Resits 2019/2020 Flashcards
What blood test results would you expect for someone with Addison’s?
Decreased Na Increased K Hypoglycaemia
What is amaurosis fugax?
A variant of retinal artery occlusion a.k.a. transient CRAO
Symptoms:
- transient painless visual loss
- “like a curtain coming down”
- lasts 5mins with full recovery
Signs:
- usually nothing abnormal to see on examination
Urgent referral stroke clinic
What is the difference between hydrostatic pressure and oncotic pressure?
simply
hydrostatic pressure pushes fluid out of the capillaries
oncotic pressure pulls fluid into capillaries
What are the potential side effects of Methotrexate?
- teratogenic
- pneumonitis/ lung fibrosis
- hepatotoxicity
- myelotoxicity
- rashes and mouth ulcers
What are the potential side effects for sulfasalazine?
- hepatotoxicity
- myelotoxicity
- rash
- reversible oligozoospermia
What are the potential side effects of azathioprine?
- hepatotoxicity
- myelotoxicity
- agranulocytosis
What are the potential side effects of gold?
- Glomerulonephritis
What are the potential side effects of hydroxychloroquine?
- Irreversible retinopathy
What are the potential side effects of anti-TNF?
- Reactivation of TB
- Increased susceptibility to infection
- Increased risk of skin cancer
What would you do for suspected endopthalmitis?
Vitreous/aqueous fluid sample for culture
What does the zona glomerulosa of the adrenal gland produce?
mineralocorticoids
e.g. aldosterone
What does the zona fasiculata of the adrenal gland produce?
corticosteroids
e.g. cortisol
What hormones does the zona reticularis of the adrenal glands produce?
androgens
e.g. testosterone pre-cursor
What does the medulla of the adrenal gland produce?
Adrenaline
Where would you expect to find a venous ulcer?
Venous ulcers tend to affect the lateral or medial malleolus
Where would you expect to find an arterial ulcer?
Arterial ulcers tend to occur on the foot or mid-shin
Do arterial ulcers get compression bandages?
NO
What is Breslow’s thickness?
The depth from the granular layer of the epidermis to the deepest melanoma cell
Describe erythema multiforme
Erythema multiforme is a rash of target lesions
- v. variable severity
- many underlying causes
- viral or bacterial infections
- drugs
- sarcoidosis
- etc
*
Describe Steven-Johnsons syndrome
SJS is a severe form of erythema multiforme with dermal changes and blister formation which can affect mouth, eyes, bronchial tree etc
The causes are the same as for erythema multiforme so:
- viral or bacterial infections
- drugs
- sarcoidosis
Describe toxic epidermal necrolysis
TEN is usually a drug reaction (but not always)
Widespread blistering results in large sheets of epidermis sloughing off
Can affect mouth and eyes
and has a significant mortality rate
Describe staphylococcal scalded skin syndrome
SSS syndrome is due to a toxic disrupting adhesin mechanism in the epidermis and also results in widespread superficial skin blistering and sloughing
The underlying staphlycoccal infection maybe minor
Describe the relationship between growth factor and insulin-like growth-factor-1
GH is released from pituitary when stimulated by GHRH (from hypothalamus). Somatostatin has an inhibitory effect on GH release.
GH then can act directly e.g. on adipose tissue
or indirectly by going to the liver and causing release of IGF-1
the majority of growth promoting effects are actually due to IGF-1 acting on cells
What is the treatment for closed angle glaucoma>
- Medically reduce IOP with pilocarpine
- Peripheral iridectomy done once IOP medically reduced
- a small piece of iris removed in both eyes to allow free circulation of movement
What investigation would you do for a suspected bactieral/chlamydial/viral eye infection?
Swab for culture
What investigation would you do for a suspected bacterial keratitis?
Corneal scrape
What would you do for a suspected acanthomeoba-caused eye problem?
Microscopy/culture
What would you do for suspected toxoplasma/toxocara infection?
Serology
List the thyroid carcinomas in order of decreasing prevalence?
