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1
Q

What is Erbs palsy? Pathology and Signs/Symptoms

A

C5 C6 Root Damage caused by Breech Presentation commonly. Leads to ipsilateral wing scapula

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2
Q

What is Klumpke’s Palsy? Pathology and Symptoms

A

T1 Root Damage Caused by traction- RTA, Horse riding. THis causes intrinsic muscle of hand and medial sensation loss of hand and forearm

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3
Q

Standard Error

A

Standard Deviation / Root of Number of patients

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4
Q

Confidence level: lower and higher

A

Mean +/- Standard error x 1.96

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5
Q

Alpha 1 Adrenoceptors

A

Vasoconstriction
Relaxation of GI Smooth M
Hepatic Glycogenolysis
Salivary Gland stimulation

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6
Q

Alpha 2 Adrenoceptors

A

Reduces transmitter release of autonomic nerves (NA or Ach)
Inhibits insulin
Platelet Aggregation

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7
Q

Beta 1 Adrenoceptors

A

Heart- Increase rate and force

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8
Q

Beta 2 Adrenoceptors

A

Broncho Dilation
Vasodilation
Relax Smooth Muscle of GI tract

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9
Q

Beta 3 Adrenoceptor

A

Lipolysis

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10
Q

TCA Overdose

A 
Anticholinergic: 
Dry Mouth
Dilated Pupils 
Blurred Vision
Tachycardia - Sinus Tachy 
QRS widening

Severe: Arrythmias, Lactic Acidosis, Prolonged QT, Coma Seizures

Tx: IV Bicarbonate
Lignocaine only safe antiarrythmia- correct acidosis
Filter is not useful

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11
Q

Peutz Jager Syndrome

A 
Freckles on face, lips, hands
GI Polyps
Increase risk of CA
Anaemia- GI bleeding
Obstruction

Monitor for Ca
Autosomal Dominant

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12
Q

BCG

A

Live Vaccine

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13
Q

Yellow Fever

A

Live Vaccine

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14
Q

MMR

A

Live Vaccine

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15
Q

Oral Polio

A

Live Vaccine

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16
Q

Oral Rotavirus

A

Live Vaccine

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17
Q

Oral Typhoid

A

Live Vaccine

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18
Q

Rabies

A

Inactive prep

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19
Q

Heb A

A

Inactive Prep

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20
Q

Influenza

A

Inactive Prep

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21
Q

Diptheria

A

Toxin

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22
Q

Tetanus

A

Toxin

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23
Q

Pertusus

A

Toxin

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24
Q

Live Vaccines

A

BCG, MMR, Oral Polio, Typhoid and Rotavirus, Yellow Fever

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25
Q

Inactive Prep Vaccines

A

Hep A, Influezna and Rabies

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26
Q

Toxin

A

Pertusis, Diptheria and Tetanus

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27
Q

Open Angle Glaucoma Signs

A

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

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28
Q

Open Angle Glaucoma Treatment

A

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

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29
Q

How does Lanoprost treat Open Angle Glaucoma

A

Prostaglandin first line increase uveoscleral outflow

Brown pigmentation of iris and increase eyelash length

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30
Q

How does Timolol treat open Angle Glacuoma

A

Reduces aqueous production (2nd Line)

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31
Q

How does Dorzolamide treat open angle Glaucoma

A

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

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32
Q

How does Bromidine treat open angle Glaucoma

A

Reduces Aqueous production and increase uveoscleral outflow

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33
Q

How does pilocarpine treat open angle Glaucoma

A

Increases Uveoscleral outflow

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34
Q

DEXA Scans: What is the scores:

A

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

> -2.5 = Osteoperosis

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35
Q

FRAX Score

A

Predicts Ten year risk of osteoperotic fracture

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36
Q

Methaemoglobinaemia Basics:

A

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

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37
Q

Methaemoglobinaemia Symptoms and Treatment

A

‘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

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38
Q

Time off Driving: TIA

A

1 Month

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39
Q

Time off Driving Multiple TIAs

A

3 Months

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40
Q

Time off Driving Simple Faint

A

Nil

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41
Q

Time off Driving Syncope explained

A

1 month

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42
Q

Time off Driving Syncope Unexplained

A

6 Months

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43
Q

Time off Driving Syncope Multiple

A

12 Months

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44
Q

Time off Driving 1st Seizure

A

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

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45
Q

Time off Driving Epilepsy

A

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

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46
Q

Osteoperosis Causes:

A

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
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47
Q

Osteoperosis Meds that make it worse

A 
SSRIs
antiepileptics
proton pump inhibitors
glitazones
long term heparin therapy
aromatase inhibitors e.g. anastrozole
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48
Q

Osteoperosis INvestigations

A

Bloods - All

DEXA

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49
Q

What predicts Steroid responsiveness in COPD?

A

Eosinophilia
Variable FEV1/ Peak Expiratory Flow
Asthma/Atopy

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50
Q

COPD Management?

A

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

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51
Q

Hiccups Palliative?

A

Chlorpromazine

Haloperidol

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52
Q

Tetanus Vaccine in Wound Management?

A

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

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53
Q

G6PD Deficiency

A

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

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54
Q

How do you test for Amoebic Colitis?

A

HOT Stool- Cool and you can’t tell?

15 min sample to local lab

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55
Q

Amoebic Colitis

A 
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

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56
Q

Breast Cancer Treatment:
Eostrogen R positive?
HER2 R Positive?

A

Tamoxifen if Eostrogen Positive

Trastuzumab (Herceptin) for HER 2 Positive

  • Flu like symptoms
  • ECHO pre as Cardiotoxic
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57
Q

AF post Cardioversion Warfarin Mx

A

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

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58
Q

Psudogout Associated conditions

A 
Calcium Pyrophosphate crystals in synovium
Associated with 
Haemochromatosis
Acromegaly
Wilsons
Hyperparathyroidism
Low Mg
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59
Q

Pseudogout features

A

Wrist or knee
Bifringent RHOMBOID Crystals
Chondrocalcinosis

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60
Q

Complement Deficiency: N. Menigitis

A

C 5- 9 Deficiency

Encodes for MAC Membrane attack Complex

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61
Q

Complement Deficiency: Immune Complex Disease

A

C2 - 4

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

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62
Q

Complement Deficiency: Hereditory angioedema

A

C1

C1 inhibitor (C1-INH) protein deficiency
causes hereditary angioedema

uncontrolled release of bradykinin

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63
Q

Complement Deficiency: Recurrent Bacterial Infections

A

C3

C3 deficiency
causes recurrent bacterial infections

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64
Q

Loud S2

A

Pulmonary Hypertension
Hypertension
ASD w/o Pulmonary Hypetension

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65
Q

Quiet S2

A

Aortic Stenosis

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66
Q

Split S2 Fixed

A

ASD

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67
Q

Wide Split S2

A

Pulmonary Stenosis
INspiration
RBBB

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68
Q

Drug induced Cholestasis

A 
the Pill
Coamox
Fluclox
Erythromycin
Anabolic Steroids and testosterone
Chlorpromazine prochlorperazine
Sulphonylureas
Fibrates
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69
Q

Drug induced Cirrhosis

A

Methotrexate
Levo Dopa
Amiodarone

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70
Q

Clinical Sign of severity in Aortic Stenosis

A 
S4 
Slow Rising Pulse
Narrow Pulse Pressure
Soft S2
Thrill
Duration of Murmur
LV failure
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71
Q

Causes of Aortic Stenosis

A

Senile Calcification
Bicuspid Valve

Williams syndrome
HOCM
Rheumatic Valve disease

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72
Q

Management of Aortic Stenosis

A

Asymptomatic- monitor
Symptomatic Replace Valve

Asymptomatic with Gradient > 40 + LV Failure- ? Surgery

Check angiogram for IHD

Valvuloplasty for too unwell for surgery

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73
Q

Investigating Occupational Asthma:

A

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

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74
Q

Larva Migrans ? Treatment and cause

A

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

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75
Q

Nematode infections

A

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

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76
Q

Addison’s Investigations

A

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

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77
Q

Addisons Biochemistry

A

Hyperkalaemia
Hyponatraemia
Hypoglycaemia
Metabolic Acidosis

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78
Q

Immunoglobulin Therapy

A 
Gullian Barre
Myathsenia Gravis
Kawasaki
Idiopathic Thrombocytopenic Purpura (NOT TTP)
Immune Deficiency
Dermatomyositis
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79
Q

ITP What is it?

