Random bits Flashcards
2 examples of ANCA -ve vasculitis
Goodpastures (anti-GBM)
Henoch Schonlein Purpura
diagnosis of febrile neutropenia
- Temperature > 38oc
- Absolute Neutrophil Count < 1
B12 deficiency can cause
- due to anaemia
- heart failure
- angina
- neuropathy
which drig will enzyme inducers stop working
the oral contraceptive pill
so barrier contraception is required
what percentage of patients infected with Hep C will get HCC
5%
what are the signs and symptoms of chronic mesenteric ischaemia
- classical triad
- upper abdo bruit
- weightloss
- severe, colicky post-prandial abdo pain
- bleeding PR
- malabsorption
- nausea and vomiting
what are the criteria for diagnosing endocarditis and summarise them
Duke’s criteria
for Dx you need 2 major criteria
1 major criteria and 3 minor
or 5 minor criteria
sickle cell disease mutation
chromosome 11
glutamic acid replaced by valine
fill in this table
Simon, a 57-year-old banker, comes in to the surgery complaining of pain immediately below the ribs. After a taking a history, he tells you the pain is typically worse at night and when he’s hungry but has found that a glass of milk seems to help. He had a MI 3 years ago and takes aspirin daily. What is this history suggestive of?
duodenal ulcer
first, second and third line treatments for Crohn’s
if mild PO prednisolone
if severe admit for IV fluids and IV methyprednisolone
2nd line is azathioprine
3rd line is infliximab (anti TNF a)
definition of seizure
an event of hypersynchronous electrical discharge in the brain that alters behaviour, sensation or movement
4 types of drug for parkinson’s and an example of each
Levodopa (with carbidopa in co-careldopa)
MAO-B inhibitors (selegiline)
Dopamine agonists (ropinirole)
COMT inhibitor (tolcapone)
pathogens that cause reactive arthritis
STIs and GI
campylobacter
salmonella
shigella
chlamydia trachomatis
which cancer is mainly associated with smoking
small cell lung cancer
which HLA type is associated with Type 1 Diabetes
HLA-DR3
HLA-DR4
murmur of mitral regurge?
pansystolic
fill in this table
how much liquid is there normally in a healthy pleural space
15ml
where are M3 muscarinic receptors found
in the airways
worldwide and UK greatest causes of adrenal insufficiency
worldwide: TB
UK: addison’s
what is IC50
it is the concentration of an inhibitor that can reduce a dose by half
what is lynch syndrome
- AKA HNPCC
- causes 1-3% of colon cancers
- AD inheritance due to mutations in MMR genes
- 80% lifetime cancer risk
- also predisposes to ovarian, gastric and endometrial
treatment for grave’s disease (2 things)
B blockers and carbimazole
treatment for tumour lysis syndrome
allopurinol
how to differentiate mnd and MS
no sensory loss in MND
4 abx that can cause C.diff
cephalosporins
co-amoxiclav
clindamycin
ciprofloxacin
what are T scores and what are Z scores
- T= Bone density )score/standard deviations away from) compared to a 25 year-old of the same gender
- Z= bone density compared to the average for their age of the same gender
is asthma worse in the morning or the evening
the morning
what is isoprenaline and when is it used
it is a B2 adrenoreceptor agonist and it is used in bradycardia and heart block
describe the process of phagocytosis
- Binding of insult e.g bacterium to macrophage
- Engulfment
- Phagosome formation
- Lysosomal fusion and digestion
- Antigen presentation (MHC II)
- Secretion of waste products.
definition of malabsorption
Inadequate absorption of nutrients/food in/by the small intestines
non smoking causes of lung cancer
chromium exposure
radon exposure
coal tar exposure
signs of iron deficiency anaemia
angular stomatitis
koilonychia
dry and brittle hair
atrophic glossitis (loss of villae)
long acting M3 receptor antagonists
tiotropium
two complications of bronchoscopy
pneumonia
pneumothorax
management of GCA
PO prednisolone
treatment for c.diff
vancomycin and metronidazole
what if you hear an early systolic click on auscultation
mitral valve replacement
IBS treatment
pain and bloating - buscopan
diarrhoea - loperamide
constipation - senna
Rx for MS
- alemtuzumab (anti-T cell)
- treating relapses
- methylprednisolone
- treating symptoms
- spasticity: baclofen
- tremor: botulinum toxin A injection
- urinary incontinence: self catheterisation
- fatigue: CBT
causes of SIADH
malignancy or drugs
really briefly what happens in pneumoconiosis
particle is phagocytosed by macrophage
macrophage releases inflammatory cytokines
infiltrating immune cells damage alveolar epithelium
fibroblasts attempt repair and deposit collagen
causes fibrosis
what is the definition of pulmonary hypertension
defined by a mean pulmonary artery pressure ≥25 mmHg at rest
black urine??? what’s your diagnosis
malaria
what is the crystal in pseudogout
calcium pyrophosphate
how does allopurinol work
it inhibits xanthine oxidase and reduces the rate of production uric acid from purines thereby reducing the concentration of circulating uric acid
what is myasthenic crisis and what is the treatment
life threatening weakness of resp muscles during relapse - it’s when FVC falls
plasmapheresis to remove the anti-AChR
sterile sites in the body
blood
CSF
bone marrow
pleural fluid
when would you see target cells?
on a blood film of thalassaemia
treatment for iron deficiency anaemia
ferrous sulphate
Patient arrives to hospital with a suspected MI. ECG shows ST elevation. What would you expect to see on the ECG over the next few hours and the next few days?
- Hours = Tall T waves, ST Elevation
- Days = T inversion, Pathological Q wave
treatment for DI
cranial: desmopressin
Nephrogenic: NSAIDs
differences in EF in systolic and diastolic heart failure
name some causes of both .
- EF > 50% in diastolic
- restricted cardiomyopathy
- tamponade
- ventricular hypertrophy
- EF < 40% in systolic
- insufficient contraction
what would be reversibility in asthma
following salbutamol there’s 400ml increase in FEV1 OR 20% improvement of PEFR
5 steps of osteoarthritis
damage
disordered repair
fibrillations
osteophytes
sclerosis
what is atropine and how does it work
it is a M2 muscarinic receptor antagonist
is therefore an anticholinergic drug
used to treat heart block and life-threatening bradycardias
how to differentiate mnd from myasthenia gravis
mnd never affects the eye movements
where is folate absorbed
jejunum
which HLA type is associated with coeliac disease
HLA-DQ2
treatment for systemic sclerosis and crest syndrome
- no cure so treat symptoms
- raynaud’s
- CCB like nifedipine
- pulmonary hypertension
- prostaglandins
immediate treatment of suspected meningitis in hospital
IV ceftriaxone
name 3 granulomatous diseases
crohn’s
sarcoidosis
TB
fill in this table
signs and symptoms of siADH
v concentrated urine, confusion, anorexia, nausea
what is Wegener’s Vasculitis
- it is aka granulomatosis with polyangiitis
- affects arterioles and capillaries
- is c-ANCA +ve
- affects
- sinuses
- lungs - causing nodules
- kidney - glomerulonephritis rapidly progressing to CKD
what do PPIs inhibit
the K+/H+ ATPase of the stomach
PR interval should be how long
0.12-0.2 s
why can granulomatous disease cause hypercalcaemia
activated macrophages produce activated vitamin D
there’s bone resorption,
renal reabsorption
and increased absorption in the gut
Tx for crohns
oral corticosteroids (prednisolone)
in severe flare ups: IV hydrocortisone
infliximab is 3rd line
what is charcot’s triad and what is reynold’s pentad
- charcot’s triad
- RUQ pain
- Jaundice
- Fever
- Reynauld’s pendat is charcot’s with:
- hypotension
- confusion
- Reynold’s means the patient is now in shock
what is the definition of hypokalaemia
<3.5mmol/L
which antibodies in crest syndrome
anti-centromere
treatment of AF
- rate control
- BB
- CCB
- rhythm control
- amiodarone
- anticoag with warfarin
- INR goal is 2-3
sjorgen’s syndrome treatment
synthetic tears and saliva
treat arthralgia with NSAIDs
symptoms specific to haemolytic anaemia
jaundice
gallstones
signs of underlying disease
splenomegaly
investigations for prostate cancer
- DRE: craggy and enlarged
- TRUSS and biopsy
- Gleason grading
- TNM staging
which substance is responsible for the skin pigmentation in addison’s
acth
what is the antibody in vasculitis
ANCA
eye signs of graves
exopthalmos
dry gritty eyes
lid lag and drag
retro orbital inflammation
photophobia
diplopia
conjunctival oedema
treatment for peripheral arterial disease
- lifestyle: usual suspects
- clopidogrel
- percutaneous transluminal angioplasty
Ix following TIA
glucose
FBC
carotid doppler
name some bugs often cause ascending cholangitis
Escherichia coli,
klebsiela spp.
enterobacter spp.
