RPA Flashcards
Which statins are associated with myopathy?
- High Intensity: atorvastatin, rosuvastatin
- Pravastatin and fluvastatin are HYDROPHILIC in contrast to lipophilic and have less muscle penetration and thus less muscle symptoms.
Which statins lead to the highest change in LDL?
RAS
Rosuvastatin > Atorvastatin > Simvastatin
Which statins are safest in CKD?
Atorvastatin
Fluvastatin
Which statin is safest in cirrhosis?
Pravastatin
Statin with
- Least DDI
- Lower overall side effects
Least DDI: pravastatin, fluvastatin (no CYP450 metabolsim)
Lower overall SE: pravastatin, rosuvastatin (hydrophilic)
What is the risk of transformation from MGUS to MM in 1 year?
1%
What is the mechanism for colistin resistance in gram negative bacteria?
Mutations in the lipopolysaccharide structure in the cell wall
T790M positive
Osimertinib
MODY
MODY 1 - HNF-4a, sulfonyureas
MODY2 - chromosome 7p - glucokinase (enzyme defect) - mild hyperglycaemia, minimal complications
MODY3 - chromosome 12q - HNF-1 a - very sensitive to sulphonylureas - MOST COMMON
What is Kartagener’s syndrome?
Kartagener’s syndrome is a rare, autosomal recessive genetic ciliary disorder comprising the triad of
- situs inversus
- chronic sinusitis, and
- bronchiectasis.
The basic problem lies in the defective movement of cilia, leading to recurrent chest infections, ear/nose/throat symptoms, and infertility.
ECG findings of dextrocardia
- Right axis deviation
- Positive QRS complexes (with upright P and T waves) in aVR
- Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave)
- Absent R-wave progression in the chest leads (dominant S waves throughout
A 20yo uni student purchases a lunch special at cafe. He has chicken fried rice and salad. He develops abdominal cramps approx 2 hours later and experiences N+V another 2 hours later. What is the likely causative organism. A. Bacillus cereus B. Campylobacter jejuni C. Norovirus D. Staph aureus
Sudden onset of vomiting and nausea is likely due to the ingestion of preformed toxin, such as S. aureus enterotoxin or B. cereus emetic toxin. Viral gastroenteritis can present with vomiting but the incubation period is usually longer. Campylobacter jejuni is a very common cause of gastroenteritis, though usually presents with severe diarrhoea.
Bacillus cereus can survive at extreme temperatures and can form spores and biofilms. The heat-resistant spores may survive cooking. Bacillus infection can result in either a diarrhoeal illness (symptom onset within 8-16 hours) or an emetic illness (symptom onset within 1-5 hours), but they aren’t mutually exclusive. Fried rice is an important cause of the emetic type of Bacillus food poisoning.
The is the effect of lamotrigine and oestrogen?
Oestrogen increases hepatic glucuronidation leading to an increase in lamotrigine clearance
Because lamotrigine is metabolized predominantly by glucuronic acid conjugation, drugs that are known to induce or inhibit glucuronidation may affect the apparent clearance of lamotrigine. Drugs that induce glucuronidation include carbamazepine, phenytoin, phenobarbital, primidone, rifampin, oestrogen-containing oral contraceptives, and the protease inhibitors lopinavir/ritonavir and atazanavir/ritonavir. Valproate inhibits glucuronidation.
Diagnostic criteria for postural orthostatic tachycardia syndrome
The diagnostic criteria for POTS requires a rise in heart rate by >30 beats per minute or an absolute heart rate of >120 within the first 10 minutes of tilt. Typically blood pressure changes aren’t a major feature and aren’t part of the diagnostic criteria
What do you think of if someone has split hand sign?
MND!
Which of the following is associated with highest risk of scleroderma renal crisis?
A. Presence of anti=RNA polymerase III ab
B. Presence of tendon friction rubs
C. Treatment with ciclosporin
D. Treatment with steroids
B - tendon friction rubs
All of these options are associated with an increased risk of scleroderma renal crisis, however the presence of tendon friction rubs is often a sign of aggressive disease, and a marker of increased risk of internal organ involvement (including renal crisis)
Vitamin B 12 deficiency investigation findings
Subacute combined degeneration of cord
Elevated homocysteine, methylmalonic acid
62yo male with metastatic prostate cancer currently treated with enzalutamide. Blood tests show newly elevated PSA and testosterone < 1.7. CT show evidence of disease recurrence and worsening skeletal mets. Noted to be heterozygote for the ATM (ataxia telangiectasia) gene carrier.
In patients who have castration-resistant metastatic prostate cancer and prior enzalutamide (or abiraterone) therapy failure, oliparib has been shown to be superior to physician’s choice of either enzalutamide or abiraterone (De Bono et al. 2020 NEJM 382: 2091-2102). Oliparib is a PARP inhibitor and PARP inhibitors are an effective option for those with a somatic or germline DNA repair mutation (ie: BRCA 1 or 2, or ATM gene).
In addition, the use of abiraterone therapy after enzalutamide has been shown to be relatively ineffective. Pembrolizumab therapy is an option in those with dMMR/MSI-H cancers.
62yo male with metastatic prostate cancer currently treated with enzalutamide. Blood tests show newly elevated PSA and testosterone < 1.7. CT show evidence of disease recurrence and worsening skeletal mets. Noted to be heterozygote for the ATM (ataxia telangiectasia) gene carrier.
