDs ASAP 1. DMARD monotherapy +/- bridging pred (short) METHOTREXATE widely used DMARD. FBC & LFTs - myelosuppression and liver cirrhosis. + pneumonitis sulfasalazine leflunomide hydroxychloroquine 2. TNF-inhibitors after inadequate response to at least two DMARDs including methotrexate Entanercept

Answer 468

Recombinant human protein Decoy receptor for TNF-α subcutaneous administration demyelination + reactivation of tuberculosis

Answer 469

monoclonal antibody binds to TNF-α + stops binding with TNF receptors Given IV Risks include reactivation of tuberculosis

Answer 470

``` CRAB Hypercalcaemia - Due to increased osteoclast activity Renal Failure Anaemia Bone Pain ``` osteoporosis + path fractures + osteolytic lesions lethargy infection amyloidosis e.g. Macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity ``` Ix: monoclonal proteins (usually IgG or IgA) Urine Bence Jones proteins X ray - Rain Drop Skull Likely MRI Body used more now ``` Low Albumin is bad prog High B2 Microglobulin is bad

Answer 471

2 groups alpha and beta haemolytic types Alpha - Strep Pneumoniae Strep Viridans as well Beta- Divided further Group A Streptococcus pyogenes SKIN: erysipelas, impetigo, cellulitis, type 2 necrotizing fasciitis MUCOUSA: pharyngitis/tonsillitis Immune: rheumatic fever or post-streptococcal glomerulonephritis erythrogenic toxins cause scarlet fever Group B Streptococcus agalactiae may lead to neonatal meningitis and septicaemia Group D Enterococcus

Answer 472

Carbemazepine Asbcence seizures exacerbated by Carbemazapine Sodium Val or Ethosuximide used instead Also contraindicatd in myoclonic seizures

Answer 473

XR SI joints Radiographs may be normal early in disease sacroiliitis: subchondral erosions, sclerosis squaring of lumbar vertebrae 'bamboo spine' (late & uncommon) syndesmophytes: ossification of outer annulus fibrosus chest x-ray: apical fibrosis

Answer 474

``` idiopathic post head injury pituitary surgery craniopharyngiomas histiocytosis X Wolfram's syndrome haemochromatosis ```

Answer 475

genetic: the more common form affects the vasopression (ADH) receptor, the less common form results from a mutation in the gene that encodes the aquaporin 2 channel electrolytes: hypercalcaemia, hypokalaemia drugs: demeclocycline, lithium tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Answer 476

Bone LEsions Ca IgG and IgA in Myeloma

Answer 477

Skewed distributions Normal (Gaussian) distributions: mean = median = mode Positively skewed distribution: mean > median > mode Negatively skewed distribution mean < median < mode

Answer 478

``` Calcium Oxylate (45%) Mixed CAlcium (25%) Triple Phosphate and and Calcium Phosphate (10% and 10%) ```

Answer 479

Urate Xanthine Cystine is semi lucent

Answer 480

``` Other features - the 'A's Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis and cauda equina syndrome peripheral arthritis (25%, more common if female) ```

Answer 481

Hashimoto's thyroiditis Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is an autoimmune disorder of the thyroid gland. It is typically associated with hypothyroidism although there may be a transient thyrotoxicosis in the acute phase. It is 10 times more common in women Features features of hypothyroidism goitre: firm, non-tender anti-thyroid peroxidase and also anti-Tg antibodies

Answer 482

Breathlessness

Answer 483

``` EBV Africa Starry sky apprearance c-MYc t 8 14 ```

Answer 484

Chronic granulomatous disease Chediak-Higashi syndrome Leukocyte adhesion deficiency

Answer 485

Peripheral Neuropathy | Hepatitis

Answer 486

Optic Neuritis

Answer 487

potent liver enzyme inducer hepatitis, orange secretions flu-like symptoms

Answer 488

verview serotonin and noradrenaline are metabolised by monoamine oxidase in the presynaptic cell Non-selective monoamine oxidase inhibitors e.g. tranylcypromine, phenelzine used in the treatment of atypical depression (e.g. hyperphagia) and other psychiatric disorder not used frequently due to side-effects Adverse effects of non-selective monoamine oxidase inhibitors hypertensive reactions with tyramine containing foods e.g. cheese, pickled herring, Bovril, Oxo, Marmite, broad beans anticholinergic effects

Answer 489

``` perioral dermatitis: red, crusted lesions acrodermatitis alopecia short stature hypogonadism hepatosplenomegaly geophagia (ingesting clay/soil) cognitive impairment ```