Bacteroides fragilis
Enterococcus spp. (group D strep)
how do penicillins work
Penicillin prevents peptidoglycan from cross-linking properly in the last stages of bacterial cell wall synthesis
what is ulcerative colitis
relapsing remitting inflammatory condition of the colon mucosa
specific signs of iron deficiency anameia
koilonychia
angular stomatitis
dry hair and nails
atrophic glossitis
What scoring tool may you use to assess the severity of LUTS in men?
IPSS (International prostate scoring system)
empirical treatment of MRSA
Vancomycin
treatment for focal seizures
carbamazepine
Go through kidney disease staging
pyrazinamide side effect
gout and rash as well as hepatitis
where do bone marrow biopsies come from
Iliac crests
INR target for patients with AF on warfarin
2-3
PTT and APTT what do they stand for, what pathway do they measure and which will haemophilia A and B affect
- partial thromboplastin time = PTT
- extrinsic pathway
- activated partial thromboplastin time = APTT
- intrinsic pathway
- Haemophilia A and b both affect intrinsic pathway so PTT is normal but APTT will be slow
Rx for addison’s
hydrocortisone for cortisol
fludrocortisone for aldosterone
what is the scoring system to evaluate risk of PE and what are the components
- well’s criteria
- clinical signs of DVT
- previous DVT
- PE is number one diagnosis or equally likely
- haemoptysis
- malignancy with recent treatment
- HR >100
- recent surgery or immobilisation
most common bacteria causing meningitis infection in adults
Strep pneumoniae
treatment for reactive arthritis
Treat underlying cause
NSAIDs
corticosteroids
DMARDS
malignant melanoma presentation
- ABCDE
- assymetrical
- border irregularity
- colour irregularity
- diameter >6mm
- evolution
where does transferrin bind iron and where does ferritin bind iron
ferritin binds iron intracellularly mainly in the liver, but also in the bone marrow, spleen, and muscles
hoespital acquired pneumonia is normally which microorganism
Staphylococcus aureus
think “hospital staff”
what criteria are used to diagnose GCA
- ACR criteria - diagnosed if 3 of these 5 met
- Age at disease onset 50 years
- New headache
- Temporal artery abnormality
- Elevated erythrocyte sedimentation rate 50 mm/hr
- Abnormal artery biopsy: biopsy specimen showing vasculitis characterised by a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells
what type of haemorrhage is a lumbar puncture absolutely contraindicated in
Extra-dural haemorrhage
they may reduce CSF pressure and speed up herniation
what is normal blood glucose
3.5 - 8 mmol/L
hand signs of liver cirrhosis
Leuconychia
Terry’s nails
clubbing
dupytren’s contracture
treatment for thalassaemia
blood transfusion
desferrioxamine for iron chelation
what does amiodarone do?
it prolongs phase 3 of the cardiac action potential and so slows the heart
so it’s used in arrhythmias
risk factors for RA
increasing age
female
premenopausal
smoking
stress
infection
small bowel obstruction in adults causes
adhesion,
malignancy,
hernia,
crohns
tongue like a sack of worms and quiet horse voice
CN 9-12 palsy caused by progressive bulbar palsy
Ix for RA
- rheumatoid factor (+ve in 70%)
- anti-CCP (anticitrullinated peptide)
- x ray
- bloods: high esr and crp
where is iron absorbed
in the duodenum
treatment for hyperkalaemia
immediate calcium gluconate
insulin infusion with dextrose
name a test for peripheral vascular disease
- Buerger’s test
- elevating leg (colour goes)
- hang over side of bed (comes back)
immediate treatment of suspected meningitis in the community
IM benzylpenicillin
causes of encephalitis
mainly viral like west nile virus, HSV and vericella zoster
who typically gets SLE
black women between ages 20 to 40
cardiac enzymes to do in ACS
troponin T
myoglobin
CK-MB
4 causes of pernicious anaemia
autoimmune
atrophic gastritis
gastrectomy
crohn’s
coeliac
hypercalcaemia clinical features
Bones, stones, abdominal groans, thrones and psych overtones
- bone pain
- renal calcuil
- constipation
- polyuria
- depression
lucid interval pattern should make you think
extradural haemorrhage
how does lidocaine work
it inhibits voltage gates Na+ channels and thereby blocks action potentials being sent
when is murphy’s sign typically positive and when is it typically negative
positive in cholecystitis,
but negative in choledocholithiasis, pyelonephritis, and ascending cholangitis.
how long after changing levothyroxine dose should you wait to measure their TSH
4 weeks
when is desferrioxamine indicated
iron chelation in haemochromatosis and if they have thalassamia and need continuous transfusions
what is dressler’s syndrome
Dressler’s syndrome is secondary pericarditis caused by an immune system response after damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury.
BRCA1 and BRCA2 lifetime risk of breast cancer
BRCA1 - 55-65%
BRCA2 - 45%
what is the Ix for Sjorgen’s
Schirmer’s test for conjunctival dryness
also serology for anti-Ro (aka anti-sjorgen’s sydrome related antibody)
acute treatment of gout
NSAIDs (like diclofenac)
colchicine if NSAIDS CI (peptic ulcer etc)
Treatment for TTP
plasma exchange to remove antibodies and replace ADAMTS13
what is the diagnosis for helicobacter pylori
C13 urea breath test
signs of cushing’s
buffalo hump
hirsutism
central obesity
bruising
thin skin
osteoporosis
moon face
acne
if a patient is male, old and has myasthenia gravis, what should you be concerned about
thymic tumour
what score would you use to predict someone’s likelihood of PE
Well’s score
What do NSAIDs inhibit and what is the result?