A

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)

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80
Q

TTP what is it?

A

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)

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81
Q

Commonest Part of Colon affected by Ischaemic Colitis?

A

Splenic Flexure

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82
Q

pANCA

A

Churg Struss + Others:

SLE, RA, IBD, Autoimmune Hepatitis

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83
Q

cANCA

A

Wegners or Granulomatosis with polyangitis

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84
Q

Pellegra

A 
B3 Niacin Deficiency
Ds:
Dermatitis
Dementia (Depression)
Diarrhoea

Can be caused by Isoniazid

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85
Q

Pernicious Anaemia Antibodies?>

A

Gastric Parietal Cell - 90%

Intrinsic Factor - 50 %

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86
Q

Schilling Test? Pernicious Anaemia

A

Radiolabelled b12 given, first alone, second with IF

Measure Urinary B12
§

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87
Q

Drug induced Urticaria?

A

Aspirin
Penicilin
NSAIDs
Opiates

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88
Q

Bicuspid Aortic Valve

A

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

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89
Q

Listeria Bacteria

A

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

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90
Q

LMWH works by? Length of Time? Given?

A

Increase Anti Thrombin III action on Xa
Long acting
SC

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91
Q

Unfractionated Heparin Lenghth of Time, Given?

Monitor?

A

Inhibits IXa, Xa, XIa, XIIa
Short
IV

Thrombocytopenia!!
APTT to monitor
Used in Renal Failure

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92
Q

Heparin adverse effects

A

Thrombocytopenia
Osteoperosis
Hyperkalaemia

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93
Q

What is Alpha 1 antitrypsin?

A

Protease Inhibitor produced by the liver

Leads to Emphysema in deficiency

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94
Q

Alpha 1 Antitrypsin Deficiency

A 
Cause of Emphysema in Young non smokers
Autosomal Recessive Chromosome 14
PiZZ Genotype most commonly 
Emphysema
Liver Cirrhosis 
Obstructive Spirometry
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95
Q

What is Angiodysplasia

A

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

Elderly patients on colonoscopy

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96
Q

What is Angiodysplasia associated with?

A

Aortic Stenosis

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97
Q

Dermatomyositis Skin Features (3)

A

Photosensitive rash on head back and shoulders

Heliotrope Rash perio orbitally

Gottron’s patches on extors surfaces of fingers

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98
Q

Dermatomyositis Other Features (6)

A 
Proximal Mm Weakness/Tenderness
Respiratory MM weakness
Raynauds
Interstitial Lung Disease- Organising PNeumonia or Fibrosing alveolitis
Dysphagia/odynophagia
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99
Q

Dermatomyositis investigations:

A

ANA positive
Jo-1

Screen for malignancy - breast, ovarian, Lung

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100
Q

Cardiac Tamponade Triad?

A

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

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101
Q

Drug Induced Lung Fibrosis

A 
Bromocriptine, cabergoline, Pergolide
Amiodarone
Bleomycin / Bulsulphan (Chemo)
Methotrexate and Sulfasalazine (RA) 
Nitrofurantoin
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102
Q

Translocation ( 9: 22) Associated with what malignancy?

A

CML - 95% have this Philadelphia gene

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103
Q

Translocation ( 11:14 ) Associated with what malignancy?

A

Mantel Cell Lymphoma

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104
Q

Translocation ( 14: 18) Associated with what malignancy?

A

Follicular Cell Lymphoma

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105
Q

Translocation ( 8: 14) Associated with what malignancy?

A

Burkitss Lymphoma

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106
Q

Translocation ( 15: 17) Associated with what malignancy?

A

Promyelocytic Lymphoma

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107
Q

Neuropathy type? CKD

A

Sensory (Uraemia)

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108
Q

Neuropathy type? GBS

A

Motor

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109
Q

Neuropathy type? Polio

A

Motor

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110
Q

Neuropathy type? Diabetes

A

Sensory

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111
Q

Neuropathy type? Leprosy

A

Sensory

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112
Q

Neuropathy type? Lead Poisoning

A

Motor

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113
Q

Neuropathy type? Amyotrophic Lateral Sclerosis

A

Motor

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114
Q

Neuropathy type? Porphyria

A

Motor

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115
Q

Neuropathy type? Charcot Marie Tooth

A

Motor

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116
Q

Neuropathy type? Alcoholism

A

Sensory

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117
Q

Neuropathy type? Diptheria

A

Motor

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118
Q

Neuropathy type? b12 Deficiency

A

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

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119
Q

Pseudoxanthoma elasticum? Features

A

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

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120
Q

How Does Nicorandil Work

A

Potassium Channel Activator Treatment for Angina

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121
Q

Side Effects of Nicorandil

A

Headache, Flushing, Anal Ulceration

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122
Q

Dabigatran Mechanism

A

Direct Thrombin Inhibitor

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123
Q

Heparin

A

Activates Anti Thrombin III

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124
Q

Clopidogrel

A

P2Y12 Inhibitor

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125
Q

Rivaroxaban

A

Direct Factor X inhibitor

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126
Q

Renal Failure Pain Relief

A

Alfentanyl
Buprinorphine
Fentanyl

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127
Q

Test for Chlamydia

A

NAAT

Nucleic Acid Amplification Test

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128
Q

Treatment for Chlamydia

A

Doxy 7 days
Azithromycin 1 dose

Azithromycin in Pregnancy

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129
Q

Donepezil

A

Anticholinesterase inhibitor for Dementia
- Caution in Bradycardia
Causes insomnia
Causes

Alternatives are galantamine and rivastigmine

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130
Q

Memantine

A

NMDA recetpor antagonist

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

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131
Q

Most Common Cause of Infective Endocarditis

A

Staph Aureus

Staph Epidermis if < 2months since valve replacement

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132
Q

Culture Negative Infective Endocarditis

A

Coxielle Burneti

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133
Q

Q Fever is caused by?

A

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

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134
Q

Eisenmenger’s syndrome?

A

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

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135
Q

Ebsteins anomally

A

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

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136
Q

Dural Ectasia

A

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

Very Common in Marfans

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137
Q

Marfans Inheritence

A

Autosomal Dominant

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138
Q

Defect of Which gene and structure causes marfans?

A

Chromosome 15, FBN1 gene which encodes for Protein Firbrin 1

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139
Q

Marfans Features

A 
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.

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140
Q

Drug induced Thrombocytopenia

A 
Heparin
NSAIDs
Quinine 
Carbomazepine
Valproate
Sulphononamides
Rifampicin
Furosemide
Penicillins
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141
Q

Thrombotic Thrombocytopenic Purpura Pathology

A

Abnormally LArge Stick Von willibrand factors cause

Platelets CLUMPING in VESSELS

DEFICIENCY OF ADAMTS13

Overlaps with HUS

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142
Q

TTP clinical features

A

Rare- Typically adult females

Fever
Confusion/New Neurology - microinfarcts
Renal Failure
Haemolytic Anaemia

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143
Q

TTP Causes

A 
Post INfective
Pregnancy
Drugs (New)
HIV
SLE
Tumours
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144
Q

Reidel Thyroiditis

A

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

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145
Q

Alcohol Withdrawal Symptomology TImeline

A

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

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146
Q

ECT Adverse Effects

A 
Arrythmia
Short Term Memory Loss
? Long Term Memory Loss
Nausea
Headache
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147
Q

What is William’s Syndrome?

A

Inherited Neurodevelopmental disorder due to micro deletion of chromosome 7

Elfish Look
Characteristically v friendly
LD
Short Stature
Neonatal hypercalacmia
Supravalvular Aortic Stenosis
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148
Q

What is Sub Valvular Aortic Stenosis associated with?

A

HOCM

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149
Q

Treatment of Neuro Toxoplasmsosis ion HIV man

A

Pyrimethamine and Sulphadiazine

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150
Q

Features of Severe Malaria?