- Papillary (75%-85%)
- Follicular (10%-20%)
- Medullary (5%)
- Anaplastic (<5%)
Papillary carcinomas and Follicular Carcinomas each have associations with causes of hypothyroidism- what are they?
Papillary carcinoma- Hashimoto’s
Follicular carcinoma- Iodine deficiency
Discuss the synthesis and storage of T3 and T4
- Iodine taken up by follicle cells
- Iodine attached to tyrosine (a protein) residues on thyroglobulin to form (MIT) & (DIT)
- This stage is inhibited by carbimazole and propylthiouracil
- Coupling of MIT + DIT (T3) and two DIT (T4)
- Stored in colloid thyroglobulin till required
Diagnose the following patients from their nail changes:
a) koilonychia
b) splinter haemorrhages
c) Beau’s lines
(obviously in real life nail changes are not diagnostic)
a) koilonychia= iron deficiency
b) splinter haemorrhages= infective endocarditis
c) Beau’s lines= chemotherapy
What nail changes can occur in psoriasis?
- pitting
- transverse ridging
- dystrophy
- onycholysis
Lable this diagram
a) Osteon (the lines often visible around osteons are called cement lines)
b) Haversion canals
c) Osteocytes in lacunae
d) Volkmann’s Canals
Name the connective tissue in and surrounding fasicles
Muscle fibres are grouped into bundles called fasicles and a muscle typically contains several fasicles
- the connective tissue that surrounds the muscle as a whole is called the epimysium
- the connective tissue around a single fasicle is the perimysium
- and the connective tissue around a single muscle fibre is the endomysium
What are the 4 c. diff c’s?
- Co-amoxiclav
- Clarithromycin
- Cephalosporins
- e.g. ceftazidime
- e.g. cefotaxime
- Ciprofloxacin
What is the CENTOR criteria?
- History of fever
- Tonsillar exudates
- Tender anterior cervical adenopathy
- Absence of cough
- <15y/o add a point and if >44 subtract a point
0 or 1 points- no antibiotic
2 or 3 points- should recieve an antibiotic if symptoms progress
4 or 5 points- treat empirically with an antibiotic
What is acne vulgaris?
Acne is an inflammatory condition of the pilosebaceous unit
What are the pathological changes in acne vulgaris?
- duct occlusion
- increased sebum production
- bacterial colonisation
- duct rupture
What bacteria is found naturally on the skin that causes duct rupture?
propionobacterium acnes
What is a black head and a white head?
- black heads are open comedones
- white heads are closed comedones
What are the treatment options for acne vulgaris?
- Topical retinoid
- Anti-keratinolytic +/- anti-inflammatory
- Benzyl peroxidase
- anti-keratinolytic + anti-inflammatory + antimicrobial
- Antibiotics
- clindamycin
- tetracycline
- erythromycin
People are short sighted are…
myopic
(maire is short)
people with hypermetropia are…
long-sighted
someone with an irregular corneal curvature has…
astigmatism
(there’s a stigma attached to being irregularly curvy)
What is presbyopia?
loss of accomodation with aging
Which 2 diabetic drugs are weight neutral?
Metformin
and DPP-4 Inhibitors (“gliptins”)
Which 2 diabetic drugs cause weight gain?
Sulphonylurea (glicazide)
and Thiazolidines (glitazones)
- sulphonyl-ur-gonna get fat
How do sulphonylureas work?
Cause pancreatic b-cells to secrete insulin via SUR1 receptors
:. adverse effect: hypoglycaemia
How do incretin analogues?
They are peptides that mimic the action of GLP-1
side effect: nausea
How do DPP-4 inhibitors work?
DPP-4 enzyme destroys GLP-1 and GIP which cause insulin secretion
DPP-4 inhibitors prevent this destruction via competitive inhibition
side effect: nausea
How do thiazolidines work?
enhance the aciton of insulin @ target tissues but don’t directly affect insulin secretion
side effects: fluid retention (watch out for heart failure) and bone fractures (watch out for old women)
Which colour of asbestos is worst?
Blue