Inhibit Cyclooxygenase enzyme (COX)
Prevents the conversion of arachidonic acid to prostaglandin H2
migraine triggers
chocolate
hangovers
oral contraceptive pill
caffeine/cheese
orgasms
lie-ins
alcohol
travel
exercise
what stain would you use on biopsy to diagnose haemochromatosis
Perl’s stain identifies iron and will show gross iron staining
what is nephrotic syndrome
proteinuria with hypoalbuminaemia and peripheral oedema
immediate medical interventions for DKA
ABCDE approach so fluids first
insulin
whats the pneumonia organism if they mention air conditioning
Legionella pneumophila
what is retuximab
monoclonal antibody against CD20 on the surface of B cells
management of sickle cell crisis
high flow O2 and morphine
transfusion
definition of neoplasia
lesion resulting from autonomous abnormal growth of cells which persist after the initiating stimulus has been removed
it is never normal
what would you hear on auscultation in pericarditis
pericardial friction rub
name 5 cancers that typically metastasise to bone
breast
prostate
bronchi
thyroid
kidney
diagnosis of acromegaly
don’t do GH test
do glucose response test: it’s Dx if GH doesn’t drop in response to glucose
follow with MRI pituitary fossa
what is a post-ictal state
it’s 5-30 mins of drowsiness, confusion, nausea and headache following seizure
5 symptoms of acromegaly
acroparaesthesia
loss of libido
sweating
arthralgia
headache
which type of head bleed do you get meningism and positive bradzinski’s
SAH
differential diagnoses for being HLA-B27+
- Ankylosing spondylitis
- Psoriatic arthritis
- Iriitis/ Acute anterior uveitis
- Reactive arthritis
- Enteropathic arthritis
acromegaly signs
massive gradual growth of hands and jaw
widely spaced teeth
big tongue
deep voice
darkening skin
puffy lips
short acting M3 antagonists
Ipratropium bromide
treatment of acute pseudogout
diclofenac or Colchicine if CI
intra articular steroids
when do you do a LP in SAH
if CT -ve but history is suggestive
wait 12hrs so it’s yellow not red
non-motor symptoms of parkinson’s
- autonomic dysfunction
- constipation
- dribbling
- urinary frequency and urgency
- sleep disturbance
- neuro-psychiatric complications
- depression
- dementia
- psychosis
what are bradycardia and tachycardia
bradycardia <60 bpm
tachycardia >100bpm
prevention of gout
low dose aspirin
allopurinol titrated up based on serum urate levels
may trigger attack so wait 3 weeks following attack to start allopurinol
what is the definition of erectile dysfunction
The inability to gain and maintain an erection long enough to achieve sexual satisfaction
which HLA is associated with spondyloarthropathies
HLA-B27
what is the gene for alpha-1-antitrypsin deficiency
SERPINA1 gene on chromosome 14
treatment for intrinsic bradycardia
atropine
Muscarinic antagonist
which antibody is associated with Sjorgen’s
Anti-Ro
very briefly what are the different hypersensitivity reactions
- ACID
- Allergic - anaphylactic
- Cytotoxic - goodpastures
- Immune complex - SLE
- Delayed - mantoux test
Ulcerative colitis Rx
- methotrexate or sulfasalazine
- corticosteroids
- azathioprine
- infliximab
- surgery can be curative (colectomy)
why might a patient have a hyperparathyroid picture with low parathyroid
Parathyroid hormone-related protein (or PTHrP) is a protein member of the parathyroid hormone family. It is occasionally secreted by cancer cells (breast cancer, certain types of lung cancer including squamous cell lung carcinoma)
bilateral hilar node enlargement is seen on CXR of what condition
sarcoidosis
causes of sjorgen’s
can be primary fibrosis of exocrine glands
or secondary to SLE, RA or systemic sclerosis
3 diseases that cause a low transfer coefficient
fibrosing alveolitis
emphysema
anaemia
does UC or Crohn’s confer a higher risk of colon cancer
UC confers higher risk
What blood test would you conduct to help diagnose this as heart failure?
BNP (Brain natriuretic peptide)
NT-proBNP (N-terminal pro b-ype natriuretic peptide)
diagnosis of migraine
- >5 headaches lasting 4-72hrs with nausea and vomiting or photo/phonophobia plus any two of the following
- unilateral
- pulsating
- impairs or is worsened by usual activity
murmur in aortic stenosis
A crescendo-decrescendo ejection systolic murmur
name a medication used to treat eczema
tacrolimus
GCA with acute blindness in one eye is called what?
what is the treatment
arteritic ischaemic optic neuropathy
this is irreversible vision loss so it’s a medical emergency to save vision in the other eye
treat with immediate IV methylprednisolone
signs of liver cirrhosis
terry nail
dupuytren’s contracture
spider naevi
jaundice
xanthelasma
ascites
bruising
palmar erythema
clubbing
leuchonychia
what does FRAX measure and what are the components
- 10 year probability of fracture
- age
- sex
- weight
- height
- previous fracture
- parent fractured hip
- smoking
- corticosteroids
- RA
- high alcohol consumption
- secondary osteoporosis
- BMD
two antibodies found in coeliac
anti-EMA (endomysial) and anti-tTG (tissue Transglutaminase)
what is morphine converted to and by what
morphine –> morphine-6-glucuronide
converted by CYP2D6
is goodpastures ANCA +ve or -ve
ANCA -ve but anti-GBM positive
histological findings in coeliac
increased intraepithelial lymphocytes
lamina propria inflammation
villous atrophy
4 signs of glandular fever in mouth and pharynx
● Tonsillar enlargement,
● tonsillar exudate,
● uvular oedema,
● palatal petichae
how common is teratology of fallot
3-6/100,000 live births
what is the definition of psoriasis and where does it mostly occur
chronic inflammatory skin condition due to hyperproliferation of keratinocytes
mostly occurs on lower back, scalp, elbows and knees
what is the crystal in gout
monosodium urate crystals
what number CD4+ T cells constitutes a diagnosis of AIDs
200/mm3
medication to improve BPH symtoms in men
tamsulosin (alpha blocker)
finasteride (5-alpha-reductase inhibitor)
AVNRT example and what is the accessory pathway called
whats BPM
wolf parkinson white
bundle of kent
BPM of up to 200
what is the system of classification of PVD - describe it
fontaine system
what are the two coeliac antibodies
- IgA Tissue Transglutaminase (tTg)
- IgA Anti-Endomysial (EMA)
treatment of DIC
treat underlying cause
give activated protein C (a clotting factor)
maintain blood volume and tissue perfusion
causes of pleural effusion consisting of exudate
- Malignancy (lung, breast, mesothelioma),
- Infection (lung, pleural, abdominal),
- Inflammatory (RA, SLE),
- Pulmonary embolism,
- Benign asbestos related,
- Traumatic (haemothorax/chylothorax),
- Drug reaction
triggers for SLE
UV light
EBV
drugs like isoniazid
treatment for migraines
- acutely
- triptans such as sumatriptan, NSAIDs and paracetamol
- propanolol can reduce attack frequency
- avoid triggers
what is amiloride and where does it act
it is a K+ sparing diuretic
it inhibits ENaC which causes Na loss and therefore water loss in the distal convoluted tubule
hypokalaemia symptoms
muscle weakness
constipation
bradyarrhythmias
murmer in mitral regurge
mid-diastolic murmur heard loudest at the apex.
MRSA treatment
vancomycin
medical treatment of osteoarthritis
steroid injections intra-articularly
analgeisic ladder
PPI if long term NSAIDs
C.diff treatment
vancomycin/metronidazole
gold standard diagnosis for mesothelioma
pleural biopsy
initial management for DKA
FLUIDS FIRST
then insulin
acute treatment of gout
high dose NSAID (diclofenac) or colchicine
oral steroids may also be used
not allopurinol
3 cardinal symptoms of heart failure
Shortness of breath
Fatigue
Peripheral oedema
DVT Ix
D-dimer
US compression test
Well’s score
triggers for trigeminal neuralgia
shaving
washing
eating
talking
define osteoporosis
● Decreased bone mass with normal mineralisation
which drug is associated with nephrogenic diabetes insipidus
what is the difference between transudate and exudate in pleural effusions and what criteria tests this
lights criteria
if Pleural fluid protein / Serum protein >0.5 then it’s exudate
i.e. if the pleural fluid is more than half as proteiny as serum then it’s exudate
what does drugability mean
It is the ability of a protein to bind small molecules with high affinity
diagnostic criteria in SLE
- You need 4/11 of MD SOAP BRAIN
- Malar rash
- Discoid rash
- Scleritis
- Oral ulcers
- Arthritis
- Photosensitivity
- Bloods (anaemia, thrombocytopenia, leukopenia)
- Renal (proteinuria)
- ANA
- Immunologica (dsDNA
- Neurological (seizures)
what is the mutation in CF say full name
cystic fibrosis transmembrane conductance regulator (CFTR) on chromosome 7
what is trigeminal neuralgia and what is the treatment
it is paroxysmal intense stabbing pain that lasts seconds and exists in the trigeminal nerve distribution unilaterally
caused by nerve compression
treatment is with carbamazepine
what is pseudohypoparathyroidism and how do you treat it
it’s decreased bone response to PTH
low Ca2+ and high PTH
treat with AdCal and calcitriol
dermatitis herpeteformis is associated with which gut disorder
coeliac
what is the mutation that is a risk factor for crohn’s
NOD2 mutation on chromosome 16
4x possible triggers for exacerbation of asthma