A 
schizonts on a blood film
parasitaemia > 2%
hypoglycaemia
acidosis
temperature > 39 °C
severe anaemia
Organ Failure:
Coma/ Seizure
AKI / Black Water Fever
ARDS
DIC
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151
Q

Indications for surgical Valve Repair in Infective Endocarditis?

A 
Severe Valve Failure
Aortic Abscess
Resistant Infections
Recurrent Emboli
Cardiac Failure
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152
Q

Likely Hood Ratio?

A

Sensitivity / 1- specificity

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153
Q

Pneumocystis Jiroveci Pneumonia (PCP) Background?

A

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

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154
Q

PCP Features

A

SOB, Fever and dry cough

Very few chest signs clinically

CXR- bilateral interstitial infiltrates, can be lobar or normal.

BAL - Silver Stain

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155
Q

PCP Treatment

A

Cotrimoxazole
IV PEntamidine
Steroids

Prone to Pneumothorax

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156
Q

3 features of typical angina

A

Constricting chest pain
Worsened by Exercise
Relieved by Rest or GTN

ALL NEED CT ANGIOGRAM in Negative ECG / Trop

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157
Q

Factor V Leinin?

A

Most Common inherited Thrombophilia

Works by Active Factor V is inactivated slower by Protein C

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158
Q

Treatment of Aortic Dissection?

A 
Type A (2/3) - IV labetalol and surgical repair
Type B (1/3) - IV labetalol only

Aim BP Systolic of <110

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159
Q

Seborrheic Dermatitis complications

A

Blepharitis and otitis externa

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160
Q

Retinitis Pigmentosa

A

Tunnel Vision
Night Blindness
Black spiculate in peripheral retina
Alports syndrome

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161
Q

ATP7B

A

Wilsons disease

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162
Q

HFE

A

Haemochromatosis

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163
Q

JAK-STAT

A

Polycythemia Ruba Vera

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164
Q

ADAMTS13

A

TTP- Large Von willi brands as not cleaved

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165
Q

Treatment of BV

A

Oral Metronidazole

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166
Q

Granulomatosis with polyangitis

A

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

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167
Q

Lung Ca that secrete ADH

A

Small cell

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168
Q

Lung CA that secretes PTH

A

Squamous

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169
Q

Lung Ca that Secretes ACTH

A

Small Cell

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170
Q

Lung Ca with Gynaecomastia

A

Adenocarcinoma

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171
Q

Lung Ca that secretes TSH

A

Squamous

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172
Q

Lung Ca with Lambert Eaton

A

Small Cell

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173
Q

Commonest viral cause of myocarditis

A

Pavovirus B19

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174
Q

Most Common Renal Abnormality in Turners?

A

Horse SHoe kidney

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175
Q

Acne Rosecea features

A

FLUSHING
TENLANGECTASIA
Papulopustle rash

Associated Blepharitis or keratitis

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176
Q

Features of Alcoholic Liver Disease Unique to ALD

A

Dupyutrons contracture

Parotid Swellings

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177
Q

Atrial Natiuretic Peptide

A

Vasodilation

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178
Q

ANP secreted when and where

A 
In response to increased volume
From the R Atrium > L Atrium
Vasodilates
Secretes Sodium
Lowers BP
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179
Q

BNP Secreted from Where and when?

Function?

A

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

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180
Q

BNP level ?

A

If <100 unlikely heart failure

BNP is PROGNOSTIC

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181
Q

Somatisation disorder

A

> 2 years of unexplained physical symptoms

Refusal to accept reassurance

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182
Q

Conversion Disorder

A

Indifference in unexplained symptoms

Typically sensory

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183
Q

Hepatitis B Virus

A

Double Stranded DNA virus

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184
Q

Complications of Hep B

A

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

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185
Q

At risk and health workers are vaccinated. Who should have anti HB levels checked?

A

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

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186
Q

Hep B treatment

A

Infereron Alpha is first line
Reduces viral replication through

2nd line is tenofivir, entecavir and telbivudine
Telbivudine works thymidine nucleoside analogue

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187
Q

Williams syndrome?

A

Suprvalvular Aortic Stenosis

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188
Q

Subvalvular Aortic Stenosis?

A

HOCM

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189
Q

ALL basics?

A

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

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190
Q

ALL epidemiology

A

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

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191
Q

ALL Good prognostic factors:

A 
FAB (French American British) L 1 Type 
Common ALL
pre B phenotype
low initial WBC
del(9)p
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192
Q

ALL Bad Prognostic Factors

A 
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
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193
Q

Minimal Change Disease

A 
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
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194
Q

St Johns Wart?

A

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

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195
Q

Most common IE organism?

A

Staph Aureus

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196
Q

Highest Mortality IE

A

Staph

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197
Q

Poor Prognosis IE:

A

Staph Aureus, Prosthetic Valve, Low Complement, Culture negative

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198
Q

Sick Euthyroid Syndrome

A

Low/Normal TSH, Low T3 and Thyroxine

Is a response to critical illness that leads to reduced thyroid hormone.

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199
Q

p53 gene?

A

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

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200
Q

Lentingo Maligna

A

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

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201
Q

Solar Lentingo

A

Similar to lentigo malignant but symmetrical. Common over 40s

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202
Q

Gonorrhea basics:

A

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

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203
Q

Gonorrhea Treatment

A

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

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204
Q

Disseminated Gonorrhea

A

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)

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205
Q

What is Fitz Hugh Curtis Syndrome?

A

Perihepatitis from Gonorrhea infection

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206
Q

Most common cause organism of septic arthritis in young person?

A

N. Gonorrhea

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207
Q

Which anti epileptic causes peripheral neuropathy?

A

Phenytoin

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208
Q

Phenytoin?

A

Inducer of Cytochrom P 450

Binds to Sodium Channels

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209
Q

Porphyria Cunea Tarda?

A

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

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210
Q

What is a porphyria

A

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

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211
Q

Acute intermittent Porphyria

A 
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
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212
Q

Variegate Porphyria?

A

Autosomal Dominant, common in south africans
defect in protoporphyrinogen oxidase

Photosensitive blistering rash + abdominal and Neurology symptoms

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213
Q

Myotonic Dystrophy? Types and Genetics?

A

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

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214
Q

Myotonic Dystrophy Features

A 
General features
myotonic facies (long, 'haggard' appearance)
frontal balding
bilateral ptosis
cataracts
dysarthria
Others:
Mild mental impairment
Testicular Atrophy
DM
Cardiac - hearblock/myopathy
Dysphagia
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215
Q

Octreotide?

A

Somatostatin analogue

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216
Q

Meglitinides? How do they work? Examples?

A

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

repaglinide, nateglinide

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217
Q

Atrial Myxoma?

A

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’

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218
Q

J Waves on ECG?

A

Seen in Hypothermia

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219
Q

Abscent Ankle Jerks and Extensor Plantars?

A

Mixed UMN and LMN signs

Causes: Acute degeneration of the cord
Motor Neurone Disease
Fredricks ataxia
Syringomyelia
Taboparesis (syphillis)
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220
Q

syringomyelia?

A

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

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221
Q

Gyno Drug Causes

A 
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
gonadorelin analogues e.g. Goserelin, buserelin
oestrogens, anabolic steroids
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222
Q

Gyno Causes

A 
Puberty
Klinefelters
Kallmans (androgen deficiency)
Liver disease
Testicular failure- mumps
Haemodialiysis 
Test cancer
Other Cancer
hyperthyroidism
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223
Q

Kartageners syndrome?

A

Primary Cilliary Dyskinesia

Dextrocardia
Sinusitis
Bronchiectasis / Chest infection
Sub fertility

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224
Q

Hereditory Angioedema

A

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)

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225
Q

IgA Nephrophathy

A

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

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226
Q

HLA DR2

A

Good Pastures

Narcolepsy

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227
Q

HLA DQ2/DQ8

A

Coeliac Disease

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228
Q

HLADR4

A

Rheumatoid Arthritis

DM 1

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229
Q

HLA A3

A

Haemachromatosis

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230
Q

HLA B27

A

Ank Spond
Reiters syndrome
Anterior Uveitis

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231
Q

HLA DR3

A

dermatitis herpetiformis
Sjogren’s syndrome
primary biliary cirrhosis

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232
Q

Diabetes Erratic Lifestyle?

