Sample Questions learnings Flashcards
What is crescenteric glomerulonephritis
Crescenteric glomerulonephritis is used interchangebly with Rapidly Progressive Glomerulonephritis.
Pathology - Crescent shaped structures in glomeruli due to proliferation of cells in Bowman’s space.
Rapid progression - kidney failure in weeks to months if untreated.
Caused by ANCA associated vasculitis, Goodpastures, Lupus, IgA Nephropathy.
Symptoms - Haematuria, Proteinuira, Oedema
When is Doxapram used?
Doxapram is used in ICU settings as a respiratory stimulant to treat respiratory depression.
Complications include arrhythmias
What is the difference between multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS)?
M spike of IgG in both MM and MGUS
However MGUS is benign. MM is cancer of plasma cells.
MM usually has end organ damage presenting as bone disease (lytic lesions, vertebral collapse, fracture), hypercalcemia, bone marrow failure ( anaemia), kidney failure due to light chain deposits.
What causes bony destruction and subperiosteal erosions in a patient on dialysis?
Secondary Hyperparathyroidism due to reduced activation of vitamin D as patient is on haemodyalisis.
What drugs are most effective at lowering triglycerides?
fibrates
what is coumarin necrosis?
skin necrosis that occurs within 2 weeks of starting warfarin
a patient presents with fasciculations and associated weakness in one limb
Motor neuron disease
cramps on initial exertion (no fasiculations)
McArdle Syndrome
What is Mcardle Syndrome
AKA Glycogen Storage Disease Type V.
Lacks enzyme which breaks down glycogen to glucose during exercise.
- Severe muscle pain and fatigue within first few minutes
- Muscle cramps
- dark urine
What is Myotonic Dystrophy?
2 types
- DM1 - more severe and common. affects muscles of face, neck and lower legs first.
- DM2 affects centre of body e.g. shoulder / hips.
Progressive muscle weakness and wasting of muscles.
Myotonia - delayed relaxation of muscles.
Cataracts
What is cryptogenic organising pneumonia?
non-infectious pneumonic process occuring in the context of pre-existing inflammatory / autoimmune conditions such as rheumatoid arthritis. Can mimic bacterial pneumonia on Xray. Crackles and inflammatory markers eg. ESR raised.
Responds to corticosteroids not antibiotics.
What are the criteria for SLE diagnosis?
Need a score of 10 or more with at least one clinical.
1. Positive ANA
2. Clinical criteria e.g. MSK involvement, renal (proteinuria, lupus nephritis on biopsy)
3. Immunologic criteria (antiphospholipid antibodies, low c3 or c4, AntidsDNA or Antismith antibodies.
What does the posterior column (dorsal column) do?
- Fine touch
- proprioception
3 synapses
- sensory neuron to dorsal column
-Dorsal column to thalamus
- thalamus to primary sensory cortex
What does Lateral corticospinal tract do?
Controls voluntary movement.
Upper motor neurone starts from primary motor cortex decusates in medulla
goes down the lateral corticospinal tract
synapses in anterior horn. Lower motor neurone then innervates muscle.
What is the lateral spinothalamic tract?
Pain and temperature sensation 2-3 segments below the level of the spinal cord on the contralateral side.
Lateral Spinothalamic Tract - L S T - lower segment three
What are the symptoms of a hemi-section of the spinal cord?
Brown Sequard Syndrome
Corticospinal tract - UMN symptoms below T8. (e.g. muscle weakness, spasticity, upward going plantars)
Dorsal column - loss of fine touch and proprioception on the same side.
Lateral spinothalamic tract - loss of pain and temperature sensation 2-3 segments below on the contralateral side.
What is paraneoplastic sensory ataxic neuropathy?
- when body’s immune response to tumour mistakenly attacks the nervous system.
- linked to small cell lung ca, breast, ovarian and hodgkin’s lymphoma.
Symptoms
- sensory ataxia - loss of co-ordination.
- Painful dysesthesias - abnormal burning / tingling sensation
- loss of proprioception.
How does syringomyelia present?
Fluid filled cyst in spinal cord
- shawl like distribution
- pain in shoulders, back , arms
- loss of hot / cold sensation especially in hands
-progressive muscle weakness / stiffness
thyroid mass following adrenal resection for pheochromocytoma?
check plasma calcitonin as higher risk of calcitonin producing medullary cell tumour
what are the features of microscopic polyangiitis?
haematuria, fever, raised inflammatory markers
Describe the renin-angiotensin-aldosterone system
When the blood pressure is low the kidneys secrete renin.
Angiotensin is secreted by the lungs and converted to Angiotensin ii by renin.
Angiotensin ii causes vasoconstriction and increased blood pressure. Also stimulates release of aldosterone from the adrenal cortex. Also stimulates posterior pituitary gland to secrete ADH which increases water re-absorption in the collecting duct.
Aldosterone increased water and sodium retention and gets rid of K+. Leading to increased circulatory volume and BP.
Aldosterone has a negative feedback loop to kidney to stop renin production.
What is Conn’s Syndrome
aka Primary HyperAldosteronism
adrenals produce too much aldosterone
leading to increased water and sodium retention causing hypertension. Increased potassium excretion.
What is microscopic polyangiitis?
Inflammation and necrosis of small blood vessels.
pANCA positive
Myeloperoxidase (MPO) positive
Affects skin, kidneys, lungs, brain, heart
Symptoms
- haematuria, proteinuria
- haemoptysis
- palpable pupuric rash (evidence of small vessel vasculitis)
- tingling, numbness, weakness
How does a rupture of sinus of valsalva present?
under age 30
chest pain
acute heart failure
continuous murmur accentuated in diastole.
how does diptheria present?
pharyngitis
grey membrane over soft palate / tonsils