Answer 490

``` Causes of a raised TLCO asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise ```

Answer 491

``` Causes of a lower TLCO pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output ```

Answer 492

Bulbar Palsy Amyotrophic LAteral Sclerosis Progressive Muscular Atrophy

Answer 493

Amyotrophic lateral sclerosis (50% of patients) typically LMN signs in arms and UMN signs in legs in familial cases the gene responsible lies on chromosome 21 and codes for superoxide dismutase

Answer 494

Progressive muscular atrophy LMN signs only affects distal muscles before proximal carries best prognosis

Answer 495

Progressive bulbar palsy palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei carries worst prognosis

Answer 496

Progressive muscular atrophy LMN signs only affects distal muscles before proximal carries best prognosis Riluzole prevents stimulation of glutamate receptors used mainly in amyotrophic lateral sclerosis prolongs life by about 3 months Respiratory care non-invasive ventilation (usually BIPAP) is used at night studies have shown a survival benefit of around 7 months Prognosis poor: 50% of patients die within 3 years

Answer 497

Progressive bulbar palsy palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei carries worst prognosis

Answer 498

IVIG Tetanus | Metronidazole

Answer 499

``` The effects of excessive ACh can be remembered by the mnemonic DUMBELLS: Diarrhoea Urination Miosis/muscle weakness Bronchorrhea/Bradycardia Emesis Lacrimation Salivation/sweating ``` Sarin Gas poisoning

Answer 500

``` Drugs causing a peripheral neuropathy amiodarone isoniazid vincristine nitrofurantoin metronidazole ```

Answer 501

Epidemiology has a bimodal age distribution - 15-25 yrs and 35-46 yrs Features arthralgia elevated serum ferritin rash: salmon-pink, maculopapular pyrexia: typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash lymphadenopathy rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative The diagnosis of Still's disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%. Management NSAIDs should be used to manage fever, joint pain and serositis in the first instance. They should be trialled for at least a week before steroids are added. Steroids may control symptoms but won't improve prognosis. If symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered

Answer 502

Poor prognostic factors syncope family history of sudden death young age at presentation non-sustained ventricular tachycardia on 24 or 48-hour Holter monitoring abnormal blood pressure changes on exercise An increased septal wall thickness is also associated with a poor prognosis.

Answer 503

massive proteinuria resulting in nephrotic syndrome normal or large kidneys focal segmental glomerulosclerosis with focal or global capillary collapse on renal biopsy elevated urea and creatinine normotension

Answer 504

Heerfordt's syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis

Answer 505

Riluzole prevents stimulation of glutamate receptors used mainly in amyotrophic lateral sclerosis prolongs life by about 3 months

Answer 506

Guanosine analogue causing inhibition of Viral DNA Polymerase Pyrophosphate analog which inhibits viiral DNA polymerase = Forscarnet

Answer 507

Inhibits neuraminidase - Influenza

Answer 508

Guanosine - IMP --> inhibits MRNA capping

Answer 509

Overview X-linked recessive deficiency of alpha-galactosidase A ``` Features burning pain/paraesthesia in childhood angiokeratomas lens opacities proteinuria early cardiovascular disease ```