A

Meglitinides,

Repaglinide and Nateglinide

Activate Secretion of insulin via K Channels

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233
Q

Gastrin?

A

Increases HCL, IF, pepsinogen, gastric motility.
In response to stomach filling

Secreted by G cells of the Antrum of Stomach

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234
Q

CCK?

A

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

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235
Q

Secretin?

A

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

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236
Q

VIP

A

Stimulates secretion from pancreas and stops HCL

From small intestines and pancreas

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237
Q

Somatostatin

A

Stops all secretion

D Cells pancreas and stomach

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238
Q

What enhances Adenosine?

A

dipyridamole

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239
Q

What reduces Adenosine?

A

Aminophylline

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240
Q

Hepatosplenomegaly Cause?

A 
Chronic Liver Disease with Port HTN
Lymphoproliferative Disorders
CML
Amyloidosis
Glandular Fever, Malaria, Hepatitis
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241
Q

Elhers Danlos Syndrome? Which type of collagen?

A

Collagen III

Rarely Collagen V

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242
Q

Good Pastures Syndrome? Which type of collagen?

A

Collagen IV

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243
Q

Osteogenesis imperfecta? Which type of collagen?

A

Collagen I

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244
Q

Lowest Blood Ig level?

A

IgE

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245
Q

Immunoglobulin responsible for blood group transfusion reactions?

A

IgM

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246
Q

Coarction of the Aorta Associations?

A

Turner’s syndrome
bicuspid aortic valve
berry aneurysms
neurofibromatosis

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247
Q

Toxic Epidermal Necrolysis?

A

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

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248
Q

Lymophogranulum Venereum

A

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

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249
Q

Ulcer STI dd

A

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

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250
Q

Epislepsy Treatment

A

Sodium Valproate for all seizures apart from focal

Carbemazepine first line for focal

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251
Q

Management of Chronic Psoriasis Plaques?

A

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

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252
Q

Vincristine? Mechanism and Adverse Effects?

A

Inhibitis formation of microtubules

Leads to Peripheral Neuropathy

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253
Q

Systemic Sclerosis Basics

A

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

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254
Q

Limited Cutaneous Sclerosis

A

Raynauds
Fingers and Face distribution of scleraderma
Anti Centromere Antibodies

Subtype = CREST
Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyl and Tenalngectasia

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255
Q

Diffuse Sclerosis

A

Trunk and proximal limbs
Scl- 70 antibodies

Respiratory disesae- ILD and PAH
Cause of death - Resp
Poor Prognosis

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256
Q

Scleroderma Antibodies

A

ANA - 90 %
RF - 30%

Anti Centromere - Limited Cutaneous
Scl 70 Antibodies - Diffuse

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257
Q

Scl 70

A

Diffuse Sclera Derma

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258
Q

Anti Centromere

A

Limited Cutaneous Sclera Derma

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259
Q

Features of Ehler Danlos

A

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

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260
Q

U Waves ECG?

A

Hypokalaemia

261
Q

Down Syndrome Facial Features?

A

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

262
Q

Other Downs Features?

A

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

263
Q

Cardiac Downs Syndrome

A 
Endocardial Cushion (40%)
VSD (30%)
ASD (10%)
TOF (5%)
Isolated PDA (5%)
264
Q

Chronic Conditions in Downs

A 
Alzhiemers
Hypothyroidism
Learning Diffculties
Short Stature
Respiratory infections
ALL
Subfertility
265
Q

Diagnostic BMs for Diabetes?

A

Fasting >7 Random > 11.1 (or after OGTT)

266
Q

Impaired Fasting Glycaemia?

A

Fasting glucose 6-7

267
Q

Impaired Glucose Tolerance?

A

OGTT 7.8-11.1

AND

Fasting Glucose < 7

268
Q

How does Ondansetron work?

A

5-HT3 Antagonist (seretonin)

269
Q

Pizotifen?

A

5-HT2 Antagonist used in migraine prophylaxis

270
Q

Cyproheptadine?

A

5-HT2 Antagonist in diarrhoea control of carcinoid pts

271
Q

Sumatriptan

A

5-HT1D antagonist used in acute migraine

272
Q

Test for Latent TB? Screening?

A

Mantoux Test

273
Q

Tuberculin Test may be false positive?

A

HIV, < 6months, Sarcoidosis, Milliary TB, Lymphoma

Interferon Gamma Blood Test not Mantoux should be performed

274
Q

What is the Mantoux test?

A

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

275
Q

Interpret Mantoux

A

<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

276
Q

Coeliac Testing

A

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

277
Q

Neuroblastoma Oncogene?

A

n-MYC

278
Q

ABL oncogene?

A

CML

279
Q

RET Oncogene?

A

MEN 2 + 3

280
Q

c-MYC Oncogene?

A

Burkitts Lymphoma

281
Q

erb-B2?

A

Breast and Ovarian Ca

282
Q

Congo Red Staining–> Apple Green?

A

Amyloidosis

283
Q

Tear Drop Poikilocytes?

A

Myelofibrosis

284
Q

Myelofibrosis?

A

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
285
Q

Howell Jolie Bodies

A

Hyposplenism (splenectomy)

+ Siderocytes

286
Q

Schistocytes

A

Haemolysis

287
Q

Target Cells

A 
Iron Def Anaemia
Hyposplenism
Sickle Cell
Thalasaemia
Liver Disease
288
Q

Pappenheimer bodies

A

Hyposplenism

289
Q

Spherocytes

A

Inheritted Spherocytosis

Autoimmune Haemolytic Anaemia

290
Q

Heinz Body

A

G6PD deficiency

291
Q

Schistocytes

A

Intravascular Haemolysis
Mechanical Heart Valve
DIC

292
Q

Burr Cells

A

Uraemia

Pyruvate Kinase Deficiency

293
Q

Basophillic Stippling

A

Lead Poisoning
Thalasaemia
Sideroblastic Anaemia

294
Q

Cortard Syndrome?

A

Major Depressive Disorder

Belief one is Dead

295
Q

Procyclidine? Mechanism of Action?

A

Parkinsons Disease
AntiMuscarinic
Drug induced Parkinsons > PArkinsons Disease

Helps Rigidity and Tremor

296
Q

Cisplatin?

A 
Cytotoxic Chemo Drug 
Causes Cross Linking in DNA
Ototoxicity
Peripheral Neuropathy (Like Vincristine and Phenytoin)
Hypo Magnesium
297
Q

% of Normal CXR that have Ca?

A

10% CXR normal then have ca

298
Q

Wiskott-Aldrich syndrome?

A

Immunodeficiency (Primary) of T and B cell

Recurrent Chest Infections
Eczema
Thrombocytopenia
Low IgM

Is X Linked
From the WASP Gene

299
Q

WASP Gene?

A

Wiskott-Aldrich syndrome

X Linked Recessive

300
Q

PKD1 Gene?

A

Poly Cystic Kidney Disease

Most Commonly Dominant

301
Q

CFTR Gene?

A

Cystic Fibrosis

Recessive

302
Q

HFE1 Gene?

A

Haemochromatosis

Recessive

303
Q

RET Gene?

A

MEN2 and Hirsprung’s

304
Q

Dilated Cardiomyopathy Cause?

A 
Idiopathic - commonest
Myocarditis - CoxsackieB , Pavovirus, Chagars
HTN
IHD
Peripartum
Iatrogenic - Doxyrubicin
Alcohol Cocaine
Haemochromatosis
Sarcoidosis
305
Q

Hyperthyroid Treatment in Pregnancy?

First, Second, Third Trimester

A

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

306
Q

Hypothyroid Pregnancy?

A

Levothyroxine is safe
Monitor levels post partum
Breast Feeding is safe

307
Q

Von willibrands disease?

A

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

Autosomal Dominant Inheritence

308
Q

Von Willi Brand Disease Types

A

1 - commonest and 80%
Reduced Von Willibrands

2 - Abnormal Von Willibrands

3- Absence of Von Willibrands

309
Q

Von Willi Brand Investigations + Management

A

Increased INR
LONG APTT

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

310
Q

Anti-cyclic citrullinated peptide antibody?