cold,
exercise,
menstrual cycle,
pets,
infections,
laughter,
emotion
management of tension pneumothorax
large bore needle aspiration
into second intercostal space in mid clavicular line on side of pneumothorax
treatment for hyperosmolar hyperglycaemic state
LMWH
fluid
insulin
diagnosis of spontaneous bacterial peritonitis
Neutrophils >250/mm3
most common type of MND
amyotrophic lateral sclerosis
causes of low calcium
- HAVOC
- hypoparathyroidism
- acute pancreatitis
- vitamin D deficienct
- osteolamacia
- CKD
sickle cell mutation
chromosome 11, glutamic acid becomes a valine on B globin gene
causes of diabetes insipidus
- cranial: head trauma, pituitary tumour
- nephrogenic: lithium
who is a blue bloater and who is a pink puffer
emphysema = pink puffer
chronic bronchitis = blue bloater
two conditions associated with asthma
eczema and hayfever
what is the name of the criteria used to diagnose MS
MacDonald criteria
what is the surgical treatment of BPH
TURP
transurethral resection of prostate
gout Ix
- joint aspirate and polarised light microscopy
- would show -vely birefringent needle shaped monosodium urate crystals
name a treatment for myasthenia gravis
pyridostigmine
red flags for back pain
Thoracic pain
Fever and unexplained weight loss
Bladder or bowel dysfunction
History of carcinoma
Ill health or presence of other medical illness
Progressive neurological deficit
Disturbed gait, saddle anaesthesia
Age of onset <20 years or >55 years
causes of secondary osteoporosis
- SHATTERRED
- Steroid use
- Hyperparathyroidism or pseudo
- Alcohol/smoking
- Thin
- Testosterone/oestrogen low
- Early menopause
- Renal disease
- Relatives (family history)
- Erosive bone disease (myeloma or RA)
- Dietary calcium low
what is the diagnostic test for the epstein barr virus
Monospot test
Paul-bunnel test
treatment of SIADH
treat underlying cause
restrict fluid
vasopressin receptor antagonists: vaptans
hyperkalaemia symptoms
cramping
flaccid paralysis
arrhythmias and arrest
what is DIC
- disseminated intravascular coagulation
- generation of fibrin within blood vessels
- consumption of platelets and clotting factors
- initial thrombosis followed by bleeding tendancy
4 secondary causes of hypertension
Conn’s
Coarctation of the aorta
CKD
Pregnancy
what tool would you use to know someone’s risk of stroke following a TIA
- ABCD2
- Age > 60 +1
- BP > 140/90 +1
- Clinical features of the TIA
- unilateral weakness +2
- speech disturbances +1
- Diabetes +1
what is eczema herpeticum
it’s a rare but severe disseminated infection that generally occurs at sites of skin damage produced by, for example, atopic dermatitis, burns, long term usage of topical steroids or eczema
caused by herpes simplex virus
3 things that make future pandemics more likely
increased travel
increased world pop
increased intensive farming
causes of bone marrow failure
chemo
malignant infiltration
congenital
aplastic anaemia (acquired)
what should you give someone with alcoholic hepatitis
pabrinex
what antibody is found in antiphospholipid syndrome
anti-cardiolipin antibody
in which age group do 50% new HIV infections occur in
19-24
what cardiac enzymes should you test for in suspected MI
troponin T
myoglobin
CK-MB
hypercalcaemia is basically always due to one of two things what are they
what does this mean for investigating hypercalcaemia
cancer
hyperparathyroidism
check corrected calcium and PTH levels
if the hypercalcaemia is due to cancer then the PTH levels will be low
secondary causes of polycythaemia are due to _______ and include:
due to increased circulating EPO
include chronic hypoxia
EPO releasing tumours
Abnormal RBC structure
what is required for diagnosis of ra
- 4 of the following 7:
- morning stiffness
- rheumatoid nodules
- symmetrical
- hand arthritis
- arthritis of >3 joints
- radiographic changes
- rheumatoid factor +ve
what type of jaundice in malaria
- Pre-Hepatic Jaundice
- Urine Normal /Yellow /Clear
- Stool Normal / Brown
what is rheumatoid arthritis
it is a systemic auto-inflammatory disorder that leads to immune complex deposition in joints which causes symmetrical deformin polyarthritis
what is the ECG of AF
irregularly irregular QRS complexes
absent P waves
how do you decide if you should give Abx for a sore throat
- CENTOR Criteria give Abx if 3 or more
- C - cough absent
- E - exudate on tonsils
- N - nodes tender and enlarged
- T - temperature above 38 C
duration of a migraine
4-72hrs
antibodies in UC
70% have anti-neutrophil cytoplasmic antibodies (ANCA)
what is the treatment for CML
imatinib which is a tyrosine kinase inhibitor
treatment for hypoglycaemia in DMT1
glucose and glucagon
two organisms that cause cellulitis
Staphylococcus Aureus,
Streptococcus pyogenes
where does insulin resistance occur in DMT2
post receptor
what is the most common non-small cell lung cancer
adenocarcenoma
management of pseudogout
- acute attacks:
- cool packs
- aspiration
- intra articular steroids
- NSAIDs and Colchicine may prevent attacks
name three sickle cell precipitants
cold
infection
hypoxia
treatment for prostate cancer
- localised
- prostatectomy
- if spread
- androgen deprivation therapy
- chemo
will back pain go with rest?
mechanical will but inflammatory won’t
which ethnic group has an increased risk of prostate cancer
Afro-Caribbean
4 features of horner’s syndrome
Ptosis, miosis, enopthalmosis, hydrosis
two structural changes that may cause epilepsy
scarring due to trauma
stroke
what are the symptoms and signs of cushing’s disease
- CUSHING
- cateracts
- ulcers
- skin striae
- hypertension
- infections
- necrosis
- glucosuria
- buffalo hump
- hirsutism
- central obesity
- acne
- moon face
what is a very important syndrome that is a complication of SLE
anti-phospholipid syndrome
prevention of gout
allopurinol (xanthine oxidase inhibitor)
definition of cellulitis
infection of the dermis and the sub cut tissue
when would you see bite and blister cells
on a blood film in glucose-6-phosphate dehydrogenase deficiency
what is the definition of CKD
abnormalities of kidney function lasting >3 months with implications for health
what is the empirical antibiotic for suspected meningitis
IV ceftriaxone
consider IV amoxicillin if >60 or immunocompromised
what is thrombotic thrombocytopaenic purpura
deficiency in ADAMTS13 which normally cleaves vWF
large vWF aggregates cause platelet aggregation and fibrin deposition in small vessels
this leads to multi-system thrombotic microangiopathy which is an EMERGENCY
thalassaemia inheritance pattern
autosomal recessive
how is IBS diagnosed
with rome criteria which includes recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria:
Related to defecation
Associated with a change in frequency of stool
Associated with a change in form (appearance) of stool.
emphysema definition
enlarged air spaces distal to terminal bronchioles
name a parasite that causes infective diarrhoea
giardia lamblia
what is the treatment for hypothyroidism
synthetic levothyroxine
namee 5 side effects of long term steroid therapy
- Weight Gain (1)
- Decreased Density of Bone / Osteoporosis (1)
- Increased risk of infection / Immunosuppression (1)
- Hyperglycaemia (1) / Link to causing DM+ HTN (1)
- Effects growth (caution use in younger people) (1)
- Skin Thinning (1)
- Fluid Retention / Oedema (1)
treatment for primary polycythaemia
blood letting and aspirin
if over 50, male and have renal colic what must you exclude
AAA rupture or dissection
management for chronic pseudogout
methotrexate or sulfasalazine
treatment for hepatitis C
pegylated interferon and ribavirin for 6 months
1 yr if it’s type 1
CLL is malignancy of what kind of cell
B cells
Dx if cushing’s
failure of dexamethasone to suppress cortisol levels over 24hr period
dexamethasone suppression test
if they have AF and acute abdo pain what should you always think of?
bowel/mesentry ischaemia
what is the RX for nephrolithiasis >10mm
percutaneous nephrolithotomy
outline DMT2 treatmnet
- lifestyle
- metformin (biguanide)
- dual therapy (metformin + DPP4 inhibitor, glitazone or gliclazide)
- triple therapy
- insulin
who does CLL typically affect
- chronic lymphocytic leukaemia
- incidence increases with age
- M>F
- White>black
secondary prevention following TIA or stroke
control risk factors
2 weeks aspirin
long term anti-platelet like clopidogrel
three treatments for guillain barre syndrome
IV Ig
infliximab (anti-TNF-alpha)
plasma exchange
which congenital disease is associated with berry aneurysms
autosomal dominant polycystic kidney disease
name the surgical treatment of GORD
fundoplication
how many genotypes of Hep C are there and which is the hardest to treat
there are 6 and 1 is the hardest to treat
what is systemic sclerosis and CREST syndrome
- ANA and ACA +ve
- 4 central features
- Calcinosis
- Raynaud’s
- Eosophageal dysmotility
- Sclerodactyly
- Telangiectasia
- CREST
- skin features limited to hands, face and feet
- fatal hypertension
- Diffuse
- all skin and multi-organ fibrosis
how will transferrin and TIBC be in haemochromatosis
In iron overload, such as in haemochromatosis, iron and transferrin saturation will be high and TIBC will be low or normal.