Answer 510

``` Pulmonary causes asthma allergic bronchopulmonary aspergillosis Churg-Strauss syndrome Loffler's syndrome tropical pulmonary eosinophilia eosinophilic pneumonia hypereosinophilic syndrome ``` Infective causes schistosomiasis nematodes: Toxocara, Ascaris, Strongyloides cestodes: Echinococcus Other causes drugs: sulfasalazine, nitrofurantoin psoriasis/eczema eosinophilic leukaemia (very rare)

Answer 511

Klinefelter's syndrome Klinefelter's syndrome is associated with karyotype 47, XXY. Features often taller than average lack of secondary sexual characteristics small, firm testes infertile gynaecomastia - increased incidence of breast cancer elevated gonadotrophin levels but low testosterone Diagnosis is by karyotype (chromosomal analysis).

Answer 512

Tyrosine Kinase inhibitor used in Leukaemia

Answer 513

Chronic myeloid leukaemia The Philadelphia chromosome translocation between the long arm of chromosome 9 and 22 - t(9:22)(q34; q11). ABL proto-oncogene from chromosome 9 + BCR gene from chromosome 22. BCR-ABL gene codes for a fusion protein which has tyrosine kinase activity in excess of normal Presentation (60-70 years) anaemia: lethargy weight loss and sweating are common splenomegaly may be marked → abdo discomfort an increase in granulocytes at different stages of maturation +/- thrombocytosis decreased leukocyte alkaline phosphatase may undergo blast transformation (AML in 80%, ALL in 20%) ``` Management imatinib is now considered first-line treatment hydroxyurea interferon-alpha allogenic bone marrow transplant ``` Imatinib inhibitor of the tyrosine kinase associated with the BCR-ABL defect very high response rate in chronic phase CML

Answer 514

Cef IV | Neurodisease

Answer 515

Prevention of renal stones Calcium stones may be due to hypercalciuria, which is found in up to 5-10% of the general population. high fluid intake low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet) thiazides diuretics (increase distal tubular calcium resorption) Oxalate stones cholestyramine reduces urinary oxalate secretion pyridoxine reduces urinary oxalate secretion Uric acid stones allopurinol urinary alkalinization e.g. oral bicarbonate

Answer 516

Therapeutic selection Disease Option Stone burden of less than 2cm in aggregate Lithotripsy Stone burden of less than 2cm in pregnant females Ureteroscopy Complex renal calculi and staghorn calculi Percutaneous nephrolithotomy Ureteric calculi less than 5mm Manage expectantly

Answer 517

Heparin-induced thrombocytopaenia (HIT) immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin these antibodies bind to the PF4-heparin complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors usually does not develop until after 5-10 days of treatment despite being associated with low platelets HIT is actually a prothrombotic condition features include a greater than 50% reduction in platelets, thrombosis and skin allergy treatment options include alternative anticoagulants such as lepirudin and danaparoid

Answer 518

Causes post-infective: tuberculosis, measles, pertussis, pneumonia cystic fibrosis bronchial obstruction e.g. lung cancer/foreign body immune deficiency: selective IgA, hypogammaglobulinaemia allergic bronchopulmonary aspergillosis (ABPA) ciliary dyskinetic syndromes: Kartagener's syndrome, Young's syndrome yellow nail syndrome

Answer 519

Allergic bronchopulmonary aspergillosis results from an allergy to Aspergillus spores. In the exam questions often give a history of bronchiectasis and eosinophilia. Features bronchoconstriction: wheeze, cough, dyspnoea. Patients may have a previous label of asthma bronchiectasis (proximal) Investigations eosinophilia flitting CXR changes positive radioallergosorbent (RAST) test to Aspergillus positive IgG precipitins (not as positive as in aspergilloma) raised IgE Management steroids itraconazole is sometimes introduced as a second-line agent

Answer 520

Extrinsic allergic alveolitis (EAA, also known as hypersensitivity pneumonitis) is a condition caused by hypersensitivity induced lung damage due to a variety of inhaled organic particles. It is thought to be largely caused by immune-complex mediated tissue damage (type III hypersensitivity) although delayed hypersensitivity (type IV) is also thought to play a role in EAA, especially in the chronic phase. Examples bird fanciers' lung: avian proteins farmers lung: spores of Saccharopolyspora rectivirgula (formerly Micropolyspora faeni) malt workers' lung: Aspergillus clavatus mushroom workers' lung: thermophilic actinomycetes* Presentation acute: occur 4-8 hrs after exposure, SOB, dry cough, fever chronic Investigation chest x-ray: upper/mid-zone fibrosis bronchoalveolar lavage: lymphocytosis blood: NO eosinophilia *here the terminology is slightly confusing as thermophilic actinomycetes is an umbrella term covering strains such as Micropolyspora faeni

Answer 521

Common drugs that cause agranulocytosis: Antithyroid drugs - carbimazole, propylthiouracil Antipsychotics - atypical antipsychotics (CLOZAPINE) Antiepileptics - carbamazepine Antibiotics - penicillin, chloramphenicol, co-trimoxazole Antidepressant - mirtazapine Cytotoxic drugs - methotrexate

Answer 522

Spontaneous bacterial peritonitis Spontaneous bacterial peritonitis (SBP) is a form of peritonitis usually seen in patients with ascites secondary to liver cirrhosis. Features ascites abdominal pain fever Diagnosis paracentesis: neutrophil count > 250 cells/ul the most common organism found on ascitic fluid culture is E. coli Management intravenous cefotaxime is usually given Antibiotic prophylaxis should be given to patients with ascites if: patients who have had an episode of SBP patients with fluid protein <15 g/l and either Child-Pugh score of at least 9 or hepatorenal syndrome NICE recommend: 'Offer prophylactic oral ciprofloxacin or norfloxacin for people with cirrhosis and ascites with an ascitic protein of 15 g/litre or less until the ascites has resolved' Alcoholic liver disease is a marker of poor prognosis in SBP.

Answer 523

Sulfonylurea

Answer 524