A

Can predict RA 10 years before

311
Q

Allergic Bronchopulmonary Aspergillosis?

A 
Results of Allergy to Aspergillus spores
Asthmatic Symptoms
Bronchiectasis
Eosinophillia
RAST positive
Raised IGE

Treatment is Steroids
Itraconazole is second line

312
Q

Premature Ovarian Failure?

A

Early Menopausal symptoms in under 40 with raised gonatrophins (FSH and LH)
1% of people

Flushes and night sweats
Infertility
Amenorrhea

313
Q

Peroxisome?

A

Long Chain Fatty Acid Metabolism

314
Q

Good Prognosis in Sarcoidosis?

A

Erythema Nodosum?
Not Black
Sudden Onset

315
Q

Clopidogrel Mechanism of Action?

A

Mechanism

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

316
Q

Clopidogrel interactions?

A

PPI - reduces affect

317
Q

Penicillamine Treatement?

A

Wilsons

318
Q

Cyanide industries?

A

Photography, Metal production and insectasides

319
Q

Cyanide Poisoning Symptoms?

A

‘classical’ features: brick-red skin, smell of bitter almonds

acute: hypoxia, hypotension, headache, confusion
chronic: ataxia, peripheral neuropathy, dermatitis

320
Q

Treatment of Cyanide Poisoning?

A

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

321
Q

Chikungunya

A 
Africa Asia India
JOINT PAIN
As well as pyrexia, Malaise, Fever, Rash, Headache
Similar to Dengue
By Mosquitos
Alphavirus
322
Q

Cytochrome P450 inducer HIV Antiretroviral?

A

Nevirapine

323
Q

Nevirapine

A

Non-nucleoside reverse transcriptase inhibitors (NNRTI)

Induces Cytochrome P450

324
Q

Indinavir

A

Protease inhibitor

kidney stones and hyperbilirubinaemia

325
Q

Ritonavir

A

Protease inhibitor HIV

Induces Cytochrome P450

326
Q

Preeclapsia starts after?

A

20 weeks

327
Q

HTN in pregnancy defined as?

A

140/90 and above

Should decrease initially then increase from 20 weeks onwards

328
Q

How regular do you check lithium doses once stablised

A 
Every Three Months 
Aim 0.4-1.0 mmol/L
Fine Tremor 
Check Us &amp; Es and TFTs every 6 months
(DI/Nephrotoxic and Hypothyroid/goitre)
329
Q

Sarcoidosis Management? (5)

A

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

330
Q

Cryoglobulinaemia?

A

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

331
Q

Cyroglobulinaemia Types?

A

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

332
Q

Investigations and Treatment Cryoglobulinaemia?

A

Tests
low complement (esp. C4)
high ESR

Treatment
immunosuppression
plasmapheresis

333
Q

Symtpoms of Cryoglobulinaemia?

A

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

334
Q

Northern Blotting?

A

Detects RNA

SNOW DROP

335
Q

Southern Blotting?

A

Detects DNA

SNOW DROP

336
Q

Western Blotting?

A

Detects Proteins

SNOW DROP

337
Q

Yellow Vision?

A

Digoxin

338
Q

Blue Vision?

A

Sildenafil

339
Q

Myasthsenia Gravis Crisis Precipitants?

A 
penicillamine - Wilsons
quinidine, procainamide
beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines
340
Q

Smoking and Asbestosis risk of lung Ca?

A

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

341
Q

Acetylator Status Durgs?

A 
Isoniazid
procainamide
hydralazine
dapsone
sulfasalazine
342
Q

Intra Renal Causes of AKI?

A

Acute Tubular Necrosis
Interstitial Nephritis
Glomerulonephritis

343
Q

Acute Tubular Necrosis?

A

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
344
Q

Interstitial Nephritis

A

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

345
Q

Glomerulonephritis

A

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 +/++

346
Q

Mantoux Test mediated by?

A

Interferon Gamma

347
Q

Leiners Disease Complement deficiency?

A

C5

348
Q

Hypokalaemia and HTN causes

A

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

349
Q

Hypokalaemia without hypertension

A 
Bartemanns 
Giltemans
GI losses 
Diurteics
Renal Tubular Acidosis
350
Q

SVT Treatment?

A 
Valsalva
Carotid MAssage
6mg 12mg 12mg Adenosine
(Verapamil in asthmatics)
Electircal Cardioversion
351
Q

Seminoma tumour marker?

A

bHCG

352
Q

Testicular Tumour?

A

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%

353
Q

Caspofungin Mechanism?

A

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

Adverse: Flushing

354
Q

Amphotericin B

A

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

355
Q

N. Gonnorrhea?

A

Gram Negative (Red) Diploccoci

356
Q

E. Coli?

A

Gram Negative Rod

357
Q

N. Meningitidis

A

Gram Negative Diploccoci

358
Q

Post-mortem examination reveals asymmetric concentric enlargement of the myocardial septum.

A

HOCM

359
Q

HOCM: Hypertrophic Obstructive Cardiomyopathy

A

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

360
Q

HOCM commonest Defects

A

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

361
Q

Features of HOCM?

A 
Asymptomatic largely
Exertional Dyspnoea
Syncope - exercise associated
Angina
Sudden Death in young
jerky pulse, large 'a' waves, double apex beat
362
Q

HOCM Assoications?

A

Associations
Friedreich’s ataxia
Wolff-Parkinson White

363
Q

ECHO HOCM Findings?

A

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

364
Q

HOCM ECG?

A

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

365
Q

Jerky pulse?

A

HOCM

366
Q

Large A Waves?

A

HOCM

367
Q

Double apex beat?

A

HOCM

368
Q

Acute Mountain Sickness Prevention?

A

Acetazolamide
Increased risk if fit
Slow ascent
Treatment descent

369
Q

HAPE - High Altitude Pulmonary Oedema

A

Treatment
Oxygen
Nifedipine, phosphodiesterase inhibitors, Acetazolamide, Dex
DESCENT

370
Q

HACE- High Altitude Cerebral Oedema

A

Treatment
Dexamethasone
Descent

371
Q

Erythema Nodosum Causes?

A

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

Pregnancy

372
Q

Anti Nuclear Antibodies?

A

Dermatomyositis

373
Q

Polymyositis?

A

Anti Jo-1

374
Q

Anti Mi-2?

A

Dermatomyositis

375
Q

Middle Cerebral Artery Stroke?

A

Hemiparesis Upper > Lower
Sensory Loss
Aphasia
Homonymos Hemianopia

376
Q

Anterior Cerbral Artery?

A

Like MCA but no Aphasia or HH

Lower> Upper

377
Q

Posterior Cerebral Artery Stroke?

A

Contralateral homonymous hemianopia with macular sparing

Visual agnosia

378
Q

Retinal / Opthalmic Artery STroke?

A

Amorosis Fugax

379
Q

Basillar Artery Stroke?

A

Locked in Sydrome

380
Q

Anterior inferior cerebellar artery (lateral pontine syndrome)

A

Symptoms are similar to Wallenberg’s but:

Ipsilateral: facial paralysis and deafness

381
Q

Posterior inferior cerebellar artery (lateral medullary syndrome, Wallenberg syndrome)

A

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

382
Q

Weber’s syndrome (branches of the posterior cerebral artery that supply the midbrain)

A

Ipsilateral CN III palsy

Contralateral weakness of upper and lower extremity

383
Q

Hairy Cell Leukamia?

A

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

384
Q

Hairy Cell Leukaemia Treatmnet and signs

A

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

385
Q

Cirrhosis Scoring?

A 
Child Pugh
Ascites
Encephalopathy
Bilirubin
Albumin
Coagulation

MELD uses Bilirubin, Creatinine and INR

386
Q

Poor Prognostic facotrs for RA?

A 
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
387
Q

Trypanosomiasis

A

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

388
Q

Ciclosporin adverse effects:

A 
Hepatorenal toxic
Fluid Retention
Tremor
Hyperkalaemia
Hyperglycaemia
Hypertension
Hypertrichosis
Gingerval Hypertrophy
Hyperlipidaemia
389
Q

What is meioldosis?