chronic complications of sickle cell
renal impairment
pulmonary hypertension
joint damage
3 stages of malaria infection
exo-erythrocytic
endo-erythrocytic
dormant: P.vivax and P.ovale
criteria for diagnosing MS
McDonald criteria
three things to check in hypertension
- eye problems
- papilloedema
- end organ damage
- urinalysis
- 12 lead ECG
- CVD risk
- fasting glucose and QRISK
side effects of chemotherapy
Alopecia,
Nausea and Vomiting,
Peripheral neuropathy,
Constipation or Diarrhoea,
Mucositis,
Bone Marrow Suppression –> Anaemia,
Fatigue,
Anaphylaxis
signs and symptoms of bone marrow failure
bruising
bleeding from nose and gums
susceptibility to infections
SAH incidence
9/100,000/yr
3 types of necrosis
coagulative
caseous
liquifactive
malaria treatment
quinine and doxycycline
how long does syncope last
5-30 seconds with a recovery of 30 seconds
4x things you’d ask in the history to support diagnosis of allergic asthma
Diurnal variation, provoking factors, other features of atopy (hayfever, eczmema,
food allergy), reversability/episodic nature, wheeziness.
diff between direct and indirect inguinal hernia
direct = medial to inferior epigastric vessels
indirect = lateral to inferior epigastric vessels
in liver disease how will TIBC and transferrin be?
Because transferrin is made in the liver, TIBC and transferrin will also be low with liver disease.
Dx of diabetes insipidus
- water deprivation test
- restrict fluid and urine osmolality remains low in DI
- then give desmopressin to differentiate nephrogenic and cranial
What 4 questions would you ask during a GP consultation to assess whether a patient’s
asthma is poorly controlled?
● In the last 4 weeks has your asthma caused nocturnal waking?
● In the last 4 weeks has your asthma caused you to get less done than
usual/interfered with ADLs?
● In the last 4 weeks how many times have you used your blue inhaler?
● In the last 4 weeks how often have you had shortness of breath/symptoms of
asthma?
where are M2 muscarinic receptors found
heart
what is the triad for critical limb ischaemia
gangrene
pain
arterial insufficiency ulcers
what is the gold standard Ix for renal colic
NCCT - KUB
how do you diagnose bronchiectasis
high res CT chest
why does cholera cause so much watery diarrhoea
causes high cAMP
leads to massive excretion of Cl- by CFTR
draws out fluid
migraines risk factors
obesity and family history
what does HAS-BLED estimate and what are the components
- assesses 1-year risk of major bleeding in patients taking anticoagulants with atrial fibrillation.
- Hypertension
- Abnormal renal or liver function
- Stroke
- Bleeding
- Labile INR
- Elderly
- Drugs or alcohol
Clinical features of acute mesenteric ischaemia
severe abdo pain out of proportion with signs
can lead to rapid hypovolaemia and shock
metabolic acidosis due to high lactate
4 stages of acute inflammation
changes of vessel calibre
fluid exudate
cellular exudate
chemotaxis
Dx of GCA
- ESR high
- temporal artery biopsy is gold standard
- necrotising arteritis
how do you diagnose ALL
>20% blast cells on blood film
What’s first line treatment is given for an acute flare of Crohn’s?
IV methyl prednisolone
treatment for cholestatic itch
cholestyramine
G-6-PD deficiency: what is the danger
- oxidative chrisis which is brought on by precipitants
- henna and nitrofurantoin
- there’s rapid haemolysis, jaundice and anaemia
treatment for minimal change disease
corticosteroids
SAH Tx
surgical clipping of aneurysm
maintain BP
what is the FRAX scrore for calculating
Risk of developing a fracture in the next 10 years
cell count where AIDS symptoms occur
500-200 cells/mm3
Tx for acute attack of cluster headache
Sumatriptan and 100% oxygen
draw the diagram of epidemiological studies
is haemophilia A more or less common than haemophilia B
A is more common
what scoring system evaluates risk of stroke with AF and what are the components
- CHA2DS2VASc
- CHF +1
- Hypertension +1
- Age >75 +2
- Diabetes +1
- Stroke, TIA or thromboembolis +2
- Vascular disease (PAD, MI etc) +1
- Age 65-74 +1
- Sex category (female +1)
Name a risk assessment tool designed to improve the prediction of short-term stroke risk after a transient ischemic attack (TIA)
describe the peramiters
name the three non-metformin diabetes drug types, give an example and say how they work and whether they cause weight gain
- sulfonyl-urea (e.g. gliclazide)
- stimulates B cells to secrete insulin
- causes weight gain
- DPP4 inhibitor (e.g. sitagliptin)
- inhibits inhibitor of incretins
- incretins increase insulin
- doesn’t cause weight gain
- Glitazone (e.g. pioglitazone)
- stimulates body to make more fat from circulating glucose
- causes weight gain
CXR of pulmonary HTN
enlarged proximal pulmonary vessels
polycythaemia signs and symptoms
headache
dizziness
fatigue
bleeding/bruising
leads to greater risk of thromboembolism
which TLR recognises LPS
TLR 4
where does furosemide act
inhibits NKCC cotransporter in thick ascending limb
causes K+, CL- and Na_ loss
which virus causes kaposi’s sarcoma
human herpes virus 8
AF ecg
F waves, no P waves, QRS irregularly irregular
cause of coeliac
inappropriate immune response to the gut flora in genetically susceptible individuals
define cellulitis
Inflammation involving dermis and epidermis
two broad reasons IM adrenaline works in anaphylaxis§
- B2 adrenergic receptor activity
- bronchial dilation
- myocardial contraction increased
- decreased mast cell acrivation
- alpha adrenergic receptor activity
- peripheral vasoconstriction
- reduction of oedema
what is impaired glucose tolerance
2hr post oral glucose test is >7.8 but <11mmol/L
what are the dukes stages
- for colon cancer staging
- A - limited to muscularis mucosae
- B - extended beyond muscularis mucosae
- C - involvement of regional lymph nodes
- D - distant mets
how common is penicillin allergy
2% population have it
Rx for nephrolithiasis >5mm but <10mm
medical expulsive therapy with tamsulosin
What is the sequence of events that take place for metastasis to occur?
invasion
intravasation
evasion
adherance
extravasation
angiogenesis
where is iron absorbed
duodenum
what does TLR 5 recognise
flagellin
CT of SAH
hyperdense crescent
name six red flags from headaches
first and worst headache - SAH
unilateral and eye pain - cluster headache
associated with fever or neck stiffness - meningitis
scalp tenderness in over 50s - GCA
headache when coughing/straining - raised ICP
unilateral headache with ipsilateral symptoms - space occupying lesion
3 causes of small bowel obstruction
Adhesions, Crohn’s, Volvulus, Herniation, Neoplasia, Foreign bodies
how do methylxanthines work
they are used in asthma and they increase cAMP levels
cAMP leads to bronchodilation AND mast cell stabilisation
what do you see on blood film of someone with Multiple myeloma
Rouleaux formation
treatment for myeloma
bisphosphonates
chemotherapy
radiotherapy
acute complications of sickle cell
painful crisis
sickle cell chest crisis
mesenteric ischaemia
antibodies in crohns?
70% have Anti-Saccharomyces cerevisiae antibodies (ASCA)
you should do a lumbar puncture in suspected meningitis unless
evidence of shock
petychial rash
raised ICP
abnormal clotting
which antibody is present in lupus
anti-dsDNA which is a type of ANA
Rx for nephrolithiasis <5mm
watch and wait
how do corticosteroids work
they bind zinc fingers that increase transcription of genes that are anti-inflammatory and decrease transcription of genes that are pro inflammatory
urine analysis results that suggest infection
presence of nitrites
leukocytes
haematuria
what is CLL, what are the symptoms and what are the treatment
- chronic lymphocytic leukaemia
- symptoms are lymphadenopathy, splenomegaly and infections
- 50% findings incidental though
- it’s chronic and incurable - patients die with rather than from
which cytokine is released after MHC-antigen complex binds CD4?