``` Marcus Gunn Pupil Causes: Causes retina: detachment optic nerve: optic neuritis e.g. multiple sclerosis ```

Answer 525

Leflunomide is a disease modifying anti-rheumatic drug (DMARD) mainly used in the management of rheumatoid arthritis. It has a very long half-life which should be remembered considering it's teratogenic potential. Contraindications pregnancy - the BNF advises: 'Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men (plasma concentration monitoring required' caution should also be exercised with pre-existing lung and liver disease ``` Adverse effects gastrointestinal, especially diarrhoea hypertension weight loss/anorexia peripheral neuropathy myelosuppression pneumonitis ``` Monitoring FBC/LFT and blood pressure Stopping leflunomide has a very long wash-out period of up to a year which requires co-administration of cholestyramine

Answer 526

Leflunomide is a disease modifying anti-rheumatic drug (DMARD) mainly used in the management of rheumatoid arthritis. It has a very long half-life which should be remembered considering it's teratogenic potential. Contraindications pregnancy - the BNF advises: 'Effective contraception essential during treatment and for at least 2 years after treatment in women and at least 3 months after treatment in men (plasma concentration monitoring required' caution should also be exercised with pre-existing lung and liver disease ``` Adverse effects gastrointestinal, especially diarrhoea hypertension weight loss/anorexia peripheral neuropathy myelosuppression pneumonitis ``` Monitoring FBC/LFT and blood pressure Stopping leflunomide has a very long wash-out period of up to a year which requires co-administration of cholestyramine

Answer 527

PPI Amox and Clarithromycin or Amox and MEthotrexate If Pen Allergic. Clarithromycin and MEthotrexate

Answer 528

Smoking | Iodine Treatment

Answer 529

Anything that opens the eye TCAs - dilate the pupil Anticholinergics ``` Causes of mydriasis (large pupil) third nerve palsy Holmes-Adie pupil traumatic iridoplegia phaeochromocytoma congenital ``` Drug causes of mydriasis topical mydriatics: tropicamide, atropine sympathomimetic drugs: amphetamines, cocaine anticholinergic drugs: tricyclic antidepressants

Answer 530

ciprofloxacin levofloxacin Adverse effects lower seizure threshold in patients with epilepsy tendon damage (including rupture) - the risk is increased in patients also taking steroids cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children lengthens QT interval Contraindications Quinolones should generally be avoided in women who are pregnant or breastfeeding avoid in G6PD

Answer 531

ciprofloxacin levofloxacin Adverse effects lower seizure threshold in patients with epilepsy tendon damage (including rupture) - the risk is increased in patients also taking steroids cartilage damage has been demonstrated in animal models and for this reason quinolones are generally avoided (but not necessarily contraindicated) in children lengthens QT interval Contraindications Quinolones should generally be avoided in women who are pregnant or breastfeeding avoid in G6PD