A

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

390
Q

Autoimmune Hepatitis?

A

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)

391
Q

Immunoglobulin raised in Autoimmune hepatitis?

A

IgG

392
Q

Autoimmune hepatitis types?

A

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

393
Q

Burkitts Lymphoma?

A

Think Tumour Lysis Syndrome

394
Q

Mycobacterium Marium?

A

Fish Tank Granuloma

395
Q

UTI sexually active woman?

A

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.

396
Q

HNPCC due to a defect which genes and what do they do?

A

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

397
Q

Immune Reconstitution Inflammatory Syndrome?

A

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.

398
Q

Factors Favouring Rate Control not Rythym control in AF

A

Age > 65

IHD

399
Q

Contraindications for surgery in small cell lung cancer?

A

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

400
Q

Giltemanns?

A

Salt Wasting Nephropathy due to abnormality in NaCl channel of DCT

Kidney Stones
Metabolic alkalosis

401
Q

Liddle Sydrome?

A

Na Channel in DCT

402
Q

Bartter syndrome?

A

Sodium Potassium Chloride pump in Loop of Henle

403
Q

Trichomonas Vaginalis

A

Like BV but green
offensive smell and treated with metronidazole

Unlike- causes dyspyrunia and cervix involvement (Strawberry Cervix). Motile on microscopy

404
Q

Pregnancy Jaundice Differentials?

A

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

405
Q

Intrahepatic cholestasis of Pregnancy?

A 
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

406
Q

Acute Fatty Liver of Pregnancy?

A 
Third Trimester
Very Rare 
abdominal pain
nausea &amp; vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia

ALT very raised
Supportive Treatment
Stabilise and Deliver

407
Q

Methaemoglobinaemia deficient enzyme?

A

NADH

408
Q

Albumin Creatinine ratio?

A

> 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

409
Q

Asthma Testing?

A

< 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

410
Q

Latent Autoimmune Diabetes of Adulthood

A

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

411
Q

Familial Mediterranean Fever

A

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

412
Q

Toxic Multinodular Goitre Treatment?

A

Radioiodine > block and replace

413
Q

Leprosy?

A

Hypopigmentation and sensory loss associated with skin lesions

Caused by Mycobacterium leprae.

WHO-recommended triple therapy: rifampicin, dapsone and clofazimine

414
Q

Polycythemia Vera

A

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

415
Q

Sarcoidosis CXR

A

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

416
Q

Type 1 Hypersensitivity reaction e.g (2-3)

A

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

417
Q

T2 Hypersensitivity reaciton? (E.g.8)

A

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
418
Q

T3 Hypersensitivity reaction? E.g (4)

A

FREE antigen and antibody (IgG, IgA) combine

Serum sickness
Systemic lupus erythematosus
Post-streptococcal glomerulonephritis
Extrinsic allergic alveolitis (especially acute phase)

419
Q

T4 Hypersensitivity Reaction? E.g (7)

A

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
420
Q

Li-Fraumeni?

A

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

421
Q

Tumour suppressor Genes?

A 
p53
APC - Colorectal 
BRAC1 / 2 - Ovarian and Breast
NF1 - Neurofibromatosis
Rb- Retinoblastoma
WT1 - wilms Tumour
422
Q

Ca 125

A

Ovarian

423
Q

Ca 15-3

A

Breast

424
Q

Ca 19-9

A

Pancreatitis

425
Q

Alpha Feto Protein

A

Hepatocellular carcinoma

426
Q

CEA

A

Colorectal

427
Q

Bombesion

A

Small cell lung, Gastric and neuroblastoma

428
Q

S-100

A

Melanoma and Schwannoma

429
Q

Cavitating Lung Lesions? (7)

A

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

430
Q

Hypokalaemia with Alkalosis

A 
Hypokalaemia with alkalosis
vomiting
thiazide and loop diuretics
Cushing's syndrome
Conn's syndrome (primary hyperaldosteronism)
431
Q

Hypokalaemia with ACIDOSIS

A 
Hypokalaemia with acidosis
diarrhoea
renal tubular acidosis
acetazolamide
partially treated diabetic ketoacidosis
432
Q

Quinine Toxicity?

A 
Cause of Flash Pulmonary Oedema
Hypotension
Metabolic Acidosis
Hypoglycaemia
Tinnitus 
Visual Distrubances
Flushing

Supportive treatment

433
Q

Quinine use?

A

Prophylaxis of Malaria

Leg Cramps

434
Q

Diabetic Dermopathy?

A

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.

435
Q

Acanthosis Nigricans ?

A

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

436
Q

Antibiotic Choice for Mycoplasma?

A

Doxycycline or Macrolide

437
Q

Rocky Mountain spotted fever

A

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

438
Q

Rickettsia infection?

A

Rickettsial infections think travel and in general :

Rash, headaches, and either single or multiple eschars.

439
Q

Coxiella burnetti

A

Q Fever
No rash but causes pneumonia
Headache ? Eschars etc

440
Q

Endemic Typhus?

A

Rickettsia typhi
Flea
Rash starts centrally then spreads to the peripheries

Rickettsia prowazekii
Human Louse

441
Q

Lyme Disease

A

Borrelia burgdorferi
Doxy
Amoxicillin if pregnant

442
Q

Cat-scratch fever

A

Bartonella henselae

443
Q

Autosomal Recessive?

A

Metabolic Conditions
Fredricks Ataxia
Ataxia Telangectasia

444
Q

Autosomal Dominant

A

Structural

Gilberts and hyperlipidaemia

445
Q

Leptin?

A 
Produced by adipose
Increases Melanocyte Stimulating Hormone
Increased in Obesity
Causes satiety
Role in weight management
446
Q

Ghrelin

A

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

447
Q

Blepharitis Causes:

A

Staph infection
Mem Gland Dysfunction
Rosecea
Sebhorreic Dermatitis

448
Q

Radial Tunnel Syndrome

A

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

449
Q

Yellow vision?

A

Digoxin tox

450
Q

Blue vision?

A

Sildenafil

451
Q

Thiazide like diuretics?

A

Indapamide
Chlortalidone

Used in HTN after A and C

452
Q

Autoimmune hepatitis immunoglobulin?

A

IgG
Females
Acute or chronic liver failure

453
Q

Cohort Study?

A

Relative Risk outcome

454
Q

Case Control study?

A

Odds Ratio Outcome

455
Q

Guanylate cyclase receptors

A

e.g. atrial natriuretic factor, brain natriuretic peptide

456
Q

Hypercalcaemia

A 
Features
'bones, stones, groans and psychic moans'
corneal calcification
shortened QT interval on ECG
hypertension

ST Elevation, PR prolongation, Short QT and Wide QRS

457
Q

Antiphospholipid syndrome?

A 
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

458
Q

Magnesium Sulphate Tox

A

3.5 -5 - loss of reflexes
> 5 respiratory depression

Can cause hypotension

459
Q

Baby Blues, Post NAtal Depression and Puerperal psychosis prevelance

A

70%, 10%, 0.2%

460
Q

Restless Legs sydnrome treatment?

A

Dopamine AGONIST
- Ropinorole
Benzodiazepine
Gabapentin

461
Q

If struggling to maintain remission in UC?

A

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

462
Q

Increased sweating?

A 
Hyperhidrosis:
Aluminium chloride
Iontophoresis
Botox
Surgery
463
Q

Causes of LBBB?

A 
Causes of LBBB
ischaemic heart disease
hypertension
aortic stenosis
cardiomyopathy
rare: idiopathic fibrosis, digoxin toxicity, hyperkalaemia
464
Q

Oral Morphine - SC:

A

Morphine / 2

Diamorphine / 3

465
Q

Codein/Tramadol to Oramorph?

A

/ 10

466
Q

Oral Morphine to oxycodone?

A

/ 1.5-2

467
Q

C. Diff Treatment?

A

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

468
Q

Lymphoma Staging?

A 
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
469
Q

Autonomic Neuropahty

A

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
470
Q

X linked Recessvie?

A

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%)

471
Q

Discoid Lupus? Treatment?

