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)