Answer 532

``` Axonal pathology alcohol diabetes mellitus* vasculitis vitamin B12 deficiency* hereditary sensorimotor neuropathies (HSMN) type II ```

Answer 533

Demyelinating pathology Guillain-Barre syndrome chronic inflammatory demyelinating polyneuropathy (CIDP) amiodarone hereditary sensorimotor neuropathies (HSMN) type I paraprotein neuropathy

Answer 534

Progressive multifocal leukoencephalopathy (PML) widespread demyelination due to infection of oligodendrocytes by JC virus (a polyoma DNA virus) symptoms, subacute onset : behavioural changes, speech, motor, visual impairment CT: single or multiple lesions, no mass effect, don't usually enhance. MRI is better - high-signal demyelinating white matter lesions are seen

Answer 535

The strongest risk factor for developing a psychotic disorder (including schizophrenia) is family history. Having a parent with schizophrenia leads to a relative risk (RR) of 7.5. ``` Risk of developing schizophrenia monozygotic twin has schizophrenia = 50% parent has schizophrenia = 10-15% sibling has schizophrenia = 10% no relatives with schizophrenia = 1% ``` ``` Other selected risk factors for psychotic disorders include: Black Caribbean ethnicity - RR 5.4 Migration - RR 2.9 Urban environment- RR 2.4 Cannabis use - RR 1.4 ```

Answer 536

The strongest risk factor for developing a psychotic disorder (including schizophrenia) is family history. Having a parent with schizophrenia leads to a relative risk (RR) of 7.5. ``` Risk of developing schizophrenia monozygotic twin has schizophrenia = 50% parent has schizophrenia = 10-15% sibling has schizophrenia = 10% no relatives with schizophrenia = 1% ``` ``` Other selected risk factors for psychotic disorders include: Black Caribbean ethnicity - RR 5.4 Migration - RR 2.9 Urban environment- RR 2.4 Cannabis use - RR 1.4 ```

Answer 537

CLL | Do Immunophenotyping

Answer 538

Vancomycin is a glycopeptide antibiotic used in the treatment of Gram-positive infections, particularly methicillin-resistant Staphylococcus aureus (MRSA). Mechanism of action inhibits cell wall formation by binding to D-Ala-D-Ala moieties, preventing polymerization of peptidoglycans Mechanism of resistance alteration to the terminal amino acid residues of the NAM/NAG-peptide subunits (normally D-alanyl-D-alanine) to which the antibiotic binds ``` Adverse effects nephrotoxicity ototoxicity thrombophlebitis red man syndrome; occurs on rapid infusion of vancomycin ```

Answer 539

Acute chest syndrome dyspnoea, chest pain, pulmonary infiltrates, low pO2 the most common cause of death after childhood ``` Treatment? - O2 - Pain - Abx with Atypical Cover - Fluids euvolaemic - Incentive Spirometry Crit Care input ```

Answer 540

Aplastic crises caused by infection with parvovirus sudden fall in haemoglobin

Answer 541

Thrombotic crises also known as painful crises or vaso-occlusive crises precipitated by infection, dehydration, deoxygenation infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain

Answer 542

The recommended initial management of otitis externa is: topical antibiotic or a combined topical antibiotic with a steroid if the tympanic membrane is perforated aminoglycosides are traditionally not used* if there is canal debris then consider removal if the canal is extensively swollen then an ear wick is sometimes inserted

Answer 543

Autoimmune haemolytic anaemia (AIHA) may be divided in to 'warm' and 'cold' types, according to at what temperature the antibodies best cause haemolysis. It is most commonly idiopathic but may be secondary to a lymphoproliferative disorder, infection or drugs. AIHA is characterised by a positive direct antiglobulin test (Coombs' test) Warm AIHA In warm AIHA the antibody (usually IgG) causes haemolysis best at body temperature and haemolysis tends to occur in extravascular sites, for example the spleen. Management options include steroids, immunosuppression and splenectomy Causes of warm AIHA autoimmune disease: e.g. systemic lupus erythematosus* neoplasia: e.g. lymphoma, CLL drugs: e.g. methyldopa Cold AIHA The antibody in cold AIHA is usually IgM and causes haemolysis best at 4 deg C. Haemolysis is mediated by complement and is more commonly intravascular. Features may include symptoms of Raynaud's and acrocynaosis. Patients respond less well to steroids Causes of cold AIHA neoplasia: e.g. lymphoma infections: e.g. mycoplasma, EBV *systemic lupus erythematosus can rarely be associated with a mixed-type autoimmune haemolytic anaemia

Answer 544

Causes of warm AIHA WARM autoimmune disease: e.g. systemic lupus erythematosus* neoplasia: e.g. lymphoma, CLL drugs: e.g. methyldopa Cold: Lymphoma EBV Mycoplasma

Answer 545

The vast majority of bronchial adenomas are carcinoid tumours, arising from the amine precursor uptake and decarboxylation (APUD) system, like small cell tumours. Lung carcinoid accounts 1% of lung tumours and for 10% of carcinoid tumours. The term bronchial adenoma is being phased out. Lung carcinoid typical age = 40-50 years smoking not risk factor slow growing: e.g. long history of cough, recurrent haemoptysis often centrally located and not seen on CXR 'cherry red ball' often seen on bronchoscopy carcinoid syndrome itself is rare (associated with liver metastases) Management surgical resection if no metastases then 90% survival at 5 years

Answer 546

Light's criteria was developed in 1972 to help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases: exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L if the protein level is between 25-35 g/L, Light's criteria should be applied. An exudate is likely if at least one of the following criteria are met: pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Answer 547

Light's criteria was developed in 1972 to help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases: exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L if the protein level is between 25-35 g/L, Light's criteria should be applied. An exudate is likely if at least one of the following criteria are met: pleural fluid protein divided by serum protein >0.5 pleural fluid LDH divided by serum LDH >0.6 pleural fluid LDH more than two-thirds the upper limits of normal serum LDH

Answer 548

Polymyositis

Answer 549

Dermatomyositis (ANA)

Answer 550

Diffuse systemic slcerosis

Answer 551

Limited Cutaneous Systemic Sclerosis

Answer 552

Sjogrens, Congenital Heart Block and SLE

Answer 553

Tuberous sclerosis (TS) is autosomal dominant condition like neurofibromatosis- neurocutaneous. Cutaneous features depigmented 'ash-leaf' spots which fluoresce under UV light roughened patches of skin over lumbar spine (Shagreen patches) adenoma sebaceum (angiofibromas): butterfly distribution over nose fibromata beneath nails (subungual fibromata) café-au-lait spots* may be seen Neurological features developmental delay epilepsy (infantile spasms or partial) intellectual impairment Also retinal hamartomas: dense white areas on retina (phakomata) rhabdomyomas of the heart gliomatous changes can occur in the brain lesions polycystic kidneys, renal angiomyolipomata lymphangioleiomyomatosis: multiple lung cysts

Answer 554

Von Hippel-Lindau (VHL) syndrome is an autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3 Features cerebellar haemangiomas: these can cause subarachnoid haemorrhages retinal haemangiomas: vitreous haemorrhage renal cysts (premalignant) phaeochromocytoma extra-renal cysts: epididymal, pancreatic, hepatic endolymphatic sac tumours clear-cell renal cell carcinoma

Answer 555

Lofepramine

Answer 556

Homocystinuria Homocystinuria is a rare autosomal recessive disease caused by a deficiency of cystathionine beta synthase. This results in an accumulation of homocysteine which is then oxidized to homocysteine. Features often patients have fine, fair hair musculoskeletal: may be similar to Marfan's - arachnodactyly etc neurological patients may have learning difficulties, seizures ocular: downwards (inferonasal) dislocation of lens increased risk of arterial and venous thromboembolism also malar flush, livedo reticularis Diagnosis is made by the cyanide-nitroprusside test, which is also positive in cystinuria. Treatment is vitamin B6 (pyridoxine) supplements.

Answer 557

B12 Deficiency

Answer 558

Antimuscarinics block cholinergic receptors now used more to treat drug-induced parkinsonism rather than idiopathic Parkinson's disease help tremor and rigidity e.g. procyclidine, benzotropine, trihexyphenidyl (benzhexol)

Answer 559

fever, neurological dysfunction, evidence of haemolysis (blood film), renal injury and thrombocytopenia. AMAMST13 --> Von willibrand cleaving isn't working

Answer 560

fever, neurological dysfunction, evidence of haemolysis (blood film), renal injury and thrombocytopenia. AMAMST13 --> Von willibrand cleaving isn't working

Answer 561