A

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

472
Q

Drusen?

A

Dry Macular Degeneration

Yellow spots in Bruch’s Membrane

473
Q

HLA DR1?

A

Bronchiectasis

474
Q

Old Man Bone Pain and Raised ALP?

A

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

475
Q

Occupational inhaled chemical that is a risk factor for developing TB?

A

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

476
Q

Lower than expected HbA1c

A

Sickle Cell
G6PD
Heredetory Spherocytosis

Any reason why glucose can’t bind to RBC as well

477
Q

Higher than expected HbA1c

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Any reason for Anaemia therefore less RBC

478
Q

Retinal Angioid Streaks?

A 
pseudoxanthoma elasticum (Chicken plucked Skin)
Ehler-Danlos syndrome
Paget's disease
sickle-cell anaemia
acromegaly
479
Q

Acne treatment that causes hyperpigmentation?

A

Minocycline

480
Q

Hodkins Lymphoma?

A

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

481
Q

Zollinger Ellison Syndrome?

A 
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
482
Q

Upward Beat Nystagmus?

A

Cerbellar Vermis Lesion

483
Q

Infective Endocarditis Antibiotics?

A

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

484
Q

Infective Endocarditis Antibiotics?

A

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

485
Q

Exposure to Chicken Pox in preganncy?

A

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

486
Q

Exposure to Chicken Pox in preganncy?

A

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

487
Q

Small Bowel Bacterial Overgrowth

A

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.

488
Q

Bisphosphonate indications

A

Pagets
Osteoperosis prophylaxis (with Vit D and Ca)
Hypercalcaemia
Bone Pain

Decrease Osteoclast formation
Can cause stress fractures
Oesophagitis

489
Q

Type V Hypersensitivity reaction?

A

Graves and Myathsenia Gravis

Antibody

490
Q

Tricuspid Regurgitation?

A

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
491
Q

Alvarado Score?

A

Acute Apendicitis

492
Q

Centor Score?>

A

Strep Throat Score and ? Antibiotics?

493
Q

Seroconversion HIV and Testing?

A

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

494
Q

Seroconversion HIV and Testing?

A

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

495
Q

Frontal Lobe Lesions?

A 
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
496
Q

Temporal Lobe

A

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)

497
Q

Occipital Lobe Lesions?

A

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

498
Q

Parietal Lobe Lesions?

A 
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
499
Q

Reactivation of Herpes pneumonia?

A

Strep Pneumoniae

500
Q

Tunnel Vision

A

Tunnel vision is the concentric diminution of the visual fields

Causes
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy secondary to tabes dorsalis
hysteria
501
Q

Bullous Pemphigoid presentation and diagnosis|?

A

Tense ITchy blisters on arms and inner thighs in the elderly

Skin biopsy
immunofluorescence shows IgG and C3 at the dermoepidermal junction

502
Q

Bullous Pemphigoid presentation and diagnosis|?

A

Tense ITchy blisters on arms and inner thighs in the elderly

Skin biopsy
immunofluorescence shows IgG and C3 at the dermoepidermal junction

503
Q

Phaemochromocytoma treatmnet of HTN?

A

Phenoxybenzamine

504
Q

Mercury Poisoning?

A

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
505
Q

virus with low CSF Glucose?

A

Mumps

506
Q

Fibrosis Lung in Parkinsons Medication?

A

bromocriptine, cabergoline, Pergolide

Dopamine Agonists

507
Q

Diptheria Features?

A

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

508
Q

Statins in pregnancy?

A

Stop 3 months before trying to conceive

509
Q

HSV Encephalitis

A

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%

510
Q

Osteopersosis further management? Raloxifene

A

Raloxifene - selective oestrogen receptor modulator (SERM)

may worsen menopausal symptoms
increased risk of thromboembolic events
may decrease risk of breast cancer

511
Q

Trontium Ranelate?

A

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

512
Q

Denosumab

A

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

513
Q

Teriparatide

A

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

514
Q

Teriparatide

A

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

515
Q

Leucocyte alkaline phosphate.

A

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
516
Q

Hepatitis C Treatment?

A

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

517
Q

Erythrasma?

A

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

518
Q

Osteomylitis common organism? Imaging?

A

Staph Aeurus
Salmonella in Sickle Cell
MRI

Fluclox for 6 weeks
Clindamycin if pen allergic

519
Q

Digoxin ECG, Mechanism

A 
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

520
Q

Paroxysmal Noctural Haemoglobinurea

A

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

521
Q

VSD associations?

A 
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
522
Q

How Do Benzos work?

A 
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

523
Q

Ethylene Glycol Poisoning?

A

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

524
Q

Methanol Poisoning

A

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

Ethanol / Fomipazole

525
Q

Methanol Poisoning

A

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

Ethanol / Fomipazole

526
Q

Psoriasis systemic drugs?

A

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

527
Q

Bactericidal?

A

Antibiotics: bactericidal vs. bacteriostatic

Bactericidal antibiotics
penicillins
cephalosporins
aminoglycosides
nitrofurantoin
metronidazole
quinolones
rifampicin
isoniazid
528
Q

Bacteriostatic

A 
Bacteriostatic antibiotics
chloramphenicol
macrolides
tetracyclines
sulphonamides
trimethoprim
529
Q

Gram Positive Rods?

A 
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
530
Q

Gram Positive/Negative Cocci

A

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

531
Q

Gram Negative Rods?

A 
Remaining organisms are Gram-negative rods, e.g.:
Escherichia coli
Haemophilus influenzae
Pseudomonas aeruginosa
Salmonella sp.
Shigella sp.
Campylobacter jejuni
532
Q

Upper Lobe Pulmonary Fibrosis?

A

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

533
Q

Lower Zone Pulmonary Fibrosis

A

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

534
Q

Waldenstrom’s Macroglonulinaemia

A

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

535
Q

Hypertriglyceridaemia

A 
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

536
Q

Rheumatoid Arthritis Management?

A

Start DMARDs ASAP
1. DMARD monotherapy +/- bridging pred (short)

METHOTREXATE widely used DMARD.
FBC & LFTs - myelosuppression and liver cirrhosis. + pneumonitis

sulfasalazine
leflunomide
hydroxychloroquine

  1. TNF-inhibitors after inadequate response to at least two DMARDs including methotrexate

Entanercept

537
Q

Entanercept?

A

Recombinant human protein
Decoy receptor for TNF-α

subcutaneous administration
demyelination + reactivation of tuberculosis

538
Q

Infliximab

A

monoclonal antibody
binds to TNF-α + stops binding with TNF receptors

Given IV
Risks include reactivation of tuberculosis

539
Q

Myeloma Features?

A 
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

540
Q

Streptococci?

A

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

541
Q

Petit Mal Seizures Contraindications?

A

Carbemazepine
Asbcence seizures exacerbated by Carbemazapine

Sodium Val or Ethosuximide used instead

Also contraindicatd in myoclonic seizures

542
Q

Imaging in Ank Spond?

A

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

543
Q

Causes of Cranial DI

A 
idiopathic
post head injury
pituitary surgery
craniopharyngiomas
histiocytosis X
Wolfram's syndrome
haemochromatosis
544
Q

Causes of Nephrogenic DI?

A

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

545
Q

Waldenstrom’s macroglobulinaemia vs Multiple Myeloma

A

Bone LEsions
Ca
IgG and IgA in Myeloma

546
Q

Skewed Distribution

A

Skewed distributions

Normal (Gaussian) distributions: mean = median = mode

Positively skewed distribution: mean > median > mode

Negatively skewed distribution mean < median < mode

547
Q

Commonest REnal Stone?

A 
Calcium Oxylate (45%)
Mixed CAlcium (25%) 
Triple Phosphate and and Calcium Phosphate (10% and 10%)
548
Q

Radioluecent Renal STones

A

Urate
Xanthine

Cystine is semi lucent

549
Q

Ank Spond Other features (As)

A 
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)
550
Q

Anti Thyroid Prexoidase?

A

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

551
Q

Ticagralor side effect?

A

Breathlessness

552
Q

Burkitts Lymphoma associations?