IL-2
it has a possitive feedback effect on production of more CD4+ T cells
HLA types for diabetes mellitus
HLA-DR3-DQ2
HLA-DR4-DQ8
different adverse drug reactions and an example of each
- Type A: Augmented pharmacological (morphine and constipation)
- Type B: Bizarre (penicillin allergy)
- Type C: Chronic (colonic dysfunction after laxative therapy)
- Type D: Delayed (malignancies and immunosuppression)
- Type E: End of treatment (opiate withdrawal)
- Type F: Failure (OCP with enzyme inducers)
most common bacteria causing meningitis infection in neonates
Strep agalactiae (group B strep)
name a drug you could use for overactive bladder
Oxybutynin which is an anti-cholinergic
what is GCA
granulomatous arteritis of the aorta and larger vessels like the extracranial branches of the carotid artery
what are the antibodies in grave’s disease
- Thyroid stimulating immunoglobulin (TSI) presence is diagnostic
- Thyroid stimulating hormone receptor antibody (TRAb)
*
what are buserelin and goserelin and how do they work
- They are GnRH agonists for prostate cancer
- they initially increase LH production and therefore testosterone production
- so tumour initially grows
- then overwhelms body’s natural rhythm and LH and testosterone levels drop off
why do you get hyperlipidaemia in nephrotic syndrome
the liver produces more lipid in response to the hypoalbuminaemia
name 3 sites where you might see a hernia?
Inguinal (direct/indirect),
Femoral,
Umbilical,
Incisional (site of previous surgical incision)
treatment for Legionella pneumophilia pneumonia
Erythromicin or or doxycycline
morning stiffness in osteoarthritis lasts how long?
30 minutes
where are NKCC cotransporters found
in the ascending limb of the loop of henle
renal causes of AKI
Glomerulonephritis
SLE
Acute tubular necrosis caused by ACEi or NSAIDs
how do you differentiate salmonella and shigella
Do serotyping (API strip) to confirm Salmonella vs Shigella
why does glandular fever sometimes cause splenomegaly
congestion and macrophage activation within the red pulp
red pulp is infiltrated by immunoblasts and
plasmablasts. In infectious mononucleosis, the spleen enlarges
rapidly, increasing capsular tension, and has a soft consistency,
making it very susceptible to rupture
causes of disseminated intravascular coagulation
septicaemia
malignancy
trauma
infection
haemolytic transfusion reaction
painless ulcer with granulating base - what type of ulcer
neuropathic ulcer
where is the pain in uc
lower left quadrant
Dx of malaria
rapid diagnostic test detects plasmodium antigens in blood
symptoms and signs of addison’s
tanned, tired, toned and tearful
- Look: lean and pigmented
- Mood: depressed and tearful
- GI: N&V abdo pain
definition of AIDS
CD4+ T cell count below 200 cells/mm3
how long do epileptic seizures normally last?
30-120 seconds
qt interval should be how long
0.4-0.43s
what will TIBC/transferrin be in iron deficiency anaemia
High in iron deficiency (more is available to bind)
hyperlipidaemia and hypoalbuminaemia are in nephritic syndrome or nephrotic syndrome
these are both only present in nephrotic syndrome
despite the fact that there may be a small amount of proteinuria in nephritic syndrome - this is not enough to cause hypoalbuminaemia
whats the name of the tool used to assess for acute appendicitis
alvarado or mantrels
what sort of drug for IBS diarrhoea
loperamide which is anti-motility
what is the triad in reactive arthritis
- reiter’s triad
- conjunctivitis
- urethritis
- arthritis
complications from ACS
- DARTH VADER:
- Death
- Arrhythmias
- Ruptured septum
- Tamponade
- Heart failure
- Valve disease
- Aneurysm of the ventricle
- Dressler’s syndrome
- Embolism
- Reoccurrence of ACS
what is the last resort treatment for migraines
botulinum toxin A injections
give three measurements and values that would warrent a diagnosis of type 2 diabetes mellitus
fasting glucose > 7mmol/L
random glucose >11mmo/L
HbA1c > 6.5% or 48mmol/mol
4 criteria for allergy to a drug
no linear relationship with dose
disappears with cessation
re-appears on re-exposure
occurs in the minority of patients on a drug
treatment for huntingon’s chorea
benzodiazepines like lorazepam
how do you diagnose osteoporosis
-2.5 T score on DEXA (dual energy x-ray absorbtiometry)
6 secondary causes of hypertension
Conn’s syndrome
Cushing’s syndrome
CKD
Phaeochromocytoma
Steroids
Acromegaly
which meningitis is a notifiable disease
Neisseria meningitidis
HLA type associated with grave’s
HLA-BO8
what is polymyalgia rheumatica and what should you treat it with
often coexists with GCA
pain in muscles of shoulders, neck and hips
high CRP and ESR
treat with prednisolone
early and late symptoms of huntingtons
- early
- irritability
- depression
- incoordination
- late
- chorea
- seizures
- death
3 viruses that cause meningitis
Vericella Zoster virus
Enterovirus
Herpes simplex virus
difference between Th1 qnd Th2 response
- Th1 recruit macrophages
- Th2 recruit eosinophils
- Th1 cause IgG production via B cells
- Th2 cause IgE production via B cells
- Th1 produce anti-viral or anti-parasitic cytokines
- Th2 produce anti-parasitic cytokines
how does warfarin work
it inhibits the enzyme that activates vitamin K so it leads to a fall in factor 7, 2, 9, and 10
antidote is vitamin K
what is anti-phospholipid syndrome and what are 4 important signs
- it is a hypercoagulable state caused by anti-phospholipid antibodies such as anti-cardiolipin
- CLOT
- Coagulation defects
- Levido reticularis
- Obstetric - miscarriage
- Thrombocytopaenia
which abx for S. aureus skin infection
oral flucloxacillin
three types of inherited causes of haemolytic anaemia
enzymopathies
membranopathies
haemoglobinopathies
what % people suffer with migraines
15%
radiographic changes in RA
Loss of joint space
erosions (periarticular)
soft bones
soft tissue swelling
Ix for spherocytosis
osmotic fragility test
RBCs are fragile in hypotonic solutions
gold standard for PE diagnosis
CT pulmonary angiography
organisms that commonly cause cellulitis
and which of these commonly causes a dangerous complication
S.aureus and S.pyogenes
S.pyogenes is commonly the cause of necrotising fasciitis which is a complication of cellulitis - infection of deep fascia
clinical features of myeloma
- CRAB
- Ca2+ high
- Renal failure (precipitation of light chains in nephrons)
- Anaemia
- Bone lytic lesions
pre renal causes of aki
- volume depletion
- D&V
- Haemorrhage
- Hypotension
- Sepsis
- Renal artery occlusion
treatment for status epilepticus
- IV Lorazepam
- Assess drug and metabolite levels
- If continues IV phenytoin
- if continues >60-90 mins then propofol infusion for paralysis
what is the management for anti-phospholipid syndrome
aspirin
warfarin or LMWH (dalteparin) if trying to conceive
how long do cluster headaches last and how often do people get them
each one last 15-120mins
1-2 per day and they are commonly nocturnal
clusters are 4-6 weeks long
SDH treatment
craniotomy or burr hole washout
urgently address clotting abnormalities
R-R interval should be how long
0.6-1 second
6 extra articular manifestations of RA
xreopthalmia
sjorgens
weight loss
pulmonary fibrosis
scleritis
pericarditis
pulmonary fibrosis
Raynauds
what are the two signs you can examine for in meningitis
what is the cause of peripheral oedema in COPD
cor-pulmonale
what scoring system do you use to assess the severity of community acquired pneumonia, what are the components and what do the different scores mean
- CURB654: one point for each
- Confusion
- Urea >7mmol/L
- Resp rate >30
- BP <90/60
- Age > 65
- score 0-1 = outpatient treatment with PO amoxicillin
- score 2 = inpatient treatment with amoxicillin and clarithromycin
- score 3 = inpatient treatment with co-amoxiclav and clarithromycin
Tx for Ulcerative colitis
- sulfasalazine
- oral prednisolone
- infliximab (anti-TNF alpha)
- colectomy if intractable
what are the polymorphonuclear leukocytes
Neutrophil, Basophil, Eosinophil
muscle groups commonly affected by myasthenia gravis
limb girdle
face
bulbar muscles
extra ocular muscles
neck
treatment for psoriasis
topical corticosteroids and vitamin D analogues
2nd line would be DMARDs like methotrexate
what is the mutation in polycythaemia rubra vera and why does it cause its effect
JAK2
causes RBC proliferation in absence of EPO
which chromosome is huntington’s mutation
4
what is the mainstay of remission induction/maintenance in Ulcerative colitis?
mesalazine PO or PR
it’s a 5-ASA
In an average 70Kg male this constitutes 42 L of water. Approximately how many liters of water would you expect to find in the following compartments of this patient: Intracellular, Extracellular, Plasma?