- In patients who have castration-resistant metastatic prostate cancer and prior enzalutamide (or abiraterone) therapy failure, oliparib has been shown to be superior to physician’s choice of either enzalutamide or abiraterone
- Oliparib is a PARP inhibitor and PARP inhibitors are an effective option for those with a somatic or germline DNA repair mutation (ie: BRCA 1 or 2, or ATM gene).
- In addition, the use of abiraterone therapy after enzalutamide has been shown to be relatively ineffective.
- Pembrolizumab therapy is an option in those with dMMR/MSI-H cancers.
Who makes decision when a person doesn’t have capacity?
Advanced care directive Enduring guardian Spouse or defacto partner Adult son or daughter Parent Sibling Primary unpaid caregiver Other person with close personal relationship
Causes of AIN
Common groups of causative drugs include antibiotics (eg rifampicin), NSAIDs, diuretics, anticonvulsants (eg: phenytoin), and proton pump inhibitors.
ECHO findings of HOCM
Ratio of septal to posterior wall thickness - 1.3:1
What is congenital hypertrophy of the retinal pigment epithelium (CHRPE)
- CHRPE is one of the earliest and most common extra-colonic manifestations of familial adenomatous polyposis (FAP).
- FAP is an autosomal dominant cancer syndrome with nearly complete penetrance of colonic polyposis, but incomplete penetrance of the extracolonic manifestations.
- CHRPE are usually benign, asymptomatic pigmented fundic lesions.
- They are congenital harmartomas of the retinal pigment epithelium (RPE).
- CHPRE are present in approximately 90% of patients with FAP.
Cogan Syndrome
The combination of vestibular abnormalities and typical ocular findings (ie: interstitial keratitis) is highly suggestive of Cogan’s syndrome. Patients with Cogan’s syndrome typically develop sensorineural hearing loss and can also develop signs and symptoms of a systemic vasculitis. Management is either with systemic immunosuppression for more extensive disease or topical agents for limited ocular disease.
What are high risk features of intraductal papillary mucinous neoplasm of pancreas?
High risk features such as
- size >3cm
- mural nodules
- intracystic solid components or changes in main duct diameter would warrant EUS assessment or surgical resection.
What can hearing loss indicate?
red flag for an anterior inferior cerebellar artery stroke
Hypersensitivity reactions
- Type I reactions- drug specific IgE mediated reactions, with repeat exposure leading to crosslinking of IgE and release of vasoactive mediators from mast cells.
- Type II reactions- uncommon and relate to antibody mediated destruction.
- Type III reactions- mediated by antibody/antigen complex formation and often presents as serum sickness, vasculitis or drug fever. Re-exposure can lead to more severe and more rapid symptoms.
- Type IV reactions- delayed hypersensitivity (48- 72hours). Not antibody mediated. Often relates to T cell expansion (and other cell types such as macrophages, eosinophils, neutrophils).
What opioids are safe in pregnancy
Methadone and buprenorphine (without naloxone) are considered safe in pregnancy. Clonidine is used in pregnancy for management of hypertension and acute opioid withdrawal, but not for maintenance of opioid abstinence
Budd Chiari Facts
- Hepatic vein
- More common in women
- JAK mutations in 25-60%
- Over 80% have identifiable cause
- HCC associated
When should HCC surveillance be performed
(1) Anyone with cirrhosis
(2) Chronic Hep B without cirrhosis
- Asian men > 40yo
- Asian women > 50yo
- Subsaharan Africans > 20
- Indigenous > 50yo
Which medications have uric acid lowering effects
Losartan, atorvastatin and fenofibrate have mild uricosuric activity and can be considered for the treatment of gout in patients with hypertension or dyslipidaemia.
MOA of linezolid
Linezolid is a member of the oxazolidinone class of antibiotics
• Protein synthesis inhibitor
• Bacteriostatic
• In vitro activity against gram positive organisms including those resistant to other antimicrobials (MRSA, MSSA, VRE and pneumococci)
• Nearly all gram-negative organisms resistant
• Excellent oral bioavailability –allowing early IV/PO switch
• Theoretical inhibition of toxin production – role in toxic shock syndrome
• Monoamine oxidase inhibitor – risk of serotonin syndrome if given to patients taking SSRIs
• Adverse effects – neuropathy and bone marrow suppression with prolonged courses > 2 weeks
What is NOD2/CADM15associated with?
What is ECM1 gene associated with?
NOD2/CADM15: Crohn’s disease
ECM1: Ulcerative colitis
What is PTPN22 associated with?
Autoimmune conditions - T1DM, RA, SLE
What causes alexia without agraphia (can write but can’t read)
Occipital cortex and splenium of corpus callosum
Splenium of corpus callosum - interhemispheric transfer of visual info to language centres
Treatment of Q fever
- Coxiella burnetti
- Tx: doxycycline
If pregnant: bactrim
Facts about functional residual capacity
Elastic recoil of the chest wall is outward
Elastic recoil of the lung is inward
Relaxation pressure of the lung and chest wall combined is at atmospheric pressure
Metastatic head and neck cancer treatment
First line: cisplastin, 5FU
2nd line: nivolumab
What test can be used to differentiate acute H pylori infection from previous?
H pylori serology
Drug resistance for clopidogrel
Polymorphisms in CYP2C19