A 
EBV
Africa 
Starry sky apprearance
c-MYc 
t 8 14
553
Q

Neutrophil Deficiencies

A

Chronic granulomatous disease
Chediak-Higashi syndrome
Leukocyte adhesion deficiency

554
Q

Pyrazinamide adverse effects?

A

Gout

555
Q

Isoniazid adverse effects?

A

Peripheral Neuropathy

Hepatitis

556
Q

Ethambutol adverse effects?

A

Optic Neuritis

557
Q

Rifampicin

A

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

558
Q

Monoamine Oxidase inhibitors

A

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

559
Q

Zinc Deficiency

A 
perioral dermatitis: red, crusted lesions
acrodermatitis
alopecia
short stature
hypogonadism
hepatosplenomegaly
geophagia (ingesting clay/soil)
cognitive impairment
560
Q

Raised TLCO causes

A 
Causes of a raised TLCO
asthma
pulmonary haemorrhage (Wegener's, Goodpasture's)
left-to-right cardiac shunts
polycythaemia
hyperkinetic states
male gender, exercise
561
Q

TLCO low

A 
Causes of a lower TLCO
pulmonary fibrosis
pneumonia
pulmonary emboli
pulmonary oedema
emphysema
anaemia
low cardiac output
562
Q

Motor Neurone Disease Types?

A

Bulbar Palsy
Amyotrophic LAteral Sclerosis
Progressive Muscular Atrophy

563
Q

Amyotrophic Lateral Sclerosis?

A

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

564
Q

Progressive Muscular Atrophy?

A

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

565
Q

Progressive Bulbar Palsy?

A

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

566
Q

Progressive Muscular Atrophy?

A

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

567
Q

Progressive Bulbar Palsy?

A

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

568
Q

Tetanus Treament

A

IVIG Tetanus

Metronidazole

569
Q

AcH Effects? Which gas causes this?

A 
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

570
Q

Peripheral Neuropathy

A 
Drugs causing a peripheral neuropathy
amiodarone
isoniazid
vincristine
nitrofurantoin
metronidazole
571
Q

Stills Disease?

A

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

572
Q

HOCM Prognostic Factors

A

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.

573
Q

HIV Nephropathy?

A

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

574
Q

Heerforts syndrome

A

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

575
Q

Amyotrophic lateral sclerosis treatment?

A

Riluzole

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

576
Q

Aciclovir and Ganciclovir action?

A

Guanosine analogue causing inhibition of Viral DNA Polymerase

Pyrophosphate analog which inhibits viiral DNA polymerase = Forscarnet

577
Q

Oseltamivir

A

Inhibits neuraminidase - Influenza

578
Q

Ribavirin

A

Guanosine - IMP –> inhibits MRNA capping

579
Q

Fabry’s?

A

Overview
X-linked recessive
deficiency of alpha-galactosidase A

Features
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
580
Q

Eosinophillia causes?

A 
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)

581
Q

Klinefelter’s ?

A

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).

582
Q

Imatinib?

A

Tyrosine Kinase inhibitor used in Leukaemia

583
Q

CML?

A

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

584
Q

Disseminated Lymes Disease?

A

Cef IV

Neurodisease

585
Q

Prevention of renal stones

A

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

586
Q

Renal Stone management

A

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

587
Q

HIT

A

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

588
Q

Bronchiectasis

A

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

589
Q

Allergic Bronchopulmonary Aspergillosis

A

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

590
Q

Extrinsic Allergic Alveolitis

A

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

591
Q

Agranulocytosis causes drugs?

A

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

592
Q

SBP

A

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.

593
Q

Chlorpropamide?

A

Sulfonylurea

594
Q

RAPD?

A 
Marcus Gunn Pupil
Causes: 
Causes
retina: detachment
optic nerve: optic neuritis e.g. multiple sclerosis
595
Q

Leflunomide

A

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

596
Q

Leflunomide

A

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

597
Q

H Pylori Treatment?

A

PPI Amox and Clarithromycin or Amox and MEthotrexate

If Pen Allergic. Clarithromycin and MEthotrexate

598
Q

Things that exacerbate Graves Eye disease?

A

Smoking

Iodine Treatment

599
Q

Causes of acute angle closure glaucoma?

A

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

600
Q

Quinilones adverse effects?

A

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

601
Q

Quinilones adverse effects?

A

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

602
Q

Axonal

A 
Axonal pathology
alcohol
diabetes mellitus*
vasculitis
vitamin B12 deficiency*
hereditary sensorimotor neuropathies (HSMN) type II
603
Q

Demylinating?

A

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

604
Q

PML?

A

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

605
Q

Schizophrenia risk

A

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
606
Q

Schizophrenia risk

A

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
607
Q

Smudge Cells?

A

CLL

Do Immunophenotyping

608
Q

Vancomycin

A

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
609
Q

Acute Chest Syndrome in Sickle Cell?

A

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
610
Q

Aplastic Crisis?

A

Aplastic crises
caused by infection with parvovirus
sudden fall in haemoglobin

611
Q

Thrombotic Crisis?

A

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

612
Q

Otitis Externa Treatment?

A

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

613
Q

Autoimmune Haemolytic Anaemias

A

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

614
Q

Autoimmune Haemolytic anaemia causes? Warm? Cold

A

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

615
Q

Lung Carcinoid?

A

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

616
Q

Lights Criteria?

A

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

617
Q

Lights Criteria?

A

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

618
Q

Anti Jo?

A

Polymyositis

619
Q

Anti La

A

Sjogren’s

620
Q

Anti Mi2

A

Dermatomyositis (ANA)

621
Q

Anti scl-70

A

Diffuse systemic slcerosis

622
Q

Anti Centromere

A

Limited Cutaneous Systemic Sclerosis

623
Q

Anit Ro

A

Sjogrens, Congenital Heart Block and SLE

624
Q

Tuberous Sclerosis

A

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

625
Q

Von Hipple Lindau Syndrome

A

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

626
Q

TCA with lowest overdose toxicity

A

Lofepramine

627
Q

Homocystinuria

A

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.

628
Q

Hypersegmented polymorphs?

A

B12 Deficiency

629
Q

Drug induced parkinsons treatment?

A

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)

630
Q

TTP Pentad?

A

fever, neurological dysfunction, evidence of haemolysis (blood film), renal injury and thrombocytopenia.

AMAMST13 –> Von willibrand cleaving isn’t working

631
Q

TTP Pentad?

A

fever, neurological dysfunction, evidence of haemolysis (blood film), renal injury and thrombocytopenia.

AMAMST13 –> Von willibrand cleaving isn’t working

632
Q

Metabolic Alkalosis

A 
Metabolic alkalosis
diuretics
Cushing's syndrome
Bartter's syndrome
vomiting / aspiration
primary hyperaldosteronism
carbenoxolone
liquorice
hypokalaemia
633
Q

CLL?

A

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)

634
Q

Indications for CLL treatment?

A 
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

635
Q

Treatment for MRSA?

A

Vanc and Rifampicin

636
Q

Anti Cadiolipin?

A

Antiphospholipid syndrome

637
Q

Insulinoma gold standard test?

A

72 hour fasted Glucose

638
Q

miller fisher triad

A

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

639
Q

Anti Ro Pregnancy?

A 
Neonatal Lupus (+ anti La)
NEONATAL HEART BLOCK
640
Q

Pseudogout crystals?

A

Weakly Positive Bifringent Rhomboid Crystals

641
Q

Gout Crystals>

A

Negatively Bifringent Needle Shaped Crystals

642
Q

Streptococcus gallolyticus (S. bovis)

A

Colorectal Ca, Chronic Liver Disease

643
Q

Yersinia enterocolitica

A

Pseudoapenidicitis

Peri ileal lyphendenopathy

644
Q

Dialysis Catheter cellulitis

A

Staph Epidermis

645
Q

Acromegaly Gold Standard Test?

A

Growth Hormone Suppression Test

646
Q

Goitre causing respiratory symptoms?

A

Volume Flow Graph

647
Q

Pericardial constrictive Pericarditis?

A

Hepatomegaly is the most common first sign

Then knock and Ascites later

648
Q

Antimitochondrial antibodies?

A

Primary Billiary Cirrhosis

MRCP (6 decks)

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