``` Metabolic alkalosis diuretics Cushing's syndrome Bartter's syndrome vomiting / aspiration primary hyperaldosteronism carbenoxolone liquorice hypokalaemia ```

Answer 562

B cell proliferation B symptoms - weightless anorexia Bleeding Bugs - infection ``` Blood complications Anaemia AI Haem Anaemia Hypogammaglobulinaemia - infections Richters transformation to high grade disease ``` Smudge Cells Immunophenotyping Treatment: fludarabine, cyclophosphamide and rituximab (FCR)

Answer 563

``` B symptoms substantial Progressive marrow failure > 10cm lymph nodes > 6 cm Splenomegaly Lymphocytes increase by 50% in 2 months Lymphocytes double in 6 months ``` Treatment is FCR Fludarabine Cyclophosphamide Rituximab

Answer 564

Vanc and Rifampicin

Answer 565

Antiphospholipid syndrome

Answer 566

72 hour fasted Glucose

Answer 567

Miller Fisher syndrome is the triad of ataxia, ophthalmoplegia and areflexia.

Answer 568

``` Neonatal Lupus (+ anti La) NEONATAL HEART BLOCK ```

Answer 569

Weakly Positive Bifringent Rhomboid Crystals

Answer 570

Negatively Bifringent Needle Shaped Crystals

Answer 571

Colorectal Ca, Chronic Liver Disease

Answer 572

Pseudoapenidicitis | Peri ileal lyphendenopathy

Answer 573

Staph Epidermis

Answer 574

Growth Hormone Suppression Test

Answer 575

Volume Flow Graph

Answer 576

Hepatomegaly is the most common first sign | Then knock and Ascites later

Answer 577

Primary Billiary Cirrhosis