Intracellular ~ 28L (2/3),
Extracellular~ 14L (1/3).
Plasma ~3 L (a component of the extracellular compartment)
characteristic X ray finding of psoriatic arthritis
pencil in a cup erosion
Giardia, Entamoeba histolytica treatment
metronidazole
what is normal ABPI
what is peripheral arterial disease
1-1.2
0.5-0.9
what happens once salbutamol binds its receptor
- it binds B2 adrenergic receptor on smooth muscle cell
- it is a g protein coupled receptor
- itracellular cascade leads to adenylate cyclase producing more cAMP from ATP
- this leads to bronchodilation
- AND cAMP also leads to stabilisation of mast cells
what are some of the clinical and biochemical findings needed to diagnose shock
● Hypotension (systolic <90mmHg) despite adequate fluid resus
● Tachycardic (HR>90bpm)
● Oliguria (<400 mL/day or 15mL/h)
● Prolonged capillary refill (>2seconds)
● Tachypnoea (>20 cycles/min)
● Raised blood lactate
gold standard Ix for angina pectoris
CT angiography of coronary arteries
primary causes of polycythaemia are due to _______
they include _______ and ______
increased sensitivity of bone marrow to EPO
polycythaemia rubra vera (JAK2 mutation)
primary familial congenital polycythaemia (EPOR mutation)
3 causes of macrocytic anaemia
B12/Folate Deficiency
- Alcohol excess/liver disease
- Hypothyroidism
2 examples of ANCA +ve vasculitis
Churg-Strauss Syndrome
Wegener’s Vasculitis
4x pneumonia signs on auscultation
● Crackles,
● pleural rub,
● increased vocal resonance,
● bronchial breathing
treatment for generalised seizures
Sodium valproate
Lamotrigine
what is the 1st and 2nd line Rx for osteoporosis
AdCal
Bisphosphonates like alendronate
2nd line is add another bisophosphonate like risendronate
blood in diarrhoea means what if it’s infectious?
means its likely bacterial
what’s required to diagose SLE
- 4 of the following 11 are required (MD SOAP BRAIN)
- Malar rash
- Discoid rash
- Serositis
- Oral ulcers
- Arthritis
- Photosensitivity
- Blood (all low, anaemia, leukopenia, thrombocytopenia)
- Renal dysfunction (proteinuria)
- ANA +ve
- Immune dysfunction (ds-DNA)
- Neurological symptoms (seizures)
components of first pass metabolism
Enzymes of GI lumen
Enzymes of gut wall
Enzymes from bacteria
Enzymes of liver
bloods in psoriatic arthritis
Anaemia
High ESR
RF -ve
Rx for acromegaly
transphenoidal surgery to remove adenoma
PEGVISOMAT = GH antagonist
crohns most commonly affects which part of the gut
terminal ileum
parkinsonism:
hypertonia
bradykinesia
resting tremor
define anaemia
Low Hb Concentration due to reduced cell mass or increased plasma volume
Name 3 drug targets.
Receptors,
enzymes,
transporters,
ion channels
hypocalcaemia clinical features
CATS
convulsions
arrhythmias
tetany
spasms and stridor
4 signs of pulmonary hypertension on an X ray
Enlargement of the pulmonary arteries,
- Lucent lung fields,
- Enlarged right atrium,
- Elevated cardiac apex due to right ventricular hypertrophy
Hep B treatment
alpha interferon
tenofovir (nucleoside analogue)
which HLA type is associated with SLE
HLA-DR2
what are the criteria for AKI
- increase in serum creatinine >26micromol/L in the last 48hrs
- increase in serum creatinine >50% baseline in the last 7 days
- urine output of <0.5ml/kg/hr for >6 consecutive hrs
where does lung cancer commonly metastasise
bones
adrenals
liver
brain
why does thalassaemia cause anaemia
precipitation of globin chains in precursors causes reduced erythropoiesis (Reticulocyte count will be high)
precipitation in mature RBCs causes increased destruction (microcytic hypochromic anaemia)
You explain to the patient her children may demonstrate symptoms earlier in their life than she. What is this known as?
anticipation
what is the antibody in addison’s
21 hydroxylase adrenal autoantibodies
how long is driving prohibited following TIA
1 month
Rx for encephalitis
IV acyclovir
when is treatment for HTN indicated
when they have BP >160/100 or if they have >140/90 and they also have other risk factors for cardiovascular disease such as diabetes
GCA diagnosis requires what
- 3 of these 5
- Age > 50
- Temporal artery tenderness
- New headache
- ESR > 50
- Abnormal artery biopsy
any old person with new back pain is what until proven otherwise?
multiple myeloma
opioid side effects
- Royal Society for Nautical Communications Is Immortal and Everlasting
- Respiratory depression
- Sedation
- Nausea and vomiting
- Constipation
- Itching
- Immune suppression
what does tobacco smoke do to alpha-1-antitrypsin and what is the effect
it inhibits it
alpha-1-antitrypsin inhibits proteases
therefore there’s uncontrolled protease activity in the lungs
this leads to degradation of elastin, formation of bullae and emphysema
as well as hepatitis what can pyrazinamide cause
arthralgia
Pericarditis ecg
saddle shaped ST elevation and PR depression
qrs complex should be how long
0.08 - 0.11 s
what condition do you see a beak like nose and microstomia
systemic sclerosis and CREST syndrome
what is it called when MS is worse in hot
Uhtoff’s phenomenon
how much higher is mortality in the epileptic population than gen pop
3x
chronic management of sickle cell
hydroxycarbamide if frequent crises (increases HbF)
Abx prophylaxis and vaccination (they’re immunocompromised due to splenic infartion)
differences between venous ulcer and arterial ulcer (can you draw the table?)
pyelonephritis treatment
Co-amoxiclav and gentamycin
neutropenic sepsis definition
fever > 38 C and N count < 0.5 x 109/L
example of low molecular weight heparin
dalteparin
two bacteria that can cause rapid onset (<6hrs) food poisoning
Bacillus cereus
Staphylococcus aureus
4 differentials for TIA
migraine
hypo/hyperglycaemia
migraine
focal epilepsy
why are those with nephrotic syndrome at risk of embolism
they have lost all their anti-coagulation factors in their urine
so you need to give them warfarin or LMWH like dalteparin
prevention of cluster headaches
avoid triggers
verapamil may help
definition of atherosclerosis
- accumulation of
- lipid
- macrophages (foam cells)
- smooth muscle cells
- in intimal plaques of large and medium sized vessels
where is vitamin B12 absorbed
in the terminal ileum with intrinsic factor
what is it when they get a hand spasm when you raise the sphygmomanometer above systolic pressure
trousseau’s sign of hypocalcaemia
what is the treatment for gonorrhoea
single dose oral ceftriaxone
how does methotrexate work
it is a folate antagonist so it can cause macrocytic anaemia
when do you see schistocytes
on blood film of haemolytic anaemia
what are the Ix of epilepsy
- to look for a provoking cause
- metabolite levels
- drug levels
- LP (infection suspeted)
- MRI for structural lesions
- EEG (electroencephalogram)
what size is microcytic, normocytic and macrocytic anaemia
●MCV<80 = MICROCYTIC
●MCV 80-100 = NORMOCYTIC
●MCV >100 = MACROCYTIC
where is vitamin B12 absorbed?
in the terminal ileum
multiple myeloma symptoms
CRAB
C = calcium (elevated),
R = renal failure,
A = anemia,
B = bone lesions
what is the scoring system for likelihood of DVT. what are the components
- Well’s criteria
- recently bedridden or recent surgery
- active cancer
- calf swelling >3cm more than affected leg
- visible colateral blood vessels
- pitting oedema confined to affected leg
- paralysis, paresis or recent plaster immobilisation of affected limb
- previous DVT
- tenderness
- entire leg swollen
- and then if there’s another diagnosis that is as likely or more likely then take away two points.
what antiviral is used to treat CMV
ganciclovir
drugs to give post-MI
ABCDE
MONA
Anticoagulate with fondaprinux (10a inhibitor)
IV glyceryl trinitrate if pain continues
Describe the difference between tolerance and desensitisation?
Tolerance - reduction in drug effect over time (continuously repeated high conc)
Desensitisation - receptors become degraded / uncoupled / internalised
biomarker for HCC
alpha fetoprotein is produced by 50% of HCCs but is very low level in normal adults
Ix for MS
MRI
CSF electrophoresis (monoclonal Ig band)
Evoked Potentials
you need to do more Ix to confirm if there are fewer lesions and fewer attacks
what would you see down a microscope looking at biopsy of minimal change disease
podicyte effacement
where is folate absorbed
in the jejunum
describe pain of appendicitis
Initially a diffuse pain around the centre of the abdomen/umbilicus then localises to the right iliac fossa
triad for DMT1
polyuria
polydipsia
weightloss
what does CFTR stand for?
cystic fibrosis transmembrane conductance regulator
Crohn’s treatment
azathioprine
Corticosteroids
infliximab
IV hydrocortisone for flare-ups
surgery is not curative
classical triad of symptoms for renal cell carcinoma
- Flank pain
- Haematuria
- Palpable Mass
clinical features of bronchiectasis
- Persistent cough,
- Purulent sputum (but some patients may have a non-productive cough,
- Clubbing,
- Dyspnoea
- Haemoptysis
- Recurrent pulmonary infections
expect non epileptic seizure if
- gradual onset
- prolonged duration
- abrupt termination
- closed eyes resistant to opening
- normal:
- CNS exam
- CT
- MRI
- EEG
compare features of severe and life threatening asthma attacks (can you draw the table)
what is the apparent volume of distribution
it is the amount of a drug that must be administered to achieve a certain plasma concentration of the drug
Vd = total amount of drug in body/plasma concentration
what is the most common cause of pericarditis
cocksackie B virus
lifestyle advice for improving LUTS in men
drink less carbonated drinks, alcohol, caffeine, and drinks with artificial sweeteners
Drink less in the evening
Double voiding
Bladder training
what are the red flags for back pain
- TUNAFISH
- Trauma/TB
- Unexplained weightloss
- Neurological deficit
- Age <20 or >50
- Fever
- IVDU
- Steroid use/immunocompromised
- History of cancer
complications of hepatic failure
coagulopathy
encephalopathy
hypoalbuminaemia
Sepsis
SBP
Hypoglycaemia
Portal hypertension -> oesophageal varices, haemorrhoids, caput medusae
organism that causes malaria
Plasmodia falciparim
P. ovale
P. vivax
why do you get immunocompromised in nephrotic syndrome
Ig loss in urine
Rx for alzheimers
acetylcholinesterase inhibitors like donepezil
antiglutamateric treatment like memantine
treatment for vibrio cholarae
doxycycline and fluids
definition of epilepsy
the tendancy to spontaneous episodes of impulse discharge in the brain manifesting in seizures
Dx of addison’s
cortisol remains low even after synthacthen stimulation test
bloods: low Na+ but high K+
post-renal causes of AKI
stones
tumour of ureter
other abdo tumour
when do you see schistocytes and what are they
they are broken down shards seen on blood film in haemolytic anaemia
what is abarelix and how does it work
it is a GnRH antagonist
it decreases LH and therefore testosterone production
there’s decreased dihydrotestosterone
tumour shrinks
in what condition is anti-topoisomerase and anti-centromere antibodies commonly seen
systemic sclerosis and CREST syndrome
treatment for DVT
- Immediately: LMWH and Warfarin
- When INR 2-3 then change to just warfarin or a NOAC like rivaroxaban
RA Rx
NSAIDs and PPI
DMARDs like methotrexat or sulfasalazine
biologics like rituximab (anti-CD20)
7 clinical features of alzheimers
- impairment of:
- visuospatial skill
- memory
- verbal abilities
- executive function
- anosogosia
- irritability
- mood disturbance
- psychosis
- agnosia
what percentage of adults and children will clear a Hep B infection when they get it
90% adults clear it
50% children clear it
what biomarker can be used to diagnose heart failure
brain natriuretic peptide over >100ng/L
but if raised at all it indicates heart failure over other causes of dyspnoea
4 stages of peripheral arterial disease
- Stage I: asymptomatic
- Stage II: intermittent claudication
- Stage III: rest pain/nocturnal pain
- Stage IV: necrosis/gangrene
Ix for multiple myeloma are
urine electrophoresis - bence jones protein
serum electrophoresis - monoclonal band
what is conn’s syndrome
hyperaldosteronism and low renin due to solitary adrenal adenoma or hyperplasia
this is 2/3 hyperaldosteronism
clinical features of aortic dissection
- Sudden ‘tearing’ chest pain +/- radiates to back
- Unequal arm pulses and BP
- Acute limb ischaemia
- Paraplegia
- Anuria
mast cell degranulation in asthma produces what
histamine
cytokines (IL-3, IL-4 and IL-5)
leukotrines
prostaglandin D2
what crystals do you see under the microscope in pseudogout
- under polarised light microscopy you see
- positively birefringent rhomboid calcium pyrophosphate crystals
what is addison’s disease
it is autoimmune impairment of the adrenal gland and consequent low cortisol and aldosterone
why does CKD cause hyperparathyroidism
no proper filtering so high phosphate
phosphate binds serum calcium so PTH detects low calcium
also not much vitamin D
3 causes of TIA
atherothromboembolism (usually of carotid artery)
cardioembolism following MI or AF
Hyperviscosity
5 steps of chronic asthma management
- SABA (salbutamol) for symptom relief
- Add inhaled steroid (beclamethasone) daily
- LABA (salmetarol)
- Increase beclamethasone dose
- add daily PO prednisolone
5 features of CF
salty sweat
reurrent chest infections
failure to thrive
late puberty
infertility in males due to abnormality in Vas Deferens
malnutrition
clubbing
ankylosing spondylitis 1st, 2nd and 3rd line treatment
- 1st: exercise and physio
- 2nd: NSAIDs
- 3rd: TNF alpha blockers like etenercept
organisms that can cause struvite stones
Proteus
Klebsiella
Pseudomonas
most common bug causing CF pneumonia
Pseudomonas aeruginosa
signs of myasthenia gravis
ptosis
diplopia
voice fades when counting to 50
myasthenic snarl
why do you get increased risk of thromboembolism in in nephrotic syndrome
they are losing all their anti-thrombotic factors in their urine
what is atropine
it is an M2 antagonist that works in the heart to treat life threatening bradycardias and heart block
treatment for hyperaldosteronism
spironolactone
what type of anaemia can methotrexate cause
macrocytic as it’s anti-folate
X-ray findings of osteoarthritis
loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
how does heparin work
inhibits factot Xa
what is the definition of inflammation
a local physiological response to injury
name and describe the bacteria commonly associated with acne
proprionibacterium
gram +ve anaerobic bacillus
which antibodies are seen in myasthenia gravis
Anti-AChR (very commonly) and Anti-MUSK
5 causes of peritonitis (and therefore DDx for what?)
- appendicitis
- ectopic pregnancy
- infection
- obstruction
- ulcer
ALL are DDx for appendicitis (DO A PREGNANCY TEST)
treatment for myasthenia gravis
anti-choline esterase
prednisolone
plasmapheresis for myasthenic crisis
What’s the first line treatment for a severe acute exacerbation of asthma?
O2
back to back salbutamol nebulisers
Dx of G-6-PD deficiency
enzyme assay
why do myeloma patients get confused
hyperviscosity and hypercalcaemia
what are renal stones usually made of
calcium oxalate
